In a previous blog of January 2022, I described the admission and treatment of women suffering from puerperal insanity in two large London asylums, Colney Hatch and Claybury, around the turn of the twentieth century. As well as confining women who became mentally ill shortly after giving birth, a significant number were admitted during their pregnancies, with a diagnosis of ‘insanity of pregnancy’. They were retained in asylums partly for their own safety, as women suffering insanity of pregnancy were seen as particularly vulnerable to suicide. Many subsequently delivered their babies in the asylum. While most of the women diagnosed with insanity of pregnancy were married, single women were also frequently admitted, and asylum doctors noted that these women were particularly liable to mental breakdown. At Claybury Asylum, 56 cases of insanity of pregnancy were admitted between 1894 and 1902; 14 of whom were single women.
A destitute girl throws herself from a bridge. Etching by G. Cruikshank, 1848. Wellcome Images
During the nineteenth century, single mothers, particularly those who gave birth to more than one illegitimate child, often found themselves condemned for their immorality. However, they were also likely to be considered as objects of pity, their mental breakdown said to be prompted by heightened feelings of shame, grief, fear and anxiety about their futures. Dr John Conolly, physician to London’s Hanwell Asylum between 1839 and 1852, described how ‘anxiety, the fear of abandonment, and the pressure of poverty’ were conspicuous causes of puerperal insanity and that ‘some of these causes operate more strongly when the mother is not married’. Even in extreme cases, when such mothers were accused of infanticide or attempting to destroy their newborn child, doctors and courts connected such actions to their desperate circumstances. Such women were described as being victims of betrayal by the men who had abandoned them, alone, in a situation of want, obliged to work, yet in terror of their pregnancies being discovered, all circumstances which exacerbated their mental distress.
Maternity hospitals, in contrast to asylums, recorded relatively few cases of puerperal insanity, as women were generally discharged within a week or so of their deliveries, before their mental disorder manifested itself. Those that did occur were more likely to be women giving birth out of wedlock. Edinburgh based obstetrician, Dr James Simpson commented that unmarried mothers were ‘far more under the influence of depressing moral emotions’ and liable to develop puerperal mania. Their ‘terrible predicament’ then exacerbated the condition. Writing in 1882, Dr Ernest Mackintosh of the Glasgow Maternity Hospital noted the general distress unmarried mothers faced in their daily lives and talked of the ‘overwhelming shame’ of local mill workers and seamstresses who were subject ‘to cold, calculating desertion’ by the fathers of their unborn children. Following delivery these women gave way ‘to paroxysms of weeping’, which threw their nervous systems into disorder.
Not all responses, however, were sympathetic, and by the late nineteenth century childbirth out of wedlock was increasingly linked to hereditary influences. Joseph Wiglesworth, Assistant Medical Officer at Rainhill Asylum in Liverpool, referred to ‘old offenders’ in a language more associated with criminality than mental illness. Women who had attacks of mania after their first confinements out of wedlock, he argued, were likely to become insane again after each subsequent delivery of an illegitimate child. He dismissed the notion that shame and grief prompted their condition, attributing their mania to the same ‘defective inhibitory power’ that caused single women to become pregnant in the first place. Robert Jones of Claybury Asylum was more sympathetic, claiming that, especially in first pregnancies, single women faced ‘the moral shock of disappointment and shame in addition to… nervous exhaustion’. Yet, he also described the role of hereditary predisposition, ‘the baneful influence of an evil heredity’, in nearly 50 per cent of the cases of insanity associated with reproduction at Claybury Asylum, and an enormous 82 per cent in cases of insanity of pregnancy.
Claybury Asylum plan, 1891, Hospitals and asylums of the world. Vols. 1-2, by Henry C. Burdett. Wellcome Images.
While it is likely that birth in the asylum was a relatively common occurrence (Jones claimed 49 cases of insanity of pregnancy were delivered in Claybury between 1894 and 1902), we know very little about the circumstances of the deliveries or how the women were cared for. Asylum case books tended to simply note the date of delivery, to report if the birth was straightforward or protracted, and briefly described the woman’s recovery. Similarly, little information is given about the fate of the baby, though most appear to have been removed to the care of relatives or to a local workhouse. Unusually, a ‘birth book’ has survived in the archives of Claybury Asylum, which recorded deliveries in the asylum between 1893 and 1955. It also recorded baptisms taking place at the asylum, vaccinations, and the removal of the newborn to the workhouse or by the husband or other relatives. Occasionally, the baby remained with the mother and they were discharged together. Sadly, amongst the most striking features of the birth book were the large number of stillborn babies and the deaths of babies shortly after delivery. Of the six babies delivered between October and December 1893, two were stillborn and two died shortly after birth. The mother was single in all but one of the cases where the infant died.
Asylum cases involving single mothers were typified by a blend of despair at the desperate circumstances these women found themselves in, alone, stigmatised and facing extreme poverty, and concerns about their loose morals and poor hereditary status, particularly if they were admitted on more than one occasion to the asylum. In the case of Maud E., admitted to Colney Hatch in May 1900, the hereditary connection was stark, as Maud herself was illegitimate. The initial diagnosis was vague, and it was Maud’s mother – perhaps reminded of her own plight two decades previously – who explained to the asylum doctors that Maud’s melancholia resulted from ‘worry resulting from her pregnant condition’. Aged 21 and a former housekeeper, Maud was noted in the casebook to be depressed and delusional. She refused food claiming it was poisoned, and her melancholia took a religious form, her ‘arms stretched out and praying’. An uncle who also visited, described Maud as previously bright and capable but she became worried ‘over the trouble she had got into’. Maud was delivered of a baby boy in August; forceps had to be used and she was also given chloroform. For a few days Maud denied that she had delivered the baby. However, shortly after the case book noted that ‘she was now satisfied that it was hers’. Maud went on to make a good recovery and was discharged together with her baby in November 1900 after six months in the asylum. The photograph below depicts a happy outcome with the mother and baby leaving Colney Hatch in good health. However, as a young single mother, Maud and her baby were likely discharged to a difficult and uncertain future.
London Metropolitan Archive, H12/CH/B/11/47, Case book for female patients, Dec. 1899-Aug. 1900.
 For responses to cases of puerperal insanity taking place out of wedlock during the nineteenth century, see Hilary Marland, Dangerous Motherhood: Insanity and Childbirth in Victorian Britain (Houndmills: Palgrave Macmillan, 2004), ch. 6 and especially pp.154-8.  Robert Jones, ‘Puerperal Insanity’, British Medical Journal, 8 and 15 March 1902, 579-86, 646-51, pp.579, 580.  John Conolly, ‘Description and Treatment of Puerperal Mania’, Lancet, 28 March 1846, 349-54, p.350.  See Marland, Dangerous Motherhood, ch. 6 and Cath Quinn, ‘Images and Impulses: Representations of Puerperal Insanity and Infanticide in Late Victorian England’, in Mark Jackson (ed.), Infanticide: Historical Perspectives on Child Murder and Concealment, 1500-2000 (Aldershot: Ashgate, 2002), 193-215 for the relationship between insanity and infanticide in Victorian Britain. See Kelly-Ann Couzen’s blog of October 2022 on the 1922 Infanticide Act and use of the insanity plea.  James Y. Simpson, Clinical Lectures on the Diseases of Women (Edinburgh: Adam and Charles Black, 1872), p.567.  Ernest Aeneas Mackintosh, ‘Mental Excitement in the Lying-in: Its Importance with Regard to Maternity Hospitals’, Edinburgh Medical Journal, XXVII (July 1881-June 1882), April 1882, 899-904, pp.900, 904.  Joseph Wiglesworth, ‘Puerperal Insanity: An Analysis of Seventy-Three Cases of the Insanities of Pregnancy, Parturition and Lactation’, Transactions of the Liverpool Medical Institution, 6 (1885-86), 349-62, pp.358-9.  Jones, ‘Puerperal Insanity’, p.585.  Ibid., p.579.  Redbridge Central Library, Claybury Asylum, Birth Book 1893-1955.  London Metropolitan Archives, Colney Hatch Asylum/Friern Hospital, H12/CH/B/11/47, Casebook for Female Patients Admitted Dec. 1899-Aug. 1900.