Hilary Marland's Dangerous Motherhood: Insanity and Childbirth in Victorian Britain is a thoroughly researched book on puerperal insanity, a diagnosis with wide-ranging and multiple definitions that was, Marland argues, “very much a disorder of the nineteenth century” (3) yet has received little attention from scholars of that period. It is a fine addition to the histories of women, psychiatry, midwifery and obstetrics, and infanticide. While some of its most intriguing suggestions could have been pursued in more depth, Dangerous Motherhood makes insightful points, prompts important questions, and creates numerous agendas for further research.

The book has seven chapters, plus a brief introduction. Chapter 1 argues for the rise in the nineteenth century of puerperal insanity as a diagnosis, while chapter 7 demonstrates that “during the late nineteenth century [puerperal insanity] began to be written out of psychiatric textbooks and out of asylum records” (203). Marland is quite convincing on these crucial questions of chronology. In chapter 1, she demonstrates that while much older descriptions of worrisome postpartum behavior exist, these did not coalesce into a recognizable illness until after 1800. Furthermore, the emergence of puerperal insanity was related to specifically nineteenth-century understandings of women's bodies and minds as almost inevitably sick and of reproduction as dangerous for women. At the other end of the century, a new emphasis on brain function, heredity, and the rhetoric of degeneration, along with a preference for fewer larger categories of mental illness, led to the abolition of the diagnosis (203–5).

Intervening chapters focus on struggles between the midwifery and psychiatric communities for expert status; the effects of puerperal insanity on middle-class women, who were usually treated at home; the effects of puerperal insanity on lower middle-class, working-class, and poor women, who were usually treated in asylums; the moral, social, and environmental explanations put forth for puerperal insanity; and the association between puerperal insanity and infanticide.

Marland uses varied and fascinating sources, including midwifery manuals, psychiatric texts, personal narratives, and case notes, and she seems well aware of the controversies surrounding and limitations of all of them. For instance, chapter 4, which is on patients in the Royal Edinburgh Asylum, relies on case notes and includes a section on the problems researchers encounter in their efforts to hear and respect the experiences and narratives of mentally ill people and the use of these “mediated” (101) sources.

Marland relates the stories of many women (most but not all of which end in recovery). Along the way, she makes several major points. One is that puerperal insanity affected women of all stations of life: “it seemed capable of striking at the heart of wealthy families … just as much as at poorer homes” (66; see also 3, 201). Indeed Queen Victoria herself is cited more than once as having been a potential sufferer (1, 201). However, the majority of victims seem to have been wives of skilled working-class men or lower middle-class men (66, 107). This brings up the question of whether puerperal insanity was actually as likely to strike rich and poor women, or whether part of its grip on the Victorian imagination was the belief that no woman was safe from it.

A second major point is that puerperal insanity was believed to arise out of domestic situations that were either overly or insufficiently demanding; “excessive luxury and a lack of preparedness for the maternal role” could be as dangerous as “poverty [and] physical exhaustion” (141, see also 7). That this was the case suggests that the understanding of puerperal insanity emerged at least in part from a narrow normative definition of the amount of domestic labor in which it was appropriate for women to engage. While Marland does refer to “domestic ideology” and the challenge puerperal insanity posed to it (65), she could have done more to explore the cultural ramifications of her research. Here, for example, it seems as if puerperal insanity not only emerged from contemporary ideas about women and domesticity but might also help us to understand them; further analysis would have been welcome.

A third point that is Marland makes is that motherhood was simultaneously constructed as entirely natural and extremely dangerous (22), with entry into it via childbirth posing grave mental as well as physical dangers. Women were expected to become mothers, but motherhood was seen as a difficult job that not every woman could shoulder; for instance, Isabella Thackeray and Sara Coleridge were both considered delicate and domestically incompetent before they developed puerperal insanity (81). Victims challenged ideals of womanhood by becoming bad mothers—irritable, violent, careless about their own appearances, and unable to care for their infants—and those that were considered cured were once again hardworking and loving mothers. This is a real insight; Marland could have done even more to explore the ramifications of a disease whose principle symptoms included a rejection of maternal status and responsibilities. What purpose might puerperal insanity have served to women, both those who experienced it and those who did not? What purpose might it have served to English society at large? Was its decline at the end of the century linked to a new vision of what it meant to be a good mother? Some consideration of these questions would have been welcome.

Finally, Marland emphasizes that puerperal insanity could be expressed as either mania or melancholia and had an astonishingly wide variety of symptoms and causes assigned to it. What, then, was it? Marland is intent on respecting the experiences of women who suffered from puerperal insanity: the book is dedicated in part to Eliza Gipps, who contracted puerperal insanity in 1860 and died nine years later in an asylum (79–80). Marland spends much of the book movingly describing the experiences of Gipps and others, stressing how the disease “caused intense suffering to the women who fell prey to it, robbing some of their sense and liberty for many years” (7). Perhaps because of her enormous respect for these women and their experiences, Marland refrains from much discussion of puerperal insanity as a cultural construction. She hints at the issue when she says that “puerperal insanity was a real condition with real sufferers, but it was also very much a product of the Victorian era” (201); however, a more thoroughgoing distinction between the disease and the idea of the disease might have enabled her to tease out some further implications.

These questions, however, should not obscure the very real achievement at hand. Dangerous Motherhood reveals much, teaches much, and raises many questions; that is what excellent books ought to do.