IMPORTANCE OF AN UP-TO-DATE MEDICAL DEPARTMENT IN A PENAL INSTITUTION. By John L. Whitman, Superintendent Chicago House Of Correction

[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.