Suffragette activity in Scotland gathered pace between the late nineteenth and the early twentieth centuries. By 1909, the authorities were having to consider how to deal with their increasingly troublesome charges. The following letter to the Prison Commissioners for Scotland gives a glimpse of what the protesters were prepared to endure for their cause. Despite the horrors of imprisonment, suffragette activism reached its peak in 1913. Among a plethora of almost daily criminal acts were arson at Ayr racecourse, an attempt to smash the windows of the King’s car, and an ambush on the Prime Minister at Lossiemouth golf course. A political ceasefire was called during the First World War, and in 1918 women – though only those over the age of thirty – were finally given the vote.
1909, 15 November
Prison Commissioners,
The Secretary for Scotland asks for full information as to the conduct of the operation of artificial feeding. This information has been fully supplied in the Reports of the Medical Officers of Perth and Barlinnie prisons, and their experience as well as that of Medical Officers of Asylums and other institutions may be epitomized as follows: –
There are three methods in use; (1) by means of a feeding cup; (2) by means of an oesophageal catheter, and (3) by means of a nasal tube.
(1) Feeding by means of a feeding cup consists of introducing the mouthpiece of a feeding-cup between the teeth and pouring the contents into the patient’s mouth. For prisoners who offer resistance it is a method attended with considerable risk of injury.
(2) For feeding by means of an oesophageal catheter, it is necessary that the movements of the patient be carefully and fully controlled, and for that purpose five assistants may be required. The ordinary method of controlling the patient is to put the patient into bed; one assistant sits on the bed at the pillow end and steadies the patient’s body with his-or-her knees and steadies the patient’s head by pressing the head against his or her chest; an assistant is required to control each of the patient’s limbs. The patient being under control, the medical officer inserts a gag into the mouth and leaves the subsequent charge of the gag to another assistant. The medical officer then introduces the catheter, previously smeared with oil or Castile Soap into the upper part of the gullet and when there reflex involuntary contractions of the gullet carry the end down into the patient’s stomach. A risk in this method of feeding is the introduction of the catheter into the windpipe instead of into the gullet; but this is an exceedingly rare accident and the effects of the accident can be obviated by observation after the introduction, for if the catheter happens to be in the windpipe respiratory movements of air would take place through the catheter, while if the catheter be in the gullet and stomach there are no such respiratory movements. The medical officer being satisfied that the catheter is properly in the stomach, connects the catheter with the feeding funnel, and then introduces a small quantity of warm water, which is a further precaution against introduction into the windpipe; and when he observes that the water enters the stomach, he gradually introduces the food, which generally consists of thin custard or a strained mixture of milk and eggs, or broth. After administering the food, the medical officer passes a little more warm water through the catheter; he then pinches the catheter to prevent entrance of the food into it at the stomach end and withdraws it in that condition. The operation should be completed in from two to three minutes. It may produce discomfort but is not painful.
(3) For feeding by means of the nasal tube, similar control to the above is necessary and the proceedings are generally the same, excepting that the tube, which is smaller in calibre than an oesophageal catheter, is introduced through the nose. The advantage of this method over that of the oesophageal catheter is that the gag can be dispensed with, but it is slower in operation on account of the narrowness of the tube, and it is not entirely free from inconvenience of the tube accidentally entering the windpipe.
It appears to me that feeding by means of a cup is altogether unsuited for prisoners who purposely resist artificial feeding, as by it considerable damage might be done to the prisoner’s mouth.
In regard to oesophageal feeding, it is attended with the objections inseparable from the forcible insertion of a gag, whereby the opportunities for resistance on the part of the prisoner are increased and may result in accidents such as the breaking of teeth and the production of superficial wounds of the mouth with bleeding. Its chief advantage is that a somewhat shorter period of time is required for the passage of the food than is the case with nose-feeding, but the difference is immaterial.
Nose feeding is not attended with any of these drawbacks or slight risks, and its easy application is only rarely interfered with by an exceptional narrowing of the nose passages.
I am, accordingly, of the opinion that when artificial feeding is adopted, the nasal method should be preferred. At the same time, seeing that the difference in risk between nasal and oesophageal feeding is only slight, this risk amounting to but little in either method, I would recommend that when the medical officer has had special or exclusive experience of oesophageal feeding, it should be optional for him to adopt that method.
The Secretary for Scotland also raises the question of how long it is safe for a prisoner to remain without food. Deprivation of food, while liquids are being freely drunk, may be continued for many days in healthy and normal persons, without immediate danger to life. It commences, however, to be detrimental to health in a few days, when the individuals are weakly and untrained for deprivation, and this is especially so in women of high-strung nervous susceptibilities. In the latter, also, the chances of deterioration in health would be increased if, when strength had already been lost by deprivation of food, they were subjected to the emotional incidents inseparable from mental and physical resistance to artificial feeding.
I am therefore of the opinion that artificial feeding should always be employed in from forty-eight to sixty hours after food has last been taken and in women of weakly constitution nearer forty-eight than sixty hours.
It would be advisable to convey definite instructions to this effect to the officials of H.M. Prisons.
(Sgd.) Thomas R Fraser
15/xi/09