Jane's Illness: What Did Acute Mania Look Like in the 19th Century?

A woman diagnosed as suffering from hilarious mania, colour lithograph, 1892, after J. Williamson, 1890. (Wikimedia Commons)

Since I began writing about Jane Darragh, my great-great-grandmother, whose cause of death was noted as "acute mania," I've heard from several readers with various theories of what might have happened to her. There are certainly many different angles to consider.

More than one reader suggested that perhaps Jane's diagnosis was a case of her being deemed "hysterical" as a catch-all for any number of ailments. Others thought her diagnosis could have been an easy way to "get rid of her" if she was being troublesome to her husband or family. Another reader suggested that physicians of the day—being male—dismissed women's complaints as being imagined or that her symptoms might not have been seen as remarkable if displayed today. All are excellent points.

There's much I don't know about Jane's situation, as her death record is the only outright statement of her acute mania diagnosis that I've uncovered so far. I've had to read between the lines of all her life events, and dig into historical medical knowledge of her time.

I've begun to piece together theories about what happened to Jane. Before I get to those, we need to understand how acute mania was understood in the 19th century.

 

A 19th Century Perspective on Acute Mania

A Compendium of Insanity, published in 1898, described mania as "...a condition characterized by an abnormal exaltation and activity of the mental functions — the intellectual faculties, the emotions, and the will — and may show itself by irrational talking and acting, by delusions, illusions, and hallucinations, and by unusual muscular activity or movements." The book further split mania into various subtypes, such as sub-acute, acute, chronic, and recurrent, which referred to the degree, intensity, duration, and frequency of a patient's episodes.¹

Patients with acute mania were thought to have inherited their condition: "When the family history is fully ascertained, it is almost universally found that there has been in the ancestry some degenerative taint..."² 

Acute mania, such as Jane was diagnosed with, presumed a history of physical or mental overwork with little rest, resulting in strain. Life events thought to bring on an episode of mania included: setbacks or successes in business; profound moral shock resulting from loss of property; loss of family through death or relocation; various disappointments; the exhaustion of carrying a pregnancy; alcoholic or sexual excess, etc. These were seen to disrupt a normal standard of health, to cause a loss of sleep, and to produce a "functional irritability of the brain."³

Disappointments, moral shock, and the rigors of pregnancy were some events thought to bring on episodes of mania in the 19th century. (Rawpixel)

  

At first, symptoms of an acute attack of mania might go unnoticed by the individual and their family. Mild depression, restlessness, some slight sleep disturbances, or a lack of appetite might be attributed to any number of reasons.⁴ 

But as an acute episode progressed, more symptoms appeared and gained intensity. Whether these came on suddenly or gradually, eventually the person experienced the rapid evolution of ideas and a lack of attention span, so that they were "...alive to every fleeting impression, but the possibility of steady concentration [was] absolutely lost..."⁵

There was also a physical expression to the mental turmoil. There were sudden and rapid emotional changes; a patient may be maudlin one moment and hilarious the next. "The patient may laugh, dance, sing, or cry, often keeping up an intense bodily and mental activity for long periods without rest or showing any signs of exhaustion." Patients often felt all-powerful with a tendency to destroy clothing, bedding, or furniture, which felt restraining to them. They may feel insensitive to heat, cold, pain, and fatigue.⁶ 

Contemporary books frequently noted manic symptoms particular to women:

• "In the case of a woman, her personality or concerns engross her thoughts, and she may give herself up to emotional disturbance, as fits of weeping, laughing, and demonstrations of extravagant conduct of an hysterical character."⁷ 
• A Practical manual of Insanity for the Medical Student and General Practitioner noted that as moral inhibitions were lost, "refined and religious women may be profane and indecent in gesture and language."⁸
• "The fact that woman [sic] are more nervous than men and more emotional may be factors. It is not to be forgotten that the puerperal state [pregnancy] is often the cause."⁹

Treatments for acute mania focused on providing rest, nutrition, and sleep in the late 19th century. Treatments could be delivered in both a home or a hospital setting, depending on how amenable the patient was and if there was a caretaker available to be sure that the prescribed treatment was strictly followed.¹⁰

Manic patients were often cared for in the home supervised by a vigilant caretaker. (Rawpixel)

 

Though the prognosis for recovery from acute mania was considered good, there was the possibility that the condition could lead to death. Patients could succumb to exhaustion from the intense and continued bodily movement and mental strain. In the days before antibiotic treatments, they might suffer infections and sepsis from cuts or broken bones resulting from their manic movements, for which they declined treatment, or opportunistic illnesses or infections that took advantage of their weakened state.¹¹

It was also considered likely that a person would suffer recurrences of the condition, and that it had a degenerative affect on the patient over time, perhaps further weakening them against future episodes.¹²

Considering this background and Jane's life, I've formulated several theories about her case.

 

My Theories 

• This episode of mania was possibly not the first Jane encountered.
• It's possible that Jane had suffered several miscarriages or stillbirths during her childbearing years. 
• Neither acute mania nor other mental illnesses were widely recognized as causes of death in Ontario in 1903. 
• Jane was treated at home and was not institutionalized before her death. 
• Her physician, Dr. Sheahan, was relatively young and likely to be familiar with the latest treatments recommended for mental illness.
• Jane was likely treated with medications to help her sleep, with plentiful food, with as much quiet as possible around her, and was watched over by a caretaker—possibly an elder daughter—to ensure that this treatment was strictly followed.
• The Catholic Church to which Jane belonged would have been sympathetic to her illness.
• Jane's illness was likely stigmatized by the general population of the time. Even her closest friends might not have known of her illness and family might have covered it up or attributed her illness to something else.

I'll work through each theory in coming posts.

Until next time... 

© Nancy Gilbride Casey, 2026. All rights reserved. 

  

NOTES

¹ John Bassett Chapin, A Compendium of Insanity (Philadephia: W.B. Saunders, 1898), 101; imaged, Internet Archive (https://archive.org/details/acompendiuminsa00chapgoog/page/n150/mode/2up?q=acute+mania : accessed 11 July 2026).  

² Daniel Roberts Brower, Henry Martyn Bannister, A Practical manual of Insanity for the Medical Student and General Practitioner (Philadelphia and London: W.B. Saunders & Co., 1902), 317; imaged, Internet Archive (https://archive.org/details/apracticalmanua00banngoog/page/n342/mode/2up : accessed 18 Nov. 2025). 

³ A Compendium of Insanity, 101.

⁴ A Practical manual of Insanity for the Medical Student and General Practitioner, 318. 

⁵ Ibid, 318-19.

⁶ Ibid, 319. Also, A Compendium of Insanity, 112.

⁷ A Compendium of Insanity,104.

⁸ A Practical manual of Insanity for the Medical Student and General Practitioner, 319.

⁹ Daniel Clark, M.D., Mental Diseases: A Synopsis of Twelve Lectures Delivered at the Hospital for the Insane, Toronto, to the Graduating Medical Classes (Toronto: W. Briggs, 1895), 7; imaged, Canadiana (https://n2t.net/ark:/69429/m0125q817v2n : accessed 13 July 2026).

¹⁰ A Compendium of Insanity, 137-38.

¹¹ Mental Diseases: A Synopsis of Twelve Lectures Delivered at the Hospital for the Insane, Toronto, to the Graduating Medical Classes, 325.

¹² A Practical manual of Insanity for the Medical Student and General Practitioner, 325, 327-28.