THE MEDICAL SERVICE.
No account of the English Prison System would be complete without reference to the place and duty of the Medical Officer in the daily administration of a Prison. The English law requires that a Medical Officer shall be appointed to each prison. The appointment is made by the Secretary of State on the recommendation of the Prison Commissioners, and office is held subject to the approval of the Secretary of State. Great care is taken in selecting suitable men with high medical qualifications, and who are possessed of proved tact and discretion; a practical knowledge of insanity is also requisite. As the size of the prison varies very considerably, in the smaller prison the Medical Officer is generally a medical practitioner residing in the vicinity of the prison, who devotes a part only of his time to prison duties: at least one visit daily is required. In the larger prisons one or more medical men are appointed, whose whole time is at the service of the Commissioners, the senior appointments being filled by promotion from the junior rank. The prisons are frequently visited by a Medical Inspector who not only supervises and advises the Medical Officers, but forms a link with the whole of the Medical Staff, thus tending to standardize the medical work carried out in prisons. He is also available to visit and report on any individual prisoner when any difficulty arises necessitating special inquiry. He works under the Medical Commissioner, who represents the medical side of the service on the Prison Board, and deals with the administration of the Department.
The mere enumeration of his statutory duties reveals the great and varying responsibility imposed upon the Medical Officer:—examination on reception and discharge; visitation of the sick and those under punishment; the sanitary condition of the buildings; ventilation; food; water; clothing and bedding:—all these things are combined in the daily round. He classifies prisoners for labour according to their physical fitness. He carefully notes the effect of imprisonment on the mental or physical state of prisoners, and advises when, in his opinion, life or reason is likely to be endangered by the continuance of imprisonment, and it is satisfactory to record that no abuse of this great responsibility has occurred since the prisons were taken over by the State in 1878. He takes under special observation any case where he has reason to suspect that the mental state is becoming impaired or enfeebled by imprisonment, and carefully notes any sign of incipient insanity. The health of the prison officers and their families, and the sanitary condition of their quarters are also his special concern.
It is a striking testimony to the skill and care with which these duties are performed that, with receptions in a normal year, we will say, of 200,000 persons, and with some 15,000 serious cases treated annually in hospital, of both sexes, and some 25,000 under continuous medical treatment for seven days or over, the death-rate in prison should be generally less than ·50 per 1,000 receptions.
Our prisons have been described by a high medical authority as among the best sanatoria in England. This praise is well deserved, but it does not mean that illness is rare or only trivial, but that the skill, industry, and patience of the medical staff, operating in healthy sanitary conditions, equipped with modern knowledge and resource in dealing with the great variety of disease, which diagnosis on reception, or individual care during detention, reveals, is effective in maintaining a high standard of general health with a comparatively low death-rate, so far as prison conditions admit a comparison with the general death-rate of England and Wales.
For instance heart disease, pneumonia, and phthisis claim a regular roll of victims, though, in most cases, death would be due to chronic complaints in old, or prematurely old persons, with broken-down constitutions.
The incidence of infectious disease in prisons has, for some years past, been remarkably low. In a prison community, any illness of an infectious character is naturally viewed with great apprehension, and is always made the subject of strict inquiry—the danger of infection being, of course, very great when so many persons are daily received and brought into association at chapel, exercise, labour, &c. Against this danger, the chief prophylactic must be in the exact and unerring skill of the Medical Officer, who is able to detect symptoms on reception which, unless detected, might spread an epidemic throughout the prison. Thus, at the time of the small-pox epidemic of 1902, it was due to the precautions taken that, with few exceptions, this highly infectious disease was prevented from spreading. When the epidemic of enteric fever raged at Lincoln in 1905, not a single case occurred in the prison, though prisoners were being received daily from various parts of the city. Erysipelas is disease which is not uncommon in prisons in the early days of imprisonment. Prisoners are not infrequently received with cut hands and other wounds in a neglected or septic condition, and with a probable predisposition to the disease arising from a weak or unhealthy physical condition. Isolation, and the usual precautions, however, generally prevent the disease, which has a tendency to recur, from spreading.
Deaths from phthisis average from ten to twenty a year. It is very rare indeed for the disease to manifest itself for the first time during imprisonment, but is already existing on reception, and more often than not in a far advanced condition. It had been observed that for the ten years ending 1901, there had been an average death-rate of 16·7 from this cause, and in that year, special instructions were issued for the segregation and special treatment of tubercular disease. Cases were to be treated in the most airy cells, with southern aspect, and special precautions taken with regard to the provision of spittoons, disinfection of clothing, utensils, fumigation of cells, &c. To carry out the spirit of these instructions necessarily entails much circumspection and good-will on the part of all concerned, both officers and patients. The effect of these regulations is not easy to discern in Local, or short-sentence, prisons, owing to the fugitive character of the population, but in convict, or long-sentence, prisons, where the conditions incident to imprisonment are operative over a sufficiently long period, evidence may be found as to the measure of the effect of prison life on this particular disease. An inquiry made in 1906-7 shows that the death-rate from phthisis among males (cases very rarely occur among females) sentenced to penal servitude (i.e. not less than three years) was 1·38 per 1,000 of the daily average population. Previously to the regulations of 1901, the mortality was nearly double, amounting to 2·00 per 1,000. Since 1901, also, another cause has been operating towards a decline in the amount of tubercular disease, i.e., the more generous prison dietary of that year, with an increase in the proportion of fatty elements.