Hilary Marland

Disappointment and Desolation: Women, Doctors and Interpretations of Puerperal Insanity in the Nineteenth Century

Taking case notes as the key source, this paper focuses on the variety of interpretations put forward by doctors to explain the incidence of puerperal insanity in the nineteenth century. It is argued that these went far beyond biological explanations linking female vulnerability to the particular crisis of reproduction. Rather, nineteenth-century physicians were looking at other factors to explain the onset of insanity related to childbirth: stress and environmental factors linked to poverty, family circumstances, poor nutrition, illegitimacy, fear and anxiety, and the strains of becoming a mother. The main focus is on female asylum patients, but all mothers were seen as being susceptible to puerperal insanity.

Midwife regulation, education, and practice in The Netherlands during the nineteenth century.

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Hydropathy at Home: The Water Cure and Domestic Healing in Mid-Nineteenth-Century Britain

This article explores domestic practices of hydropathy in Britain, suggesting that these formed a major contribution to the popularity of the system in the mid-nineteenth century. Domestic hydropathy was encouraged by hydropathic practitioners in their manuals and in the training they provided at their establishments. We argue that hydropathy can be seen as belonging to two interacting spheres, the hydro and the home, and was associated with a mission to encourage self-healing practices as well as commercial interests. Home treatments were advocated as a follow-up to attendance at hydros and encouraged as a low-cost option for those unable to afford such visits. Domestic hydropathy emphasized the high profile of the patient and was depicted as being especially appropriate for women, though in many households it appears to have been a common concern between husbands and wives.

Under the shadow of maternity: birth, death and puerperal insanity in Victorian Britain.

Death and fear of death in cases of puerperal insanity can be linked to a much broader set of anxieties surrounding childbirth in Victorian Britain. Compared with other forms of mental affliction, puerperal insanity was known for its good prognosis, with many women recovering over the course of several months. Even so, a significant number of deaths were associated with the disorder, and a large proportion of sufferers struggled with urges to destroy their infants and themselves. The disorder evoked powerful delusions concerning death, with patients expressing intimations of mortality and longing for death.

Weighting for health : management, measurement and self-surveillance in the modern household

Histories of late nineteenth- and early twentieth-century medicine emphasise the rise of professional and scientific authority, and suggest a decline in domestic health initiatives. Exploring the example of weight management in Britain, we argue that domestic agency persisted and that new regimes of measurement and weighing were adapted to personal and familial preferences as they entered the household. Drawing on print sources and objects ranging from prescriptive literature to postcards and ‘personal weighing machines’, the article examines changing practices of self-management as cultural norms initially dictated by ideals of body shape and function gradually incorporated quantified targets. In the twentieth century, the domestic management of health—like the medical management of illness—was increasingly technologised and re-focused on quantitative indicators of ‘normal’ or ‘pathological’ embodiment. We ask: in relation to weight, how did quantification permeate the household, and what did this domestication of bodily surveillance mean to lay users?

‘A Burden on the County’: Madness, Institutions of Confinement and the Irish Patient in Victorian Lancashire

This article explores the responses of the Poor Law authorities, asylum superintendents and Lunacy Commissioners to the huge influx of Irish patients into the Lancashire public asylum system, a system facing intense pressure in terms of numbers and costs, in the latter half of the nineteenth century. In particular, it examines the ways in which patients were passed, bartered and exchanged between two sets of institution—workhouses and asylums. In the mid-nineteenth century removal to asylums was advocated for all cases of mental disorder by asylum medical superintendents and the Lunacy Commissioners; by its end, asylum doctors were resisting the attempts of Poor Law officials to ‘dump’ increasing numbers of chronic cases into their wards. The article situates the Irish patient at the centre of tussles between those with a stake in lunacy provision as a group recognised as numerous, disruptive and isolated.

Boundaries of Expertise and the Location of Puerperal Insanity

Fondly anticipating the joy, perhaps of a first-born, a beloved wife patiently submits of all the inconveniences and restraints of pregnancy, however irksome, and the pains and dangers of labour, however great. The affectionate husband and relatives await with deep and anxious expectation the event; and at length, when the joyful period arrives, and the happiness of all is completed by a safe delivery, — how dreadfully is the scene reversed, when the happy mother suddenly displays symptoms of delirium!1

Introduction: Migration, Health and Ethnicity in the Modern World

In recent decades, migration studies has become a vibrant discipline, urged on by the impact of ever more dramatic waves of migration on economies, societies and the provision of services, not least often overstretched and under-resourced health services. The publication of the latest census returns for England and Wales, for example, showed immigration to be ‘larger and greater’ than anticipated: by 2011, 56.1 million people lived in the two nations, an increase of 7 per cent over the previous decade, and more than half of the increase was due to immigration.1 In 2008, fertility rates reached their highest level for 15 years, when figures from the Office of National Statistics revealed that nearly a quarter of babies in England and Wales were born to mothers who came from outside the United Kingdom, particularly women from Pakistan, Poland and India.2 Other countries have experienced a similar growth in the scale of immigration. The Republic of Ireland, historically an exporter of large numbers of its population, had the highest per capita rate of net migration among European Union member states in 2001. Between 1996 and 2002, approximately 310,700 persons migrated to Ireland representing an 8 per cent population increase; a significant proportion, probably over 46 per cent, was returning Irish.3 The impact on already struggling health services, especially maternity hospitals and psychiatric support, was substantial and received extensive and often negative press coverage.4

The Birth of Puerperal Insanity

The erratic, crazy and disruptive behaviour of women around the time of childbed had been described long before the nineteenth century. In a unique account of madness by a medieval woman, Margery Kempe expressed in detail the mental torment and spiritual crisis that followed the birth of her first child.1 She was troubled with severe sickness during her entire pregnancy, tortured by dreadful labour pains and following the birth, she saw, as she thought, devils opening their mouths all alight with burning flames of fire, as if they would have swallowed her in, sometimes pawing at her, sometimes threatening her … and bade her that she should forsake her Christian faith and belief, and deny her God … And so she did. She slandered her husband, her friends, and her own self … She would have killed herself many a time as they stirred her to, and would have been damned with them in hell …2 Kempe’s words are steeped in reflective Christianity, but they would be echoed in eerily similar descriptions of puerperal insanity centuries later, with sufferers relating how they were provoked and tormented by devils.3

From Redemption to the Dark Age: The Demise of Puerperal Insanity

Motherhood was deemed dangerous in numerous ways in Victorian Britain, able to leave the highest and lowest born, Queen, commoner and pauper, weakened and mentally disturbed. Pregnancy, birth and lying-in were fraught with physical and mental hazards, hazards that persisted for women who breastfed their infants for long periods. Puerperal insanity made its victims dangerous in all manner of ways, to the household, to themselves, to their family and particularly to the newborn. Their physical state could bring them to the point of collapse. Their delusions were dreadful and alarming. While melancholia crept stealthily into the household, mania tore into it, destructive, noisy and violent. Women falling victim to puerperal mania revealed their dreadful power and, unfettered in their actions, wildly abandoned their domestic and maternal functions. However, puerperal insanity remained a largely domestic disorder, treated at home, or if not there, then in the increasingly domesticated space of the asylum. Though attempts were made by families to maintain privacy when their mothers, wives and daughters were afflicted with insanity, highly publicised courtroom appearances of women who had murdered their infants while disordered thrust them into the public arena.