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MONUMENT TO DR. THEODORE B. SACHS Erected at Dr. Sachs' grave, in the grounds of Edward Sanatorium, Naperville, Illinois, by the directors of the Chicago Tuberculosis Institute, the patients at Edward Sanatorium and the Jewish Consumptives Relief

Society

Journal of the OUTDOOR LIFE

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TUBERCULOSIS IN CALIFORNIA STATE

PRISONS

By L. L. STANLEY, M.D., RESIDENT PHYSICIAN, SAN QUENTIN PRISON, CAL.

The opinion has long been held by a great standing in the center of 20 acres of land, withmany people that the state prisons, for the out guard rooms, officers quarters, infirmary or most part, are hot beds for the propagation of hospital rooms, and without even a kitchen. respiratory diseases, and particularly tuberculo- Two gentlemen of San Francisco owned a sis. Within the past five years at San Quentin, brick yard adjoining that of the State Prison. the tuberculosis situation has received consid- They had a right and did keep such boats as erable attention and much has been done to they pleased. In a general revolt fourteen of lessen this grave menace.

the prisoners took a whaleboat belonging In order to show what has been done in the to them and attempted to escape. Many of past, under what conditions the prisoners were them were killed or wounded in the fight for confined, what obstacles the prison authorities the boat, but several escaped. On other occahad to contend with, and to compare these with sions similar occurrences happened with similar our recent efforts, it has been my endeavor results. Dense fogs prevail for five months to trace back the health situation to 1851, when in the year. The Pacific Ocean is but a few San Quentin was established, and 1881, when miles to the westward of the prison, washing a prison was founded at Folsom.

the base of the mountains beyond Corte MaThe following history is gleaned for the dera. Heavy winds lift dense fogs over the most part, from the biennial reoprts of the summit of the mountains and precipitate them, various Boards of Prison Directors, and per- without notice, on the eastern slope, rendering sonal experiences of the past five years. it impossible to distinguish an object at a

Soon after California was admitted to the few yards. Prisoners learn all the peculiarities Union, the necessity arose, on account of the of the location, and are not slow in availing lawlessness incident to the gold rush, for themselves of every opportunity that occurs. proper restraint for the state's criminals. The It frequently happens that several days will Legislature in 1851, provided for the securing elapse without the possibility of taking the of convicts by leasing them to contractors who prisoners from their cells in consequence of quartered them on a prison ship anchored near heavy fogs. On one occasion the prisoners Vallejo. Fifty-three men were committed at passed an entire week in their cells, without the end of that year. One year later the land being able to go even to their meals, the fog was secured near the present site at San being so dense. During these fogs the powdQuentin, and building was begun. Ihese early er and caps are all damp and the guns are days were full of revolt, escapes, and murders, wet, all of which is as well known to the conpartly due to the fact that from the first the victs as the guards.” prison was overcrowded.

On account of the difficulties of prison manJ. M. Estell, the lessee, in informing the agement the State in 1854 took control of the Legislature of 1855 about the condition of the penitentiary, and the following year spent half prison, notes particularly the trouble with es- a million dollars in maintenance, buildings and capes, and says, “I have the mortification daily repairs. of seeing the graves of my guards, murdered Apparently this large sum had little beneby the hands of infamy, and meeting others ficial effect on the health or welfare of the maimed for life whilst in the discharge of prisoners, for a legislative committee was aptheir unenviable duty. This is truly alarming pointed to investigate the prison, and in 1858 at least to me, and I feel it my duty in this reported in part as follows: “The general connection to say it is almost impossible to clothing of the prisoners seems too scant for procure guards in consequence of the personal winter weather, the most of which clothing, or damage they have daily to undergo. The a greater portion thereof, appears to be the last California State Prison is an isolated building, remains of what was worn there by them, now in such a tattered, torn, forbidding and filthy He stated that the sanitary condition of the condition that the commonest street beggars prison had been unusually good, and that there sleeping by the wayside and begging their had been a decrease in dysenteries, diarrhoeas, daily bread, would have the appearance by com

and various affections of the stomach and parison, of newly Parisian clad gentlemen. bowels, which had been quite prevalent, but The bedding (if bedding it can be called) of catarrhal and rheumatic affections had become the prisoners, especially those confined in cells, quite troublesome. “As you know, the men seemed to be insufficient to protect them from when locked up are literally piled one upon absolute suffering from the cold. The cells be- another; this fills the room with animal heat ing six feet by ten, with something like two and impure air. The mornings are cold and shelves on each side, about two feet in width

chilly, and the men are called out early to each, upon which is a kind of straw mattress

work. The sudden transition from heat to and one coarse, shaggy, double blanket, which cold, with their bodies much relaxed and deis all that is found when the complement of

bilitated by the heat and impure air of the bedding is full. But at present many of the

rooms, renders them very susceptible to the blankets are torn and partially gone, and they

above mentioned diseases." Out of a total of are compelled to sleep with their day clothes

374 cases treated during this year, there were on, shoes and all (if they chance to have them).

150 influenza, 7 pleurisy, 3 pneumonia, 73 caAnd being without a sufficient quantity of bed- tarrh, 3 phthisis pulmonis, 29 constitutional ding and clothing to admit of a change, the

syphilis. At the close of the year 1860 the whole has become a mass of filthy, dirty rags,

doctor deplored the crowded condition of the the lice being so plentiful as to be seen crawl

prison as a cause of considerable suffering and ing about the so-called beds and bedding, these

recommended its immediate abatement. being the only places where the convicts of

It appears that in 1863 the position of Resithe State for crimes induced to be committed

dent Physician was abolished and Dr. J. D. B. probably not from bad instincts, but from

Stillman was appointed visiting physician by examples in early life, from want of educa

Leland Stanford, President of the State tion, from intemperance and want, and sen

Prison Directors. Stillman, in his first retenced and compelled by bolted doors and iron

port states that at the time he took charge of bars to undergo suffering in comparison with

the Medical Department a smallpox epidemic which death, with all its terrors, would seem

was prevailing throughout the State, and that pleasurable relief.

he vaccinated 503 prisoners. He also nar"But this is by no means the worst feature

rated the surgical attendance he gave to the

wounded in an emeute in which 32 were of the prison. In the 'Long Room,' so-called, which is in size 24 by 146 feet, are turned loose

wounded by gunshots, eight of whom sub

sequently died, one of them passing out like so many brute animals in a corral, to stay

from “tuberculous disease of abdomen superand sleep, the young, middle-aged, and old; the boy of fifteen, perhaps his first offence,

vening upon gunshot wound.” He pays tribute with upward of three hundred convicts, among

to the salubrity of Point San Quentin : “Situ

ated as it is at the extremity of a high peninwhom are necessarily the vilest of the vile, thus rendering reform and reformation seem

sula which forms the dividing ridge between

Corte Madera and San Rafael creeks, almost ingly impossible. The bedding in this room surrounded by tidewater and salt marshes is of the same kind and class as before described, except in a

and swept by breezes from the spruce-covered worse condition, being sides of Tamal Pais and the Pacific through alike infested with the same kind of animals,

all the dry or summer seasons of the year, only perhaps a little more so. The manner

one will not be surprised to learn that there of stowing away such a number in so small a

has not been a single case of epidemic, conspace is accomplished by placing a number of

tagious or epidemic disease during the year. standing bunks close to each other along the

Phthisis here as in all prisons carries off the sides of the room, with their heads to the wall,

greatest number of all those who die from leaving an open space through the middle of

natural causes.

The Indian race suffers parthe room; the bunks being one above the other,

ticularly from this cause, as they appear to do and into which the prisoners crawled from wherever they are subject to confinement. the end, the open space being so small that Generally speaking, the regimen of the prison before they take their bunks it is with a great has been more favorable to health than any deal of difficulty you can make your way circumstances by which the inmates would be through the crowd; and the stench ensuing likely to be surrounded if at large. I have from the room when open in the morning will given constant attention to the prisoners' have to be imagined, as a description is im- food-inspecting its quality and quantity. It possible.”

has always been ample, the quality good, and Salutary effects were produced by this ex- suited to the health of the convicts." He gives posé, for uniforms were provided and sanitary a list of the food, with the amount for each arrangements which were of the crudest were man, and adds: “From this it will be seen remedied, and a visiting physician was ap- that frequently repeated reports of starvation pointed, Dr. A. W. Taliaferro. He rendered at the prison are wholly without foundation." his first report to Warden Joseph Walkup, on Again in 1864 Dr. Stillman made another Dec. 31, 1858, for the seven months preceding. very complete report at the time when the pro

newcomers.

posal had been made to establish a branch

No one

was allowed to enter prison at the stone quarries near Folsom. He the walls until they had been thoroughly lauds the San Quentin climate where the abluted in the Bay, and their old garments exprisoners' apartments require no artificial heat changed for new prison attire. In conclusion, the year round, and condemns the climate of I cannot too strongly reprobate the system of

om "where it freezes sometimes very hard punishment that is sometimes adopted here, by and much of the winter is freezing weather.” confinement in a place called the dungeon, and He thought that malaria, “a great source of dungeon it is in every sense of the word, and disease in prisons and one that is a cause of a in the fullest import. Down there the prisoner large proportion of deaths," would put half of is subjected to the very counter parts of what the inmates on the sick list during the summer is necessary to health. To have health we must and autumn months, if the branch were estab- have light, pure air, exercise, warmth, dryness, lished at Folsom "whose climate is so notorious and good food. Down there in that horrible for its malarious character.” Morever he adds: hole, the prisoner gets darkness, foul air, "It has been determined by prison statistics dampness, cold, bread and water simply, and that the dark races (the Chinese are not no exercise.” included) suffer most severely in confinement. The next physician, P. W. Randle, in 1873 In the E tern Penitentiary, where confinement observes that, "the sanitary management of is most strict, the mortality of white prisoners the prison has been conducted with unremitting is 20 per 1000, whilst that of the Negro and scrupulous attention and energy by Lieuprisoners amounts to the startling number of tenant Governor Pacheco, who has the respect70 per 1000. The rate of mortality from con- ful confidence and good will of all of the sumption has been 11 per 1000 annually prisoners. A large proportion of the convicts amongst the colored male population of New sent to the prison, especially those from the York City, while in the eastern penitentiary large centers and towns, are affected with it appears to have been as high as 40 per 1000. chronic diseases upon their arrival, such as Here the Indians are chiefly from the southern syphilis, phthisis, scrofula, rheumatism, etc., states. Of the seven deaths from tuberculous generally contracted previous to their arrest, disease during the past two years, six have and aggravated by confinement and want of fallen upon Indians." Out of 550 prisoners attention in the county jail, some of whom do 22 were Indians.

not recuperate sufficiently to be able to perDr. Charles Burrell succeeded Dr. Stillman form ordinary labor for weeks and months, in 1867, and in stating the health of the pris- and some never recover, but linger awhile and oners, wrote that there were twelve deaths, die from exhaustion and delapidated constiseven resulting from pulmonary disease, the tution, notwithstanding all the attention (both subjects of which were in an advanced stage medical and nursing) that can be rendered when admitted.

them. I take pleasure in believing that the In 1868, Dr. Taliaferro, who is remembered hygienic condition of the prison has much as the pioneer physician of Marin County, improved since the physician has been reagain took charge of the medical department: quired to reside here. "An examination of the mortuary reports” He reports again in 1875, deploring the he writes, “s ows that most of the diseases crowded condition of the prison, and describes occur from consumption and that it is confined the basement of the manufacturing department, mostly to the Indian race. Out of ten deaths which has been fitted up exclusively as a in 1868, five were Indians, and four of the dormitory for the Chinamen, and containing deaths were consumption, and one chronic 168 beds. “It is a very unhealthy sleeping bronchitis and asthma; of the eight deaths apartment, by reason of the impossibility of occurring in 1869, four were Indians, and six regulating the ventilation for so large a room of the deaths were consumption, making out (58 ft. x 39 ft.) containing so many occupants.” of the eighteen deaths occurring from natural This increase of room was not equal to the causes during the years 1868—1869, twelve increase of prison population. He thought an cases of consumption and chronic bronchitis, earnest and enlightened effort should be made with nine of that number among the Indian for the prisoners' reformation—“But it is alrace. It is worthy of remark here that the most, if not quite absurd, to expect reform Indian race is particularly prone to scrofula either morally or physically under such circumand scrofulous consumption, when brought to stances. Good constitutions become enervated this place. Free as the air when upon his na- and decay. Feeble physical organizations fail tive heath, of all hereditary disease, here he to recuperate, but rather continue to decline." soon falls a victim to those ills flesh is heir One half the evils, moral turpitude, degradato, and sentence to this place is almost a sure tion, mental and physical obliquity here existdoom for life. I must put in here a good ing is not told and cannot be written, all for word for teetotalism, and say that perhaps want of more room and different management." the good sanitary conditions of the prison are Then we have four rooms with 45 men in due more to total abstenance than any other each, with all the others equally crowded, and cause—we have been most lucky in escaping one half, if not more of them, afflicted with the smallpox during its fearful visitation of various maladies, and locked up for 13-14 this State. This was due in a great measure

hours out of the 24 sleeping and existing in a to the active precautions adopted toward all fetid and illy ventilated atmosphere, made ab

in a

solutely poisonous by exhalations from diseased lungs, and to a great extent, unwashed surfaces, and effluvia arising from the accumulation of excrementitious matter deposited

common receptacle during all these hours."

To aggravate further the lack of building at San Quentin, a fire in February, 1876, destroyed the principal workshops, including quarters for nearly 200 prisoners. This, of course, necessitated extreme vigilance on the part of the resident physician, J. E. Pelham, to keep down epidemics and ill health. At this time a prison rule was adopted confining to their prison quarters during day and night, all convicts not engaged in some employment or occupation, which resulted in the locking up of over 500 persons each day 24 hours of the 24."

The hospital building was pointed out as being inefficient for the uses intended. “It is singularly destitute of the necessities, the conveniences, and the material usually considered essential for such an institution. This ill conditioned building for the care of the sick was handed down as to an heir from one administration to another."

In his report dated July 1, 1879, Warden James A. Johnson, of San Quentin (not the present Warden, James A. Johnston) gives a table designated “Labor of convicts, other than those employed by contractors, outside the walls,” and another table entitled “Labor inside the walls, other than contract labor.” In the first table were enumerated such prisoners as carpenters, gardeners, stable men and others whose work necessitated their being outside the walls. They numbered in all 292.

In the second table were those employed inside the walls to care for the general upkeep of the prison. They were such men as cooks, room-tenders, plumbers, sweepers, and numbered 394 in all.

At this time a number of the prisoners averaging 300 were employed by contractors in the shops at a minimum wage of fifty cents per day. The work for the most part consisted of furniture manufacture and sash and door work. No provision had yet been made for the prisoners to work on state account. At that time the prison population was 1564.

In his report the Warden states : “This leaves a surplus of over 500 that must be kept in confinement. We recognize the great wrong thus done those prisoners, but we are powerless to remedy the evil. It will be understood that all attempts at order and discipline with 500 convicts at large in the prison yard would be absolutely futile. We do the best we can for these convicts by letting out a limited nunber at a time for exercise by walking between the cells and in the rear yard of the prison. It will also be seen that in every case, except in shop labor, we put in all the force possible to crowd in. In many cases one quarter of the force employed would do the work better. Much of he labor done by these men is of a purely penal nature, and for exercise and air, being of little utility and bringing no return."

At the same time appears a report of the Resident Physician and Surgeon, J. E. Pelham, M. D., which gives a table enumerating the deaths from July, 1877, to July, 1879, as 55, being more than two each month, making a death rate of 17 per 1000. Among the cause and number of deaths the doctor gives as follows: Congestion of lungs, 2; phthisis pulmonis, 7; chronic bronchitis, 5; bronchial consumption, 15; pulmonary gangrene, 1; making a total of 43 out of 55 deaths due to affections of the lungs. From this classification it may be assumed that at least 32 were caused by tubercle bacillus, making a rate of 9 per 1000.

The following is an excerpt from the same full report: “From the accompanying tables, to which your attention is called, it is apparent that the general health of the prison has been excellent, and that there has been a remarkable degree of exemption from diseases common to cell life, originating from blood poisoning called zymotic, and also of malarial origin, the few cases occurring of this class having received the germs of disease before their arrival here."

"But there has been an increase in the number of chest diseases and the death rate from this cause has been augmented. This is mainly caused by the sudden change of temperature, produced by the removal of the convict from the close air of the cells, to the cool atmosphere which is common here in the morning. As a rule in these cases the subject visits me suffering from a cold, more or less severe, affecting the first air passages. The same cause of disease still operating, the case may present itself with chronic inflammation of the larynx, pharynx or trachea, some one or more of these organs, which by easy grades passes to chronic bronchitis, and finally terminating in bronchial consumption. The remedy for this state of affairs would be the confinement of the prisoners in their cells until a late hour in the morning, a thing which is impracticable in a work prison."

In 1880 Folsom Prison was ready for occupancy and 200 prisoners were transferred to that place from San Quentin. "Still there are 1309 convicts remaining in this prison, crowded into 703 cells, seven of which are large rooms into which are crowded nearly 200 prisoners” quotes the report of the first Board of Prison Directors to Governor Geo. C. Perkins.

Dr. L. H. Cary, in commenting on the health of the prison, reports: "The number of deaths during the year cannot be justly regarded as a high rate of mortality, when it is considered that many of the convicts are afflicted with chronic diseases when admitted, or with broken down constitutions from exposure and dissipation, incident to a career of vice and crime. It will be observed that the prison has been almost entirely free from diseases of a miasmatic or malarial origin; the reason of which is readily explained by the favorable hygienic condition, mi climate, abundant supply of pure water, and the excellent system of sewerage." Among his recommendations, Dr. Cary

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