In February 1904, Florence H. was admitted to Claybury Asylum with a diagnosis of acute puerperal mania. Aged 23 and a resident of Islington in north London, the birth of her first child was given as the ‘exciting cause’ of her illness. The entry in the asylum casebook described how Florence ‘had tried to get at baby’ and to throw the three-week-old child out of the window. She was raving, restless and noisy and was taken to the asylum on a stretcher under restraint. ‘She chatters and sings incoherently’, it was noted in her case history. The diagnosis of puerperal insanity was confirmed by Medical Superintendent, Dr Robert Jones, a week later. Florence was initially kept in a padded room where she was said to have been ‘constantly moving about’ and to ‘turn somersaults’. She was noted to be in poor health, was coaxed to eat by the nurses and thereafter ‘took nourishment abundantly’. After ten months in Claybury, Florence was reportedly much better, and in February 1905, a year after her admission, she was discharged recovered to a local workhouse.
Over the last few months, I have been exploring the early twentieth-century casebooks of two major London lunatic asylums and the admission of patients experiencing mental disorders attributed to pregnancy, childbirth and breastfeeding. The first, Colney Hatch Asylum in North-East London, opened in 1851 and served the most deprived and densely populated areas of London’s East End. The second, Claybury Asylum in Woodford Bridge, Essex, was established over four decades later in 1893, as London’s fifth County Council asylum. By the early twentieth century, London County Council had built up one of the largest asylum systems in the world, and in 1907 its ten asylums housed over 20,000 patients.
The records of both institutions present challenges for researchers. Access to archives involving patient records is restricted to casebooks over 100 years old for reasons of both confidentiality and sensitivity, and Claybury has few surviving casebooks for this period. Meanwhile, Colney Hatch has an exceptionally full run of casebooks but a number of these have been closed to researchers due to their extremely fragile state. Nonetheless, these sources provide valuable testimony about how women suffering insanity related to childbearing were diagnosed, their backgrounds and their experiences in the asylum.
Dr Robert Jones, Claybury’s Superintendent, had a special interest in mental breakdown related to childbirth. He published extensively on puerperal insanity in British and American medical journals, declaring in 1902 ‘that gestation is attended with much nervous disturbance in many, and some nervous disturbance in all’. Claybury provided Jones with ample material for his publications. Childbirth was listed as a major cause of mental breakdown, and between 1896 and 1902 259 women were admitted with diagnoses of insanity of pregnancy, confinement or lactation.
Florence H.’s experience cited above is representative of numerous women admitted to Claybury and other London asylums in the early years of the twentieth century. The majority of women suffering puerperal insanity were brought to Claybury within a few weeks of their confinement, and many were discharged relieved or cured within a year of admission. Some were sent home, others removed to the workhouse. While puerperal insanity was often associated with hereditary causes and instances of mental illness in the family, social and economic factors were also deemed significant. Jones also appeared to empathise with the plight of his female patients, highlighting in his published work the stress resulting from overwork, penury and domestic troubles.
In terms of treatment, there was little in the way of medical or pharmaceutical intervention. Though sedatives might be prescribed, attention was primarily devoted to encouraging the women to rest, eat and take on a regular routine. Given the impoverished backgrounds of most patients, many were poorly nourished on admission and were ‘coaxed’ to eat by spoon feeding or use of a feeding tube. Unlike current day treatment, where ideally women keep their babies with them, the infant was usually removed from the mother, and brought to the workhouse or cared for by a family member. Florence’s confinement in a padded room might have been to protect her from harming herself – she was reported to be very excited and badly bruised on admission – and it avoided the use of a strait jacket. It was commonly observed that women experiencing puerperal mania might, like Florence, be in poor physical health yet at the same time exceptionally strong, energetic, and violent. Her threatening behaviour towards her baby was common in such cases, and many women were also believed to be at risk of harming themselves.
Colney Hatch Asylum was notable for its admission of large numbers of ‘alien’ patients, particularly after London County Council took the decision to concentrate Jewish patients there in 1872. Colney Hatch introduced special religious and dietary provisions for their Jewish or as they were commonly referred to ‘Hebrew’ patients. Many were recent migrants to London from Eastern Europe, some of whom spoke little or no English, and almost all were impoverished and in poor physical health. Despite efforts to accommodate a growing asylum population that had reached 2,500 by 1900, the institutional experience for inmates was likely to be grim. For women already struggling with the disruptive and alienating consequences of mental illness, daily life on wards, which were reportedly decrepit, gloomy and uncomfortable, must have been frightening.
The medical staff appear to have been responsive to the information given by Jewish family members, particularly if the patients were unable to communicate themselves. Usually, it was husbands who described how childbirth had prompted their wives’ mental breakdown and on occasion this led to a change in diagnosis. When Eva C., ‘Hebrew’, aged 24 and resident in Mile End, was admitted on 15 February 1905, the cause of her insanity was given as ‘a fright’. She was described in the case notes as depressed, melancholic and vacant, yet also liable to be troublesome and ‘spiteful’. She was also refusing to eat. When her husband visited, he explained that she had ‘not been right’ since the birth of her second child five months ago and had been unable to sleep; accordingly, a provisional diagnosis was recorded of ‘melancholia lactational’. Sadly, Eva’s condition worsened, and she died at the end of February, when the cause of death was given as ‘Acute Melancholia or Exhaustion. Natural Causes’. This was an unusual outcome for such cases given their generally good prognosis, though lactational melancholia was regarded as particularly difficult to cure.
Twenty-three-year-old Leah C., also recorded as ‘Hebrew’ and from Mile End, was admitted to Colney Hatch with a diagnosis of puerperal mania on 2 June 1900. The admission notes reported her to be ‘dazed, bewildered and wild’ and her physical health ‘impaired’. On visiting the asylum, her brother-in-law and husband explained that Leah had lost her first baby after a miscarriage; she also had a three-year-old child at home. Several weeks before her last delivery on 22 May, her husband explained that Leah had begun to ‘talk nonsense, saying she would do away with herself’. She initially refused to eat, and her recovery was slow throughout the rest of the year. However, in February 1901, Leah showed significant signs of mental improvement. She was sent out for a trial period with her family and was discharged ‘recovered’ the following month. (Photographed before discharge, it is possible in the image below to see the restraining hand of a nurse keeping Leah still while the photograph was taken.)
These select examples provide some insights into childbirth-related cases of mental illness treated at Colney Hatch and Claybury Asylums in the early twentieth century. Many patients were single mothers, and a future blog will describe their experiences, including, for some of these women, delivery in the asylum. Though admission to an asylum must have been a miserable experience, it provided a route to recovery for many. The women appear to have been well treated on the whole, despite the limitations of overcrowded wards, staffed by overworked doctors and nurses. These cases also provide insights into the hardships experienced by working-class women of London around this time, compounded for many by anxiety about bringing another child into the world. For some the asylum proved to be just that: a place offering shelter, food, care, and respite.
 I am using early twentieth-century terminology in this blog. At this time the term ‘lunatic asylum’ was still in common usage to describe what after the 1930s were increasingly referred to as ‘mental hospitals’. I have also employed terms such as 'insanity' and 'mental disorder', in frequent usage during this period.  Redbridge Central Library, Claybury Asylum Female Casebook Nov. 1903-Aug. 1904, Florence H, admitted 17 Feb. 1904.  Robert Jones, ‘Puerperal Insanity’, British Medical Journal, 8 March 1902, 579-86, quote p.579.  Ibid.  Louise Hide, Gender and Class in English Asylums, 1890-1914 (Houndmills: Palgrave Macmillan, 2014), p.33.  Rob Ellis, London and its Asylums, 1888-1914: Politics and Madness (Basingstoke: Palgrave Macmillan, 2020), 212-13, 215; Len Smith, ‘Insanity and Ethnicity: Jews in the Mid-Victorian Lunatic Asylum’, Jewish Culture and History (1998), 1, 27-40, p.34.  London Metropolitan Archives (LMA), Colney Hatch Asylum/Friern Hospital, H12/CH/B/11/54, Casebook for Female Patients Admitted Dec. 1904-June 1905, Eva C. admitted 10 Feb. 1905.  LMA, H12/CH/B/11/47, Casebook for Female Patients Admitted Dec. 1899-Aug. 1900, Leah C.. admitted 2 June 1900.