Abstract
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
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
Notes
The Book of Margery Kempe, translated and introduced by B.A. Windeatt (London: Penguin, 1985). Kempe lived between c.1373 and c.1440.
The suggestion that Kempe experienced some form of ‘postpartum disorder’ has been challenged by Freeman et al., with an alternative explanation that she was suffering from episodes of mania and melancholia, culminating in mystical visions. Though the authors strive to put Kempe in her ‘proper medieval context’ and are correct in arguing that attaching the modern label of postpartum psychosis to her case is misleading, none the less parallels in Kempe’s description of her disorder with accounts from other centuries from the eighteenth to the twenty-first are striking. See Phyllis R. Freeman, Carley Rees Bogarad and Diane E. Sholomskas, ‘Margery Kempe, a New Theory: The Inadequacy of Hysteria and Postpartum Psychosis as Diagnostic Categories’, History of Psychiatry, 1 (1990), 169–90. For an account of postpartum psychosis which seeks to locate the disorder in different historical contexts and compare its aetiology, see I.F. Brockington, G. Winokur and Christine Dean, ‘Puerperal Psychosis’, in I.F. Brockington and R. Kumar (eds), Motherhood and Mental Illness (London and New York: Academic Press/Grune and Stratton, 1982), pp. 37–69.
The Holy Life of Mrs Elizabeth Walker (London, 1690), pp. 25–6. Cited Anne Laurence, ‘Women’s Psychological Disorders in Seventeenth-Century Britain’, in Arina Angerman et al., Currentlssues in Women’s History (London and New York: Routledge, 1989), pp. 203–19, quote on p. 209.
Michael MacDonald, Mystical Bedlam: Madness, Anxiety, and Healing in Seventeenth-Century England (Cambridge: Cambridge University Press, 1981), p. 108.
Anne Laurence, Women in England 1500–1760: A Social History (London: Phoenix, 1996), p. 80.
John Pechey, A General Treatise of the Diseases of Maids, Bigbellied Women, Child-bed Women, and Widows (London, 1696), p. 170. Cited Laurence, ‘Women’s Psychological Disorders’, p. 210.
Mark Jackson, New-Born Child Murder (Manchester and New York: Manchester University Press, 1996), p. 20.
Jackson, New-Born Child Murder, especially pp. 120–3. Depositions in infanticide trials provide some of the best evidence of seventeenth- and eighteenth-century understandings of insanity related to childbirth. See also Peter C. Hoffer and N.E.H. Hull, Murdering Mothers: Infanticide in England and New England 1558–1803 (New York: New York University Press, 1981). See chapter 6 for the relationship between puerperal insanity and infanticide.
John Woodward, Select Cases, and Consultations, in Physick. By the Late Eminent John Woodward … Now First Published by Dr. Peter Templeman, 1757 (London: Davis & Reymers, 1757), pp. 259–65. The full case, from which this summary is drawn, is published in Richard Hunter and Ida Macalpine, Three Hundred Years of Psychiatry 1535–1860 (London: Oxford University Press, 1963), pp. 338–41. See, for maternal imagination, Dennis Todd, Imagining Monsters: Miscreations of the Self in Eighteenth-Century England (Chicago and London: University of Chicago Press, 1995); and Herman W. Roodenburg, ‘The Maternal Imagination: The Fears of Pregnant Women in Seventeenth-Century Holland’, Joumal ofSocial History, 21 (1988), 701–16.
John Leake, A Lecture Introductory to the Theory and Practice of Midwifery (London: R. Baldwin, 1773), p. 25.
Jane Sharp, The Midwives Book. Or the Whole Art of Midwifry Discovered (London: Simon Miller, 1671), ed. Elaine Hobby (New York and Oxford: Oxford University Press, 1999), p. 191. Elaine Hobby notes that ‘fits’, ‘strangling’ and ‘Rage’ refer to hysteria.
Ibid., p.193, ‘swoonding’ = swooning; ‘watching’ = insomnia; ‘doting’ is not explained, but presumably refers to longings.
Martha Mears, The Midwife’s Candid Advice to the Fair Sex; or the Pupil of Nature (London: Crosby and Co. and R. Faudler, c.1805), pp. 15, 21–2, 87, 28, 33.
Martha Ballard, practising in Hallowell, Maine between 1785 and 1812, was dismissive of weakness and mental disorder following birth. She was impatient with her old friend and neighbour Elizabeth Weston, who became intensely anxious during her last pregnancy at the age of 45. After delivery she was ‘of the mind Shee Cannot take care of hir infant at home’ and a month later remained weak. Mrs Williams fell ‘in a Deliriam by reason of a mistep of her Husband’. The ‘Deliriam’ seems to have been emotional, but one cannot be sure, and Ballard remarked only on her swift recovery: Laurel Thatcher Ulrich, A Midwife’s Tale: The Life of Martha Ballard, Based on Her Diary, 1785–1812 (New York: Alfred Knopf, 1990), pp. 195–6, 191–2.
Shelley Day cites a handful of mainly uninfluential continental works published from early in the eighteenth century, including a cluster of German dissertations: Shelley Day, ‘Puerperal Insanity: The Historical Sociology of a Disease’, unpublished PhD thesis, University of Cambridge, 1985, p. 153.
William Smellie, A Treatise on the Theory and Practice of Midwifery, vol. I, third edition (London: D. Wilson and T. Durham, 1756), pp. 395–6.
Ibid., vol. III, A Collection of Preternatural Cases and Observations in Midwifery (1764), pp. 469–70. ‘The college’ presumably refers to the College of Physicians.
William Hunter, ‘On the Uncertainty of the Signs of Murder, in the Case of Bastard Children’, Medical Observations and Inquiries, 6(1784), reprinted in William Cummin, The Proof of Infanticide Considered: Including Dr. Hunter’s Tract on Child Murder, with Illustrative Notes; and a Summary of the Present State of Medico-Legal Knowledge on that Subject (London: Longman, Rees, Orme, Brown, Green, and Longman, 1836). See chapter 6, p. 170 and Jackson, New-Born Child Murder, especially pp. 115–23, for Hunter’s contribution to the debate on infanticide.
John Clarke, Practical Essays on the Management of Pregnancy and Labour; and on The Inflammatory and Febrile Diseases of Lying-in Women (1793), second edition (London: J. Johnson, 1806), p. 1.
Quoted in James Cowles Prichard, A Treatise onInsanity and OtherDisordersAffecting theMind (London: Sherwood, Gilbert, and Piper, 1835), pp. 311–12 and taken from John Ferriar, MedicalHistories andReflections, published between 1792 and 1798. James Cowles Prichard claimed that Ferriar made the only useful attempt to explain the disorder in this period.
William Pargeter, Observations on Maniacal Disorders (1792); reprint edited by Stanley W. Jackson (London and New York: Routledge, 1988), pp. 58–61.
Thomas Trotter, A View of the Nervous Temperament; being a Practical Inquiry into the Increasing Prevalence, Prevention, Treatment of those Diseases commonly called Nervous, Bilious, Stomach & Liver Complaints; Indigestion; Low Spirits, Gout, &c. (Boston: Wright, Goodenow and Stockwell, 1808), pp. 95, 92.
For a full account of John Haslam’s career, see Andrew Scull, Charlotte MacKenzie and Nicholas Hervey, Masters of Bedlam: The Transformation of the Mad-Doctoring Trade (Princeton, NJ: Princeton University Press, 1996), chapter 2. Haslam’s name has been strongly associated with the scandals at Bethlem, particularly the case of James Norris, but his opinions and writings while resident apothecary to Bethlem were highly influential, also among lunacy reformers such as Pinel and Tuke.
John Haslam, Observations on Insanity: with Practical Remarks on the Disease, and An Account of the Morbid Appearances on Dissection (London: F. and C. Rivington, 1798), p. 108.
Michael J. O’Dowd and Elliot E. Philipp, The History of Obstetrics and Gynaecology (New York and London: Parthenon, 1994), p. 624. See Judith Schneid Lewis, In the Family Way: Childbearing in the British Aristocracy, 1760–1860 (New Brunswick, NJ: Rutgers, 1986), for Denman’s practice amongst the upper class.
Thomas Denman, An Introduction to the Practice of Midwifery, second edition (London: J. Johnson, 1801), vol. 2, chapter XIX ‘On Mania’, pp. 494–503. The first edition, published in 1794–95, had no details of mental disorders in childbearing wornen, though it included long sections on diseases and disorders following childbirth and the management of women in childbed.
Thomas Denman, Observations on the Rupture of the Uterus, on the Snuffles in Infants, and on Mania Lactea (London: J. Johnson, 1810), pp. 37–70.
Ibid., vol. 1, p. 163. Cited Anne Digby, ‘Women’s Biological Straitjacket’, in Susan Mendus and Jane Rendall (eds), Sexuality and Subordination: Interdisciplinary Studies of Gender in the Nineteenth Century (London and New York: Routledge, 1989), pp. 192–220, on p. 197.
Eardley Holland, ‘The Princess Charlotte of Wales: A Triple Obstetric Tragedy’, Journal of Obstetrics & Gynaecology of the British Empire, 58 (1951), 905–19, quote on p. 905. The triple obstetric tragedy refers to the death of Princess Charlotte, her baby and the subsequent suicide of Richard Croft.
Ellen Ross, Love and Toil: Motherhood in Outcast London, 1870–1918 (New York and Oxford: Oxford University Press, 1993), p. 92.
For the persistence of maternal deaths, see Irvine Loudon, Death in Childbirth: An International Study of Maternal Care and Maternal Mortality 1800–1950 (Oxford: Clarendon, 1992).
For the takeover of childbirth by male practitioners, see Adrian Wilson, The Making of Man-Midwifery: Childbirth in England, 1660–1770 (London: UCL Press, 1995); Jean Donnison, Midwives and Medical Men: A History of InterProfessional Rivalries and Women’s Rights (London: Heinemann, 1977; second edition New Barnet: Historical Publications, 1988); Hilary Marland (ed.), The Art of Midwifery: Early Modern Midwives in Europe (London and New York: Routledge, 1993, 1994); Hilary Marland and Anne-Marie Rafferty (eds), Midwives, Society and Childbirth: Debates and Controversies in the Modern Period (London and New York: Routledge, 1997); and, for a comparison with the US, Judith Walzer Leavitt, Brought to Bed: Childbearing in America, 1750–1950 (New York and Oxford: Oxford University Press, 1986). Donnison’s book also gives a detailed account of the campaign for midwife training and legislation in the late nineteenth century.
Irvine Loudon, ‘Childbirth’, in W.F. Bynum and Roy Porter (eds), Companion Encyclopaedia of the History of Medicine, vol. 2 (London and New York: Routledge, 1993), pp. 1050–71.
For changing terminology with respect to male midwifery practice, see Wilson, The Making of Man-Midwifery, pp. 164–5, 175–6. Ornella Moscucci gives a full and excellent description of the heightened emphasis on women’s diseases and the evolution of gynaecology in The Science of Woman: Gynaeocology and Gender in England 1800–1929 (Cambridge: Cambridge University Press, 1990). See also Ann Daily, Women under the Knife: A History of Surgery (London: Hutchinson Radius, 1991), and, for a comparison with North America, Ann Douglas Wood, “‘The Fashionable Diseases”: Women’s Complaints and their Treatment in NineteenthCentury America’, and the response of Regina Markell Morantz, ‘The Perils of Feminist History’, in Judith Walzer Leavitt (ed.), Women and Health in America (Madison: University of Wisconsin Press, 1984), pp. 222–38, 239–45; G.J. Barker-Benfield, The Horrors of the Half-Known Life (New York: Harper and Row, 1976); Deborah Kuhn McGregor, From Midwives to Medicine: The Birth of American Gynecology (New Brunswick, NJ and London: Rutgers University Press, 1998), and Wendy Mitchinson, The Nature of their Bodies: Women and their Doctors in Victorian Canada (Toronto: University of Toronto Press, 1991).
Wilson, The Making of Man-Midwifery, chapter 11, pp. 145–58; Bronwyn Croxson, ‘The Foundation and Evolution of the Middlesex Hospital’s LyingIn Service, 1745–86’, Social History of Medicine, 14 (2001), 27–57; Margaret Connor Versluysan, ‘Midwives, Medical Men and “Poor Women Labouring of Child”: Lying-in Hospitals in Eighteenth-Century London’, in Helen Roberts (ed.), Women, Health and Reproduction (London: Routledge & Kegan Paul, 1981), pp. 18–49.
Irvine Loudon has calculated that there were 15,000 general practitioners in Great Britain by 1841, the ratio of all medical practitioners to the population 1:1,000, leading to claims that the profession was ‘overstocked’. Irvine Loudon, Medical Care and the General Practitioner 1750–1850 (Oxford: Clarendon Press, 1986), pp. 215, 216.
Anne Digby, Making a Medical Living: Doctors and Patients in the English Market for Medicine, 1720–1911 (Cambridge: Cambridge University Press, 1994), chapter 9.
Patricia Branca, Silent Sisterhood: Middle-Class Women in the Victorian Home (London: Croom Helm, 1975), p. 65.
Andrew Scull, The Most Solitary ofAfflictions: Madness and Society in Britain, 1700–1900 (New Haven and London: Yale University Press, 1993), especially chapter 6; Kathleen Jones, Asylums and After: A Revised History of the Mental Health Services: From the Early 18th Century to the 1990s (London: Athlone, 1993); and for Scotland, Jonathan Andrews, ‘They’re in the Trade … ofLunacy, They “cannot interfere” — they say’: The Scottish Lunacy Commissioners and Lunacy Reform in Nineteenth-Centwy Scotland (London: Wellcome Institute for the History of Medicine, Occasional Publications, No. 8, 1998).
William L.1. Parry-Jones, The Trade in Lunacy: A Study of Private Madhouses in England in the Eighteenth and Nineteenth Centuries (London: Routledge & Kegan Paul, 1972).
Showalter cites figures from the 1871 census when there were 1,182 female lunatics for every 1,000 male lunatics, and 1,242 female pauper lunatics for every 1,000 male pauper lunatics. Elaine Showalter, The Female Malady: Women, Madness and English Culture, 1830–1980 (London: Virago, 1987, first published New York: Pantheon, 1985), p. 52.
See Joan Busfield, Men, Women and Madness: Understanding Gender and Mental Disorder (London: Macmillan, 1996), especially. ch. 7. David Wright, ‘Delusions of Gender? Lay Identification and Clinical Diagnosis of Insanity in Victorian England’, in Jonathan Andrews and Anne Digby (eds), Sex and Seclusion, Class and Custody: Perspectives on Gender and Class in the History of British and Irish Psychiatry (Amsterdam and New York: Rodopi, 2004), pp. 149–76. In the York Retreat women usually outnumbered men during the nineteenth century, but here, as elsewhere, this could be linked to women’s lower mortality rates and longer period of stay, and to the fact that they outnumbered men in the general population. Women also outnumbered men in the Society of Friends, while the Friends subsidised treatment, an inducement for women to be sent to the Retreat. See Anne Digby, Madness, Morality and Medicine: A Study of the York Retreat, 1796–1914 (Cambridge: Cambridge University Press, 1985), pp. 174–5.
Edinburgh University Library: Lothian Health Board Archive, Royal Edinburgh Hospital, LHB7/7/6, Annual Reports of the Royal Edinburgh Asylum, 1812–55: Physician’s Annual Report for the Year 1855, p. 25. ‘Climacteric change’ refers to the menopause and ‘secret vice’ was a veiled reference to masturbation.
Charlotte MacKenzie, ‘A Family Asylum: A History of the Private Madhouse at Ticehurst in Sussex, 1792–1917’, unpublished PhD thesis, University of London, 1987, pp. 273, 504–5.
See e.g. Moscucci, The Science of Woman, ch. 1; Bruce Haley, The Healthy Body and Victorian Culture (Cambridge, Mass and London: Harvard University Press, 1978).
For an excellent summary of this process, see Digby, ‘Women’s Biological Straitjacket’. See also for the dominance of women by their reproductive systems, Jeffrey Weeks, Sex, Politics and Society: The Regulation of Sexuality since 1800 (London: Longman, 1989).
See Moscucci, The Science of Woman, pp. 102–33; and Pat Jalland and John Hooper, Women from Birth to Death: The Female Life Cycle in Britain 1830–1914 (Brighton: Harvester Press, 1986), for a cradle-to-grave assessment of the risk of being a woman.
John Burns, The Principles of Midwifery; Including the Diseases of Women and Children, seventh edition (London: Longman, Rees, Orme, Brown and Green, 1828). (The work was first published in 1809 and by 1837 had gone through nine editions.) Lochia is the postpartum discharge from the uterus.
See Moscucci, The Science of Woman, pp. 112–27 for the fierce debate surrounding the ‘speculum question’ and pp. 135–40 for the controversy over the surgical removal of the ovaries (quote on p. 138). Towards the end of the century, a number of gynaecologists were opposing surgical procedures and other radical forms of intervention. W.S. Playfair, for example, discouraged excessive ‘local uterine treatment’ and was reluctant to intervene in cases where he simply did not know what was wrong with his patients. See Hilary Marland, “‘Uterine Mischief”: W.S. Playfair and his Neurasthenic Patients’, in Marijke Gijswijt-Hofstra and Roy Porter (eds), Cultures of Neurasthenia From Beard to the First World War (Amsterdam and New York: Rodopi, 2001), pp. 117–39. See also Barker-Benfield, The Horrors of the HalfKnown Life and for a balanced discussion of the role of surgical gynaecology, Judith M. Roy, ‘Surgical Gynaecology’, in Rima Apple (ed.), Women, Health, and Medicine in America (New Brunswick, NJ: Rutgers University Press, 1990), pp. 173–95.
Moscucci, The Science of Woman, p. 128. Elaine Thomson, ‘Women in Medicine in Late Nineteenth- and Early Twentieth-Century Edinburgh: A Case Study’, unpublished PhD thesis, University of Edinburgh, 1998; and Judith Lockhart, “‘Truly a Hospital for Women”: The Birmingham and Midland Hospital for Women, 1871–1901’, unpublished MA dissertation, University of Warwick, 2002 have also explored the relationship between poor health, lack of medical attention and gynaecological complaints.
Judith Walzer Leavitt’s study of the shift from social childbirth to physician-attended deliveries in America has described the search for safer and less painful childbirth by women with debilitating and dangerous obstetrical histories, describing how ‘the shadow of maternity’ dominated the lives of women with large families and the impact of difficult labours, which could lead to devastating and painful conditions and deformities. Leavitt, Brought to Bed, chapter 1. See chapters 4 and 5 for the poor health of women admitted to asylums with puerperal insanity.
Alexander Hamilton, A Treatise on the Management of Female Complaints, seventh edition (Edinburgh: P. Hill and London: Underwood and Blacks, 1813; first published 1780), pp. 46–7. Cited Digby, ‘Women’s Biological Straitjacket’, p. 197.
Burns, The Principles ofMidwifery, third edition (London: Longman, Hurst, Rees, Orme, and Brown, 1814), p. 107. For details of the relationship of the female life cycle to insanity, see Showalter, The Female Malady.
Notably E.J. Tilt, On the Preservation of the Health of Women at the Critical Periods of Life (London: John Churchill, 1851), pp. 25–42, quote on p. 31.
There is a large secondary literature on hysteria, including Sander Gilman, Helen King, Roy Porter, George S. Rousseau and Elaine Showalter, Hysteria Beyond Freud (Berkeley, CA: University of California Press, 1993); Carroll Smith-Rosenberg, ‘The Hysterical Woman: Sex Roles and Role Conflict in 19th-Century America’, Social Research, 39 (1979), 652–78; Showalter, The Female Malady, chapter 6, and idem, Hystories: Hysterical Epidemics and Modern Culture (New York: Columbia University Press, 1997).
Thomas Laycock, A Treatise on the Nervous Diseases of Women; Comprising an Inquiry into the Nature, Causes, and Treatment of Spinal and Hysterical Disorders (London: Longman, Orme, Brown, Green, and Longmans, 1840), pp. 8–9.
For example, one case of ‘hysteria’ was admitted to Hanwell Asylum in 1840 compared with four cases connected to childbirth, three to ‘milk fever’, and three related to pregnancy, out of 88 female admissions. Admissions with hysteria, especially to large pauper asylums like Hanwell, were unusual. Wellcome Trust Library: T.216.21, John Conolly, The Report of the Resident Physician of the Hanwell Lunatic Asylum, Presented to the Court of Quarter Sessions for Middlesex, at the Michaelmas Sessions, 1840, p. 11.
See Helen King, Hippocrates’ Woman: Reading the Female Body in Ancient Greece (London: Routledge, 1998), chapter 11 for changing ways of describing hysteria, quote on p. 205.
For networking and cultural links between mothers and midwives, see Doreen Evenden, The Midwives of Seventeenth-Century London (Cambridge: Cambridge University Press, 2000), and for the organisation of labour and the lying-in by midwives, Adrian Wilson, ‘The Ceremony of Childbirth and Its Interpretation’, in Valerie Fildes (ed.), Women as Mothers in Pre-Industrial England (London and New York: Routledge, 1990), pp. 68–107.
David Harley, ‘Provincial Midwives in England: Lancashire and Cheshire, 1660–1760’, in Marland (ed.), The Art of Midwifery, pp. 27–48 argues that women’s changing tastes influenced the shift to male practitioners. See also, for the move to physician-attended births, Lewis, In the Family Way; and Amanda Vickery, The Gentleman’s Daughter: Women’s Lives in Georgian England (New Haven and London: Yale University Press, 1998), chapter 3.
Francois Mauriceau, The Diseases of Women with Child, And in Child-bed, trans. Hugh Chamberlen (London: John Darby, 1683), p. 299.
John Burns, Popular Directions for the Treatment of the Diseases of Women and Children (London: Longman, Hurst, Rees, Orme and Brown, 1811), Preface, p. iv.
Thomas Bull, Hints to Mothers, for the Management of Health during the Period of Pregnancy and Lying-In Room; with an Exposure of Popular Errors in Connection with Those Subjects, sixteenth edition (London: Longmans, Green, and Co., 1865; first published 1837), pp. 3–4, 4–5.
Robert Lee, Lectures on the Theory and Practice of Midwifery, Delivered in the Theatre of St. George’s Hospital (London: Longman, Brown, Green, and Longmans, 1844) (also reported in the London Medical Gazette, 1842–43), p. 1.
Michael Ryan, A Manual of Midwifery and Diseases of Women and Children, fourth edition (London: published by the author, 1841), p. 167.
Nakamura has concluded that interest in the mental state of pregnant women had strong roots in the eighteenth century and that the nineteenth century provided no significant turning point in tone or context, but, though citing some interesting individual cases up to the eighteenth century, little in the way of evidence is provided to match the outpouring of material and efforts to develop an aetiology of puerperal insanity in the nineteenth century: Lisa Ellen Nakamura, Tuerperal Insanity: Women, Psychiatry, and the Asylum in Victorian England, 1820–1895’, unpublished PhD thesis, University of Washington, 1999, pp. 112–13, 133.
Author information
Authors and Affiliations
Copyright information
© 2004 Hilary Marland
About this chapter
Cite this chapter
Marland, H. (2004). The Birth of Puerperal Insanity. In: Dangerous Motherhood. Palgrave Macmillan, London. https://doi.org/10.1057/9780230511866_2
Download citation
DOI: https://doi.org/10.1057/9780230511866_2
Publisher Name: Palgrave Macmillan, London
Print ISBN: 978-1-349-51463-2
Online ISBN: 978-0-230-51186-6
eBook Packages: Palgrave History CollectionHistory (R0)