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Medical Care in English Prisons 1770-1850 Open Research Online The Open University’s repository of research publications and other research outputs Medical care in English prisons 1770-1850 Thesis How to cite: McRorie Higgins, Peter (2004). Medical care in English prisons 1770-1850. PhD thesis The Open University. For guidance on citations see FAQs. c 2004 Peter McRorie Higgins Version: Version of Record Link(s) to article on publisher’s website: http://dx.doi.org/doi:10.21954/ou.ro.0000f9f7 Copyright and Moral Rights for the articles on this site are retained by the individual authors and/or other copyright owners. For more information on Open Research Online’s data policy on reuse of materials please consult the policies page. oro.open.ac.uk MEDICAL CARE IN ENGLISH PRISONS 1770-1850 Peter McRorie Higgins, M.A. (Open), M.Ch. (Oxon), F.R.C.S. (England) Thesis submitted for the degree of Doctor of Philosophy The Open University (Department of the History of Science Technology and Medicine) April 2004 ProQuest Number: 27527263 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 27527263 Published by ProQuest LLO (2019). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code Microform Edition © ProQuest LLO. ProQuest LLO. 789 East Eisenhower Parkway P.Q. Box 1346 Ann Arbor, Ml 4 8 1 0 6 - 1346 Abstract: Medical Care in English Prisons 1770-1850 A consensus exists amongst both contemporary and present day students of penology that the prison reform process of the late-eighteenth century achieved one of its main objectives: the removal of a high risk of death from disease whilst incarcerated as an additional penalty to that imposed by the courts. Most observers are also in agreement that much of this desirable outcome was achieved by improving the prison environment - principally in respect of better standards of hygiene and a reduction in overcrowding. No such consensus exists amongst modem commentators as to the role of prison medical officers in this amelioration; indeed there has been a tendency to impute a negative role to these men. They are accused of being deeply involved in a system designed to control and dominate the lower orders of society, conniving in resultant deleterious effects on the health of their patients. This thesis provides the first detailed analysis of the effects of the day-to-day work of prison medical officers in the period 1770 to 1850. I have amassed information from several sources including: (1) journals kept by prison medical officers, (2) parliamentary enquiries, and (3) reports of prison inspectors. Some of these sources have never been previously studied; others have never been subjected to scmtiny from an informed medical standpoint. I have concluded that the prime factor motivating prison medical staff was the provision of care; their participation in a control system, although unavoidable, did not have an adverse effect on the standard of care. This care was, so far as can be ascertained, of the same standard as that provided to their private patients and although some treatment methods may seem primitive or even cruel to the modem reader, these were standard at the time. The practice of medicine involves the exercise of power; these men exercised that power in a correct and professional manner, caring for their patients to the best of their ability and ensuring maintenance of as healthy a prison environment as was possible. CONTENTS 1 Introduction 1 2 Prisons: development and reform 21 Reform 28 The process of reform 34 Penal systems: transportation and prison hulks 39 Penal systems: separation and provision of work 41 Penal systems: renewed enthusiasm of separation 43 The reformers’ motives 45 3 Prison surgeons: training, status and working practices 49 Remuneration of prison surgeons 52 Working practices 58 Infirmary facilities 60 Nursing care 65 Prisoners’ hygiene 72 Sanitary conditions 74 Environmental and other problems 77 Discharge from prison 79 Conclusion 81 4 Clinical medicine in prisons 82 Gaol fever 82 Smallpox 88 Cholera 92 The incidence of illness in prisons 95 Ulcers and wounds 99 The Itch 105 Venereal and skin diseases 107 Rheumatic complaints 109 Gastro-intestinal problems 111 Respiratory disorders 116 Fevers 117 General treatment 124 Surgical intervention 129 The prisoner/doctor dialectic 134 Prisons healthier than home? 139 Conclusion 145 5 Malingering and insanity in prisons: surgeons’ response 147 Malingering: how serious a problem? 147 The why and how of feigned illness 157 Malingering and the treadmill 157 Insanity in prisons: the background 159 Insanity: management after 1820 162 Insanity in Gloucestershire prisons 166 Suicide in prisons 173 Conclusion 178 6 Deaths in prison 180 Mortality rates in prisons 180 Comparative mortality rates 186 Individual deaths: those ill on committal 192 Individual deaths: Gloucestershire, Lancaster and Norwich 195 Compassion rather than punishment 204 Deaths in the hulks 207 Inquests on prison deaths 213 Conclusion 216 7 Prison surgeons and authority 218 Interaction with authority 218 Surgeons and prison diet 223 Diet at Lancaster castle 226 “Scurvy” at Millbank penitentiary 232 Prisons surgeons’ obedience to the rules 240 Surgeons and discipline 245 Head shaving 251 Failures to abide by the rules 252 Henry Hunt and Ilchester gaol 256 Conclusion 261 8 Conclusion 261 9 Bibliography 267 Acknowledgements My thanks are due to staff at the Record Offices at Gloucester, Norwich, Preston and Leigh and to the staff at the House of Lords Archive, all of whom gave all the help one could have wished for. Similar thanks are due to staff at the Bodleian Library, at the Gloucestershire Collection and at the Bingham Library (Cirencester). When the project was in its infancy 1 received considerable encouragement from my Open University M.A. tutor. Dr Joe Coohill, but most of all thanks are due to Dr Debbie Brunton, my supervisor, for her unflagging enthusiasm and help in the preparation of this thesis. Valuable critical input was provided by my other internal supervisor. Dr Jim Moore. 1 must also acknowledge the help given by my wife, Pamela, who has had to put up with my absences and failure to participate in activities which might normally have been expected of a husband in retirement. 1 am gratefiil to the Wellcome Trust for awarding a grant which covered a substantial part of the costs of travelling and maintenance when visiting Record Offices and the House of Lords Archive. 1 Introduction In 1618 a released prisoner wrote: ‘[Prison] is a place that hath more disease predominant in it, than the Pesthouse in the plague-time, and it stinks more that the Lord- Mayor’s dogge-house or Paris-garden^ in August’? This cri-de-coeur was echoed and embellished in 1777 by John Howard - with words indicating that not much had changed in 160 years: I beheld in many of them [the houses of correction and city and town gaols], as well as in the County-Gaols, a complication of distress: but 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. [..,] These effects are now so notorious, that what terrifies most of us from looking into prisons, is the gaol distemper so frequent in them,^ [...] some [prisoners] are grievously affected with scorbutic distempers: others have their toes mortified, or are quite rotted from their feet; many instances of which I have seen,'* Minshul’s comments fell on deaf ears but the nation was ready for prison reform when Howard’s words were written. Thus, sixty years later in 1836, prison inspector Bissett Hawkins was able to pen this eulogy: In all the County Gaols which I have entered, a remarkable degree of cleanliness and neatness has reigned throughout, equalling that which is usually maintained among the middle class in England, and largely surpassing the standard which generally prevails in the most splendid residences in Continental Europe. [...] The rate of mortality is, in most of these abodes [the principal gaols], so remarkably low, that I can confidently affirm, that in very few situations in life is an adult less likely to die than in a well-conducted English prison.^ * Paris-garden: a bear garden at Bankside, Southwark. ^ Geffiuy Minshul,Essayes and Characters o f a Prison and Prisoners (Edinburgh: Ballantyne, 1821, reprinted from 1618), pp. 14-15. Minshul was incarcerated in the King’s Bench prison, probably for debt. ^ John Howard, The State of the Prisons in England and Wales, with Preliminary Observations and an account of some Foreign Prisons (T* edn., Warrington: Eyres, 1777), pp. 2-3. ^Ibid., p. 39. ^ First Report Inspector of Prisons, Southern and Western Districts, PP 1836 (117), XXXV, 269, pp. 1-2. William Guy agreed, albeit in more measured tones: In reference to this class of prisons, the work which John Howard set himself to do seems to have been folly accomplished. The prisoner not only undergoes no punishment beyond that which the law awards him, [...] not only is he not exposed to the gaol fever, the small-pox, and other fatal maladies which decimated our prisons less than a century ago, but his health is carefully protected against every cause of injury not inseparable from the state of imprisonment.^ Even allowing for Hawkins’ hyperbole, it is clear that the later years of the eighteenth century and the first half of the nineteenth century saw a marked improvement in health care in English prisons.
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