Showing posts with label London prisons. Show all posts
Showing posts with label London prisons. Show all posts

Friday, 13 February 2015

Messing with minds: Pentonville, the New Model Penitentiary

[NOT INSIDE FOR THEIR HEALTH: Part 3,]


The prisoners must at no time during their imprisonment, whether at prayer or at exercise in the open air, see each other; nor may they converse with each other; every method is taken to prevent such an occurrence taking place, - and to such an extent is this carried, that even the pipes which convey the soil from the water closets are provided with valves, to prevent any communication through that channel; in fact every thing that human ingenuity can suggest has been employed to isolate the prisoner...
- The Times, May 20, 1841, commenting on the system adopted at Pentonville Prison.

Persuaded by favourable accounts, like William  Crawford’s 1834 report, of the ‘separate system’ operating in the United States, the British government adopted a variant of it as the keystone of its penal policy, as set out in the 1839 Act (2 & 3 Victoria, cap. 56). This made provision for establishing prisons on the cellular plan, with a standard code of regulations. The foundation stone of Pentonville on the Caledonian Road in North London – still there of course, a looming landmark -  was laid in April of the next year; it opened (and closed its gates on inmates) as the New Model Penitentiary in 1842. (1) For the remainder of the decade it was a primary focus of attention both for supporters and opponents of the new system, as they set about collecting and interpreting evidence on how it worked in practice.
It was a testing time for prisoners as well as for penal theories, such confinement having been originally intended as a probationary period, or ‘penal Purgatory’ for those sentenced to transportation, on the results of which their subsequent fate would depend. The initial intake was comprised of men aged between 18 and 35, physically fit, and judged to be mentally and morally suitable cases for the treatment they were about to receive: ‘model prisoners’ to match the model prison, as Hepworth Dixon remarked. (2) Each man was to be accommodated in an individual cell measuring 13 feet by 7 by 9, constituting a ‘workshop by day and bedroom by night’ and comparatively well appointed, even with heating in cold weather. There was to be no physical privation. Provision was made for exercise, instruction, religious observance and medical care; communication with officials of the prison was to be possible at any time, and the ‘schoolmaster’ and chaplain were to be always on hand to interrupt the isolation. But prisoners were on their own ‘as regards congenial society’ as one chaplain was quoted as saying (3), forbidden to have any contact with their fellows, and as far as possible denied individual identity. To this end, exercise yards were divided into one-man airing pens, chapel and schoolroom partitioned into stalls with high sides. Whenever a prisoner left his cell he had to wear a cap with a peak, pulled down over his face to prevent recognition, and cell numbers were used instead of names. A concomitant deprivation was that of personal initiative, since every detail of daily routine was prescribed by a strict schedule, which also applied to staff.
As the effects of this regime began to become evident, the debate about its merits or iniquity gained momentum. The country’s leading newspaper, The Times, not noted for its championship of the criminal classes, opposed it as cruel, ineffective and dangerous to health, going so far as to allege that the government was coolly contemplating a prospect of the multiple suicide of those subject to its discipline and punishment. (4) For this attitude it was criticised at length by devotees like Joseph Adshead, who claimed the prisoners were thriving – acquiring skills and education, happy in their work, and generally benefiting from the experience. According to Adshead, a Commissioners’ Report in the mid-1840s also showed their health to be ‘most excellent’ and their mental condition ‘highly satisfactory’. (3)
The Commissioners themselves, appointed to supervise Pentonville, were less uniformly complacent than this suggests. Mayhew and Binny referred to two of them, Sir Benjamin Brodie and Sir Robert Ferguson, warning that: ‘the utmost vigilance and discretion on the part of the governor, chaplain and medical attendants would be requisite, in order to administer, with safety, the system established there.’ Moreover, it transpired that some supposedly mitigating influences could turn out to have the opposite effect from that intended, as when, in September 1843, Commissioner Brodie and the first medical officer of Pentonville, George Owen Rees, had occasion to complain about ‘morbid symptoms’ induced in prisoners by the chaplain’s visits and preaching. Their misgivings were endorsed by Lord Wharnecliffe in an admonitory note: ‘... [W]hen the medical officers state to [the chaplain] that they apprehend ill effects from the state of spirits of any prisoners, he must attend to their suggestions... I will not allow the mental health of the prisoners to be risked,  as it appears to be now.’ (5)
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In a set-up featuring techniques that have been plausibly likened to those of brain-washing, advocates of the system were able to claim it had had a degree of success in obtaining a certain number of apparently reformed and repentant wrong-doers. Not all of these would have been working the system, having learned to make the right noises and faces; prisoners did, however, soon develop ways to adapt and survive. Most cases termed ‘overt insanity’ occurred shortly after admission – if they survived the initial shocks of subjection to the regime, they had a chance of surviving the rest of their sentence. In 1847 Captain Maconochie, who had long experience of managing convicts, described  Pentonville prisoners as being in a state of ‘complete physical and mental prostration’ but later modified his view to of an initial stage of ‘extreme mental irritation’ followed by a sort of acclimatisation. (6)  Hepworth Dixon asserted prisoners could perfectly well recognise each other in spite of masks and partitions, and that anonymity was a fiction connived at by officers and their charges alike. (2) As for reform, he adduced evidence form projects in the colonies and from public works in England to show that the men, once outside the walls, were quite ready to revert to their bad old ways and  even, allegedly, to riot when confronted with hard work.  While attesting to a certain robustness of mind, this was hardly an indication of the kind of character-building the new prison was designed to promote.
 All the same, if the state and its advisers underestimated the capacity of the human mind, even when incarcerated, for adaptability, cunning and sheer perversity, they also underestimated its vulnerability. There would always be a certain number for whom the stress would be too great, and the number was large enough to bother the authorities; eventually it impinged sufficiently to lead to some modification of the system. The period of separate confinement was reduced from 18 to 12 months, then to nine; an element of association was introduced when the realisation began to dawn that complete isolation from human society might not be the best preparation for a trouble-free return to society.
In the first half-dozen years of its existence Pentonville had become notorious for its high death rate and incidence of insanity. Mayhew and Binny (5) produced official figures giving an annual rate of ‘removals from Pentonville to Bedlam on the ground of insanity’ averaging 27 per 10,000 prisoners from 1842 to 1849, rising to a peak of 32  per 10,000 in 1850, but halved in the following two years, The annual figure for cases of insanity as distinct from ‘removals’ to Bedlam was put by the medical officer at 120 per 10,000 prisoners in 1843 to 1852, with half as many in 1853. This was compared with the figure of 5.8 ‘criminal lunatics’ per 10,000 prisoners in all the prisons of England and Wales during 1842 to 1849. Even allowing for a fairly wide margin of error, such statistics leave little room for doubt that the incidence of mental disturbance in Pentonville was several times that of ordinary gaols, and that the ending of the first, strictest phase of experimentation with the new system bought a definite improvement in this  respect.
It might therefore be expected that a conclusion would be drawn to the effect that the experiment was not proving a success, and that the verdict of those in charge would go against the separate and silent system, but such was not the case. During the 1840s, 54 prisons were built or extended on the Pentonville model, and at the end of the decade the House of Commons Select Committee on Prison Discipline concluded that, “If properly regulated, the separate system was more efficient than any other as a deterrent and a reform measure.’ (7) There were reasons for its appeal, as a writer (quoted by the Webbs) pointed out in the same year, 1850: ‘The officials like it; it gives them very little trouble, so, without pretending to understand its complicated effects, moral or mental, they almost all swear by it.’ (6) Its attractions included the fact that there was little chance of escape, prisoners could be kept in a state of ‘harmless docility', and once the building had been constructed, admittedly at considerable expense, it was thought to be reasonably economical to keep going.
From the official point of view, lessons had been learned and put into practice, so that it was now less likely that physical and mental health problems in prisons would obtrude themselves upon the notice of the public. Inmates would be mostly out of sight, out of mind – and unlike the old Newgate, neither offensive to the sense of smell nor a source of infection to those outside – kept securely in the hands of the responsible authorities. Another result was that it had become more difficult for outside to investigate and report on conditions within the walls. Hepworth Dixon (2) complained about having to obtain warrants from designated officials, while Flora Tristan (8) found in 1842 that foreign visitors were barred from eight of London’s prisons. Not that this meant an end to or a lull in controversy over penal policy. Many new developments were still to come, along with some backtracking, but in some respects a pattern had been set that was to last throughout the next century and beyond. Reformers still found multiple causes for concern, even if purely medical considerations constituted a smaller proportion of these – for a time at least.
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Towards a judicial summing-up
The State
Whatever bodily sufferings and ailments, up to and including death, were incurred by prisoners in 18th-century gaols, they could generally be seen as the inadvertent results of neglect and inaction on the part of those responsible for the prison establishment, Local government, such as it was, left things to the private enterprise of gaolers (who could of course be deliberately cruel and sadistic rather than merely venal and indifferent) while national government preferred to keep its distance, until something like a ‘Black Assizes’ occurred to carry the problems out into the wider world, Faced with the threat of deadly infection, the rulers could be spurred to take action, and to seek advice, which when acted on led to the implementation of some reforms, even if these were patchy, piecemeal and imperfect. This necessarily entailed increasing state regulation and control, and went along with an expansion in the prison population in a process that was far from unique to Britain and has been described by historians as ‘the great incarceration’. As a new interest in and commitment to penal administration took hold in the 19th century, different kinds of damage were inflicted as a consequence of government policy and the experimental testing of various theories on its powerless captive subjects, rather than the lack of any intervention.
The Medics
Doctors were to the fore in the movement for prison reform. Some of them were ready to undertake the regular medical care of prisoners at a time when most members of respectable society were afraid to enter a gaol, not so much because of its dangerous inmates as on account of the health hazards known to abound there. They were often prepared to badger the authorities into taking measures they saw as medically necessary or beneficial. When called in at times of crisis, they took seriously the responsibility of investigating what was happening, the impact conditions were having on prisoners’ health, and what might be done to make the prison environment less life-threatening. Later, in the newly designed purpose-built edifices of the Victorian era, doctors became an integral part of prison establishment, involved in the daily working of the system. In theory this accorded them the status and power to supervise, advise and mitigate its worst rigours; in practice they could hardly help being identified with the establishment and thus forfeiting some of their patients’ trust, even if they believed themselves to be independent and objective.
 The Prisoners
The viewpoint of those incarcerated is generally the most difficult aspect to elucidate when investigating prisons. Apart from a minority of celebrities and dissidents who were able to give an account of their experiences and articulate their reactions to it, what the inmates themselves thought was usually mediated by the voices of visitors, concerned professionals or officials whose background was very different from theirs. Such people might often have an agenda of their own, whether collecting picturesque anecdotes, compiling a dossier of evidence or justifying a particular position. Much the same would apply to writers who took the prisons as their subject, in fiction or otherwise – always a popular one with readers avid for details of what it was ‘really’ like inside – and sometimes fostered myths that could be reinforced by supposedly genuine ‘memoirs’.
It is possible to discern, however, that in spite of the successive, variously dehumanising regimes that ruled their lives, prisoners were not so hopelessly unthinking and unable to express their thoughts and feelings as the prevailing stereotypes would suggest. Collective petitions, more or less organised ‘trouble-making’ and individual statements could break through the silence, indicating the survival of the will to resist. One thing they were clear on, before, during and after the crucial hundred years under consideration here, was that they were not in prison for their health. Old problems confronted and new ones created between 1750 and 1850 were not going to go away. Many of them are still very much with us, and especially with those concerned to safeguard, as far as possible, the health and welfare of prisoners.
Postscript, 1916-19
During the First World War hundreds, perhaps thousands, of conscientious objectors (COs) were imprisoned, some sentenced repeatedly to terms of hard labour, after the introduction of conscription in early 1916; quite a lot were not released until well into 1919. The appalling details of the treatment to which many of them were subjected caused a scandal at the time, with protests and questions in parliament, and has been well documented since. (9) In several cases prison doctors were implicated in the deaths of young COs, through conniving at harmful conditions and ill- treatment, neglect, or failing to take their symptoms seriously and give an accurate diagnosis. But many COs were not only worried about themselves. Horrified by what constituted life inside even for ‘normal’ prisoners in normal times, they continued to campaign for  improvements in conditions after the war, providing significant impetus to the work of prison reform.
E. A. Willis
Notes   (Numbered separately from Parts 1 and 2)
1. Websites with information on and/or illustrations of Pentonville:
2. Hepworth Dixon, The London Prisons. London, Jackson & Walford, 1850.
3. Joseph Adshead, Prisons and Prisoners, London: Longman, Brown, Green & Longman, 1845.
4. The Times, (London), 25 November 1843.
5. Henry Mayhew and John Binny, The Criminal Prisons of  London and Scenes of Prison Life (1862). London, Frank Cass,  1971; p.113.
6. Quoted in Sidney and Beatrice Webb. English Prisons under Local Government. London: Longmans, Green & Co, 1922.
7. W R Cornish, Crime and Law in Nineteenth-Century Britain. Dublin, Irish Academic Press, 1978; pp.71-93.
8. Flora Tristan, The London Journal of  Flora Tristan, 1842 (Promenade dans Londres). Translated by J. Hawkes. London, Virago, 1982.
9. David Boulton, Objection Overruled: Conscription and Conscience in the First World War, Dent, Cumbria: Dales Historical Monographs in Association with Friends Historical Society, 2014.

Further reading (relating to all three parts)
Joe Sim, Medical Power in Prisons: The Prison Medical Service in England, 1774-1988 . Milton Keynes, Open University Press, 1990.
Geoffrey Howse. History of London's Prisons. Stroud, Pen Sword Books, 2014.
Sean McConville, History of English Prison Administration: 1750-1877. London, Routledge & Kegan Paul, 1981.
R. Creese et al., eds.  The Health of Prisoners: Historical Essays. Amsterdam, Editions Rodopi, 1995. 
Richard Smith, Prison Health Care. London, BMJ Publishing Group, 1984.


Monday, 9 February 2015

Millbank: Malnutrition and Epidemics

  [NOT INSIDE FOR THEIR HEALTH: Part 2]


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.
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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.

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.