The English Prison System

by Sir Evelyn Ruggles-Brise

Inquiries made at the time of the appointment of the Royal Commission to inquire into the prevalence of Venereal disease in 1913 showed that of the receptions into prison during the six months between November and April 1914, 64,023 males and 17,161 females were received into prison. Of the males 1·58 per cent., and of the females, 1·98 were found to be suffering from some form of venereal disease. Full advantage is taken of the modern methods of treatment, and practically at all the larger prisons there is a clinic. Where facilities do not exist in the smaller prisons, prisoners are treated at an outside clinic, or transferred to a prison where there is one.

Medical Officers also have very important duties and responsibilities in connection with the feeding of prisoners. Prison dietaries in this country have always been prescribed by Statute, but these definite prescriptions—what a prisoner shall eat and drink—are always subject to the moderating discretion of a Medical Officer. Formerly, the prison dietary was regarded as an element of penal discipline. Sir J. Graham, when Home Secretary, had repudiated this principle as long ago as 1843, but the Secretary of State of those days had no power to enforce his views on the local Justices, who gave effect to the popular idea that the ordinary prison diet might properly be regarded as an instrument of punishment. It must not be supposed, however, that the elimination of the penal element necessarily connotes an attractiveness of prison fare. This is not the case; but the difficulties of framing a dietary which shall be sufficient and not more than sufficient, for the varying needs of many thousands of human beings of different ages and physique is admittedly very great.

The dietary of 1900 has, at least, removed one grave reproach against the system, viz:—that prisoners habitually, and almost invariably, lost weight. Under the old dietary, no less than 80 per cent. of prisoners engaged on hard labour for a month or less lost weight. The progressive improvement of dietary scale, proportioned to length of sentence, has been effective in mitigating the ill-effects arising from the application of the principle of punitive diet as a part of the sentence of imprisonment.

The skill and care of the medical staff would, however, be less positive in its results but for the sanitary condition of the interior of prisons, which has, for many years past, engaged the closest attention. Great improvements have taken place of late years in the construction of hospitals, and in the ventilation of halls and of cells, and in the reconstruction of drains on the most up-to-date lines. Formerly, the gas-lights, which are now in the corridors, were inside the cell—in many cases, naked lights,—an objectionable system from a sanitary point of view, and affording an easy means for mischief or self-destruction, while giving inadequate light for reading or working. It is not only with regard to artificial light that progress has been made. The opaque window glass excluding the light of day, and the hermetically closed window are now only memories of the past. All these things of late years have had the effect of improving the sanitary condition of prisons and the health of prisoners, and have, no doubt, contributed to the remarkable bill of health which our prisons present.

But it is not only with the physical state of prisoners and the sanitation of prisons that the medical staff is concerned. The prison Medical Officer has justly acquired a reputation as an expert in mental disease. Although a practical acquaintance with lunacy is expected of a candidate for the Medical Service, it is owing to the exceptional opportunities afforded for diagnosis of the varying and often peculiar mental states of prisoners that he is expected, and is able, to give an expert opinion, not only in the grave cases where sanity is in question, but also in those difficult and doubtful cases of mental defectiveness which are continually occurring in every mode and degree. Especially is great importance attached to the opinion of the Medical Officer of prisons as that of an unbiassed expert witness on the mental condition of cases charged with a capital offence. The growing practice of the Courts to remand for medical observation in prisons when any doubt exists as to the state of mind, has the desired result of preventing the commitment to prison of persons who would be certified to be insane almost as soon as received. Thus, twenty years ago the number certified insane after reception into prison was a little over one per cent. of the total receptions. To-day it is about half that number.

It is, however, with regard to a class of prisoner, who, for want of a more precise and descriptive term, is designated "mental defective", that the Medical Officer is called upon to exercise all his vigilance and powers of diagnosis. There are persons who cannot be deemed sufficiently irresponsible as to warrant certification, but who, from obvious mental deficiency, cannot be considered fit subjects for penal discipline. In 1901, a special treatment was established for this class in local and in convict prisons. The effect of the new regulations was largely to increase the rôle and responsibility of Medical Officers in controlling the daily routine in respect of food, labour, and punishment. It was about this time that the question of the best method of dealing with mentally defective persons, other than those certified under the Lunacy and Idiots Acts, came prominently before the public, and a Royal Commission was appointed to inquire into the matter. At the same time, an attempt was made to ascertain the number of persons in prison who, on account of mental defect, were deemed unfit for ordinary penal discipline. Medical Officers were requested to note down for six months the number of persons received into their respective prisons who, in their opinion, were of such a low order of intelligence as would be likely, by want of normal self-control, to get into mischief, or commit crime. The result was that 3 per cent. of both sexes of the total number of prisoners received were shown to fall within this category. Writing on this subject in 1912, Sir Herbert Smalley, until lately the Head of the Prison Medical Service, states:—

"The number of prisoners who are mentally defective is the subject of the very widest difference of opinion. There are some who would have us believe that all prisoners are mentally affected, in fact they urge that the mere fact of their committing crime is a proof of this. There are others, who, whilst not going this length, yet put the number at a very high figure. One well known writer recently alleged in the daily press that probably 40 per cent. of our criminals are mentally defective. A well known alienist writing to the "Times" some years ago stated that at least 20 per cent. of all police court cases belonged to the class of mental defectives. The Medical Investigators appointed by the Royal Commission for the care and control of the feeble-minded, after visiting several prisons and having seen some 2,553 prisoners, estimated the number as mentally defective at 10·28 per cent. This is again a higher rate than is generally returned by the prison authorities as the number of mentally defective persons amongst the prison population (irrespective of those certifiably insane who are obviously unfit to be at large), viz., 3 per cent.

"Here at once is a wide divergence of opinion and the reason for the great discrepancy is that so much depends on the view that is taken as to the degree of mental deficiency which justifies an individual being regarded as "Feeble-minded." There is no hard and fast line of demarcation, as has been asserted, between feeble-mindedness and sanity, any more than there is between a great many cases of insanity and sanity; from the normal down to the lowest idiot, or dement, it is only the question of degree of deficiency of mental power. This was pointed out by the Departmental Committee on Defective and Epileptic Children as far back as 1898."

"One of the Medical Investigators of the Royal Commission alleges that "the higher grade aments" are sometimes not recognised by the prison authorities, who are apt to think a man who works well and behaves well in prison must be normal. There is some truth, no doubt, in this, for in prison there is strict and close supervision, there is the daily routine and the absence of "stress," "alcohol" and "temptation," to which people are subject in the outer world; moreover, in many cases, their time in prison is very short and their true mental condition is masked by the condition in which they are received (as, for instance, under the influence of drink and deprivation) so that the medical officer very naturally hesitates before reporting them feeble-minded."

The Mental Deficiency Act, 1913, came into operation on the 1st April 1914. It provides for three forms of supervision for defectives, viz:—State Institutions for defectives of dangerous or violent propensities, Certified Institutions, and Guardianship. The last named can be ignored in considering criminal defectives.