In this blog post, Dr William Murphy explores the contested meaning of vomiting in the force-feeding of suffragettes
The Hunger Strike
Few groups of political campaigners were cannier than the suffragettes when it came to using imprisonment to win attention. And, in Britain and Ireland during the years 1907 to 1914, the effect of imprisonment upon the health of jailed suffragettes was a particular focus of their campaigns. This was most obviously the case from 1909 when some suffragettes turned to the hunger strike. In adopting that tactic these women purposefully endangered their health. They did this in protest at not receiving a ‘political’ status, or in an effort to secure their release, but also to draw attention to their ultimate demand, the vote for women.
In turn in September 1909, the state, the prison system, and their employees – in practice the prison medical officers, assisted by other staff – began to force-feed the striking suffragettes. Collectively, the authorities presented this response as necessary to preserve health and, crucially, life, successfully defending their actions on these grounds in the courts. Of course, force-feeding also limited the effectiveness of the protest in that it allowed the authorities to sustain suffragette prisoners in a state of health that facilitated their continued incarceration, at least in the short term.
Despite the decision of the courts, the suffragettes gained some advantage from their force-feeding by presenting the process as cruel, as a form of assault. The state’s and doctors’ actions were the subject of considerable negative publicity and, as Ian Miller has shown in his recent book, the ethics of the force-feeding provoked a good deal of debate between those who viewed it as ‘therapeutic’ and those who argued that it was ‘torturous’.
Vomiting: ‘I have a very strong suspicion that this was self produced’
What, however, if a suffragette began to vomit in the aftermath of force-feeding, mitigating the sustaining effects? How was this interpreted? Was the vomiting understood as a consequence of the force-feeding itself? If so, what did this say about the constitution of the prisoner and the immediate prospects for her safety? What did it say about the process or for the competence of the doctor? Alternatively, what if the vomiting was a deliberate response of the suffragette? How was this being achieved, could it be stopped, and by what means?
Mary Leigh, who was then among a group of suffragettes at Winson Green prison, Birmingham, began a hunger strike on 22 September 1909. She had been released from Walton Gaol, Liverpool as recently as 26 August when her condition had become ‘critical’ during a strike. In the intervening month, however, the state’s policy had changed and, consequently, she was one of the first suffragettes to be force-fed. Ernest Hasler Helby, the medical officer at Winson Green, began to do this on 25 September. From 2 October, when Leigh resisted the use of a feeding-cup, Hasler Helby switched to the consistent use of a nasal tube. According to Leigh, ‘I was very sick on the first occasion after the tube was withdrawn,’ whereas Hasler Helby recorded that Leigh first retched during feeding by nasal tube on 7 October. Subsequently, Hasler Helby ascribed this turn of events to his having substituted olive oil for glycerine as a lubricant for the tube.
An immediate return to glycerine appeared successful, but Hasler Helby reported a ‘slight sickness’ after a feeding on 10 October. Then, on 18 October, he noted that Leigh vomited after her morning meal, stating ‘I have a very strong suspicion that this was self produced’. Despite his suspicion, Hasler Helby responded by reducing the quantity given with each feeding. Four days later he was recording increased weight loss, emphasizing that he was not in a position to increase Leigh’s diet ‘owing to her liability to vomit’, and indicating that he ‘did not feel at all confident’ that ‘it will be possible for this prisoner to complete her sentence.’ It seems likely that Hasler Helby had become more sensitive to Leigh’s vomiting and weight loss, and increasingly anxious about his responsibility for her, because she had begun legal proceedings against him and the Home Secretary, Herbert Gladstone. On the day after this report, he would provide a legal affidavit in preparation for such a case.
A Failure to Sustain Health
On 24 October Hasler Helby noted that Leigh vomited half a pint after her morning feed, having vomited smaller amounts following the ‘three preceding meals.’ At this point the vomiting was undeniably persistent with Hasler Helby describing it as ‘a regular event after each meal’ in his report of 26 October. By the next day he was characterizing this as ‘a source of considerable embarrassment’. Force-feeding was not supposed to be like this, leading him to begin ‘trying to persuade her to take medicine for this [the vomiting]’. But he did not succeed and the pattern continued till three days later, on 30 October, the Secretary of State ordered Leigh’s discharge. She had ‘vomited all or nearly all the food administered to her during the preceding forty eight hours.’  The vomiting had frustrated Hasler Helby. He had failed to sustain Leigh’s health and ensure that she served her sentence.
In December the courts would uphold his actions, ruling that Hasler Helby was obliged to act to save Leigh’s life, including the use of force-feeding. During the hearings, the likely cause of vomiting in cases of forcible feeding arose on several occasions with Sir Victor Horsley, a witness for Leigh, insisting that ‘retching’ was a likely consequence of the insertion and withdrawal of the feeding tube and also a likely symptom of a patient’s system becoming exhausted during prolonged force-feeding. Under cross-examination, Horsley acknowledged that a resisting patient could cause vomiting by passing ‘their fingers down their throat in order to vomit’. In court, Hasler Helby admitted that inserting the nasal tube had, on occasion, caused irritation and retching, but ascribed Leigh’s later, more regular, vomiting to the likelihood that her strike had weakened her constitution in the days before forcible feeding began. According to this logic, even if Leigh had not deliberately vomited, the vomiting was her responsibility for hunger striking, not Hasler Helby’s for force-feeding.
Emetics and Responsibility for Health
If, in 1909, there was some room for debate about the extent to which Leigh was responsible for her vomiting then, in 1914, the cases of Grace Roe and Nellie Hall were somewhat more clear-cut. On 30 May, a wardress at Holloway prison supervising a visit to Roe from Arthur Barnett, the clerk of Arthur Marshall, the solicitor of the Women’s Social and Political Union (WSPU), observed Barnett passing a ‘small packet’ to Roe. When examined, the packet was found to contain six small tablets with instructions that she should take ‘three at a time and if this not effective four; but on no account more.’ The author of the note went on to stress that Roe’s friends were acutely aware of her sufferings before continuing, ‘we must get you out’. Four days earlier, after an appearance at Marylebone Police Court of Roe and another suffragette, Nellie Hall, a small tube of similar tablets and another note had been found and retained by the authorities. It seems that some tablets made it through on that occasion because in the aftermath Roe, but especially Hall, began to vomit considerable amounts. As yet unaware that Hall may have had emetic tablets, on 27 May the medical officer at Holloway responsible for Hall’s treatment, Francis Forward, had stationed a supervising officer in Hall’s cell after force-feeding ‘to prevent her putting her hand in her throat to induce vomiting.’ When tested in the days that followed, both sets of tablets were found to contain ‘apomorphine hydrochloride’, leading the examining chemist to conclude that ‘the tablets are made expressly for the purpose of causing vomiting.’
This led to the immediate banning of visits by Marhsall and Barnett to the prisoners at Holloway and the prosecution and conviction of Barnett on 13 June 1914 (under the 1865 Prisons Act) for his attempts to smuggle in both the note and the drugs. The Home Office regarded that case, and the publicity surrounding it, as a propaganda blow against the suffragettes’ attempts to portray prison as a danger to their health. Instead, they believed, that it would show the public, once again, that it was the suffragettes who deliberately imperiled their own health. In particular, the prosecuting counsel Archibald Bodkin took advantage of the case to refute allegations in the WSPU newspaper, The Suffragette, that suffragette prisoners were being given hypnotic drugs so as to make them more amenable to force-feeding. Instead, he insisted, this case proved that it was the prisoners themselves who were taking drugs that might endanger their health.
From the point of view of the suffragettes and their friends, taking the emetic would have speeded up the prisoners’ release, an eventuality that might be arrived at much more quickly since the introduction of the Prisoners (Temporary Discharge for Ill-Health) Act, more popularly known as the Cat and Mouse Act, of 1913. This would not alone have frustrated the authorities – a pleasing consequence from their point of view – but it would have hastened an end to the trauma and dangers of force-feeding for Roe and Hall. If the suffragettes believed they were being given hypnotic drugs, the emetics would have had the further effect, from their point of view, of expelling those drugs from their systems.
Torture or Self-Endangerment?
In addition to the prosecution, the case led to a regime of more rigorous searching of suffragette prisoners. The reverberations were felt in Ireland where, on 11 July, S.H. Douglas, the secretary of the General Prisons Board of Ireland, issued an order that all suffragette prisoners were to be thoroughly searched on admission in order to prevent the smuggling in of emetic drugs. Roe and Hall were released under a general amnesty, on 10 August, when the suffragettes suspended their campaign at the outbreak of war, but these incidents had one final consequence. The Prison Commissioners were prompted to introduce a new, and more detailed, rule on the smuggling of items into prison. This came into effect in April 1915.
As these cases illustrate, during suffragette hunger strikes the causes and meaning of the vomiting that sometimes followed force-feeding was a matter of concern and of vigorous contest. Exploring this, adds a further layer to our knowledge of the battles fought through these women’s bodies. If, as the suffragettes suggested, this vomiting was a direct consequence of the force-feeding then it re-enforced their case that their health was being damaged, that they were being tortured. If, on the other hand, as the authorities sought to demonstrate, the suffragettes were themselves responsible for the vomiting, then this not only absolved the authorities, it bolstered the case that the women were pursuing a perverse policy of self-endangerment.
Featured Image: A suffragette on hunger strike being forcibly fed with a nasal tub. The Suffragette by Sylvia Pankhurst. New York: Source Book Press, 1970. First published by Sturgis & Walton Company (New York), 1911. Facing p. 433. Public Domain.
 Ian Miller, A History of Force Feeding: Hunger Strikes, Prisons and Medical Ethics 1909-1974 (Palgrave MacMillan, 2016), pp 35-66.
 For a short biography of Mary Leigh see Elizabeth Crawford, The Women’s Suffrage Movement: A Reference Guide 1866-1928 (UCL Press, 1999), pp 338-340.
 Statement by Mary Leigh enclosed in a letter from Mabel Tuke, honorary secretary to the WSPU, to Herbert Gladstone, Home Secretary, 15 October 1909, HO 45/10417/183577 (Part One), TNA, London.
 MO Report by Ernest Hasler Helby, 8 October 1909, HO 45/10417/183577 (Part Two) and Affadavit by Ernest Hasler Helby, 23 October 1909, HO 45/10417/183577 (Part Three), TNA, London.
 MO Reports by Ernest Hasler Helby, 11, 18, 19, 22, 24, 26, 27, 28, 29, and 30 October 1909, HO 45/10417/183577 (Part Three), TNA, London.
 Leigh v. Gladstone and Others: Medical Evidence, High Court of Justice, 9 Dec. 1909, in HO 144/1320/252950, TNA, London.
 For short biographies of Roe and Hall see Crawford, The Women’s Suffrage Movement, pp 258-9 and 604-6.
 See extensive correspondence concerning, and the transcript of, Barnett’s prosecution in HO 144/1320/252950, TNA, London.
 S.H. Douglas to Governors of Prisons, 11 July 1914, in GPB/SFRG/1/20, NAI, Dublin.