The Victorian era was a period of time in which men and women operated in separate spheres, with men being involved in the outside world of work and politics, whereas women were confined to the duties and responsibility of the home – which included being a dutiful wife and mother. Indeed, the cult of domesticity was so strong that the middle-class nuclear family was seen as the bedrock of society so that anything which challenged or threatened it was seen as potentially dangerous to society itself. Therefore, most Victorian women and especially middle-class women, knew from an early age that their futures involved marriage and motherhood.

However, it soon became apparent in the 19th century that not all women found giving birth and caring for infants and children an easy transition to make. In fact, some unfortunate women, whether rich or poor, were prone to outbreaks of mental illness following childbirth which involved a long period of depression as well as an inability to care for their baby and fulfil their domestic duties. Furthermore, a small percentage of women actually fell prey to a serious mental illness called puerperal insanity which was characterised by outbreaks of mania and bizarre behaviour, as well as a deep and enduring depression. Therefore, those women suffering from puerperal insanity were seen to be at high risk of committing suicide and also infanticide, so that medical intervention was immediately required. This usually entailed the working-class mother being admitted to an asylum, while the better off had the option of employing a nurse to care for both the mother and her baby.

Puerperal insanity
Indeed, puerperal insanity was recognised in the 19th century as a serious medical condition and one which threatened not only the stability of families but also society at large. The fact that a new mother was unable to care for her child and was behaving so out of character by exhibiting hysteria, shouting and even violence shocked respectable society and showed that puerperal insanity was a serious threat to the cult of domesticity. Motherhood had been expounded as a woman’s paramount duty, so that those who failed to thrive after childbirth were regarded as societal misfits whose behaviour and actions needed to be quickly modified and brought under control. Doctors and psychiatrists debated the possible causes of puerperal insanity and put forward the idea that many women were too weak and mentally unstable to be able to cope with the trauma of birth and the transition to motherhood. Moreover, when social issues such as poverty, malnourishment and repeated pregnancies (as was the case for working-class women) were brought into the equation, it was seen as surprising that not even greater numbers of women fell victim to puerperal insanity. Midwives meanwhile blamed the toll that repeated childbirth placed on women as the real cause of puerperal insanity.

Certainly, puerperal insanity affected women from all classes and walks of life. Two very famous sufferers were Isabella Thackeray, the wife of the author William Makepeace Thackeray, and Sara Coleridge, who was the daughter of the poet Samuel Taylor Coleridge. Both of these women were regarded as fragile during their pregnancies and doubts were cast by family members about whether they would adapt and thrive as mothers.

Isabella Thackeray
Isabella suffered with severe melancholia, as depression was then termed, as well as episodes of mania which unfortunately persisted for the rest of her life. Indeed, having married at age 18 she gave birth to three children within four years, the second of whom died so that it is perhaps not surprising that she was very depressed following her next confinement. In fact, she attempted suicide several times during a voyage to visit her mother in Ireland. Sadly, despite rest and good food as prescribed by her doctor, she failed to fully recover and suffered 53 years of mental illness up until her death.

Sara Coleridge
Sara Coleridge became extremely depressed following the birth of her second child. She also had trouble sleeping and had stomach and bowel problems too. She was prescribed opiates to help her sleep, which was a standard practice for insomnia at this time, but which led to her subsequently becoming dependent upon them. Furthermore, repeated pregnancies and the tragic death of three children, including a set of twins, meant that although her depression eventually lifted it returned with subsequent pregnancies, highlighting her biological vulnerability to mental illness. Nevertheless, Sara Coleridge wrote of her experiences in her diary and, despite being unwell for long periods of time, she still managed to write. Her domestic duties were passed on to others, although she was able to educate her children herself. Therefore there is a sense that she was able to manage her condition and still function effectively, unlike poor Isabella Thackeray, who was eventually confined to various private clinics and mental institutions in Paris until her husband hired two women to live in and care for her in the family home, in Camberwell, until her death in 1894. Sadly, despite her eventual recovery, poor Sara Coleridge fell victim to breast cancer and died from the disease aged only 49 in 1848.

As the incidence of puerperal illness became more frequent and visible in the Victorian era, doctors and psychiatrists tried various methods of treatment in order to cure the condition. Physical treatments included purging the patient by making her sick or administering laxatives to further purge the stomach. Bloodletting also took place or patients were doused with cold water, while more extreme treatments involving the shaving of the head. In addition, narcotics were also prescribed, such as opiates, in order to induce calmness and restore the capacity to sleep. These treatments must have been rather unpleasant and certainly had unpleasant side effects. Indeed, the use of opium was noted as causing excitement instead of calmness in some patients as well as being linked to constipation.

However, despite these bizarre treatments, most of the women suffering with puerperal illness were treated with care and consideration, even in the asylums. For instance, great emphasis was placed on rest and good nutrition, which no doubt helped improve the condition of these unfortunate, underfed women. Unmarried women were not discriminated against and even those who had committed infanticide on account of their illness were not judged and were treated with kindness and consideration. It was recognised that childbirth and breastfeeding were exhausting times for women and whether in an asylum or being treated at home, women were relieved of this responsibility to help them regain their strength and hopefully their peace of mind. Tonics were also frequently given such as cod liver oil and iron tablets as was alcohol, with a glass of wine often being prescribed each day.

Part of the treatment for women with puerperal illness involved the establishment of regular daily routines which was also regarded as moral management. The patients were expected to eat regular meals, exercise daily and also perform therapeutic tasks such as needlework or in the case of the middle classes play the piano. Clearly, the aim was to restore a state of calm and reacquaint women with their domestic responsibilities. Thus many of the women being treated in the asylums were expected to undertake sewing and laundry work, which if successfully completed was an indication of recovery as they were once more fulfilling their domestic duties as prescribed by the cult of domesticity. Indeed, despite the somewhat bizarre treatments, many women benefited enormously from a period of rest and calm and usually recovered in a matter of months although they often became ill again with future pregnancies.

Therefore, despite the fear that puerperal illness raised in the family concerned, the medical profession and in society in general, the overall prognosis was good. At Bethlem asylum in London, the cure rate ranged from 50 to 85%, with most mothers recovering by the fourth month. Likewise, the Rotunda hospital in Dublin reported a recovery rate of 70%. Furthermore, as the 19th century progressed, more attention was given to social issues such as poverty and malnutrition which could predispose a woman to puerperal illness. More importantly, the relevance of having a hereditary predisposition towards mental illness was recognised. Thus, if a woman was genetically prone to depression then puerperal illness was to be no longer regarded as a separate illness associated solely with childbirth but should instead be seen as no different to other incidences of manic depression (nowadays known as bipolar disorder). Certainly, very detailed case notes were taken when women entered asylums, including the incidence of mental illness within the immediate family. Once in an asylum their behaviour was closely observed and recorded, which provided doctors with considerable insight into this most distressing and disturbing illness.

Fortunately, the majority of women suffering from puerperal illness went on to recover and resumed their roles as dutiful wives and mothers. As the 19th century progressed, maternity was still seen as the ultimate goal for women although there was now a greater understanding of the problems and the challenges that new mothers faced.