Monday, 9 February 2015

Millbank: Malnutrition and Epidemics


Whereas if many Offenders, convicted of Crimes for which Transportation hath been usually inflicted, were ordered to solitary imprisonment, accompanied by well-regulated Labour, and religious instruction, it might be the means, under Providence, not only of deterring others from the Commission of the like Crimes, but also of reforming the Individuals, and inuring them to the Habits of Industry.     
- Preamble to the Statute for the National Penitentiaries, 1779

The 1779 Act authorised the establishment of two Penitentiaries, one for men and one for women, to which convicts were to be committed directly or after commutation of a death sentence, and for which the central government was to be responsible. What with one thing and another it was 1812 before the construction of Millbank Penitentiary got under way, and 1816 when the first part opened. The building, on the site later occupied by the Tate Gallery, was completed in 1821; a less than eye-catching, memorial stone on the north bank of the Thames recalls its location. (1,2)
The easy-to-miss monument to Millbank and its transportees

... vaguely old-style-dustbin shaped...
looking over  the Thames from Millbank, SW1

The prison extended further along Millbank from the site of corner galleries of Tate Britain in the east, to the far side of Erasmus Street in the west and northwards into the Millbank Estate, and then southwards, almost to the river. If you walk down John Islip Street towards Vauxhall Bridge Road, you can still see the remains of the moat (the paved alley way with the lamp post and bollards) which surrounded the prison on your right, behind Wilkie House.                     
Its design was a modification of Bentham’s ‘Panopticon’, meaning that prisoners were to be kept in separate cells, with stone walls and barred windows, provided with toilet receptacle, wash-basin, hammock and loom, and positioned so that they could be supervised constantly. Only the first five days of imprisonment were to be in solitary confinement, however, after that it was to be reserved for punishment. A medical officer, chaplain, master-manufacturer and matron were included among the staff. Of course it was not to be thought that the government would be pampering its prisoners. The doctrine of ‘less eligibility’ ruled: however hard life outside might be, prison must never appear preferable to it  One way of trying to make a prisoner’s life less bearable than that of the non-criminal poor was the imposition of a restricted diet. In the year 1818 there were two days of rioting over the poor quality of prison bread, then in July 1822 provisions were curtailed, so that it was said the ‘animal’ part was reduced to almost nothing. (Vegetarianism would not have been common.)
By early the next year it was becoming apparent that all was not well, as large numbers of inmates succumbed to illness. Constrained to seek outside help, the authorities called in doctors Peter Mark Roget, later of Thesaurus fame (3), and Peter Mere Latham to investigate what had gone wrong and work out how to put it right. They remained in the service of the Penitentiary until May 1824. During that time the ‘Millbank epidemic’ attracted a good deal of public attention; they found themselves having to make reports, answer questions and put forward explanations while dealing with the sometimes touchy prison establishment as well as with the formidable task of medically managing the outbreak, When it was over, Latham wrote and published a detailed account, based as he said on memoranda of all the circumstances which had appeared important at the time. (4)
Between February 14th and March 1st, 1823, when the two doctors began their examination, 48 prisoners had been taken ill, mostly suffering from diarrhoea and dysentery, but of a ‘peculiar kind, suspected of connexion with the scorbutic disease.’ The first signs of scurvy (a deficiency disease) had been noticed at the beginning of February, in a few individuals. The prevailing malady was found to be ‘the same with Sea Scurvy’, conjoined with bowel disorders in almost every case, and always presenting the same ‘constitutional derangement’: sallow countenance, impaired digestion, diminished muscular strength, feeble circulation, various degrees of ‘nervous affection’.  More than half of the prisoners were affected in at least one way, but in differing proportions. Women had suffered much more than men, and the Second Class, i.e. those who had been confined longest, much more than the First; on the other hand, 21 out of 24 who worked in the kitchens had escaped the sickness, as did a total of 106 prison officers and servants, and their resident families. It emerged that during the previous autumn ‘the general health of the prisoners began visibly to decline. They became pale and languid, and thin and feeble...’
All things considered, Roget and Latham felt justified in inculpating the change in diet – which had allowed one ox-head in a soup of pease or barley to 100 male or 120 female inmates – as a prime cause of the outbreak; 8 months of the reduced allocation, and a severe winter, had preceded the epidemic. They therefore ordered an immediate improvement in the prisoners’ food. Each was now to receive a daily allowance of 4 ounces of meat and 8 of rice, with white bread, not brown, and 3 oranges as ‘the best antiscorbutic article procurable at this season’ (now known, like other citrus fruit, to be a way of supplying the necessary Vitamin C), A modified version of this ‘dietary’ was to be continued after the patients recovered, as they began to do with its more effective nutritional intake. Soon, however, it was observed that the bowel complaints in particular had a ‘a great liability to return’, so a convalescent ward was opened. At the time of the doctors’ first Report, dated April 15, 1823, out of 332 patients admitted to the infirmary, 11 had died, and of the remaining 111 there 36 were convalescent, 46 had other complaints, and 19 were not free of symptoms of the ‘prevailing disease’. On this basis they concluded that there was now ‘no obstacle to the entire re-establishment to the healthy state of the Penitentiary.’
As Latham ruefully observed, ‘This Report, as a medical document, was unquestionably premature.’ Almost as soon as it was published, the bowel disease reappeared, pervading the prison by mid-May; within another month it was affecting all the former sufferers and very nearly everyone else who had been exposed to the presumed causes – deficient diet and the rigours of winter – plus very nearly all new admissions taken in after those causes had ceased to be present. After trying some milder and less controversial remedies and seeing that symptoms of scurvy were no longer apparent, the doctors resorted to mercury, which was often prescribed for venereal disease but thought to be contra-indicated in cases of scurvy. Latham describes their feeling of ‘relief from awful responsibility’ when mercury was seen to have a salutary effect, especially against the most intractable diarrhoea and dysentery, and where there were neurological complications.
Still the malady was not eradicated, so that the entire establishment eventually had to be evacuated and closed down for several months, and its inmates moved to the hulks, the notorious prison ships on the Thames. Despite the reputation of the hulks, the health of those transferred showed a dramatic but sadly temporary improvement, Not very surprisingly, they had brought the disease with them and it soon flourished again, most devastatingly on the ‘Narcissus’, where ‘the bodily sufferings and mental misery’ of the women from Millbank were, in the end, so pitiable as to procure them pardons. Whether they then recovered, or carried the disease into their communities, seems not to have been recorded.
From this whole episode, the authorities evidently drew the conclusion that experimenting with prisoners’ diets by reducing their nutrition below certain minimum standards could lead to much more trouble than it was worth. And Dr Latham, for one, learned a bit about attending to the prisoners’ point of view. At first, he acknowledged, he and Roget had tended to believe people like the officers and surgeon with reference to the timing of the disease first starting to show itself; later he admitted that the prisoners had probably known better when, very soon after the diet had been changed,  they reported symptoms that were dismissed as insignificant or as malingering but were actually genuine portents of what was to come.
Millbank was generally regarded as a very unhealthy place, to the extent that a transfer even to the hulks, where morbidity and mortality were always high even for prisons, was seen as desirable, and was often granted on medical grounds. This in turn, in vicious-circle mode, was taken to be one reason for the high incidence of sickness on the hulks. The bad reputation of the penitentiary in this respect was confirmed when the collection of statistics began: pioneer statistician William Farr contended that ‘the criminal’s liability to die was more than doubled by imprisonment’ there. (5) Comparing the figures produced by William Baly, physician to Millbank for the years 1825 to 1842 (6) with mortality rates at the same ages in the general population, he showed that nearly five times as many deaths occurred at Millbank from fevers and bowel complaints than in London as a whole. He endorsed Baly’s finding that ‘consumption and scrofula are shown by irrefrangable evidence to be the diseases to which the excessive mortality of prisoners under long confinement is due.’ Baly had disputed the theory that the ‘unhealthy site’ of Millbank was to blame, pointing to similar ill effects observed in long-term prisons in other countries.
Farr, too, extended his critique, pouring scorn on those who claimed, on the basis of erroneous figures, that prisons were really healthy places: ‘The present system of imprisonment destroys ten times as many lives, and produces a thousand times as much actual suffering, as the executioner.’ In addition to their own problems, prisons were especially vulnerable in times of general epidemics – ‘a good sanitary test’ as Farr noted. He demonstrated that in the cholera year of 1832 mortality in prisons, at 29 per 1,000 per annum, was three times the ordinary mortality in England and Wales, ‘and we know that the general mortality at the same age was raised to nothing near this pitch.’ Millbank and the hulks were known to be extra prone to this disease. At least one modern commentator (7) has suggested that the 1823 episode ‘may have been cholera’, and Latham had in fact described some of the cases he saw as resembling descriptions he had read of ‘the Indian cholera’ (although the term did not necessarily mean the same as in later outbreaks). In 1850 Hepworth Dixon wrote of Millbank: ‘Here the cholera first appears; hence, we fear, it will depart the last. And this in spite of care and attention, regular diet (excellent in quality and sufficient in quantity), admirable cleanliness, and order.’ (8) Probably he had in mind the 1848 epidemic, when, according to Mayhew and Binny, so many corpses of cholera victims were interred in the churchyard at Millbank that the authorities, convinced it had become a health hazard, ceased to use it as a burying place. (9)
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Long-term imprisonment presented other problems for the policy-makers, for whom its somatic and psychological effects were largely an unknown quantity, although that did not preclude theorising about them. With the increasing use of confinement in prison as a deliberate punishment instead of a more inadvertent one inflicted pending trial, transportation or execution, there came many attempts to lay down definitive rules and regulations, and recurring debates on the relative merits of deterrence or reformation as the guiding principle. The main trends that emerged to win favour with the authorities were: towards isolating the individual prisoner from the supposedly (morally) contaminating influence of his or her fellows; and the determination to impose strict work discipline. These evolved in practice into the ‘separate system’ with ‘hard labour’. Both could be traced back theoretically to the ideals of reformers intent on rescuing the objects of their concern from the old chaotic proximity, promiscuity, and enforced idleness; in institutional regimes, where they were introduced with a considerable amount both of ingenuity and expense, they had the effect of making inmates’ lives thoroughly nasty and brutish, while their time inside must have seemed anything but short.
Some of the early reformers were still around to be worried by certain developments. Elizabeth Fry criticised the use of solitary confinement, the treadwheel, poor diet and penal labour, especially for women, commenting in 1835: ‘In some respects, I think there is more cruelty in our Gaols than I have ever before seen.’ Certainly her proposal for letting the prisoners approve their own rules, as women in Newgate did in 1818, was unlikely to win acceptance. (10)
Inventions like the treadwheel or treadmill, shot-drill, and the crank, set up as means of ‘labour’ in prisons along with the more traditional oakum-picking (praised, incidentally, by John Howard as ‘a salutary employment as the strong cent [sic] of the pitch and tar may counteract any contageous [sic] or unhealthy effluvia in the work-room...’) were designed to be physically exhausting and energy-consuming while soul-destroyingly lacking any useful end product. Initially indiscriminate use of the treadmill involving slow, arduous, painful upward steps, that stretched the limbs to the utmost for hours on end irrespective of age, sex or infirmity, had to be modified because of its harmful effects. These normally included ‘spinning’ head, numbed limbs and strained stomach muscles, and sometimes more serious damage such as loss of consciousness, falls, miscarriage, upset nervous system, hernia, chronic illness and crippling. (11) A few enthusiasts, like the Governor of Coldbath Fields in 1837, nevertheless managed to recommend it as ‘If judiciously used... highly beneficial to health, particularly in the case of disorderly women, prostitutes, etc.,’ although he had to admit that men, especially if they were heavily built or habitual drinkers, could become ‘greatly distressed’ by it. Self-explanatory nicknames for the ‘wheel’ included ‘shinscraper’ and ‘cockchafer’.
A five-man Inspectorate of Prisons was instituted in 1835, and in 1843 its Inspectors recognised officially that treadwheel labour was injurious to health if used indiscriminately, and was not suitable for women, boys aged under 15, or the  medically unfit. The convict population could have told them as much, and more, years earlier. Wherever the wheel was operating, its victims went to great, even self-injuring lengths to avoid it, inducing illness and inflicting wounds on themselves in their desperation to evade what they viewed, not without justification, as a worse evil. Not for the first or last time, society’s rejects showed they well knew what was not good for them.
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In spite of efforts at standardisation by the state, starting in earnest with the Prison Act brought in by Robert Peel in 1823, prison regimes varied from one establishment to another. At Coldbath Fields from 1834 to 1854 the ‘silent system’ was in force, permitting the prisoners to see each other and work together but not to speak unless it was to ask for the doctor if they were ill. Of course they developed many ingenious dodges to get round the rule, but its effect overall was depressing in the extreme. A French observer, Flora Tristan, wrote in 1842 about the total submission of those formerly defiant (doubtless a ‘result’ from the authorities’ standpoint) who found themselves unable to endure so much gloomy inactivity and sepulchral silence. At Millbank, where association was permitted during the day, she noted that its ‘material comfort combined with the impossibility of escape’ had produced ‘no sign of suffering, only total apathy.’ (12) Perhaps more sensitive than most outsiders to indications of broken spirit, she went so far as to take exception to the ‘customary servile curtsey’ with which the women in Newgate, beneficiaries of Fry’s reforms, greeted visitors. Her impression of Millbank was confirmed by Hepworth Dixon, who reported that ‘suicides and attempted suicides are among the ordinary events of this great prison.’ The separate cell was an object of dread, even without the added sensory deprivation of ‘dark’ cells used for punishment. Inmates were not grateful for the opportunity supposedly to meditate and repent, foisted on them in solitude.
In terms of discipline for its own sake, though, the outcome could be presented as a success story. ‘The order is perfect. The silence is profound. The march of industry is steady and regular,’ Dixon wrote. Whatever the misgivings of the occasional thoughtful visitor, it was a picture that appealed to the official mind. Fashionable ideas of penology remained obstinately sanguine about its presumed power to reform and/or deter offenders. And the next development was a step further in the same sort of direction.
E. A. Willis
Coming shortly: Part 3, Messing with minds: Pentonville, the New Model Penitentiary

Notes   (Numbered separately from Part 1)
1. Websites with information on and illustrations of Millbank, including its location and design:
2. Arthur Griffiths, Memorials of Millbank (1875).
3. David Emblem, Peter Mark Roget: the word and the man. London, Longman, 1970. pp.162-170.
4. Peter Mere Latham, An Account of the disease lately prevalent at the General Penitentiary. London, Thomas & George Underwood, 1825.
5. William Farr, Vital Statistics: A memorial volume of selections (1885). Metuchen, NJ, Scarecrow Press, 1975; pp. 418-422.
6. William Baly. On the mortality in prisons, and the diseases most fatal to prisoners. Paper read 25 Feb. 1845; printed copy undated, no imprint. (Wellcome Library, probably).
7. URQ Henriques, ‘The rise and decline of the separate system of prison discipline’. Past & Present 1972, No. 54, p.61-93.
8. Hepworth Dixon, The London Prisons. London, Jackson & Walford, 1850.
9. Henry Mayhew and John Binny, The Criminal Prisons of  London and Scenes of Prison Life (1862). London, Frank Cass,  1971; p.199; 235.
10. June Rose, Elizabeth Fry: A Biography, London, Macmillan, 1980; pp. 143-162.
11. Flora Tristan, The London Journal of  Flora Tristan, 1842 (Promenade dans Londres). Translated by J. Hawkes. London, Virago, 1982. (For John Howard, see Part 1 of this article). 
12. Quoted in Anthony Babington, The English Bastille: A History of Newgate and Prison Conditions in Britain, 1188-1902. London, Macdonald, 1971.


  1. A recent news item raises the question of how much attitudes have changed:
    "Is it fair to punish prisoners with horrible food?"
    By Vanessa Barford. BBC News, Washington DC. 18 Dec. 2015

  2. See Past Tense blog for a relevant article featuring a picture of prisoners using the treadwheel, and a poem: "Today in London penal history, 1800: protest in Coldbath Fields prison."