The opinion has long been held by a great many people that the state prisons, for the most part, are hot beds for the propagation of respiratory diseases, and particularly tuberculosis. Within the past five years at San Quentin, the tuberculosis situation has received considerable attention and much has been done to lessen this grave menace.

In order to show what has been done in the past, under what conditions the prisoners were confined, what obstacles the prison authorities had to contend with, and to compare these with our recent efforts, it has been my endeavor to trace back the health situation to 1851, when San Quentin was established, and 1881, when a prison was founded at Folsom.

The following history is gleaned for the most part, from the biennial reoprts of the various Boards of Prison Directors, and personal experiences of the past five years.

Soon after California was admitted to the Union, the necessity arose, on account of the lawlessness incident to the gold rush, for proper restraint for the state's criminals. The Legislature in 1851, provided for the securing of convicts by leasing them to contractors who quartered them on a prison ship anchored near Vallejo. Fifty-three men were committed at the end of that year. One year later the land was secured near the present site at San Quentin, and building was begun. Ihese early days were full of revolt, escapes, and murders, partly due to the fact that from the first the prison was overcrowded.

J. M. Estell, the lessee, in informing the Legislature of 1855 about the condition of the prison, notes particularly the trouble with escapes, and says, "I have the mortification daily of seeing the graves of my guards, murdered by the hands of infamy, and meeting others maimed for life whilst in the discharge of their unenviable duty. This is truly alarming, at least to me, and I feel it my duty in this connection to say it is almost impossible to procure guards in consequence of the personal damage they have daily to undergo. The California State Prison is an isolated building,

standing in the center of 20 acres of land, without guard rooms, officers quarters, infirmary or hospital rooms, and without even a kitchen. Two gentlemen of San Francisco owned a brick yard adjoining that of the State Prison. They had a right and did keep such boats as they pleased. In a general revolt fourteen of the prisoners took a whaleboat belonging to them and attempted to escape. Many of them were killed or wounded in the fight for the boat, but several escaped. On other occasions similar occurrences happened with similar results. Dense fogs prevail for five months in the year. The Pacific Ocean is but a few miles to the westward of the prison, washing the base of the mountains beyond Corte Madera. Heavy winds lift dense fogs over the summit of the mountains and precipitate them, without notice, on the eastern slope, rendering it impossible to distinguish an object at a few yards. Prisoners learn all the peculiarities of the location, and are not slow in availing themselves of every opportunity that occurs. It frequently happens that several days will elapse without the possibility of taking the prisoners from their cells in consequence of heavy fogs. On one occasion the prisoners passed an entire week in their cells, without being able to go even to their meals, the fog being so dense. During these fogs the powder and caps are all damp and the guns are wet, all of which is as well known to the convicts as the guards."

On account of the difficulties of prison management the State in 1854 took control of the penitentiary, and the following year spent half a million dollars in maintenance, buildings and repairs.

Apparently this large sum had little beneficial effect on the health or welfare of the prisoners, for a legislative committee was appointed to investigate the prison, and in 1858 reported in part as follows: "The general clothing of the prisoners seems too scant for winter weather, the most of which clothing, or a greater portion thereof, appears to be the last remains of what was worn there by them, now

in such a tattered, torn, forbidding and filthy condition that the commonest street beggars sleeping by the wayside and begging their daily bread, would have the appearance by comparison, of newly Parisian clad gentlemen. The bedding (if bedding it can be called) of the prisoners, especially those confined in cells, seemed to be insufficient to protect them from absolute suffering from the cold. The cells being six feet by ten, with something like two shelves on each side, about two feet in width each, upon which is a kind of straw mattress and one coarse, shaggy, double blanket, which is all that is found when the complement of bedding is full. But at present many of the blankets are torn and partially gone, and they are compelled to sleep with their day clothes on, shoes and all (if they chance to have them). And being without a sufficient quantity of bedding and clothing to admit of a change, the whole has become a mass of filthy, dirty rags, the lice being so plentiful as to be seen crawling about the so-called beds and bedding, these being the only places where the convicts of the State for crimes induced to be committed probably not from bad instincts, but from examples in early life, from want of education, from intemperance and want, and sentenced and compelled by bolted doors and iron bars to undergo suffering in comparison with which death, with all its terrors, would seem pleasurable relief.

"But this is by no means the worst feature of the prison. In the 'Long Room,' so-called, which is in size 24 by 146 feet, are turned loose like so many brute animals in a corral, to stay and sleep, the young, middle-aged, and old; the boy of fifteen, perhaps his first offence, with upward of three hundred convicts, among whom are necessarily the vilest of the vile, thus rendering reform and reformation seemingly impossible. The bedding in this room is of the same kind and class as before described, except in a worse condition, being alike infested with the same kind of animals, only perhaps a little more so. The manner of stowing away such a number in so small a space is accomplished by placing a number of standing bunks close to each other along the sides of the room, with their heads to the wall, leaving an open space through the middle of the room; the bunks being one above the other, and into which the prisoners crawled from the end, the open space being so small that before they take their bunks it is with a great deal of difficulty you can make your way through the crowd; and the stench ensuing from the room when open in the morning will have to be imagined, as a description is impossible."

Salutary effects were produced by this exposé, for uniforms were provided and sanitary arrangements which were of the crudest were remedied, and a visiting physician was appointed, Dr. A. W. Taliaferro. He rendered his first report to Warden Joseph Walkup, on Dec. 31, 1858, for the seven months preceding.

He stated that the sanitary condition of the prison had been unusually good, and that there had been a decrease in dysenteries, diarrhoeas, and various affections of the stomach and bowels, which had been quite prevalent, but catarrhal and rheumatic affections had become quite troublesome. "As you know, the men when locked up are literally piled one upon another; this fills the room with animal heat and impure air. The mornings are cold and chilly, and the men are called out early to work. The sudden transition from heat to cold, with their bodies much relaxed and debilitated by the heat and impure air of the rooms, renders them very susceptible to the above mentioned diseases." Out of a total of 374 cases treated during this year, there were 150 influenza, 7 pleurisy, 3 pneumonia, 73 catarrh, 3 phthisis pulmonis, 29 constitutional syphilis. At the close of the year 1860 the doctor deplored the crowded condition of the prison as a cause of considerable suffering and recommended its immediate abatement.

It appears that in 1863 the position of Resident Physician was abolished and Dr. J. D. B. Stillman was appointed visiting physician by Leland Stanford, President of the State Prison Directors. Stillman, in his first report states that at the time he took charge of the Medical Department a smallpox epidemic was prevailing throughout the State, and that he vaccinated 503 prisoners. He also narrated the surgical attendance he gave to the wounded in an emeute in which 32 were wounded by gunshots, eight of whom subsequently died, one of them passing out from "tuberculous disease of abdomen supervening upon gunshot wound." He pays tribute to the salubrity of Point San Quentin: "Situated as it is at the extremity of a high peninsula which forms the dividing ridge between Corte Madera and San Rafael creeks, almost surrounded by tidewater and salt marshes and swept by breezes from the spruce-covered sides of Tamal Pais and the Pacific through all the dry or summer seasons of the year, one will not be surprised to learn that there has not been a single case of epidemic, contagious or epidemic disease during the year. Phthisis here as in all prisons carries off the greatest number of all those who die from natural causes. The Indian race suffers particularly from this cause, as they appear to do wherever they are subject to confinement. Generally speaking, the regimen of the prison has been more favorable to health than any circumstances by which the inmates would be likely to be surrounded if at large. I have given constant attention to the prisoners' food-inspecting its quality and quantity. It has always been ample, the quality good, and suited to the health of the convicts." He gives a list of the food, with the amount for each man, and adds: "From this it will be seen that frequently repeated reports of starvation at the prison are wholly without foundation."

Again in 1864 Dr. Stillman made another very complete report at the time when the pro

posal had been made to establish a branch prison at the stone quarries near Folsom. He lauds the San Quentin climate where the prisoners' apartments require no artificial heat the year round, and condemns the climate of Folsom "where it freezes sometimes very hard and much of the winter is freezing weather." He thought that malaria, "a great source of disease in prisons and one that is a cause of a large proportion of deaths," would put half of the inmates on the sick list during the summer and autumn months, if the branch were established at Folsom "whose climate is so notorious for its malarious character." Morever he adds: "It has been determined by prison statistics that the dark races (the Chinese are not included) suffer most severely in confinement. In the Eastern Penitentiary, where confinement is most strict, the mortality of white prisoners is 20 per 1000, whilst that of the Negro prisoners amounts to the startling number of 70 per 1000. The rate of mortality from consumption has been 11 per 1000 annually amongst the colored male population of New York City, while in the eastern penitentiary it appears to have been as high as 40 per 1000. Here the Indians are chiefly from the southern states. Of the seven deaths from tuberculous disease during the past two years, six have fallen upon Indians." Out of 550 prisoners 22 were Indians.

Dr. Charles Burrell succeeded Dr. Stillman in 1867, and in stating the health of the prisoners, wrote that there were twelve deaths, seven resulting from pulmonary disease, the subjects of which were in an advanced stage when admitted.

In 1868, Dr. Taliaferro, who is remembered as the pioneer physician of Marin County, again took charge of the medical department: "An examination of the mortuary reports" he writes, "shows that most of the diseases occur from consumption and that it is confined mostly to the Indian race. Out of ten deaths in 1868, five were Indians, and four of the deaths were consumption, and one chronic bronchitis and asthma; of the eight deaths occurring in 1869, four were Indians, and six of the deaths were consumption, making out of the eighteen deaths occurring from natural causes during the years 1868-1869, twelve cases of consumption and chronic bronchitis, with nine of that number among the Indian race. It is worthy of remark here that the Indian race is particularly prone to scrofula and scrofulous consumption, when brought to this place. Free as the air when upon his native heath, of all hereditary disease, here he soon falls a victim to those ills flesh is heir to, and sentence to this place is almost a sure doom for life. I must put in here a good word for teetotalism, and say that perhaps the good sanitary conditions of the prison are due, more to total abstenance than any other cause-we have been most lucky in escaping the smallpox during its fearful visitation of this State. This was due in a great measure to the active precautions adopted toward all

newcomers. No one was allowed to enter the walls until they had been thoroughly abluted in the Bay, and their old garments exchanged for new prison attire. In conclusion, I cannot too strongly reprobate the system of punishment that is sometimes adopted here, by confinement in a place called the dungeon, and dungeon it is in every sense of the word, and in the fullest import. Down there the prisoner is subjected to the very counter parts of what is necessary to health. To have health we must have light, pure air, exercise, warmth, dryness, and good food. Down there in that horrible hole, the prisoner gets darkness, foul air, dampness, cold, bread and water simply, and no exercise."

The next physician, P. W. Randle, in 1873 observes that, "the sanitary management of the prison has been conducted with unremitting and scrupulous attention and energy by Lieutenant Governor Pacheco, who has the respectful confidence and good will of all of the prisoners. A large proportion of the convicts sent to the prison, especially those from the large centers and towns, are affected with chronic diseases upon their arrival, such as syphilis, phthisis, scrofula, rheumatism, etc., generally contracted previous to their arrest, and aggravated by confinement and want of attention in the county jail, some of whom do not recuperate sufficiently to be able to perform ordinary labor for weeks and months, and some never recover, but linger awhile and die from exhaustion and delapidated constitution, notwithstanding all the attention (both medical and nursing) that can be rendered them. I take pleasure in believing that the hygienic condition of the prison has much improved since the physician has been required to reside here.'

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He reports again in 1875, deploring the crowded condition of the prison, and describes the basement of the manufacturing department, which has been fitted up exclusively as dormitory for the Chinamen, and containing 168 beds. "It is a very unhealthy sleeping apartment, by reason of the impossibility of regulating the ventilation for so large a room (58 ft. x 39 ft.) containing so many occupants." This increase of room was not equal to the increase of prison population. He thought an earnest and enlightened effort should be made for the prisoners' reformation-"But it is almost, if not quite absurd, to expect reform either morally or physically under such circumstances. Good constitutions become enervated and decay. Feeble physical organizations fail to recuperate, but rather continue to decline." One half the evils, moral turpitude, degradation, mental and physical obliquity here existing is not told and cannot be written, all for want of more room and different management." Then we have four rooms with 45 men in each, with all the others equally crowded, and one half, if not more of them, afflicted with various maladies, and locked up for 13-14 hours out of the 24 sleeping and existing in a fetid and illy ventilated atmosphere, made ab

solutely poisonous by exhalations from diseased lungs, and to a great extent, unwashed surfaces, and effluvia arising from the accumulation of excrementitious matter deposited in a 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 number 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 the 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 causes 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, mild climate, abundant supply of pure water, and the excellent system of sewerage." Among his recommendations, Dr. Cary