Thursday, 5 February 2015

NOT INSIDE FOR THEIR HEALTH

A three-part series looking at:
Some medical considerations relating to London prisons, c.1750-1850
(based on a dissertation for DHMSA, 1983)
Newgate, Millbank and Pentonville, the three establishments focused on here, in turn stood for the grim reality of prison life in contemporary discourse and as reference points for critics and advocates of the dominant ideas about prison discipline and administration. They were testing-grounds for how those ideas worked out in practice. Each was also the scene of crucial episodes of crisis of particular interest to medical historians.
[Part 1]           
Newgate: Neglect and Gaol Fever
“... But the dirt of a prison speaks sadness to the heart, and appears to be already in a state of putridity and infection.”         
- William Godwin, Caleb Williams, or, Things As They Are, 1794
Newgate Gaol, on the site where the Old Bailey now stands, had by the mid 18th century already been notorious for several hundred years as a breeding-ground for infectious diseases as well as for a variety of other evils. (1)  In April 1750 the germs broke out in a big way when ‘gaol fever’ (typhus) spread from prisoners taken from Newgate to stand trial and infected others in the court, including some who could be seen as representing the system that sent them to gaol; the Lord Mayor, a Justice of the Peace, and a Baron of the Exchequer were among the 50 or so fatalities. This was not the first ‘Black Assizes’, as such outbreaks were called, nor quite the last, but it made a unique impression on the populace, beyond the local residents and tradesmen around Newgate who had long considered it a public nuisance, and said so. A consensus rapidly developed to the effect that something must be done about the place. (2,3 )

   John (later Sir John) Pringle, MD, was well aware of this when he wrote to fellow doctor Richard Mead on 24 May and put forward some practical proposals based on his experience of the type of fever involved. (4,5) As he pointed out, it was the same as ‘hospital’ or ‘camp’ (as in army) fever: ‘I shall therefore consider the two diseases as one,’ he stated, and went on to give advice on the ‘means of preservation’,  not only for the sake of respectable society but, first, for the prisoners themselves. Without guessing at the means of transmission by body-lice, he nevertheless advocated that the clothes of discharged and executed prisoners should be burned, and ‘above all, that before prisoners are brought into the court, they should be cleaned and put in cloaths to be kept for that purpose, and washed from time to time.’
Inside the gaol, his recommendations were shaped by his conviction that ‘the cause seems plainly to arise from a corruption of the air.’ He deplored the prevailing filth resulting from keepers’ neglect of the inmates’ most basic needs, but thought the root of the problem lay elsewhere: ‘When crowds of people are pent up in a close place, there is no degree of cleanliness, either of the room or the persons in it, that can secure them from falling sooner or later into a putrid fever...’ Logically, therefore, he put his faith in the supply of ‘pure’ air by means of ventilators, and was closely involved with Stephen Hales’ installation and supervision of a new ventilation system at Newgate. (6) At the same time, he emphasised that ‘clothes probably convey the infection’, woollen stuffs being the more apt to retain ‘pernicious effluvia’, referring to evidence from the colonies, where it had been found that naked slaves did not transmit the contagion. (7)
   Hales himself accompanied his design for improved ventilation with advice on cleanliness and the prevention of infection, since, as he believed, ‘ventilation will effectively prevent the first breeding of the infection, yet it will not easily cure it.’ (8) The doctors were pleased with the functioning of the new ventilators, comparing the death rate of 6 to 7 per week before they were installed, with only one in the two months immediately after, but there had been unfortunate consequences for some of the workmen, who caught the gaol fever and took it home with them. (9) One of them died, his widow being granted £20 in compensation. The episode tended to strengthen the ‘bad air’ theory, on the basis of a perceived direct connection with noxious smells as a precipitating cause. Pringle noted ‘the agreement of this distemper with what has been called the fever of the hospital, or more generally a malignant or pestilential fever.’
   Several years later, James Lind advocated measures similar to Pringle’s: stripping, bathing, and baking infected clothing in ovens. (10) He made the point that ventilators had proved less successful than had been hoped, although he still did not judge ‘animalcules’ (tiny organisms) to be responsible. It was becoming accepted by those with an interest in the subject that, as John Coakley Lettsom wrote, ‘a putrid, jail, hospital or camp fever’ were ‘one and the same in event’. Subscribing to the idea of infection via clothing, Lettsom criticised the Gaol Distemper Act of 1774 for neglecting this pathway, although it legislated for the cleaning of cells and provision of baths in gaols. In his report on fourteen cases of the fever caught from a single prisoner released from Newgate, he noted that: ‘this contagion... appears, indeed, to remain in a concentrated state on the surface of the body retaining it, and on the garments and substances which have been in vicinity to the diseased, in the same manner as odors adhere to bodies in general.’ (11)
   Lettsom’s commitment to philanthropy led him to work among the London poor (12), and directly for inmates of another prison, the Wood Street Compter, at the behest of the governors of the General Dispensary, where, according to John Howard, ‘he was esteemed by the prisoners’.(13) He observed that the living conditions of the poor, in narrow, crowded courts and alleyways, were like the gaols conducive to the spread of fever, being notably lacking in fresh air in particular. This point was reiterated by John Hunter, MD, on the basis of observations made between 1779 and 1785 in homes where overcrowding, poor nutrition and inadequate ventilation – made worse by efforts to keep out the cold – were the rule, and fever occurred frequently. There was, he concluded, ‘no doubt that this malady was the same as the jail or hospital fever.’
   One doctor who made a direct, vehement appeal for better care for the health of prisoners was William Smith. To underline the reality that ‘sickness in gaol heaps distress upon distress, until it becomes almost insupportable,’ he painted a graphic picture of the poor debtor, often worse off than the felon, deprived of adequate air, cleanliness, food and clothing, and ‘eat up with vermin’. (15) ‘Their miseries and wickedness,’ he insisted, ‘do not warrant their being poisoned.’ John Howard, whose name was to become so closely identified with the cause of prison reform, was similarly struck by the life-threatening hazards of being banged up: ‘My attention was principally fixed by the gaol-fever and the small-pox, which I saw prevailing to the destruction of multitudes, not only of felons in their dungeons, but of debtors also.’ He retained a preoccupation with the IMPORTANT NATIONAL CONCERN (his capitals) of ‘exterminating the gaol-fever, which has so often spread abroad its dreadful contagion.’ (16)
   The message was beginning to get across, reinforced by the manifest inadequacy of existing arrangements in the changing circumstances of the industrial revolution, and by the crisis in prison accommodation after transportation of criminals to the North American colonies was stopped. But the government was not always able to put even the best of its intentions into practice. For example, the provisions of the 1774 ‘Act for Preserving the Health of Prisoners in Gaol, and preventing the Gaol Distemper’ depended on the willingness of keepers (who were obviously in it for the money*) to finance the requisite cleaning and other improvements. Although John Howard sent copies of the Act to all prisons in the country, he found that it was seldom heeded or displayed as it was supposed to be. All the same, on his later visits to Newgate and other places, he found fewer cases of the gaol fever, even if not few enough to convince him that its eradication was imminent or should be made less of a priority.
++++++++++++++
   There was one more celebrated outbreak of fever at Newgate before the end of the century, in October 1793, when Lettsom was called to attend Lord George Gordon, whose name had been invoked by the (ostensibly) militant Protestant ‘Gordon’ rioters in 1780. These had had among their targets the London gaols, several of which were burnt down, including the recently rebuilt Newgate itself (arguably a service to public health).
   After Gordon and ‘another gentleman’ had died of the disease, Lettsom was invited to visit the whole of the prison and report on the health of the prisoners. (17) By now it was, he presumed, ‘an opinion pretty generally established, that the gaol, camp, hospital and putrid fevers, are the same species of typhus, differently modified; and that they often originate from the human contagion, or effluvia from the human body.’ He considered Newgate to be a favourable environment for the disease, and was rather surprised that it was not more widespread, and that it had on this occasion appeared on the ‘state side’, which was more airy and accommodated fewer prisoners, of higher rank (who paid for its privileges), in individual rooms. He theorised that a process of ‘habituation’ might explain the apparent lesser susceptibility in other parts, as well as referring to Gordon as being subject to depression and debility: ‘the fatal influence of despondency’, leading to ‘that  state of constitution... disposed to receive, and to sink under a typhus.’ The psychological dimension was quite commonly taken into account in this context; Howard, for one, averred that ‘the sudden change of diet and lodging so affects the spirits of new convicts, that the general causes of putrid fevers exert an immediate effect upon them,’ (18)
    Lettsom’s suggestions for preventing infection included air, exercise, and diet, but above all he advised particular attention to clothing, personal cleanliness, and bedding.  He went so far as to design iron bedsteads, raised off the floor and easy to dismantle and clean. An allusion to ‘iron cots’ in the records of the Court of Aldermen indicates among other evidence that they listened to some of the advice offered, even if it cost money to act on it. (19) ‘By these precautions.’ Lettsom hoped, ‘all stagnant human effluvia will be obviated and destroyed, and vermin prevented from harbouring in the furniture.’ The realisation that infestation by vermin, especially lice, held dangers as well as unpleasantness, seems in fact to have been widespread, (20) It extended to prisoners themselves – not always so insensitive and gaol-hardened as to have no standards, and not mere passive beneficiaries, ‘miserable objects’ in Lettsom’s phrase, of reforming zeal. In addition to protesting about the quality and quantity of provisions, they might take direct action on matters of hygiene, when the keepers were ineffectual. Questioned by MPs in 1813, the Keeper of Newgate admitted that he did not know how to enforce cleanliness in the individual prisoner, adding: ‘Sometimes the debtors, if a man is so filthy and lousy, for that is their chief complaint, if it is from his own want of cleanliness, will take his clothes from him, and put them under the pump and let him be naked.’ (21)
   A need for reforming zeal as applying to prisons nonetheless continued. Howard’s wish for ‘the reformation to be not for the present only, but lasting,’ remained largely unfulfilled. When James Nield investigated ‘The State of the Prisons in England, Scotland and Wales’ he found plenty to report, in a series of articles in the Gentleman’s Magazine (introduced by Lettsom and published as a book in 1813). The topic was at least recognised as a valid medical concern, and doctors continued to publish on it; it was accepted that efforts should be made to preserve the health of prisoners, however imperfect their medical care in practice. Prior to 1774, doctors had been called to Newgate only in emergencies, usually from nearby St. Bartholomew’s hospital, and requests for their attendance had sometimes met with reluctance. (22) Conversely, when medical men like John Pringle felt they had a contribution to make or a remedy to offer, they had to force themselves on the attention of the city authorities.
   Surgeons, when they were appointed to work in prisons, found plenty to do. Dr Ramsden in Newgate in the early years of the nineteenth century recorded 10,000 cases per annum of sickness and disease, ‘medical and surgical’, including fevers, asthma, bowel complaints, dropsies, dysenteries, agues, nervous afflictions and fits; fractures, contusions, wounds, ulcerated legs, itch, syphilis, venereal inflammations, and abscesses. One of the gaol’s more conscientious surgeons, he stated that under prevailing conditions Newgate ‘must continue to be destructive to health.’ (23) It was still manifestly so when discovered by Elizabeth Fry in 1816. (24) Private initiatives like hers joined with public policy in improving standards, until ‘gaol fever’ as such became a thing of the past (of course typhus did not). Newgate, rebuilt in 1857 on the ‘cellular' system (its older section demolished), lasted until 1881 and remained a focus for complaints; but new theories were coming to the fore, resulting in new types of prison which brought their own problems.
E. A. Willis
*At the time of writing, it was assumed that privately-run prison had been long ago consigned to a more primitive and brutal past.

Next time: Part 2, Millbank: Epidemics and Experiments

Notes
1. Anthony Babington, The English Bastille: A History of Newgate and Prison Conditions in Britain, 1188-1902. London, Macdonald, 1971.
2. Arthur Griffiths, The Chronicles of Newgate. London, Bracken Books, 1987. Ch.10, pp.265-283, The Gaol Fever.
3. Charles Creighton, A History of Epidemics in Britain. Vol.2. Cambridge University Press, 1894. pp.90-98.
4. John Pringle, Observations on the nature and cure of hospital and jayl-fevers. In a letter to Dr. Mead. London, A. Millar & D. Wilson, 1750.
5. Sidney Selwyn, ‘Sir John Pringle: hospital reformer, moral philosopher and pioneer of antiseptics. Medical History 1966, vol.10, pp.266-274.
6. Bills for ventilators, etc. Corporation of London Record Office (CLRO) Misc. MSS 54.8.
7. John Pringle, Letter to S. T. Janssen, Esq., Alderman of the City of London, 15 Oct. 1750. CLRO Misc. MSS 54.8.
8. Stephen Hales, Account of ventilators in Newgate and the Savoy. CLRO Misc. MSS 54.8. See also The Gentleman’s Magazine, 1752, xxii, p.180, quoted in Griffiths (note 2 above).
9. John Pringle, An account of several persons seized with the Gaol Distemper working in Newgate, and of the manner in which the infection was communicated to the family. CLRO Misc. MSS 54.8. See also Philosophical Transactions 1752 vol. 48, Pt. 1, p.42.
10. James Lind, An essay on the most effectual means of preserving the health of seamen in the Royal Navy. London, A. Millar, 1757; quoted in Creighton, note 3 above.
11. John Coakley Lettsom, Medical Memoirs of the General Dispensary in London, for part of the years 1773 and 1774. London, Edward and Charles Dilly, 1774, pp.19-26..
12. James J. Abraham, Lettsom: His life, times, friends and descendants. London, Heinemann, 1933; pp.150151, 242-257.
13. John Howard, Prisons and Lazarettos, Vol.1: The state of the prisons in England and Wales [1792]. Montclair, NJ, Patterson Smith, 1973.
14. John Hunter, Observations on the gaol or hospital fever, in Med. Trans. Coll. Phys. Vol. 3, 1787,
15. William Smith, The state of the gaols in London, Westminster and the borough of Southwark. London, J. Bew, 1776.
16. Howard, note 13 above, p.469.
17. Lettsom, ‘Hints respecting the prison of Newgate’, Mem. Med. Soc. Lond. 1795, vol. 4, 321-341.
18. Howard, note 13 above, pp.467-8.
19. CLRO, Index to the Repertory of the Court of Aldermen, 1750-99; section on prisons.
20. For a more upbeat view of living with lice, see Hans Zinsser, Rats, Lice and History. London, Routledge, 1935; pp.185-7.
21. Parliamentary Papers, 1813-14, IV, pp.21-24: Keepers of Newgate. Quoted in Michael Ignatieff, A Just Measure of Pain: the Penitentiary in the Industrial Revolution. 1750-1850. London, Macmillan, 1978.
22. Wayne J Sheehan, The London Prison System, 1666-1795. Chapter 8, The health of the prisons. PhD Thesis, University of Maryland, 1975.
23. Ramsden, reports quoted in Sheehan, above.  
24. June Rose, Elizabeth Fry: A Biography. London, Macmillan, 1980.                                    

Published online only (so far), but there’s supposed to be a copy of the original 1983 version in the library of the Society of Apothecaries.

Now available: all 3 parts, plus the following book review, formatted as a 20-page pamphlet.

No comments:

Post a comment