[Read at the American Prison Association, October, 1913]
It would seem as though the management of penal institutions, and
especially houses of correction, could do no greater service to society
than to give to their inmates the medical treatment and training they
so badly need, and send them back to society at least somewhat prepared
to take their places among men with a more equal chance of success.
As a result of observation made at the Chicago House of Correction,
along these lines, the medical department of this institution has been
equipped and enlarged during the last five years, so as to carry on
some of the kind of work indicated.
The demonstrations made are most encouraging, not only to continue,
but to still further increase the capacity. At present, instead of
having only one physician, as in former years, who was expected to look
after the needs of the entire population in all the different branches
of medical science, which is impossible for one man to do, no matter
how efficient and interested he might be, we have in addition to Dr.
Sceleth, the Medical Superintendent, whose entire time and attention
is given to the department, four internes, who are physicians, and two
professional and registered nurses, who also reside on the premises,
and are instructors for the inmate nurses used in accordance with their
capacity.
As a consulting staff, we have twelve physicians, surgeons and
specialists, who are actively engaged in the work of the department,
visiting the institution at least once a week, and oftener as required.
The entire staff consists of nineteen, who are experts in their
profession, find an abundance of work that, in doing, is in most
cases a direct benefit to the community, as well as to the individual
treated, as the delinquency of many can be traced to their physical
ailments.
As a typical case, I might relate the story of a man that had been a
delinquent or criminal (so called) for several years, during which
time he had been estranged from family and relatives, who did not want
to be identified with one of his reputation. He had for a long time
been suffering from a rupture, and used this fact as an excuse for not
applying himself to ordinary labor, and claimed he could not earn a
living otherwise, so had drifted into criminal ways. When committed
to the House of Correction and opportunity given him to be treated for
his trouble, he gladly accepted; an operation was successful, and while
convalescing he realized an obligation for having received, while under
the bane of the Law, that which he had for years so badly needed.
The return to normal physical condition brought to him a desire
to discharge that obligation. Upon the advice of the General
Superintendent, he communicated for the first time in years with his
family, and satisfied them that he was determined to no longer disgrace
them, whereupon, with their moral support, he did renounce his vicious
way, and has been in no further trouble with the law.
In other ways the Medical Department is of great assistance to the
management of the institution, especially in furnishing to it reports
of findings in individual cases of limited mental or physical capacity,
so that the facts contained in the report may be considered in making
assignments to work. Everyone, especially prison wardens, can readily
see the advantage of this.
Not long ago, one of the boys in the School Department was reported
to the management for apparently making no effort, particularly in
his physical training exercises, to develop with the class, and was
indolent in other studies. He was sent to the doctors for examination,
and they learned by applying the X-Ray that he was suffering from
tuberculosis of the shoulder joint. It is needless to say that the boy
did not merit punishment under the circumstances.
Out of the fourteen thousand commitments to the Chicago House of
Correction last year, three thousand three hundred and seventy-two were
treated in the hospital, besides those who were prescribed for in the
cell house, whose ailments did not require hospital care. Two hundred
and fifteen were major surgical operations.
The results obtained in this work have attracted the attention and
commendation of all who have observed them, especially judges of
the courts, and captains of the police department, who could see an
opportunity for great good to come to many individuals, their own
work facilitated and simplified, if treatment could be given and
observation made before the cases were disposed of in court.
In order to do this and prevent legal technicalities from arising
by receiving patients before commitment by the courts, the House of
Correction Hospital was organized by the executive officers of the
institution as individuals, and is operated under a license granted
by the city, under the name of the Sceleth Hospital. In one section
of it, regularly committed sick prisoners to the House of Correction
are kept, and in another section those under arrest, and cases pending
in the courts, are brought by the police, placed under treatment and
observation, and when able are taken to court with a statement from
the physicians as to mental and physical conditions, so that the court
can more intelligently dispose of them. Some are returned for further
treatment and confinement under fine or sentence; others may be held
to await the action of the grand jury on more serious charges; while
others who had been treated for alcoholism, and for the first time in
years were free from the effects of liquor, physically able and willing
to support their families as they should, would be allowed to go home,
with no record of fine or imprisonment against them.
The courts, and especially the court of domestic relations, finds
that the hospital is a great aid in solving some of the problems
submitted to them by families whose breadwinners have become neglectful
or abusive, as a result of excessive drinking. In such cases, a
sentence may be imposed, which carries with it a recommendation for
such treatment as the defendant may need. When he has responded to
treatment, and the proper disposition is shown toward his family,
the court is made aware of the fact, and he is released. In a normal
physical condition, he is very apt to realize his possibilities as
the head of a family and avoid the courts in the future. I can best
describe the different classes of cases brought to the Sceleth Hospital
by using the words of the Medical Superintendent, in a report made to
me by him, which is as follows:
“I wish to emphasize the importance of a higher medical and
surgical standard for the treatment of prisoners in our penal
institutions.
“The officials controlling the Medical Department in ninety-five
per cent. of our prisons and workhouses do not provide a proper
equipment or staff of trained surgical and medical specialists, and
they fail to recognize the importance of the medical department in
educational and reform work.
“The proper care of prisoners and the remedying of bodily defects
through such treatment as modern surgery and medicine can give,
will decrease the prison population. There is not a day that we do
not receive unfortunates who are compelled to beg or steal, because
of their inability to earn a living on account of some physical
infirmity which is readily cured by proper surgical or medical
treatment.
“The Chicago House of Correction to-day is looked upon by the
police department, the judges, and part of the public, as a city
emergency hospital and sanitarium for all the alcoholics, drug
habitues, epileptics, chronic incurables, cripples, blind and
helpless beggars, cranks, perverts, and general mental and moral
defectives who require special medical and surgical attention.
Fully twenty per cent. of the cases that we receive are sent here
by the judges for medical and surgical care. During last September
four hundred and thirty-six cases were treated in the male hospital
alone, with eleven deaths. Almost one hundred of these were ‘no
paper’ cases, admitted to the Sceleth Emergency Hospital for
treatment and observation. Among the cases that have been sent to
us as alcoholics, we have found unfortunates suffering from skull
fractures, syphilis, softening of the brain, delirium of pneumonia,
brain tumors, acute dementia and other forms of insanity.
“Cases of nervous disease, with symptoms which simulate the ‘drunk’
in walk, speech and dull intellect, cases of coma, due to kidney
disease, to hemorrhage, or injury of the brain, to exposure, to
cold, to apoplexy, to sunstroke, meningitis, narcotic poisoning,
etc.
“Please understand this is not a criticism of our ambulance
surgeons or our police department, ‘as they need more than a
curbstone diagnosis’ but to give you an idea why you need an
efficient medical department. A man may be sitting on a curb, or
lying in the gutter in a collapsed condition, with cold clammy
skin, unable to talk intelligently, with or without an alcoholic
breath; he may be on the verge of delirium tremens, or his
condition might also be due to heart disease, to arsenic or lead
poisoning, to intestinal, kidney or liver colic, to intestinal
obstructions, to sunstroke, to the rupture of an artery in his
brain, to shock, to the onset of some acute disease, or to a plain
fainting spell.
“He may have had a tremor that looks like chronic alcoholism, but
it may be a disease of the spine or brain, paralysis agitans or
general paralysis of the insane. There was a time not very long
ago when these cases were taken to the police station, locked
up as drunks and died in a cell, when proper medical or surgical
assistance would often have saved a life. Over one-half of our
‘no paper’ cases are not able to give any history of themselves;
we know absolutely nothing except that the police brought in
an unconscious man to us. This makes a diagnosis almost an
impossibility in many cases. A printed history sheet was given to
the police department, a sample of which is enclosed, which has
been of great assistance to us in making a diagnosis.
“A number of insane cases, which are not responsible to man or God,
are sent here for violating some statute. Among them are violent
cases who have tried to commit murder, or assault, and would be a
danger to any city to have at large; these of course are sent to
asylums.
“Another type are unfortunates who are charged with being
shiftless, who will not work to support themselves or their
families. These are often unrecognized cases of brain or spinal
diseases which leave the victim absolutely helpless and unable to
work. These are often treated as worthless bums, when they need
good medical care and kind treatment.”
Another point of view deserving of strong emphasis is one directly the
opposite of that usually held. We know well that alcohol is responsible
for many conditions which are daily called upon to treat, but we do
not give due consideration to the fact that the alcohol or drug habit
had its beginning in an effort to relieve pain due to sickness, or to
obtain solace after unsuccessful attempts to obtain or keep a job, when
handicapped by some disease, recognized or not. Disease, alcoholism and
crime are very closely interwoven.
Especial efforts are made at our institution to detect pulmonary
tuberculosis in its early stages. Whenever possible, such cases are
transferred to institutions devoted to the care of such patients,
the aid of the courts being invoked in many cases to overcome the
legal obstacles. If it is necessary for us to retain the tuberculosis
patients, we place them under the best possible hygienic conditions.
We point with pride to our out-of-door cottage tents, where the three
essentials for cure are at hand--fresh air, rest and good food.
The House of Correction has a well deserved reputation for its success
in the management of drug and alcoholic cases. But no “cure” such as
is employed in most institutions is made use of here. The treatment
is essentially educational. The offending drug is withdrawn, and the
patient convinced that he can get along without it. Then, upon his
release, it is entirely “up to him,” so to speak, as to whether he
returns to the habit or not.
This is in no sense intended to underestimate the psycho-therapeutic
treatment where it is indicated. However, we do desire to point out
the absurdity of psycho-therapeutic treatment in cases suffering with
a definite physical ailment where a careful and complete physical
examination by competent men is most essential.
We have each week the following clinics:
Three Surgical Clinics,
One Medical Clinic,
One Nervous and Mental Clinic,
Two Eye, Ear, Nose and Throat Clinics,
One Skin Genito Urinary Clinic,
One Gynecological Clinic,
Two Dental Clinics.
In addition to the above, the health of two thousand inmates and the
sanitation and food are cared for.