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asks that the prisoners be allowed warm baths, instead of the cold, open air baths, and comments on the improved physical condition of the convicts superinduced by the improved quality and abundant supply of food provided. During this year there were 26 deaths, half of which were due to tuberculosis."

Concerning the 200 prisoners sent from San Quentin to the new penitentiary at Folsom, the Resident Physician, Dr. W. W. Grover, reported that "two were suffering from chronic bronchitis and disease of the lungs, . . . I find that over 30% of the whole are suffering from some chronic or organic disease, which together with long confinement and vicious habits have so enfeebled them that they are unable to perform any laborious work and are subjects of constant and daily medical treatment.... The prescriptions and calls have averaged about 25 per day. . . . In regard to the climate of Folsom and its effect upon the prisoners, I was, at first, greatly in doubt, but I am pleased to say that thus far it has been more favorable than otherwise, and many of those who were unaccustomed to hard labor, and more or less enfeebled by long confinement and chronic diseases have here been daily employed in the open air, and if they have not entirely recovered have been greatly benefited thereby."

By the end of 1881 the jute mill of 100 looms at San Quentin was finished and put in operation. All of the buildings were made by convict labor. A chair factory was also established and the Warden was enabled to assign to work every convict not disabled by sickness. By a legislative enactment the entire contract system came to an end in January, 1882. The prison population had by this time been reduced to 1199, due to transfers to Folsom, and the deaths for the year were fourteen, seven of which were due to phthisis pulmonis. The observation in regard to these cases of tuberculosis made by the resident physician was, that they were diseases contracted before entering prison.

This was decidedly an improvement over the previous year, and was attributed by Dr. N. J. Bird to be due to "the kind and quality of food reconstruction and careful daily cleansing of the sewers, in rigid enforcement of cleanliness of person, cell and clothing . . . vigilant espionage upon smuggling and smoking opium... and a complete system of prison industry."

At Folsom prison the health situation is best explained in Warden John McComb's report to the prison Directors: "The physician's report will show that the deaths (other than from casualties) during the year, amounted to five, or less than one and three quarters per cent. of the population. Dr. Henry Gibbons, Sr., member of the State Board of Health, and Dr. F. W. Hatch, Secretary of the State Board of Health, made an official visit to the prison, and were evidently well pleased with their critical examination. Gibbons spent nearly three days in the insti

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tution, and had unlimited opportunities for observation. In an address to the prisoners on Sunday, he foreshadowed what would appear in his report, which, however, will not be available for present use; but I may be permitted, in view of the high standing of the venerable physician, and his large experience as a philanthropist, to quote from his publication, the Pacific Medical and Surgical Journal, the following expressions of his views: "The Senior Editor, in company with Dr. Hatch, representing the State Board of Health, recently visited the new state prison near Folsom. Prejudiced more or less by what had been said of the burning climate and malarial character of the locality, a visitor for the first time is not prepared to find an establishment so free from such influence. As to sickness, it might be said there is none, excepting some trivial disturbance of the digestive organs, not sufficient to deter from labor. The hospital has but five or six inmates, mostly cases of injury at the quarries. It is the only department at the prison not in a flourishing state. Our old friend and townsman, Dr. W. A. Grover, is the medical superintendent, and has devoted his entire energies to the sanitary care of the building and inmates. Great credit is given him by the warden and officers for his efficient services. Not a case of malarial disease was discovered in or about the institution. This is not the season for such diseases to abound, yet we are informed that the locality has so far been almost entirely exempt from them. Dr. Durant, of Folsom, informed us that a change had taken place in this respect in Folsom and surrounding country, intermittents having diminished, and an autumnal typho-malarial taking their place. The prison apartments are as neat and clean as it is possible for private dwellings to be. Everything about them is watched with sedulous vigilance to remove all offending causes. Water is abundant, being pumped up by steam plentifully and readily from the American River hard by, and is profusely used. prisoners have the use of a large cistern for bathing and swimming, the water of which can be heated by steam. The broom and the whitewash brush are constantly in use. The ventilation of the cells is excellent, and no odor is perceptible except that of the inevitable tobacco pipe, which is but faint. The prison edifice was planted here in a little nook on the borders of the swift and noisy river, on a bed of rocks surrounded by masses of granite and by rugged hills, covered with a few scattered oaks."

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In this year-1883-excerpts from Dr. Bird's report sum up the health situation at San Quentin, as follows: "Again I have the honor of submitting to you a report of a most remarkable sanitary condition of the California State Prison at San Quentin. The unprecedented low death rate of the preceding year, and a condition unsurpassed by any similar institution throughout the world, have been maintained through another year, establishing

marvelous results, beyond the empirical or incidental, upon a basis of wise and humane administration, at which philanthropic penalogy should rejoice, and with which the most sanguine expectations should be satisfied. We have nearly 1200 prisoners, of whom about one-third are either totally or partially disabled-some scarcely able to walk through the gates on their arrival here, to the hospitaland nearly all of whom are victims of some disease, or of alcohol, or of opium, that has undermined their health and their manhood before they entered these walls. The climatic influences of this place have been less favorable to health than usual. The extremes of temperature have been greater, as low as 25° Fahrenheit, January 19, and as high as 104°, June 6. The mean temperature for six months ending June 30, 1883, was 59°. Early in the fiscal year we were threatened with an epidemic of measles, presenting the purpura haemorrhagica of malignancy; forty-five cases in all occurred. We scarcely hoped also to escape the ravages of smallpox threatened by infected jails in some sections of the state. Every possible attention was paid to vaccinating, quarantining, and cleansing, and we are saved from this dire disaster."

However, there were thirteen deaths, seven from phthisis pulmonis, one from scrofula, two from emphysema of the lungs, and one from pneumonia. A comparison of the deaths at San Quentin and Folsom for this year show a similar number, but at Folsom only three were attributable to tuberculosis. "Bilious fever," probably typhoid-carried away four of this number, but, the report adds, "an impression has been created throughout the State of California that Folsom prison and its immediate vicinity are unhealthy localities

and although there were an unusually large number of deaths during the last year, yet when we take into consideration the history of the patients and the character of their diseases, the wonder is not that so many died, but that so many lived so long."

In 1885 a two-story brick hospital, costing $8000, was constructed at San Quentin. It had two large wards upstairs with dispensary and physician's office below. It was at this time that mention was made that several prisoners who were certified to be in imminent danger of death by the prison physician, were pardoned and sent to their relatives and friends. It is probable that some of those pardoned in this way were afflicted with tuberculosis.

In 1886 there was a high death rate. Commenting on this to Warden Shirley, Dr. T. B. Eagle wrote: "During the fiscal year just closed we have had about the usual amount of sickness incident to an institution of this character, the greatest number of cases of mortality resulting from that dread disease, consumption. Out of a total of twenty-nine deaths, eighteen died of pulmonary disease, and three of scrofula. . .. I am pleased to report that with our improved and increased hospital facilities, we are now able to give

the sick as good care as they could receive in any hospital that I have visited in the state." The following year the warden called the attention of the Board of Prison Directors to his recommendations for the health and security of the prison. He advocated "repair of the roofs of the cell buildings, which were old, leaky, and beyond successful repair. . The brick walls around and between the cell buildings are much worn, and as the sun never reaches the alley-ways, they are always wet and cold, and detrimental to the health of the prisoners. . . . The old hospital building should be completely renovated, and changed into quarters for the insane. We could then remove our unfortunate cranks and insane from the cold, damp alleys between the cell buildings to comfortable and safe quarters."

Light upon the cause of the increased morbidity and mortality of the prison at this time is cast by the observations of Resident Physician Eagle who says that "Our new and improved hospital facilities are known to most of the courts of the state, and in consequence our chronic and invalid population has largely augmented." It is noted that at that time the tabulated physician's report shows that an average of fifteen cases hemoptysis, fifty-three of pulmonary phthisis, and eighty of scrofula, were treated each quarter. Chaplain W. H. Hill notes among other things, that he had attended thirty-one funerals.

At Folsom during this time construction of the new prison was going on all the time, the convicts being engaged in the quarries, bringing out granite not only for the construction of the cell buildings, but for the outside market. This work was mostly outside, but had the disadvantage of being somewhat dusty due to flying particles of granite.

The buildings were made of granite covered by an iron roof, "to give additional ventilation and light, the side walls of the prison have been carried up four feet by four courses of dressed stone; along the line of the first and second courses of this work, openings are left every alternate two feet, which create currents of air, even on still days, and make ventilation all that can be desired. The skylight being continuous the whole length of the roof, there is a flood of light in all parts of the building." Dr. F. C. Durant believes this "is one of the healthiest, if not the healthiest, penitentiary in the land. . . . In looking at the causes of death, one is struck with the number of deaths from consumption-just one half dying from that fell disease."

Dr. Durant was transferred from Folsom prison to San Quentin in January, 1888, and made his annual report, basing some of his data on the records of his predecessors. He notes: "I find here two classes of prisoners that I did not come in contact with in Folsom, viz., Indians and Mexicans. They are sent here from the lower country and stand imprisonment very illy. Those who have employment on the outside of the prison do much better than those kept inside the walls, and

kept at work in the shops and jute. More than one half of the patients that are sent to the hospital are of this class. Very soon after coming in they will break out with scrofulous or syphilitic sores, which on treatment mend, and then attack the lungs and they die of phthisis. . . . In the matter of deaths, the average is large, much larger than at Folsom, but we have a different element to deal with here, both in climate and material. While the climate at Folsom is warm and dry and preeminently suited to prolong the life of a consumptive, the moist climate of this place militates against and causes death in a short time."

At this time a distinction was no doubt made in the various forms of tuberculosis, for of the thirty-two deaths, eleven were classified as consumption, six as scrofula, and four as phthisis.

During this year, on account of the increased demand for jute products throughout the State, there became a necessity for either enlarging the jute mill, adding more machinery, or working a night shift. The latter plan was thought to be more feasible by Governor Waterman and the Prison Board. Accordingly 150 convicts were sent from Folsom to San Quentin to perform this work.

In 1889 Dr. Durant again observed the tuberculosis situation in the following words, ". . . I desire to call your attention to the unusual number of deaths from consumption,-seventeen, half of the whole number of deaths, from this fell scourge. Nearly all came here with the disease perfectly developed and easily distinguishable. I now have five men in the hospital, who will eventually die with this awful disease, whose lives could have been prolonged could they have been sent to a more salubrious climate.

"Therefore, I am in hearty accord with Dr. Ruggles, of the State Board of Health, when he proposes to have the Board issue a circular addressed to all judges, asking them to carefully examine (or have the County Physician do so) all prisoners, and have them send those who have the slightest lung trouble to Folsom, for this reason: that the increased dryness of the air at that place is greatly to the advantage of all who suffer from lung troubles, more particularly consumption and asthma.

"It is well known that the Bay climate is the worst possible for those troubles; therefore, for the sake of extending the life of those suffering from those troubles and for the better preservation of the health of the convict, it would be only humane to send all who show the slightest disease of the lungs to Folsom.

"Another thing is the great number of Spaniards who develop this disease. After being confined here for a few weeks, they commence coughing and rapidly go down, are taken to the hospital, and eventually die in spite of all medication.

"The jute mill seems to be the worst place for them, and I am very careful to take them out of the mill when my attention is first

called to them and put them in the road gang, where they sometimes pick up, but in nearly every case the relief is but temporary, and they soon sicken and die.

"Taking data from these facts, I would most strongly urge you to call attention to all these facts, and urge upon the Board of Directors to cooperate with the Board of Health and call upon the different judges to send all who are so afflicted to Folsom. . . . The death rate continues to be somewhat large. This is owing to the large per cent. of Spaniards, Indians and Chinamen who, from the very nature of things, are prone to develop consumption, scrofula, and other kindred diseases.

"The average number of inmates was 1,338, with a total of 34 deaths, making a death rate of 21⁄2 plus per cent. Of this number, two died by suicide, and one was murdered. Taking this from the total will leave but 25-13 per cent."

The report of the doctor for the following year, 1890, is somewhat encouraging. "While the death rate is smaller than last year, yet it has not kept within my expectations, being but two less than the previous year. This was due to the very severe weather we had in January, when the whole country was suffering from the 'Grippe'; the men, while not dying from the 'Grippe' were so affected by it that they never recovered; this, particularly among men who were troubled with lung difficulties. Thus, we had ten deaths in April, which was an unusual number; but you will see by the tables that this occurred among the phthisical patients almost entirely.

"I think I can see the benefit of the resolution of the State Board of Prison Directors, passed about a year ago, requesting all prisoners troubled with lung difficulty to be sent to Folsom, in the decreased number of consumptives coming to this prison; there is certainly less consumption here than formerly. I have but two or three that show evidence of that trouble at present."

But in reply to this, note the report of Dr. Eagle of Folsom: "I desire to take issue with the effort that is being made in certain quarters tending to establish at this prison a "Sanitarium" or "Lying-in Asylum" for all the broken down phthisical criminals of the state. I will admit that the climate here is all that can be said for it, so far as its benefits are concerned to the consumptive, the rheumatic, and the syphilitic; but so long as the present sanitary conditions here obtain, and until our narrow and limited hospital accommodations are enlarged, it would not be only unwise and inhuman, but exceedingly detrimental to the interests and health of this institution, to foist upon it the burden and care of the bacillusbearing criminal to propagate and spread disease and death in our little community. To treat tuberculosis successfully strict isolation must be resorted to, and the most stringent aseptic conditions observed in order to insure favorable results. How can we do this in one (Continued on page 246)

A DAY AT A NEGRO SANATORIUM

A STORY IN PICTURES OF THE PIEDMONT STATE
SANATORIUM AT BURKEVILLE, VA.

BY BLANCHE F. WEBB, R.N., EXECUTIVE SECRETARY, RICHMOND
ANTI-TUBERCULOSIS ASSOCIATION, RICHMOND, VA.

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1 to 2 p. m. Dinner (on grounds to-day, entertaining visitors and friends).

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9.

10.

2 to 4 p. m. Quiet hour.

11. 4 p. m. Nourishment.

14. Croquet.

12 and 13. 4 to 6 p. m. Rest or exercise as ordered.

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