Newgate prison had a hospital within its walls. The prison hospital was in a “large and airy apartment,” adjoined to a “hospital kitchen,” which was separate from the prison’s main kitchen.i The patients in the hospital were attended by a physician, an apothecary, and nurses.ii The physician came to visit the sick twice per week, or more frequently if needed.iii Under the physician worked an apothecary, who resided within the prison and was able to prescribe medications to patients in the physician’s absence.iv The nurses were the apothecary’s subordinates and were chosen from among the prisoners.v
All of the treatments carried out in the prison hospital are not specifically enumerated in the inspectors’ reports or in Thomas Eddy’s writings, but some details are recorded, and others can be deduced. The amenities described by Eddy include warm and cold bathing and exercise machines.vi The exact nature and structure of the exercise machines is not described, but their function was to act as an intermediate between bed rest and full blown physical activity.vii
In 1803, the Inspectors’ Report detailed the supplies purchased for the hospital.viii Medicines constituted the largest line item, but beyond that, no specific medicines were listed.ix In the 18th and 19th centuries, before drugs were well regulated, physicians had trouble prescribing proper doses because the potency of drugs varied widely depending on the apothecary or druggist.x However, within the prison, this was likely less of an issue because the physician knew that all of the patients would receive their prescriptions from the same apothecary.
In 1803, the prison hospital spent almost as much money on alcohol as it did on medicine ($141.13 versus $158.40).xi This large volume of alcohol (226 gallons) is the clearest example of largely palliative nature not only of medicine in the prison hospital, but early 19th century medicine in general.xii Besides medicine and alcohol, another of the line items in the prison hospital budget was “setting lancets,” which would have been used for bloodletting.xiii The practice of bloodletting has since been proven to be largely ineffective, with the exception of a few diseases.xiv The other items listed in the prison hospital budget are various foods.xv
Who Was in the Hospital?
The percentage of prisoners being treated in the prison hospital for various years is depicted in Figure 1, below. The purple, dotted line represents the average, 7.433%.
These data points are obtained from the Inspectors’ reports, where the number of prisoners in the hospital on December 31st of each year was recorded. Consequently, these points offer mere snapshots of the number of patients, and are not perfectly representative of an entire year. Figure 2, below depicts the percentage of prisoners admitted to the hospital over the course of a year. In some ways, the figure offers a more complete representation than does Figure 1, because it is not restricted to a snapshot of December 31st of each year. However, it is also less complete than Figure 1 in that it only includes data from the years 1801, 1805, and 1806.
Notably, the percentages of prisoners admitted to the hospital were greater than 100% in both 1805 and 1806. More specifically, 476 prisoners were admitted to the hospital during the year 1805, out 453 “total” prisoners.xvi Additionally, only 28 prisoners were recorded as hospital patients at the end of 1805.xvii A portion of this discrepancy came from summer fevers resolved before winter, an “unusually great number” of which (43) occurred between July and October of 1805.xviii However, the large percentages in both 1805 and 1806 are more likely due to repeated hospital admissions of prisoners with recurring diseases and turnover between prisoners discharged and received from the prison itself; more than the “annual total” of prisoners passed through the prison during a given year.
The prison inspector stated multiple times that some contingent of the prisoners in the hospital were a constant, chronic presence.xix Some prisoners were admitted to the hospital as soon as they were received, and some of these the inspector “deem(ed) remediless.”xx The inspector’s primary concern regarding these prisoners was not their health, but their inability to labor coupled with their medical care’s increased cost to the prison.xxi
In the years 1812-1814, there was a noticeable increase in the percentage of prisoners in the hospital (Fig. 1). The 1812 inspectors’ report points to overcrowding as a cause of decreased health.xxii This statement seems logical because during 1812-1814, almost 500 prisoners were living in quarters designed to house 336.xxiii However, such overcrowding was neither unprecedented nor significantly worse than that of preceding years. The inspector had been citing overcrowding as a health concern since 1806.xxiv In 1811, there were 466 prisoners, 5.79% of whom were hospitalized.xxv In 1812, there were only twenty more prisoners (486), but more than twice as many (12.96%) were hospitalized.xxvi In the following years (1816-1817), the prison population increased dramatically (>600), but the percentage of prisoners in the hospital decreased (5.56% and 4.17%, respectively).xxvii From this data, it is clear that overcrowding alone could not have caused the high percentages of prisoner hospitalizations between 1812 and 1814. The inspectors provided no other explanation for the hospital’s increase in patient volume, so the true cause(s) is unclear.
Some of the terms used to describe diseases in the hospital prison records are no longer used in common medical jargon. For clarity’s sake, some of these terms are defined below.
- Catarrah: secretion of thick mucus by the mucous membranes of the respiratory tract.xxviii
- Consumption & Phthisis: both refer to pulmonary tuberculosis.xxix
- Debility: any condition of being weak or feeble; want of strength.xxx
- Dyspepsia: indigestion.xxxi
- Intermittent Fever: a fever that subsides and returns (characteristic of malaria).xxxii
- Remittent Fever: a fever in which body temperature fluctuates but does not return to normal.xxxiii
- Rheumatism: disorders involving joint and muscle pain, including osteo- and
rheumatoid arthritis, rheumatic fever, and gout.xxxiv
- Typhus: a bacteriological infection transmitted by arthropods (fleas, lice, etc). Symptoms include: severe headache, widespread rash, prolonged high fever, and delirium. The louse-borne (epidemic) strain is associated with unsanitary conditions and has a mortality rate of close to 100%.xxxv
- Yellow Fever: a viral infection that is transmitted by mosquitoes and causes tissue degeneration in the liver and kidneys. Symptoms include: chill, headache, back and limb pain, fever, vomiting, constipation, a reduced flow of urine (which contains high levels of albumin), and jaundice. Yellow fever can be fatal, but those who survive it become immune.xxxvi
Figure 5, below, shows the average annual number of cases of common diseases that were treated in the prison hospital, in descending order. This data is obtained from the years: 1801, 1805, and 1806, for which detailed reports of the diseases treated in the hospital were available.xxxvii By no means does this chart provide an exhaustive list of the diseases treated.
The terms used in record keeping among these years are not entirely consistent. For example, no cases of “debility” were recorded in 1801, but over 100 cases were recorded in both 1805 and 1806.xxxviii For years in which a disease was not listed, its value was recorded as 0 and then averaged as such. However, it is unclear whether some diseases truly were not treated, or if they were lumped in with another disease in the hospital records. Synonymous terms are combined where possible (e.g. consumption and phthisis), but the zero values (mostly from 1801) did lower some of the averages significantly.
Of the diseases treated in the prison hospital, some were more fatal than others. Figure 6 displays statistics for the two most common causes of death. Once again, this data is obtained from the years: 1801, 1805, and 1806, for which detailed hospital reports were available.xxxixIn order to obtain the percentages in the chart, the number of deaths caused by the particular disease was divided by the total number of deaths for each year.
*Typhus is not listed as a disease that was treated in the hospital in 1801.xl However, the generic term “fever” was used in only the 1801 records, and resulted in two of that year’s four total deaths.xli Logically, one or both of these fatal fever cases might have actually been typhus. 25% is recorded in the chart above as an average between the 0% reported cases/deaths and the 50% of deaths that could have been due to typhus.
Interestingly, typhus and consumption/phthisis were the two most common causes of death but were only the twelfth and ninth most common diseases, respectively. Of the cases of consumption/phthisis in 1801, 1805 and 1806, 44 % were reported as terminating fatally.xlii Of the cases of typhus in 1805 and 1806, 39% were reported as terminating fatally.xliii Compared to epidemic typhus, which has a mortality rate of close to 100%, the mortality rate for typhus at Newgate was relatively low.xliv Therefore, at least the majority of the cases of typhus were likely of a milder strain, transmitted by rat fleas rather than lice.
Newgate vs. New York City
A detailed picture of health in early 19th century New York City at large is difficult to paint due to minimal record keeping. “Respectable citizens” were treated by doctors in their homes, while only the poor and destitute were treated in hospitals.xlvPrivate physicians, in turn were often loath report their patients’ illnesses in any official capacity due to stigma.xlvi
The failure to report due to stigma was most pervasive regarding cases of yellow fever.xlvii Yellow fever epidemics engulfed New York City annually, often with disastrous effects, from 1791-1822, with the exception of the years 1806-1818.xlviii Many believed that the disease could be transmitted between people because the true method of transmission, mosquitos, had not yet been discovered.xlix For these reasons, the stigma surrounding yellow fever diagnoses, which were inexact just like any other diagnosis at the time, is quite understandable.
Because of Newgate’s location on the Hudson River, north of what was then the city proper, the prison was not largely affected by yellow fever.l In all except the worst outbreaks, the cases of yellow fever were largely confined to the area surrounding the docks along the East River.li The only year in which yellow fever is documented at Newgate is 1805.lii There were two cases, one of which terminated fatally.liii It was determined that the two cases were not related, as both prisoners likely contracted the disease before entering the prison.liv
In New York City itself, the worst outbreak of yellow fever occurred in 1798.lv At the height of this outbreak, 2,000 people died of yellow fever over the course of 2 weeks.lvi While other years were not as severe, yellow fever was still far more common in New York City proper than it was at Newgate. At least in regard to this disease, the health of Newgate prisoners was superior to that of the average New Yorker.
Although death rates are not an overly specific measure, they are can be concretely compared between Newgate and New York City. Figure 7, below, compares death rates between Newgate Prisoners (gray) and the rest of the New York City population (red).
The death rates for Newgate are obtained from the inspectors’ annual reports, while the New York City Death rates are obtained from John Duffy’s A History of Public Health in New York City.lviiThe average death rate from 1801-1818 at Newgate was 5.34%, while the average death rate for New York City from 1804-1818 was 2.64%. As is evidenced by these averages, and the bar graph above (Fig.7), the death rate at Newgate was approximately twice that of New York City.
The prison inspectors would likely have attributed Newgate’s high death rate, at least in part, to those were ill upon their arrival at the prison.lviii Logically, these initially ill prisoners would have increased the death rate, but not necessarily by twofold. The inspectors also cite overcrowding and solitary confinement as sources of illness within the prison.lix These assertions provide causality to correlation between high death rates and Newgate. Overcrowding as a source of illness would also explain the relatively low death rate at Newgate in 1801, a year during which the prison’s population (345) was close to the capacity for which the prison was designed (336).lxAlthough it was not the sole cause, overcrowding had a definitively negative impact on the health of prisoners at Newgate.
i. Thomas Eddy, An account of the state prison or penitentiary house in the city of New York. (New York: n.p., 1801), 48-49.
ii. Ibid, 48.
vi. Ibid, 49.
viii. New York (State) Legislature, Assembly Journal 1803 (Albany, New York: John Barber, 1803), 107.
x. John Duffy, A History of Public Health in New York City, volume 1 (Hartford, Connecticut: Connecticut Printers, 1968), 232-233.
xi. New York (State) Legislature, Assembly Journal 1803, 107.
xiii. Elizabeth Martin, Concise Medical Dictionary (Oxford University Press, 2015.), http://www.oxfordreference.com/view/10.1093/acref/9780199687817.001.0001/acref-9780199687817, “Lancet.”
xv. New York (State) Legislature, Assembly Journal 1803, 107.
xvi. New York (State) Legislature, Assembly Journal 1806 (Albany, New York: n.p., 1806), 135.
xix. New York (State) Legislature, Assembly Journal 1814 (Albany, New York: np., 1814), 197.
xx. New York (State) Legislature, Assembly Journal 1806, 134.
xxii. New York (State) Legislature, Assembly Journal 1812 (Albany, New York: np., 1812), 118.
xiii. New York (State) Legislature, Assembly Journal 1806, 136.
xiv. Ibid, 133.
xv. New York (State) Legislature, Assembly Journal 1812, 119.
xvi. New York (State) Legislature, Assembly Journal 1813 (Albany, New York: np., 1813), 239.
xxvii. New York (State) Legislature, Assembly Journal 1816 (Albany, New York: np., 1816), 287.
New York (State) Legislature, Assembly Journal 1818 (Albany, New York: np., 1818), 281.
xxviii. Elizabeth Martin, Concise Medical Dictionary, “Catarrah”
xxix. Ibid, “Consumption”
xxx. “debility, n.”, OED Online (Oxford University Press, September 2016). http://www.oed.com/view/Entry/47886?redirectedFrom=debility.
xxxi. Elizabeth Martin, Concise Medical Dictionary, “Dyspepsia”
xxxiv. Ibid, “Intermittent Fever”
xxxv. Ibid, “Remittent Fever”
xxxvi. Ibid, “Rheumatism”
xxxvii. Ibid, “Typhus”
xxxviii. Ibid, “Yellow Fever”
xxxix. Thomas Eddy, An account of the state prison or penitentiary house in the city of New York (New York: n.p., 1801), 89.
New York (State) Legislature, Assembly Journal 1806, 136, No.9.
New York (State) Legislature, Assembly Journal 1807 (Albany, New York: n.p., 1807), 92, No.8.
xl. Thomas Eddy, An account of the state prison or penitentiary house in the city of New York, 89.
xlii. Thomas Eddy, An account of the state prison or penitentiary house in the city of New York (New York: n.p., 1801), 89.
New York (State) Legislature, Assembly Journal 1806, 136, No.9.
New York (State) Legislature, Assembly Journal 1807 (Albany, New York: n.p., 1807), 92, No.8.
xlv. John Duffy, A History of Public Health in New York City, 241.
xlvi. Ibid, 102.
xvliii. Ibid, 115.
xlix. Ibid, 106.
l. Thomas Eddy, An account of the state prison or penitentiary house in the city of New York, 20.
li. John Duffy, A History of Public Health in New York City, 119.
lii. New York (State) Legislature, Assembly Journal 1806, 136, No.9.
liv. Ibid, 136.
lv. John Duffy, A History of Public Health in New York City, 133.
lvii. Ibid, 575-576.
lviii. New York (State) Legislature, Assembly Journal 1806, 136.
lx. Thomas Eddy, An account of the state prison or penitentiary house in the city of New York, 79.
Figure 3-Late (petechial) Rash on Palm and Forearm. Digital image, n.d., http://www.microbiologybook.org/mayer/ricketsia.htm.
Figure 4-Infected with Yellow Fever. Digital image, n.d., http://ghstravelsafe.com/yellow-fever-series-what-is-yellow-fever-how-does-yellow-fever-spread/.