Postpartum Madness

The Perceptions of Pregnancy blog, like the Researchers’ Network, aims to reach beyond boundaries and borders, and to facilitate an international and interdisciplinary conversation on pregnancy and its associated bodily and emotional experiences from the earliest times to the present day. Today’s post from Marystella Ramirez Guerra looks at an incident of ‘postpartum madness’ from the Jena Court of Law in the 1790s.

A 28-year-old woman was brought before the Jena Court of Law in the 1790s for murdering her only child.[1] Three years prior she had been a patient of Johann Christian Stark, sub-director of the new Jena birthing house. While a patient there she had given birth naturally and had lost very little blood in what was then considered the body’s naturally cleansing of impure blood during the postpartum period.[2] Failure to lose large amounts of blood was seen as problematic as it indicated that the body was unable to clean itself of the excess fluid accumulated during pregnancy. Excess accumulation of fluids in the body was thought to bring on illness and, in the case of fluids in the female body, it was believed the nerves were particularly affected.

Records from the Jena birthing house demonstrate the occurrence of what was identified at the time as hysteria, which reflects symptoms of what today is known as postpartum depression. The cause of hysteria was unclear, but it was seen as an exclusively female ailment because their nerves were considered weaker and more easily affected by changes in the body. These changes could range from too much excitement to excess fluid in the body. Cases of hysteria were recorded alongside births because they happened amongst the birthing house’s patients in the weeks and months after giving birth.

Stark believed that the women who suffered hysteria and/or hypochondria, or in one case a psychotic episode, were women whose nerves were not strong enough to withstand the emotions brought on by the huge physical change that childbirth implied.[3] The exact causes of their illnesses, however, were debatable. There was a general notion that something had moved during birth, particularly if the body’s post-partum cleaning process was suppressed and led to an accumulation of fluids that could rise up to the brain.

Stark, however, was quick to point out that this did not mean congestion or heightened accumulation of blood. He believed that the cause of illness was not always related to retained fluids and that the exact cause of hysteria and general postpartum illness was still unknown. For example, women were prone to pensiveness right before giving birth and these cases could not be blamed on natural accidents or defects of the physical head; the source of this pressure on the brain (different to the pressure exerted by accumulated liquid from the womb after a birth) was unknown to physicians.[4]

L0028550 Medical Times Gazette,

L0028550 Medical Times Gazette, “Puerperal mania in four stages”. Credit: Wellcome Library, London. Wellcome Images

Stark concluded that though the origin of melancholy, fantasies, and excessive anger had its place in the organs of the abdomen, liquids and materials could accumulate in the small vessels of the head and affect the nerves, the pressure in the brain causing a form of nervous melancholy.[5] One of the cases that helped Stark reach his conclusions was one of his patients from July 1797 who returned because of listlessness and general malaise that was accompanied by yellowing of the skin. She reported three months of not menstruating and general bodily pain. She only improved after taking purging powders and the return of her periods.[6] He concluded that if the body did not expel excess fluid with the afterbirth, the fluid would seek a way to leave the womb and might travel to other parts of the body. It was also believed that a liquid or humid material formed the cave of the brain; it followed that if additional humidity were added to the brain the entire body would be overloaded, causing illness.

The conclusion reached about the effects of accumulated liquid in the cavern of the brain was that the pressure it exerted led to sadness, listlessness, inadequate amount of consciousness, and pensiveness. Though many behaviors considered abnormal were attributed to women suffering under hysteria—leading to a large array of often-contradictory symptoms used to diagnose it—there were commonalities in all the cases. For example, many tended to show lack of good skin color with some patients suffering from gaunt, yellow faces during periods of pensiveness. [7]

Returning to the trial, it was reported that the unnamed 28-year-old mother had preferred to avoid society in the postpartum period, and in her solitude tended towards melancholy and excessive religiosity. After these periods of solitude she seemed annoyed at what was expected of her in the new role of mother, crying profusely and complaining of suffering from anxiety. Though the mother was unable to defend herself before the authorities it was concluded that this state of disturbed nerves, arising from retention of fluid after birth, had led to her murderous actions. It was the only explanation of how she had been able to lovingly bathe and dress her child before slitting its throat and presenting it to her husband with the look of one who has done something wonderful.[8]

Author Bio: Marystella Ramirez Guerra is a PhD candidate at RWTH Aachen, Germany, and an Associate Director for the Perceptions of Pregnancy Researchers’ Network. 

[1] The woman is never mentioned by name as the Jena administration by a 1779 edict promised anonymity for women who gave birth at the institution. Due to a fire at the Weimar State Archives many case files that would have allowed for a possible identification were lost.

[2] Sig V87_020f Jena Romantiker Haus (JRH); this case file is un-dated due to the attending physician. It was likely to have happened in the 1790s.

[3] Sig V87_003f, JRH

[4] Sig V87_004r, Nöttlich, Geburten

[5] Sig V87_003r, JRH

[6] Sig V87_087, _088f, _089f, _089r

[7] Sig V87_020 f, Casus Forensis, Nöttlich, Geburten

[8] Sig V87_004r JRH


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