There was a knock at the study door; at the threshold stood two women, both of whom presented a disconcerting sight in their different ways. One was the patient, introduced as Mrs Elizabeth Glassford, but Raven found his eye drawn to the other.

Sarah escorted Mrs Glassford through the study door, a supportive hand upon her arm. A cursory visual assessment revealed only that she looked well. Her hair was swept upwards into a loose bun and she wore no cap. She was wearing a plain gown, neat and well fitted – a far remove from the servants’ garb he had become accustomed to seeing her in.

Was he imagining it, or did she carry herself differently? He could not stop thinking of the implications, of knowing what she had now experienced. So often he had thought back to the small intimacies they had shared, and the nights he had lain in this house, troubled by the attendant dangers should they share more. Now she had shared all, with someone he knew not, a face he could not even picture. He was not sure if this was a consolation or a further torment.

His staring, he was sure, would have become prolonged and awkward had his professional attention not been drawn to the patient. Mrs Glassford walked with the gait of one far advanced in years, although she could not have been much more than thirty. As she moved slowly across the room, she supported the sides of her protuberant abdomen with her hands. In contrast to the swelling of her belly, the rest of her seemed excessively thin, as if whatever was growing in her abdomen was leeching all nourishment from every other part of her. The effort of her short walk had rendered her profoundly breathless. Raven knew immediately that this was not a pregnancy, real or imagined.

Sarah helped the woman onto the examination couch, as Raven had seen her do with countless patients before. She then pulled across the screen that shielded the couch from the rest of the room and assisted in loosening the patient’s clothing. Raven could hear her making encouraging remarks to the woman, though he doubted she would have any misapprehensions about the likely prognosis. He remembered that she always had a good diagnostic eye despite her lack of formal training.

Raven went behind the screen, with its incongruous embroidered panels depicting chrysanthemums and peacocks, and proceeded with his examination. He was unsurprised by what he found. The skin of the abdomen was stretched tight, the umbilicus protuberant. Fluctuation was easily discernible, suggesting a large volume of fluid contained within. There was also gross swelling of both legs and of the lower abdominal wall. Where he had pressed on the abdomen, an imprint of his hand remained. The diagnosis was obvious.