Doctors tried to prevent puerperal mania by advocating the use of chloroform and forceps during labour to shorten and relieve the pain, and by curtailing breastfeeding, to further limit a woman’s exertions. Unfortunately, both strategies increased a woman’s risk of puerperal mania, the first because of the devastation of unnecessary pelvic damage, the second because of increased numbers of pregnancies and increased risk of mastitis, breast abscess and septicaemia.
Elizabeth dies of puerperal mania on Turrbal country ‘It is wrong from beginning to end,’ said the Caterpillar decidedly, and there was silence for some minutes. 67
In 1849, just over the river from where my Brisbane home is now, Elizabeth Grimes stood on Turrbal country and signed her name in a fine slanting fountain-pen script, with a stray ink blot above the ‘s’. I pause for a long time before the microfiche of this petition, staring at the only trace of my step-great-great-great grandmother’s life that remains. She was 22, younger than my daughters is now, when she put her signature to this request to the Governor of New South Wales for land for a Presbyterian school. She’d married the draper from Warwickshire not so long after his first wife died, becoming stepmother to his seven young children, and he’d poured all his meagre capital, everything he had, into his re-constituted family’s passage out on the Chaseley.
Elizabeth survived childbirth three times in what was a dirty, violent frontier town on the edge of the antipodean jungle. At the time of her first ‘lying-in,’ there is no record of a midwife who held qualifications in the Moreton Bay district, and anyway, she and the draper would not have been able to afford a midwife, with nine mouths to feed. Back home in Warwickshire, women with children of their own who had an aptitude or interest made themselves available as midwives for a fee. But here, at the end of the earth, in a district of 1500 white settlers, the local ladies helped, and the doctor was called in, with his ether, laudanum and forceps, if things went wrong.
Eight years after signing that petition, a world away from her mother and sisters, Elizabeth gave birth to a fourth child, and died. She died of puerperal mania, of ‘insanity of pregnancy, parturition and lactation’. Her funeral procession, The Moreton Bay Courier reports, wound down by the banks of the Brisbane River to the Baptist Burial Ground, where the Suncorp Stadium is today. At the other end of that terrible summer, the baby died, too.
I tell you this story because puerperal mania was, you could say, an early widespread outcome of the breakdown in the social behaviours that supported neurohormonal synchrony between mothers and babies. It was endemic in England and the colonies, a broad, imprecise diagnosis that marked the frontiers of medical knowledge concerning mother–baby care. Doctors tried to prevent puerperal mania by advocating the use of chloroform and forceps during labour to shorten and relieve the pain, and by curtailing breastfeeding, to further limit a woman’s exertions. Unfortunately, both strategies increased a woman’s risk of puerperal mania, the first because of the devastation of unnecessary pelvic damage, the second because of increased numbers of pregnancies and increased risk of mastitis, breast abscess and septicaemia. This strange phenomenon of expert advice being directly contradicted some time later (known as a ‘medical reversal’) still persists in the care of mothers and babies. Experts in different disciplines wear particular lenses with particular assumptions about causality, which affects the way they makes sense of the matter. It’s as if by giving birth we suddenly find ourselves in a topsy-turvy Wonderland with Alice.
My great-great-grandfather had lost both his own mother and Elizabeth, his stepmother, before he was
out of his teens. He married the daughter of another immigrant and they had eleven children. Although the Queensland Lying-In Hospital was established 6 years after Elizabeth’s death, within its timber walls unwashed hands spread infection, and death lurked in its corridors. For half a century only the most abjectly impoverished women used it. My great-great-grandmother and her respectable friends would have preferred the care of a Ladies Monthly Nurse – women who’d given birth to their own children and offered their services in the home or in small private lying-in facilities for 1 week prior and 3 weeks after birth.
Among my female forebears living in the Brisbane district in the second half of the 1800s, the stories are similar: they had seven, eleven and thirteen children; they regularly lost babies and young children, at least two deaths in each family; and the women died young, due to physical complications of birth or weakened by the exhaustion and poor nutrition of repeated reproduction.
In the final decade of the 1800s, when my nana was born into a poor protestant farming family in country Queensland, birth remained informal and domestic. Although there was also by this time a ready availability of foods promoted for infant feeding, mostly dried or condensed cow’s milk, breastfeeding still worked in those days, thanks to the Ladies Monthly Nurses surviving knowledge about the behaviours that supported synchrony between mother and baby, and the relative lack of medical technologies that interfered with hardwired mother–infant hormones. All but the most wealthy Australian women breastfed back then, but when my nana was born, female life expectancy was just 45 years; 1 in 200 mothers died due to birth complications; and one in ten infants died. Social visionaries longed to do something about this brutal waste of life. Adapted from Douglas, Pamela, 'Appendix 1: An Intimate History of Mother-Baby Care in the English-speaking World,' The Discontented Little Baby Book, UQP: 2011;pp. 208-221. References Carroll L, Alice’s Adventures in Wonderland, first published Macmillan and Co., London 1866; Books of Wonder, William Morrow & Co., Inc. New York 1992. Davies RA, ‘She did what she could’: childbirth and midwifery practice in Queensland 1859-1912, PhD thesis, Queensland University of Technology, Coopers Plains, 2003. Douglas P, ‘Yummy Mummy and the Medicalised Milkmother’, Hecate, 2010;26:119-135. Image credits Elizabeth Grime’s signature 1849, State Library of Queensland. ‘Disease or cause of death: puerperal mania’, from historical list of puerperal related causes of death http://www.antiquusmorbus.com/English/Puerperal.htm Samuel Grimes, a photo of his late wife Julia, and nine of their eleven children.