Medicine

EARLY MEDICAL PRACTICE

When Kingston Penitentiary opened in 1835, one feature that distinguished it from gaols and workhouses in Upper Canada was the provision for professional medical care. The medical inspection of prisoners was an important component of the new modern institutions like Auburn and Kingston. Gaols and workhouses in this era were cavalier about inmates’ health because such institutions did not hold individuals long enough to see the consequences of poor hygiene and deficient medical care. In the penitentiary, medicine assumed new importance as a component of much longer prison sentences. The moral reform of criminals was considered impossible if the institution could not keep them healthy. Furthermore, the rigorous labour regime could not be sustained if prisoners were depleted by poor medical care, deficient diet, and debilitating disease. As Kyle Jolliffe argues, in the larger sense, the new emphasis on medical care also helped establish the moral legitimacy of the new institutions. Early reformers were concerned to demonstrate that the penitentiary was a humane alternative to brutalizing punishments because of its protection of inmates’ health.³

In Kingston’s early years, the penitentiary surgeon was expected to be a constant presence at the penitentiary. It was his duty to respond to medical complaints each morning. He treated minor concerns such as colds and injuries on an outpatient basis and admitted those with more serious illnesses and injuries to the penitentiary hospital. Much like the rest of the early penitentiary, the hospital fell victim to the chronic delays in penitentiary construction. Although a dedicated hospital wing was included in the original plans, it was a low priority for the Building Committee throughout the 1830s and 1840s. Surgeon James Sampson complained in his 1844 annual report that he could not treat a sufficient number of prisoners in the temporary hospital quarters and was forced to discharge convicts to the confines of their cells.⁴ Thus, the number of cases treated in the hospital was extremely small. Table 4 illustrates the nature of medical concerns treated both in and out of the hospital in the first years at Kingston Penitentiary. Most involved minor treatment, and the number of serious cases requiring ongoing care was quite low. In these early years, the penitentiary surgeon was also on continual watch for the development of epidemic disease. Outbreaks of fever, cholera, and smallpox in the Midland district required extra effort on the part of the surgeon.

The hospital at Kingston was finally finished in early 1852, but due to overcrowding of female convicts, they were moved into the newly completed infirmary. Dr. Sampson sarcastically reported to the government his great satisfaction that the hospital was finished and expressed his hope that it would one day be used for its intended purpose.⁵ These ongoing delays and the willingness to improvise solutions for medical care illustrated a lack of commitment to the principles of medical reform on the part of penitentiary administrators. This was a theme that would be repeated at Kingston throughout the century and replicated at each institution added to the federal penitentiary system in the post-Confederation era.

SOURCE: "Surgeon's Report, 1837." Appendix to the Journal of the House of Assembly of Upper Canada, 1838, 207—8.

Despite the presence of staff doctors, medical care in Canadian penitentiaries remained rudimentary in the years after Confederation. Of the five federal penitentiaries in operation by 1880, only Kingston and St. Vincent de Paul featured separate hospital facilities. British Columbia, Dorchester, and Manitoba had no formal infirmaries; in all three prisons, both minor and serious illnesses and injury were treated in standard punishment cells until very late in the century. Not only was this treatment inconvenient and distasteful to the penitentiary surgeons, but it was a constant danger to the health of prison populations due to the threat of communicable disease.

MEDICAL POWER AND THE LABOUR FORCE

In both Madness and Civilization (1967) and The History of Sexuality (1976), Michel Foucault writes about the expanding role of medicine in defining relations of production in the industrial era. In the earlier work, Foucault notes that, in dividing the sick from the well, medicine furnished a means by which non-productive individuals could be segregated until they were ready to rejoin the productive world. Underlying this division was an association between physical health, signalled by the ability to perform labour, and moral health. “The prisoner who could and who would work,” Foucault wrote, “would be released, not so much because he was again useful to society, but because he had again subscribed to the ethical pact of human existence.”⁶ A sharp distinction was drawn between productive and unproductive members of society, and Foucault hints at how such categories helped to organize institutional life. In his later work, Foucault investigates medical power (bio-power), examining the specific role that medicine played not merely in segregating the sick but in their potential reformation. Medical power functioned to insert the sick back into productive roles, sustaining their health to ensure their continued participation in the world of production.⁷ The history of medical intervention in the lives of the urban poor during the late eighteenth and early nineteenth centuries offers multiple examples of this impulse. Public health initiatives in England stemming from the Poor Law addressed the failing health of the working class. Not only did these initiatives work toward the containment of working-class contagion, but they ensured the vitality of a newly urbanized labour force.⁸ As Michael Ignatieff argues, much like penitentiaries, hospital reforms in the late eighteenth century aimed at “saving” the poor played into a new strategy of class control.⁹

Although the primary interest of penitentiary medicine was maintaining the health of the penitentiary labour force, the penitentiary surgeon played a role in the disciplining and policing of the penitentiary labour force from the earliest years. In 1837 the provincial inspector noted, “It will be seen that his office is not merely curative of the health of the prisoners, but it is also necessarily corrective in detecting imposition by feigned sickness, a matter of no small importance as regards both the discipline and pecuniary interest of the establishment.”¹⁰ It is significant that discipline and pecuniary interest both tended to coalesce around the issue of regulating the prison labour force. In part, it was this role of policing prisoners and controlling the supply of labour that underpinned the power invested in early penitentiary surgeons. Kingston surgeon James Sampson referred to his task of detecting feigned illness in his 1837 report:

I noticed in my report of last October, the remarkable disposition I had observed amongst Convicts, to feign sickness, or, to complain of very slight ailments. The truth of this observation is also confirmed by experience, and seldom is the Medical Officer’s daily visit made, that an example of it does not occur. His attention therefore is as much to be directed to the prevention of fraud as to the treatment of disease. He is regarded by the scheming Convict, as a ready medium through which he can occasionally gain a respite from his labour, and thus elude a material item in the sum of his punishment; and it therefore behooves him to be continually on his guard against this species of fraud.¹¹

The ability to detect this type of deception contributed to the standing and power of the penitentiary surgeon in the institution. Sampson noted that not just any practitioner could detect such fraud: it took a professional with long experience in the institution. As an example, he cited a four-day period when he was absent. Upon his return, he found that the sick list had ballooned from eight to thirty-six. When the doctor examined these sick prisoners himself, he determined that twenty-four of the total were fit for labour.¹²

The connection between medicine and discipline was raised in every decade throughout the nineteenth century. Surgeons in the post-Confederation era noted the same ongoing problem with feigning illness. While Kingston’s James Sampson viewed the practice with a touch of sympathy for the plight of labouring prisoners, other doctors assumed a harder position. In 1881 Kingston surgeon O. S. Strange wrote: “It is not surprising that the comforts of a fully equipped prison hospital are sought for by others than the really sick. Hard work is not a luxury for those whose previous mode of living has been a constant effort to evade it, and the Surgeon, having to assume the responsibility of deciding in the matter, has not unfrequently had to submit to animadversion.”¹³ Surgeon Robert Mitchell at Dorchester Penitentiary frequently remarked on the dishonesty of the men requesting his medical assistance to avoid daily labour. In an 1892 annual report, he wrote, “The ills of man are innumerable, and quite enough to occupy our attention; but it is surprising the number of men that labour under supposed infirmities in this prison and are rather indignant when I find myself unable to agree with them as to the seriousness of their complaints.”¹⁴ The volume of requests for assistance that Mitchell turned down illustrates the extent of his crusade against feigning. In 1884 he received 837 applications for advice but treated just 225 cases.¹⁵ Three years later, he received a staggering 3,098 applications and offered treatment in just 455 instances, of which only thirteen were deemed serious enough to admit to the penitentiary hospital.¹⁶ Thus, with an inmate population of 150 in 1887, the Dorchester surgeon received, on average, twenty requests per prisoner that year. The disparity between medical assistance requested and offered hints at the persistence shown by prisoners in making medical applications even in the face of unbending authorities. In many cases, doctors offered “just enough” medicine to avoid recording such treatment in their medical records. Robert Mitchell noted in his 1889 report that he avoided medical treatment in the majority of cases by offering the minimal medical intervention; this usually included some liniment for injury or all-purpose cough mixtures for cold and flu.¹⁷ The most important thing for doctors was to keep prisoners at steady labour. According to the 1868 Penitentiary Act, the system of remission was tied to the performance of labour. Prisoners who were ill, whether feigned or not, were ineligible for full remission. Prisoners absented from labour because they were in the hospital or asylum received only half the remission of a working prisoner.¹⁸

In their encounters with penitentiary doctors, inmates found themselves on the poor end of a power imbalance that was deeply entrenched and difficult to transcend. Prisoners who required assistance appealed directly to the surgeon for inclusion on the “sick list,” but they were well aware of the skepticism of penitentiary doctors and were often reluctant to trust the surgeons any more than the disciplinary staff. One former prisoner wrote in a Globe story about the intense unease that overtook prisoners as they sat on a wooden bench outside the surgeon’s office at Kingston Penitentiary.¹⁹ Another Kingston prisoner, in order to overcome his anxiety, employed the unique strategy of writing to the surgeon to request medical assistance. His note stated,

Pardon the liberty of my addressing you but your time is so valuable in the morning and my being very nervous cannot explain to you my pain and symptoms properly. The medicine you have kindly prescribed for me of late does not help my sufferings. I am convinced I am suffering from ulcerated stomach, everything I take either eating or in liquid makes me sick and nasty secretion or … is passing away from me profusely. I trust my note will not offend, but I do hope that you will change my present medicine and give me something that will meet my present ailment.²⁰

Although many penitentiary inmates were not literate enough to express their concerns in this way, the encounter with doctors required careful negotiation, and the anxiety that this clearly caused some inmates hints at the real and perceived power of the penitentiary surgeon.

ILLNESS AND INJURY

In spite of advancing medical reform in the years after 1850, the health of penitentiary inmates was generally quite poor. In 1883 Kingston surgeon Michael Lavell reported that many of the men sentenced to the penitentiary were “hopelessly diseased,” an assessment that is borne out by the frequency of degenerative illnesses such as cholera and bronchitis recorded on annual sick returns.²¹ Given the impoverished material conditions in which the nineteenth-century working class lived, especially its poorest strata, these high levels of disease are hardly surprising. Moreover, penitentiary officials generally expected the prevalence of disease in the criminal class. In a revealing comment comparing the former lives of penitentiary inmates to their experience in prison, Inspector Moylan wrote, “In respect to the condition of their life, their habitation, clothing, and diet are more favourable here than they probably are in a state of freedom.”²² This was a comment on the living conditions of Ontario’s industrial poor. However, penitentiary officials linked poor health in the prisons not only with the poor, but more specifically, with the underclass and criminal classes that they already perceived as the primary targets of the penitentiary. This resulted in a discourse connecting disease and illness with compromised morality and degeneracy.

These ideas contributed to medical characterizations of penitentiary inmates, which are illustrated by the broad conclusions that prison medical professionals advanced about their patients. In 1881 Dr. Michael Lavell wrote, “The massing together of men, most of whom are of low moral type, with confirmed filthy habits, and broken down constitutions, inherited and acquired, offer[s] facilities for the encroachment of disease, which demands the most humane and vigilant oversight to avert.”²³ In 1900 Kingston surgeon Daniel Phelan reported that a large number of prisoners came to him with broken-down constitutions as a result of “disease, alcoholism, filthy and vicious habits, and exposure to the vicissitudes of criminal life.”²⁴ Phelan explicitly associated poor health with immorality and criminality, but more specifically, he used health to create a demarcation between the working class and the dangerous classes: the following year, he wrote, “Habitual offenders or recidivists, those without any trade or calling, form the largest contingent of those whose health requires attention.”²⁵

Portrayals of the poor health of inmates were often contrasted with the positive influence of the “penitentiary lifestyle.” In his 1874 annual report Kingston surgeon Michael Lavell noted,

Many of these convicts enter the prison debilitated by dissipation and disease, very soon, however, a marked change is observable, contrasting in an eminent degree their present with their former physical condition, and bearing the best of testimony to the effects of good diet and enforced cleanliness and regularity of living.

I believe that apart from the humane efforts for their personal comfort, the confident feeling that these people have, that their slightest ailments will be attended to promptly, and that in severe disease every provision is made to mitigate their sufferings and promote recovery, have a tendency to maintain a cheerfulness, which contributes largely to the prevention of sickness.²⁶

In spite of doctors’ insistence that the penitentiary promoted healthful lifestyles, they could not completely ignore the fact that the penitentiary was simply too rigorous for some prisoners to endure. In these cases, doctors frequently referenced “broken down constitutions” when elderly prisoners died while incarcerated.²⁷ In just one of many examples, the death of a man in his sixties from a bladder infection was attributed to being “a worn out, intemperate debauchee.”²⁸ Such quasi-medical explanations often obscured the fact that penitentiary life was particularly difficult on the elderly. Most elderly prisoners were unable to participate in the daily labour regime, and some were too weak for any form of physical work. In 1887 O. S. Strange reported that a number of Kingston’s elderly inmates waited out the working hours in a “dry room” while others were permanently confined to the infirmary. One seventy-four-year-old prisoner at Kingston spent the entire winter of 1886 in the dry room. He was sentenced to ten years, but Strange believed he would not survive half that time.²⁹ Often doctors argued against the fallacy of incarcerating elderly prisoners only long enough to die in the prison hospital. This argument also stemmed from the fact that the elderly occupied a morally ambiguous position in the institution since they were unable to participate in the reformation offered by penitentiary labour.

Doctors determined a response to the terminally ill on a case-by-case basis. In many instances, doctors and wardens tried to secure pardons for prisoners suffering from the later stages of degenerative diseases, particularly respiratory illnesses such as tuberculosis. In the late 1880s, Dorchester surgeon Robert Mitchell noted that a considerable number of prisoners had been pardoned in hopes of increasing their chances for recovery from the disease.³⁰ Such pardons were undoubtedly motivated by humanitarian concern, but penitentiary administrators were also charged with reducing the rates of inmate mortality; thus, many terminally ill prisoners were released so they could die outside of the institution. In an 1888 report, the Catholic chaplain at Kingston argued for pardoning these inmates on compassionate grounds:

Society cannot be injured by their release, and the ends of justice cannot be served by keeping them until they die. No matter what care they receive in the prison hospital (and they are always kindly treated there) the grating sound of the iron doors, and the cheerless cell, and the bare prison walls and all their surroundings, make death more terrible and the consoling truths of religion less sweet, as they fall upon the ears of the dying prisoner. Let a man feel that he is free once more and no longer an outcast from society and he can dispose himself to die with greater resignation to the will of God who calls him hence. Surely Justice, without injury to herself, can afford to be merciful, at the hour of death. I have been led to these remarks by the piteous appeals made to me a few days ago, by a consumptive convict, whose life is fast ebbing away.³¹

While no penitentiary authority disputed these sentiments, pardons were not always possible and sometimes took too long. Wardens did not have the authority to summarily release a prisoner from the institution, even if the inmate was terminally ill, and the granting of pardons from the governor general in Council was a painfully slow political process. Catholic chaplain Denis A. Twomey detailed the tragic consequences of such delays at Kingston Penitentiary. When one prisoner was pardoned and died two days after his release, the chaplain noted, “The life of the [prisoner] would have been prolonged if executive clemency were exercised towards him some months sooner.”³² In a more striking example, eighteen-year-old William Baylis was pardoned from Kingston in July 1888 on the recommendation of the surgeon. He waited three days for his father to escort him home. On the day he arrived, as Baylis was walking toward the warden’s office to be released, he collapsed and died.³³

In many cases, it was the labour regime itself that caused injury or breakdown of prisoners’ health. Industrial accidents were common at each institution, frequently claiming digits, eyesight, and even limbs. Eye injuries were especially common wherever stonework was undertaken. In 1889, for instance, a worker in the Kingston stone shed was struck in the eye by a rock chip, which penetrated the cornea and caused him to lose vision on one side.³⁴ In addition to accidents causing physical harm, working conditions sometimes led to mental problems. In 1891 Manitoba Penitentiary surgeon W. R. D. Sutherland noted that inmates working in the kitchen were suffering mental breakdowns, and he appealed to the warden to shorten the length of indoor service to allow the prisoners some fresh air.³⁵ Similar conditions plagued prisoners working in the laundry and tailoring department at St. Vincent de Paul—surgeon L. A. Fortier described his inspection of the workshop:

Upon entering the tailor’s department, a “sui generis,” indefinable smell struck me, and then my eyes perceived heaps of dirty stockings and clothes; a cloud of vapour impregnated with unhealthy smell rose up above a large washing machine installed without ceremony alongside a hot air drying apparatus in a hall occupied by about sixty convicts. I asked Dr. Duchesneau to kindly come to the rescue of a colony of convicts doomed to work in a repulsive and suffocating hall in the name of the grand secular principle: “The action of the atmospheric air on man is of every instant and this gas is the most indispensable agent to life.”³⁶

In another case, George Garnett, an inmate at Manitoba Penitentiary, suffered from an unlucky assignment to the penitentiary furnace room. He was awakened daily at 3:45 a.m. to begin his work day and remained on duty until 10:00 p.m. Sutherland finally informed Warden Bedson that Garnett was ill with a nervous disposition and was breaking down mentally from lack of sleep.³⁷

RACE AND PENITENTIARY MEDICINE

Non-white prisoners were often the subjects of unique medical discourses that stemmed from racist beliefs about their inherent physiological inferiority. In most cases, racial assumptions about this inferiority were supported by health and mortality statistics collected in the penitentiary. In 1858 Kingston surgeon James Sampson noted the shocking mortality rates of black and Aboriginal prisoners over the twenty-five-year history of the institution:

The mortality among the Protestant Convicts this year, has been very small, being eight only, out of five hundred and thirty-two, less than one per cent. But, as usual, among the Indians, the Negroes, and Negroloids, the mortality has been severe. Out of eight deaths, five were of the latter and one of the former class, while two only were whites. Death has seized one to every eight Indians, one to every twelve Negroes, and one to every two hundred and twenty-five Protestant Convicts.³⁸

The most marked examples of racial discourses occurred with First Nations prisoners at Manitoba Penitentiary. Although officials at Manitoba touted the success of their efforts to “civilize” the First Nations people during their time at the penitentiary, these efforts were obviously undercut by the distressing rates of illness and mortality.

A Blood prisoner named Ka-ka-wink became ill with scrofula soon after arriving at Manitoba Penitentiary to serve a sentence for horse stealing. After spending 309 days in the hospital, he died in early 1882 at the age of nineteen. The same year, Jingling Bells, also imprisoned for horse stealing, died in November.³⁹ The arrival of larger numbers of First Nations convicts in the following years brought the problem into sharp relief. Beginning with the Cree who arrived in 1883 after being convicted for horse stealing, W. R. D. Sutherland, the penitentiary surgeon, began noting the tendency of First Nations prisoners to become quite weak soon after their sentences began. Some deteriorated faster than others. Cree prisoner The Thigh died in September 1883, just two months after his arrival.⁴⁰ Sutherland reported that the men were suffering from “hereditary disease, quite incurable, and clearly aggravated by the confinement of prison life.” He stated that he had done everything possible to build the men’s strength and combat their deteriorating health. Still, he wrote, “they grew daily worse, until it seemed nothing further which we could do for them here would be of any avail.” When Sutherland reported to the Department of Indian Affairs that the fifteen prisoners convicted of horse stealing were in this depleted condition, it helped speed the decision to pardon the men and release them into the custody of the Department of Indian Affairs.⁴¹

First Nations mortality at Manitoba Penitentiary worsened when the prisoners sentenced after the Northwest Rebellion began to arrive in the summer of 1885. Three of the Cree prisoners died within months of arriving at the penitentiary: Louison McLeod and Leon Francis both succumbed to tuberculosis in March 1886, and Wyinous died of the same disease three months later. Francis was just fifteen years old. A total of six First Nations prisoners from the rebellion died at Manitoba between 1886 and 1890. “During the past year a good many Indians and other convicts were visited by sickness,” wrote Father Cloutier in early 1887. “Five times I celebrated the funeral services for some poor unfortunate departed. I visited them often during their illness, and it is my sincere conviction that they received all the care possible. All that was asked for was allowed to them.”⁴² The previous year, Cloutier had written in his annual report, “I am inclined to think that too long a detention may have caused the sickness which led them to the grave. They were young, healthy, strong; but these advantages were useless preventatives against death. The idea of their detention was for them something very heavy and hard. I often heard them saying: Wayo otatchi ayayan; Estitotemak ayayayan gakekon—If I were not here, if I were with my people, I would surely recover.”⁴³ From descriptions of the rebellion prisoners, it is clear that many were already in a depleted state of health when they arrived at the penitentiary. Years of malnutrition on the Canadian plains and a summer of fighting the Canadian militia had left many of the men weak and susceptible to tubercular infection. The poor physical conditions at Manitoba also contributed to the situation: the damp and the cold probably exacerbated existing medical problems in many of the prisoners, who were interned together in common cells without proper ventilation. Their already compromised health would explain the rapid deterioration of some of them. Tuberculosis was a swift killer in the penitentiary, and even though doctors cited “inherited conditions” for the failing health of the rebellion prisoners, they still understood that the men would have a better chance of survival if they were released as quickly as possible.

The number of deaths in the years after 1885 would certainly have been higher if not for pardons secured for several of the men who were critically ill. Chief One Arrow was one of the first rebellion prisoners to be pardoned in early 1886 because officials realized he was terminally ill. The chief made it only as far as St. Boniface, where he died a few days after leaving the penitentiary. The Saskatchewan Herald reported that some of the men who were pardoned with One Arrow were so weak that they could not walk: they were taken from the penitentiary in a cart and had to be lifted in and out for the journey.⁴⁴ Most of the men were probably sick with tuberculosis. Sometimes the effects of the disease lingered for months or years after release from the penitentiary. Chief Poundmaker left Manitoba Penitentiary at the same time as One Arrow. He had suffered from the effects of tuberculosis in the years prior to the rebellion and died just three months after being pardoned.

Two more cases illustrate the urgency with which penitentiary officials tried to secure pardons for terminally ill First Nations prisoners. In July 1895 Sutherland, a surgeon at Manitoba Penitentiary, wrote to the warden to recommend the release of Wolf Child and Low Man, imprisoned for horse stealing, after less than a year of imprisonment. “I beg to report specially upon the serious condition of convict no. 17 Wolf Child,” he wrote. “He is dying of consumption. During the last year he has been constantly under treatment which gave temporary relief. He has now reached the last stage of the disease and cannot live. I would therefore recommend his immediate release.” The next day, after removing four scrofulous cysts from Low Man’s neck, the surgeon wrote, “I would thoroughly urge his release before the stage is reached which is not far distant. Further confinement is sure to prove fatal to him.”⁴⁵ Wolf Child and Low Man were both pardoned on 30 July 1895. Wolf Child subsequently died on the Canadian Pacific train outside of Moose Jaw, where the NWMP took charge of his remains, continuing with them on the train for interment on the Blood Reserve.⁴⁶

The comments made by penitentiary officials regarding First Nations health reflected widely held beliefs about the physical inferiority of Aboriginal people. As Maureen Lux argues, government officials were prone to explain higher rates of death among First Nations people in institutional settings by resorting to racial justifications.⁴⁷ Transmittable (and preventable) respiratory disease reimagined as racial defect became the standard response to the illness and death of First Nations prisoners. The discourses surrounding the health of Aboriginal people echoed the ideas about social degeneration among other members of the dangerous classes. Anne McClintock explores the discourse of “degeneration” in an imperial context. She argues that social crisis in Britain in the 1870s and 1880s caused a eugenic discourse of degeneration predicated upon the fear of disease and contagion. Ruling elites classified threatening social groups (working-class and racialized people) in biological terms that pathologized their perceived shortcomings and potential to threaten the riches, health, and power of the “imperial race.”⁴⁸

These discourses were particularly powerful in the Canadian North-West after the 1870s, when First Nations people struggled with sweeping epidemic disease coupled with the destruction of their traditional economy. Lux argues that bureaucrats, missionaries, and politicians explained the high death rates and continuing poor health in racial terms, inferring that only the fittest should be expected to survive.⁴⁹ Penitentiary officials often resorted to similar racial explanations for high rates of illness of black and Chinese prisoners. When British Columbia Penitentiary opened in 1880, the assistant inspector noted that the large number of “Indians” and Chinese among the prison population had the effect of swelling expenditures for the treatment of syphilis and tuberculosis.⁵⁰

Two years later, the surgeon at British Columbia Penitentiary repeated the maxim that First Nations prisoners could not withstand the physical burdens of imprisonment. Reporting on the higher level of hospital committals from the previous year, C. Newland Trew wrote, “This is owing to increased severity of the chronic forms of disease among the Indian convicts—that race, apparently, not able to withstand the depressing effects of confinement so well as the whites or Chinese.”⁵¹ In institutional settings, such attitudes proved disastrous for First Nations individuals. Mary-Ellen Kelm explores the health of residential schoolchildren in post-1900 British Columbia and uncovers several similarities to the penitentiary experience. She describes a “scandalous procession” from school to grave that awaited many First Nations children in the early years of the residential school system in British Columbia. They succumbed to the same diseases that claimed penitentiary prisoners—largely respiratory illnesses that were highly transmittable and were preventable with proper nutrition, ventilation, and medical care. The terrible irony, as Kelm aptly describes, was that school officials viewed First Nations children as inherently diseased and susceptible to illness because of what were perceived as unique racial characteristics. In reality, it was exposure to squalid conditions, poor diet, and a harsh work regime that broke the health of residential school children.⁵²

The health of First Nations prisoners did not improve in the years following the Northwest Rebellion. Although racial explanations for their poor health prevailed, it is also clear from some penitentiary records that cultural misunderstandings or miscommunication sometimes perpetuated these beliefs and resulted in tragedy for First Nations prisoners. Twenty-six-year-old “Sam,” a member of the Nez Perce First Nation, was convicted of murder in 1892 and his sentence was commuted to life at Manitoba Penitentiary. After only a few months in prison, he became unresponsive and unwilling to work. In early March 1893, the surgeon examined him and reported to the warden, “My examination today as well as previous ones made at your request of convict No. 64 Nez Perce Sam leads one to the opinion that this man is intellectually deficient. His unreasonable refusal to leave his cell or do the slightest work throws evidence of a melancholic nature while his periods of brighter intelligence show signs of excitement.”⁵³ The doctor made this diagnosis despite admitting that he could not understand what the patient was saying. He concluded only that he would keep the patient under observation. In late August 1893, Sam was in the hospital again with dropsy and was diagnosed with phthisis two weeks later. He died on October 1.⁵⁴

“Jackson,” another Nez Perce, experienced a similar slow deterioration due to tuberculosis. He arrived at Manitoba Penitentiary in July 1886 and by the following January was confined to the hospital. On 1 September 1887, the surgeon noted in the medical casebook that Jackson was “getting more feeble and requires constant attention.” By October 1, he was refusing his medicine, and on October 9 he died at 10:30 p.m.⁵⁵ That year, Father Cloutier reported again on the failing health of First Nations prisoners. “I have this year again to deplore the poor state of health of a great many Indians,” he wrote. “It has happened pretty often that the same men were in the hospital for weeks and for months. If something could be done in their behalf it would be quite an act of charity.”⁵⁶

MENTAL ILLNESS AND CURABILITY

Canadian penitentiaries in the nineteenth century played an important role in shaping the state response to mental illness, particularly in western Canada. Penitentiaries incarcerated several categories of mentally ill individuals in this period, the most common being prisoners who lapsed into mental illness during the course of their sentence. Medical understandings of mental illness in the nineteenth century were often ambiguous. Doctors recognized three primary types of insanity: mania, melancholia, and dementia. Mania exhibited symptoms such as violence, delusions, paranoia, jealousy, excessive drinking, and excessive religious observance. Melancholia was characterized by a depressive tendency and a refusal to eat, work, or participate in daily routines. Dementia was identified by verbal incoherency, paranoia, poor personal cleanliness, and refusal to participate in daily activities. Contributing to the ambiguity of these three categories was the fact that many of these qualities were recognized as both causes and symptoms of the conditions with which they were associated.⁵⁷ Penitentiaries also imprisoned individuals who were found “criminally insane” or unfit to stand trial by reason of insanity. In other cases, penitentiaries in Canada were the only institutions that could accept “dangerous insane” individuals who could not be cared for in government asylums.⁵⁸ In some jurisdictions, such as Manitoba, the North-West, and British Columbia, any person committed to the care of the state as a result of mental illness was incarcerated in a penitentiary because there were no formal asylum facilities in these regions until the late 1880s.

The mentally ill were always regarded as a problem population in penitentiaries. At Kingston in the 1840s, for example, prisoners who lapsed into mental illness caused great difficulties. The surgeon argued that their “proper moral management” was impossible inside the penitentiary.⁵⁹ To relieve the situation, Upper Canada introduced a new penitentiary statute in 1851 that permitted the penitentiary to remove thirteen mentally ill prisoners to the provincial lunatic asylum in Toronto.⁶⁰ The Toronto Asylum objected to this arrangement, arguing that it was unequipped to handle the “moral monsters” being transferred from the penitentiary and citing the relative incurability of criminal lunatics compared with regular asylum patients.⁶¹ Joseph Workman, the asylum superintendent, thundered in his 1853 annual report: “An evil of inconceivable magnitude, and distressing results, in the working and present condition of this Institution has been the introduction of Criminal Lunatics from the Provincial Penitentiary and the County Gaol. It is an outrage against public benevolence.”⁶² After the return of the mentally ill convicts to Kingston Penitentiary in 1855, they were segregated in the west wing of the building. In an arrangement that negated the moral concerns expressed by Workman about combining criminal and non-criminal lunatics, the transfer also included twenty-four regular patients from the provincial asylum to help alleviate overcrowding.⁶³ Circumstances deteriorated for the entire group of recently transferred patients when they were forced to vacate the west wing and moved to the penitentiary basement in 1856. Although the basement accommodations were intended to be temporary during the erection of a separate penitentiary asylum, construction dragged on for eight years: the Rockwood Criminal Lunatic Asylum was finally opened in 1864. Rockwood operated in this capacity until 1877, when the federal government sold it to the province of Ontario, which was seeking to expand the provincial asylum system. From 1877 onward, all mentally ill prisoners remained at Kingston in a detached wing of the penitentiary. Thereafter, Kingston became the repository for “criminal lunatics” from all over the dominion.⁶⁴

Concerns about mental illness in the penitentiary during this period turned on a medically ambiguous definition of curability. Throughout the nineteenth century, approaches to mental illness closely reflected reform views of criminality in that evangelicals and humanists believed both could be “corrected.” With this idea at the root of Victorian social reform, asylums assumed the task of attaining the “perfectibility of man” through new psychological medical methods.⁶⁵ In the penitentiary, “perfectibility” was never a resounding theme with medical professionals. Rather than an indicator of whether a patient’s life could be saved, curability often referred only to the chances of returning the ailing individual from the sick list to the daily routines of prison labour. Penitentiary doctors complained that the number of prisoners confined permanently to infirmaries was turning penitentiaries into “hospitals for incurables.”⁶⁶ As the population of federal inmates grew toward the end of the nineteenth century, penitentiary doctors and officials struggled with how to respond to increasing numbers of prisoners who were incapacitated. Among those often counted as “incurables” were prisoners suffering from various forms of mental illness. While most doctors would have preferred to offload these prisoners to the care of provincial asylums, the political realities of post-Confederation social policy often made this impossible.

Forced to contend with the care of mentally ill prisoners, penitentiaries in Canada made some efforts to emulate the standards of contemporary asylums. In the mid-nineteenth century, asylum reform was characterized by a movement from “custodial” to “curative” care. Older methods of custodial treatment involved only the most basic medical care, often accompanied by physical restraints or sedative tonics. British asylum reformer James Hack Tuke (great-grandson of philanthropist and asylum reformer William Tuke) visited the Toronto Asylum in 1845 and condemned the outdated medical care and brutal treatment of the inmates under a custodial model. He described “one of the most painful and distressing places I ever visited”:

There were, perhaps, 70 patients, upon whose faces misery, starvation, and suffering were indelibly impressed. The doctor pursues the exploded system of constantly cupping, bleeding, blistering, and purging his patients, giving them the smallest quantity of food and that of the poorest quality. No meat is allowed.

The temples and necks of the patients were nearly all scarred with the marks of former cuppings, or were bandaged from the effects of more recent ones. Many patients were suffering from sore legs, or from blisters on their backs and legs. Everyone looked emaciated and wretched. Strongly-built men were shrunk to skeletons, and poor idiots were lying on their beds motionless, and as if half dead.⁶⁷

The abuse that accompanied custodial treatment was increasingly condemned in favour of a curative program involving “moral therapy.” Moral therapy concentrated on the psychological and emotional causes of illness, advocating psychological methods to treat mental medical disorders.⁶⁸ This treatment depended on the restful setting of the modern asylum, including plenty of fresh air, sunlight, and exercise. The curative program also assumed a moral dimension that gave meaning to labour as a means of criminal reformation in penitentiaries. Sometimes referred to as “occupational therapy,” prescribing work to the mentally ill was intended either to distract them from their delusions or to encourage the growth of mental powers and concentration.⁶⁹ As Anne Digby notes, it was the simple process of being employed rather than the quality of the work performed that supposedly offered therapeutic benefits.⁷⁰ Although the moral elements of labour were always present in the penitentiary, its practical components often played the greater role in shaping responses to the mentally ill. These practical considerations informed rationales for keeping prisoners engaged in labour. Other elements of moral therapy met with the limitations and restrictions particular to the disciplinary environment.

Some evidence suggests that even transferring prisoners to provincial asylums provided no guarantee that mental illness would be properly treated. In the mid-1850s, Kingston surgeon James Sampson struggled to find adequate care for two mentally ill prisoners but found the provincial asylum in Toronto to be of little assistance. Convicts Therein and Geintner were both convicted murderers whose capital sentences were commuted to life imprisonment for reasons of criminal insanity. Geintner was transferred to the asylum in December 1851 but returned to the penitentiary in mid-1853, when he was reported to be of “sound mind.”⁷¹ Sampson, however, could not see any improvement in his case, and Geintner was subsequently confined permanently to his cell to prevent him from doing violence to keepers or other prisoners. Therein’s case was even more troubling. While incarcerated in the Three Rivers gaol and suffering a bout of violent delusion, he murdered a fellow prisoner. Once at Kingston Penitentiary, his condition did not improve. Therein undertook a twenty-seven-day hunger strike and was transferred to the provincial asylum. After just forty-four days, the asylum returned him to the penitentiary. Like Geintner, Sampson could see no improvement in Therein upon his return. The most likely explanation for their lack of improvement while at the Toronto Asylum was that the asylum simply refused to treat these men because of their status as convicted murderers.⁷²

Although penitentiary reform was closely associated with asylum reform, the conditions in Canadian penitentiary asylums and the methods of treatment for mentally ill prisoners showed little improvement into the late nineteenth century. Daniel Hack Tuke (brother of James) visited the Kingston Criminal Lunatic Asylum in 1877 and described the shocking conditions he witnessed there:

The patients are treated with almost as much rigour as convicts, though not dressed in prison garb…. In the basement are “dungeons,” to which patients when they are refractory are consigned as a punishment, although the cells above are in all conscience sufficiently prison-like. The floors of the cells are of stone, and would be felt to be a punishment by any patient in the asylums of Ontario….

Two men in the cells had once been patients in the asylum. One, with whom we conversed at the iron gate of his dungeon, laboured under a distinct delusion of there being a conspiracy against him. It was certainly not very likely to be dispelled by the dismal stone-floor dungeon in which he was immured, without a seat, unless he chose to use the bucket intended for other purposes, which was the only piece of furniture in the room.⁷³

Such conditions had more in common with early pre-reform penitentiaries than with anything required by modern moral treatment. In spite of the construction of a dedicated asylum wing for the criminally insane at Kingston in 1877, the treatment of patients reverted to a neglectful custodial system that reformers thoroughly condemned. In 1890 Inspector Moylan visited the asylum at Kingston and reported on the lack of recreational grounds, fresh air, or opportunity for physical exercise.⁷⁴ Featuring similar dimensions to the punishment cells, the rooms in the asylum wing measured a length long enough for a bed and a width of just twenty-eight inches.⁷⁵ Dr. O. S. Strange admitted to the inspector that he managed to visit the asylum patients just two or three times a week. When pressed about how he was effecting a “cure” under the restrictive physical conditions in the asylum, Strange responded, “If they require tonics, I give them tonics and different medicines as the case requires. We give them the moral treatment. Talk to them and try to convince them of their delusions.”⁷⁶ “Tonics” usually referred to the use of sedative medicine, which was administered until a patient was calmed or unconscious. The care at Kingston suggests how easily psychiatric standards could be dismissed or modified to fit the limitations of penal institutions.

Two examples from Manitoba Penitentiary illustrate some parts of the experience of mental illness in a penitentiary in this period. Harry Brown was a thirty-seven-year-old book binder sentenced to fifteen years for stopping mail in 1894. Brown was transferred to Manitoba from British Columbia Penitentiary in April 1895 with thirteen other men to alleviate overcrowding. In June 1895 the Manitoba surgeon treated him for insomnia, which usually involved doses of castor oil. In July the surgeon diagnosed Brown as melancholic.⁷⁷ Melancholia was treated similarly to insomnia but was regarded as a mental illness. Brown continued receiving castor oil into 1896 and was also prescribed heavy doses of sedatives. In April 1896 he was listed on the medical register as “well—out of his cell,” but he remained under treatment until September of the following year, when he was transferred to the Criminal Insane Asylum at Kingston Penitentiary.⁷⁸ This was a final admission of Brown’s incurability, at least within the confines of Manitoba Penitentiary.

Frank Jackson was twenty-two when he was sentenced to five years for arson in July 1892. Three years later, he was admitted to the Manitoba Penitentiary hospital with melancholia and treated with “pills” and bromidia. Although he ingested daily quantities of bromidia, in October 1895 he became overly excited and tore his clothing; the next day, he was strapped to his bed. He continued to be treated through the spring of 1896 and in June again became overly excited and had the “lunatic belt” put on him. Jackson was kept in his cell continuously throughout this time: he spent nearly two years in total isolation with no outside stimulation or interaction. He was issued no books from the library and received no visitors. Jackson was finally transferred to local authorities in October 1896, more than eighteen months after he had first exhibited signs of mental disorder.⁷⁹

Between 1870 and 1890, the Criminal Insane Asylum at Kingston received 222 admissions.⁸⁰ Thirty-three inmates died while incarcerated, sixty-eight were discharged as “improved,” and eighty were “cured.” Thirty-three inmates in this period were removed to the provincial lunatic asylum, implying that although these patients’ sentences had expired, they were insufficiently well to be safely released from custody. Of the 222 admissions, only 30 percent could be classified as “incurable” since they either died or were transferred to another mental institution. What is suggested here is that medical diagnoses such as “improvement” and “cure” were motivated by their practical outcomes. If a penitentiary inmate was improved or cured by a stay in a criminal lunatic asylum, it would guarantee only a return to the general inmate population and the daily labour of prison life. To this end, penitentiary doctors served conflicting interests of the institution’s labour demands and their patients’ mental health. The high rate of “success” at Kingston in spite of institutional shortcomings (compared to medical asylums) suggests that doctors effected a “cure” as quickly as possible.

An ongoing component of the “cure” for mental illness was physical labour. Penitentiary doctors enthusiastically subscribed to the occupational elements of moral therapy. In some senses, they believed in its therapeutic benefits, but they were also certainly relieved to find practical solutions preventing the continued confinement of the mentally ill in the same cell or hospital wing without cessation. In 1895 the surgeon at Kingston noted that his hospital ward would be overflowing if all the “weak-minded” convicts were relieved of their daily labour.⁸¹ This labour regime prevailed in most Ontario asylums and, as Geoffrey Reaume suggests, actively promoted the theoretical connection between physical labour and the recovery of the “alienated mind.”⁸² Reaume also argues that the interests of economy played a primary role in the constant promotion of labour in these asylums. Penitentiary doctors sometimes advanced similar arguments. At St. Vincent de Paul Penitentiary, Dr. L. A. Fortier defended the use of labour as a form of therapy in penitentiary asylums:

The fact that an insane convict soon after his arrival at Kingston Asylum is sent to work with a squad of convicts is not proof that the surgeon of a penitentiary was wrong to order the transfer…. It is not an argument establishing that the subject is sui mentos compos; far from it; a convict being susceptible to be affected with transient mental insanity, another with intermittent insanity and a third one with permanent mental insanity.

It is elementary [that] in every case of mental insanity the first thing to be done is to isolate the patient from his habitual lodging, to procure him a good change of scenery and to occupy his mind with work, amusements and distractions of all kinds.⁸³

Fortier’s arguments were aligned with long-standing beliefs in the asylum movement about the importance of patient labour. William Tuke argued that using patients as labourers at the York Retreat was “suitable and proper for them, in order to relieve the languor of idleness and prevent the indulgence of gloomy sensations.”⁸⁴ It was convenient for medical authorities that labour was not incompatible with the accepted therapeutic response to mental illness; in most cases, penitentiary doctors could offer little else. Under the guise of “moral therapy,” labour served mostly practical solutions to the accommodation of the mentally ill. The effect was often that the patient and prisoner experienced confinement in ways that were ultimately very similar. Two factors tended to emphasize this point, the first being gender. Female patients suffering mental illness experienced increased marginality in penitentiaries that were already ill-equipped to handle non-working prisoners. The second factor was the geographic isolation and rudimentary nature of newly built penitentiaries in western Canada.

GEOGRAPHIC ISOLATION AND GENDER

The first penitentiary facilities in Manitoba were housed at Lower Fort Garry, a former Hudson’s Bay Company trading post. Although the site was designated a federal penitentiary in 1874, it also served as the first asylum in Manitoba. Unlike Kingston Penitentiary, the mental patients at Manitoba were not criminal convicts but individuals who were committed by family or friends for “safekeeping” under warrant of the lieutenant governor of Manitoba and the North-West Territories, since the institution served both jurisdictions. The conditions at the early penitentiary did not begin to approximate asylum care or moral treatment. Patients were kept in the centre of the fort in a basic log structure designed only to segregate them from the other prisoners.⁸⁵ There was no doctor with psychological expertise on staff, and penitentiary officials exhibited little concern with the possibility of curing anyone. Manitoba Penitentiary was truly the last resort for those patients who could no longer be cared for in the home or the community in this period.

When the mentally ill could not be integrated with the regular workforce, some penitentiaries found unique assignments for such patients. In 1879 Warden Bedson at Manitoba Penitentiary ordered the guard in charge of the mental patients to employ their labour in preparing the prison garden. That same year at Manitoba, two other patients were tasked with supplying the ice house with snow throughout the month of January.⁸⁶ Since some of these patients were not criminal convicts, they could be trusted with outdoor labour without the threat of escape. Angus Smith was one such inmate committed to Manitoba Penitentiary as a lunatic in 1878. The warden took advantage of his physical abilities, assigning him a variety of unusual tasks throughout the penitentiary. One job reserved for Smith was attending the fire at the penitentiary lime kiln through the night. The night guards were instructed to visit him at midnight and again at 4:00 a.m. to ensure that he was not asleep and neglecting his “duties.” Guards and keepers also sought out Smith to perform extra chores around their domestic quarters. When the warden learned about this, he forbade the staff to employ Smith in this way since it disrupted “the work set out for him.”⁸⁷ These examples demonstrate the unusual circumstances under which the mentally ill were incarcerated and accommodated to prison life, sometimes in ways that exploited their ability to work. The willingness of penitentiary administrators to press the mentally ill into marginal forms of labour reveals not only the role that work played in medical treatment but the degree to which this ideology contributed to the construction of all penitentiary inmates as workers. The mentally ill were regarded not only through specific pathologies that defined their afflictions but often by categories linked to the foundations of penitentiary labour.

When patients in penitentiaries were too sick for any type of labour, they often experienced remarkable neglect and marginality. Such neglect was experienced more by female mental patients than by any other group. Gender played a key role in the determination of who was committed to penitentiaries as mental patients, particularly in western Canada. That nearly all of the early asylum patients at Manitoba Penitentiary were female makes this plain. Between 1871 and 1885, Manitoba Penitentiary admitted a total of eighteen women as mental patients, five of whom died.⁸⁸ Wendy Mitchinson notes that in the nineteenth century, symptoms of mental illness were heavily gender based, which probably accounted for higher committals of women. For example, excitability or overly verbal displays by women could speed the diagnosis of mental illness since such behaviour did not conform to acceptable female behaviour.⁸⁹ The gendered division of labour in isolated prairie homes probably caused families to resort to the penitentiary for the care of women who could no longer contribute to the domestic economy. Class also played a role because wealthier families could afford to send mentally ill members to private asylums in Ontario, Québec, or the United States. Thus, in some cases, the penitentiary was largely an institution providing mental health relief to poor and working-class families when formal asylums were not an option. T.J.W. Burgess’s turn-of-the-century presidential address to the Royal Society of Canada noted the solution employed by family and friends of the mentally ill: “The Toronto asylum being full, friends in their anxiety to have insane relatives placed in safe-keeping, perhaps also with the object of saving themselves the cost of transport to that institution, soon found a means to evade the law, which but inadequately safeguarded the real purpose of the establishment. The process of evasion was simply to have the poor lunatic committed to jail as dangerous, whether really so or not.”⁹⁰ When the new penitentiary in Manitoba opened at Stony Mountain in 1877, five female mental patients were transferred from the old prison at Lower Fort Garry. At the new penitentiary, the material conditions of the patients’ incarceration deteriorated rapidly. Whereas able-bodied prisoners like Angus Smith were integrated into some form of daily labour, the female patients at Manitoba performed no work. The women’s deteriorated condition was the likely reason since female mental patients in other penitentiaries regularly performed basic domestic labour for the institution.⁹¹

Because male and female prisoners required segregation, the warden and doctor decided that the women should be housed in basement cells next to the penitentiary dungeons. The wretchedness of the basement was remarkable. By 1880 faulty drainage around the penitentiary had caused several inches of waste and fecal matter to accumulate under the flooring, resulting in a wave of typhoid fever that killed three members of the penitentiary staff (but, surprisingly, no prisoners).⁹² The unsanitary conditions in the basement were matched by the absolute neglect of the women incarcerated there. One guard reported in 1881 that the women and their bedding had not been washed the entire winter and that the patients received only five minutes of attention each day at meal times. The guard noted that Ellen McLean, who was hired to attend to the women, had been co-opted by the warden’s wife to work in her house as a cook and domestic servant; nobody had bothered to hire a replacement.⁹³

Eliza Templeton was one Manitoba asylum patient who endured this neglect until the end of her life. She was a forty-six-year-old married mother received at the penitentiary for “safekeeping” in August 1877. Five months after her arrival, she was granted a brief reprieve from the basement cells and released into the custody of friends. (Records are unclear on any further involvement of her family.) A short time later, Templeton was returned to the penitentiary, where her condition deteriorated. Throughout March 1881 she tore at her clothing and blankets, and then began to throw the contents of her night bucket around the cell and corridors.⁹⁴ The medical officers could offer no solution to her deterioration. Templeton died in her cell in the basement of Manitoba Penitentiary in July 1882.⁹⁵ Although penitentiary officials were not absolutely blind to the neglected state of the female patient, the deputy warden at Manitoba blamed the state of affairs on Ellen McLean rather than the prison administration. He reported, “If the same time was spent on the lunatic women that was spent in looking after the other rooms, the women would be taken care of.”⁹⁶

Clearly, gender played a key role in how the mentally ill were cared for in the penitentiary. Basic medical care for women depended upon the labour of poorly paid female matrons. Ellen McLean worked a gruelling schedule as the matron at Manitoba Penitentiary: Bedson noted that she was on duty from 6:00 a.m. until 10:00 p.m. daily, Sunday included, and was charged with cooking, cleaning, and washing for the four female mental patients in the basement.⁹⁷ She was paid a salary of $15.00 per month, or $180.00 for the year—$5.00 less per month than the penitentiary messenger, who worked part time, and less than half of the lowest-paid guard, who earned an annual salary of $480.00.⁹⁸ McLean was well aware of how inequitable her situation was. In 1880 she personally petitioned the lieutenant governor of Keewatin for compensation for the extra labour she performed at the penitentiary:

Dear Sir, for the past two years I have had to take charge of the 2 female lunatics from the district of Kee-wa-tin and as you are aware of their very troublesome nature they have much increased my labours, as I am only paid for looking after the insane for Manitoba. I beg to request that you will use your influence in my behalf to get some compensation for my past services and make some arrangements for the future.⁹⁹

Even more important in the care of the mentally ill than the cheap labour provided by women staff members was the free labour gained from inmates. In 1905 the Department of Justice ordered that patients could only be attended to by paid staff. The warden at Manitoba wrote to defend the use of inmate orderlies in the care of the mentally ill. “No guard is fitted for the job and none of them would undertake it,” he reported. The warden detailed the extensive duties of the convict nurse to impress upon the penitentiary inspector the importance of this labour:

In the very case which necessitated the services of convict nurse mentioned in the evidence from which you made the discovery, the bed-pan had to be used as often as 18 times in a single night. And the patient was helpless and delirious. And the bed was soiled from involuntary passages. Such a patient (in all civilized countries) must have constant attention—not by a police officer, but by a nurse; and the time honored custom has been to assign such duties to a fellow convict who may be allowed access to the sick man’s cell, but who is supposed to be under the eye of an officer in charge of the ward. Theoretically, such practice is not up to the mark, but practically, it is as near as we can get without extra expense.¹⁰⁰

At Manitoba Penitentiary in 1905, convict Adelaide Elgin fulfilled the role of nurse during a two-year sentence for larceny. Prior to her conviction, Elgin had been a fixture in the Winnipeg community, providing medical service to the wives of NWMP officers. In the penitentiary, the staff made extensive use of her medical experience. She was entrusted with the full-time care of two mental patients, Josephine Astzman and Maggie Two Flags, for the duration of her sentence. The warden noted that the unpaid services Elgin provided to the penitentiary would have cost the institution hundreds of dollars.¹⁰¹ Thus, the care of the mentally ill in western Canadian penitentiaries was often improvised and irregular. The inconsistencies highlighted by different responses to gendered mental illness illustrate one more element in the problematic role of the penitentiary as surrogate asylum. They also demonstrate the importance of region in shaping responses to prisoners and patients in the far-flung Canadian system. Geographically isolated prisons simply could not offer specialized care for the mentally ill even if medical experts at the time would have seen this care as preferable.

While particular groups were subject to increased marginalization, the mentally ill were also sometimes the target of overbearing control by penitentiary authorities. In this respect, they were similar to incorrigible offenders whom wardens were often reluctant to release without establishing some form of surveillance in coordination with local police forces. An example is George Dunsterville, who was sentenced to five years at Manitoba Penitentiary for larceny in November 1892.¹⁰² Soon after he arrived, the penitentiary surgeon reported to the warden that Dunsterville was suffering from sub-acute mania. Although he continued to work with the regular convicts, the surgeon strongly recommended his removal to the provincial asylum.¹⁰³ Sometime during 1896, Warden William Irvine received communication from a member of Dunsterville’s family in Britain informing him that there was money waiting for Dunsterville in England to support him after his release from the penitentiary. Although he was due to be released from the penitentiary the following year, Irvine decided not to inform Dunsterville of the money waiting on his release due to his deteriorated mental condition. “It would be better that nothing be said to Dunsterville about the money,” Irvine replied to the family, “until it be definitely decided what is to be done with him. With no resources as he now stands, that fact alone will reconcile him to confinement in an asylum for a time, but once I let him know there is money at his command … it [could] do him a great deal of harm.”¹⁰⁴ In a subsequent letter, Irvine restated his desire to keep the money for Dunsterville a secret: “I did not tell him of the money lying for him in England as I believe it will be good for him, for a time, to have to rely entirely on himself for support.”¹⁰⁵ Irvine’s stated concern for Dunsterville’s mental condition was thus recast as insistence that the former convict should prove his worth and mental improvement through the fruits of labour in the institution.

The moral imperative functioned even when a convict moved beyond the grasp of institutional confines. Dunsterville was released from the provincial asylum shortly after his committal, and it can be surmised that he subsequently learned of the warden’s interference. Perhaps expressing his frustration at the machinations set against him, Dunsterville wrote threatening letters to officials at Manitoba Penitentiary. These letters only confirmed to Irvine that his prognosis on Dunsterville’s mental condition was correct. Writing to the inspector of penitentiaries, Irvine included the letters “as a proof that the man is not fit to be at large and that as far as myself and the Surgeon are concerned, we did our duty in having him handed over to the Provincial Authorities as insane.”¹⁰⁶ Dunsterville’s sentence should have expired sometime in 1896, but the diagnosis of his mental condition made him subject to additional incarceration and control beyond the confines of a traditional penitentiary sentence. When he was finally released from Manitoba Penitentiary, he relocated to Ontario, where he met with more misfortune. In October 1899 he was convicted of arson and sentenced to three years at Kingston Penitentiary.¹⁰⁷ Three weeks after his arrival at Kingston, he was transferred to the insane ward and diagnosed by the surgeon there as “incurable.”¹⁰⁸

SEXUALITY

Among the more unique manifestations of medical power in the penitentiary were doctors’ efforts to control and pathologize male sexual activity. The threat of criminal prosecution and disciplinary activity regulated sex between prisoners. Penitentiary surgeons played an important role through the surveillance and restriction of masturbation. In the mid-nineteenth century, masturbation was both pathologized by doctors and condemned in moral terms. Medically, it was believed to contribute to mental and physiological disorders. Robert Darby notes that “a significant stream of medical opinion went further to conclude that almost any seminal emission was damaging, or indeed that sexual excitement could be a symptom of disorder. This amounted to pathologizing of male sexuality itself.”¹⁰⁹ In multiple cases, penitentiary surgeons noted that masturbation caused or contributed to mental illness. This medical proscription of male sexuality was heightened by the moral condemnation associated with masturbation. In 1852 penitentiary inspector Wolfred Nelson, who was also a medical doctor, wrote this directive to prison doctors:

When consulted he should not fail to point out all the circumstances that might militate against the health of his patient, and he should in a most especial manner warn him of the dreadful effects that follow, sooner or later, the baneful and revolting habit of self pollution; a degrading vice that prevails to a frightful extent in all such places of seclusion, a habit that irrecoverably injures the body and stultifies the mind, when persisted in, and is withal the source of the great majority of cases of insanity which are far more frequent in these places than elsewhere.¹¹⁰

Given the debilitating effects that surgeons attributed to masturbation, it is unsurprising that they regarded its prevalence as an inherent danger to the health of prisoners. Thus, uncontrolled sexuality was perceived as a real threat to the productivity of the penitentiary labour force. In The History of Sexuality, Volume 1, Foucault made this link between the moral imperative of labour and Victorian sexuality: “If sex is so rigorously repressed, this is because it is incompatible with a general and intensive work imperative…. At a time when labor capacity was being systematically exploited, how could this capacity be allowed to dissipate itself in pleasurable pursuits, except those—reduced to a minimum—that enabled it to reproduce itself?”¹¹¹ The regulation of sexuality by penitentiary medical officials illustrates what Foucault calls scientia sexualis—the power relation created by scientific discourses that determined sexual deviance.¹¹² In the mid-nineteenth century, this was manifested through the construction of a specific pathology connected to masturbation that doctors called spermatorrhea.

French physician Claude Francois Lallemand wrote an influential treatise on spermatorrhea in the 1840s as part of his three-volume work, Des pertes séminales involontaires. He defined spermatorrhea as the excessive discharge of semen resulting from illicit or excessive sexual activity. Much like nineteenth-century understandings of masturbation, the disease was thought to cause male sufferers anxiety, nervousness, lassitude, impotence, and finally death. In his work on Victorian sexuality, Michael Mason describes understandings of spermatorrhea as distressingly contradictory due to its Catch-22 symptomology and solutions. Symptoms included nocturnal emission, premature ejaculation, or impotence.¹¹³ Lallemand argued that masturbation caused the seminal tract to become irritated, causing additional unwanted seminal emission and excitement, leading to even more masturbation. Yet when doctors advised patients to avoid all sexual activity, emissions and unwanted excitement increased, which merely proved evidence of the disease. While Lallemand’s ideas were widely accepted in the early Victorian era, by the mid-1870s, many doctors were questioning the logic of classifying both impotence and excessive sexuality under the same pathology. Doctors who continued to subscribe to Lallemand’s theory merely argued that spermatorrhea developed in two stages: the first involved overproduction of semen, which caused the acceleration of the disease and led to the second stage, impotence.¹¹⁴

All of this ambiguity and contradiction, combined with the social anxiety surrounding male sexuality, fuelled a booming trade in medical quackery. Spermatorrhea commanded the fears and anxieties of middle-class men who sought to shape their sexuality according to strict Victorian moral codes. Some doctors established a swift trade in treating spermatorrhea, targeting bourgeois men who could afford to seek medical advice for their anxieties. Doctors emphasized the consequences of the disease that Victorian men found especially troubling, including not only the physiological outcomes listed above but also threats to normative masculinity: loss of confidence, lack of control over emotion, nervousness, poor concentration, and an inability to work productively.¹¹⁵ Playing on these anxieties, doctors encouraged their patients to confess their sexual anxieties and sexual habits so that spermatorrhea could be properly diagnosed. The seedier practitioners promoting “cures” for the disease could usually be assured that their patients’ shame would prevent them from questioning the diagnosis or the sale of expensive remedies.

The medical treatment for spermatorrhea was first developed by Lallemand in the 1850s. It involved cauterization of the urethra by depositing nitrate of silver at the prostatic portion of the canal. Doctors used an instrument called a bougie: a long thin metal rod with a ball on its end. Coated in the caustic substance, the instrument was passed down through the urethra.¹¹⁶ The treatment was designed to deaden nerve endings so the patient would become less susceptible to sexual arousal. While most practitioners claimed the procedure was painless, some admitted that the treatment caused violent spasms or that their patients were in visible agony during the application of the bougie. Worse, painful side effects of exposure to the nitrate persisted well after the procedure.¹¹⁷ By the md-1880s, spermatorrhea was being attacked by more reputable surgeons as a scam perpetuated for profit by quacks and pseudo-doctors. For example, in 1882 the Canadian Medical and Surgical Journal reviewed a popular manual on the disease and suggested that true instances of spermatorrhea (defined as the involuntary discharge of seminal fluid) were extraordinarily rare. The review concluded that readers suffering from sexual anxieties would be better served reviewing Sir James Paget’s classical essay on sexual hypochondriasis.¹¹⁸ Respectable surgeons warned that true instances of spermatorrhea had nothing to do with masturbation and that there was no specific pathology associated with an excess of sexual energy.¹¹⁹

In spite of the waning medical belief that spermatorrhea was a legitimate affliction, it continued to be treated in Canadian penitentiaries until the turn of the century. The first appearance of spermatorrhea on a penitentiary medical register was in 1853, but it is difficult to know the exact nature of what penitentiary surgeons were observing when they recorded its appearance. It is possible that spermatorrhea was used as a medical euphemism for masturbation, but this seems unlikely given that doctors also listed instances of masturbation on medical registers as an indicator of declining mental health. For example, in five cases of mental illness at Kingston in 1859, the cause was attributed to masturbation.¹²⁰ This approach to masturbation persisted throughout the 1860s and 1870s, but during this period, patients were also treated specifically for spermatorrhea. At Manitoba Penitentiary, prisoner Alexander Munro was treated for spermatorrhea in January 1878. The remedy listed in the medical records is strikingly similar to the cure offered by quack doctors: he was cauterized with a silver solution. Two weeks after his first treatment, he was treated again. Subsequent to these treatments, Munro was admitted to the penitentiary hospital to address the side effects of his original treatment, including irritable bladder and a painful rash on his penis.¹²¹

Treatment for spermatorrhea was relatively isolated in the years after Confederation, but some prisons treated it with increasing frequency in the last decades of the century. Thirty cases were treated at St. Vincent de Paul in 1894, and twenty-five cases the following year.¹²² Spermatorrhea was treated twenty-three times at Kingston in 1898, and Dorchester surgeon Robert Mitchell noted thirty cases in 1900.¹²³ After the turn of the century, incidences of the disease disappeared from medical registers altogether. The strange surge in cases in the last decade of the century raises several questions to which there are no clear answers. Did doctors seek out sufferers of spermatorrhea, or was the condition raised by the prisoners themselves? Given what we know about how penitentiary medicine worked in this era, patients were usually required to make their complaints directly to penitentiary surgeons if they wanted medical assistance. Yet spermatorrhea was also directly associated with masturbation, which was the subject of ongoing surveillance and regulation by penitentiary staff. One explanation for the surge in cases may have been renewed investment in detecting masturbation by either surgeons or keepers during these years. But none of this answers the question of whether each of these cases was treated with a method similar to that used on Alex Munro at Manitoba Penitentiary. The great irony of such a possibility is that in an effort to forestall lost production on the basis of a moral panic, the treatment for spermatorrhea was likely more debilitating than the effects of unregulated prisoner sexuality.

INTELLECTUAL DISABILITY

Although some penitentiary doctors and wardens found workable solutions to employing the mentally ill, often a greater struggle was to respond to cases of intellectual disability. In 1882 Inspector Moylan alerted the minister of Justice to the increasing presence of “imbecilic and idiotic” prisoners in the federal system. As Jessa Chupik and David Wright argue, during this era, there was only a vague notion of the difference between mental illness and intellectual disability.¹²⁴ These prisoners were difficult to discipline, and Moylan noted that “they are in constant violation of the rules for which it were a cruelty to punish them.”¹²⁵ Five years later, after a visit to Kingston, Moylan identified the same problem, reporting that a “certain class of imbeciles” were misfits at the penitentiary, “not crazy enough to confine them in a criminal lunatic asylum; but … sufficiently gone to render their treatment in a penal establishment extremely difficult and embarrassing.”¹²⁶ Moylan referred to a group that included those labelled by doctors as “idiotic,” “feebleminded,” or “weak-minded.” While “feebleminded” and “weak-minded” individuals were difficult to identify, “idiotic” was a more specific designation. David Wright describes the concept of idiocy in the nineteenth century:

The nineteenth-century term of “idiot” referred to persons who were considered as suffering from mental disability from birth or an early age, or what is now commonly referred to in Britain (though not in North America) as learning disability. It was packed with social, medical, and legal meanings. Commonly the term “idiot” did not stand alone, and was associated with childhood—hence “idiotic and imbecile children”, reflecting, in part, the life-expectancy at the time for those born with severe mental disabilities.¹²⁷

Comments of penitentiary administrators such as those of Inspector Moylan above illustrate the difficulty of properly classifying the intellectually disabled in this era. Anne Digby argues that penitentiary surgeons contributed to assumptions regarding the criminality of “weak-minded” individuals who faced incarceration. She notes that prisons were the focus of the worst kinds of stereotyping of imbecility due to the perceived social threat in the condition. Thus, the driving force for segregation of these individuals often originated with penitentiary surgeons.¹²⁸

Although the medical classification of intellectual disability in this era was not exact, penitentiary officials seemed to have a clear idea that individuals who fell into these categories did not belong in penitentiaries. Their status was informally determined by whether such intellectual disability prevented participation in the routines of daily labour. Penitentiary labour—which could be heavy, demanding, and often unrelenting—probably taxed the abilities of individuals who, prior to institutionalization, may not have been diagnosed in less structured environments in the home or community. Indeed, Angus McLaren suggests that the spread of compulsory education in the twentieth century precipitated the widespread “discovery” of “feeblemindedness” in modern society.¹²⁹ Once these individuals were incarcerated, however, the demands and rigours of penitentiary labour may have helped prison doctors identify and define the characteristics of intellectual disability.

Much like his arguments about the mentally ill, Moylan complained that penitentiaries were becoming convenient repositories for the intellectually disabled. Penitentiary officials blamed magistrates, prosecutors, and municipal and provincial prison authorities for “passing along” these individuals to federal penitentiaries. Moylan argued that the asylum was the only proper place for “such poor creatures” and that an interest in saving money and institutional space caused other medical and legal authorities to allow the intellectually disabled to be sentenced to time in federal penitentiaries.¹³⁰ Moylan stressed the problem in his 1882 annual report: “I would most earnestly beg to call your attention to a class of convicts that is becoming more numerous every year, namely the imbecile and idiotic…. It is the experience of the Wardens, the Surgeons, and other officers who have to deal with such prisoners that, for the most part, they should have been sent rather to the insane asylum.”¹³¹ The continued presence of the intellectually disabled in penitentiaries, like that of the mentally ill, was often premised on class and domestic circumstances that precluded them from finding more appropriate solutions. In the absence of care in the community or the home, these individuals sometimes became pauperized and were often convicted on vagrancy or burglary charges. Even in instances where they had committed no crimes, the intellectually disabled were sometimes criminalized on the authority of local or provincial judges so they could be institutionalized in local gaols or prisons, where they became official wards of the state. When faced with evidence of intellectual disability, some “benevolent” judges even handed out sentences in excess of two years so that such individuals would be sent to federal penitentiaries, which were considered more humane environments than chaotic municipal or provincial prisons.

Penitentiary officials deeply resented this method of handling individuals with intellectual disabilities. In the resulting squabbles among different institutions and legal jurisdictions, disabled individuals were caught in the middle. In one striking example, St. Vincent de Paul Penitentiary received sixteen-year-old Oscar Gagné in 1899, committed by the district magistrate of Trois-Rivières on a four-year sentence for burglary. In his report, under the subtitle “Idiot,” Fortier, the penitentiary surgeon, stated, “His arrival was illustrated by the hilarity of the convicts, the surprise of all the officers and the indignity of the Warden. The unhappy sentenced boy is a poor likeness of a human being, unfavoured by nature, delayed in his mental and physical unfolding, and bearing strong marks of cretinism. His sole appearance provokes a feeling of repulsion engaged with compassion.”¹³² Clearly, doctors understood that individuals like Gagné deserved better than to become the objects of derision and humour. Fortier appealed directly to the federal minister of Justice to intervene in the case. It seemed that no medical or legal authority wanted to assume responsibility for the boy, and the minister replied that he could not secure a pardon from St. Vincent de Paul until an asylum space was found. The situation deteriorated into a bitter squabble among the penitentiary, the district magistrate at Trois-Rivières, and the minister. The warden fumed in his annual report, “His arrival provoked my indignation, because I saw in this event the municipal egotism repulsing in the name of the law, an irresponsible unfortunate.”¹³³ Finally, Gagné was sent back to prison at Trois-Rivières, after which his family secured a spot for him at the Beauport Asylum in Québec.¹³⁴ By condemning local authorities who “passed along” intellectually disabled people to federal penitentiaries, wardens were offering a critique of a larger problem in the legal system that paid scant attention to disability among convicted criminals. Pressing cases such as that of Gagné received attention, but the majority of such prisoners were simply lumped among increasing numbers of the “weak-minded” and “feebleminded.”

As with other medical diagnoses, the classification of intellectual disability in the penitentiary was linked to the imperative of labour. Digby notes that British workhouses favoured the imbecilic and idiotic because they were usually sufficiently able-bodied to participate in daily labour.¹³⁵ This eagerness for able-bodied workers in institutions contrasted with a growing pessimism about the “curative potential” of such inmates. In asylums and prisons, authorities fretted over the inability of medical treatment to effect any change or improvement for years on end. These “incurables” consumed considerable time, manpower, and expense in the institutions charged with their care. Gradually, the idiotic and lunatic patients came to be represented by the “incurable” label, and authorities abandoned the pretense that confinement in the penitentiary could effect improvement or cures. Within Kingston’s insane ward, surgeon O. S. Strange noted in 1897 that “most of those here are incurable.”¹³⁶

The status of intellectually disabled people in penitentiaries was ambiguous because they could not be adapted to either medical models or the prevailing division of labour. In contrast, the status of the mentally ill was clearer. Some individuals could be cured, and thus returned to productive roles. In cases of intellectual disability, doctors and administrators struggled because these were prisoners who existed outside of this division, both within and outside the penitentiary: they would never be regarded as either productive or curable. Disability historians have noted that classical political economy often constructed the disabled in ways that were inaccurate. For example, Marx wrote about those individuals who succumbed to “their incapacity for adaptation, an incapacity which results from a division of labour.”¹³⁷ As Paul Abberly argues, viewing disabled people through the lens of political economy in this way is inadequate because it positions them as only the inversion of able-bodied workers. This reproduces the suggestion that in a utopian economic society, the disabled could be “cured.” Abberly writes, “Marx’s and Engels’ description of capitalism captures the way in which capitalism creates both disabled people and a concept of disability as the negative of the normal worker. It is labour power which workers sell to capitalists for a money-wage, and impaired labour-power that characterises and accounts for the specific character of disablement under capitalism.”¹³⁸ Peter Linebaugh addresses the same issue, emphasizing the ideological fetters of political economy that “chain the understanding of living labour to the wall of capitalist development.”¹³⁹ The great difficulty faced by disabled people in the nineteenth-century penitentiary illustrates how inadequate prison medicine was at the task of understanding and responding to difference. It also makes clear the purchase of ideas about industrial production over the lives of these individuals, who often had no choice over their internment in these institutions.

One conclusion that can be drawn from the history of medicine in Canadian penitentiaries is that evidence about the material condition of incarceration must be weighed carefully against the influence of penitentiary and asylum reform ideologies in the nineteenth century. In the late nineteenth century, Canadian penitentiaries exhibited deep connections to transnational ideologies about labour, punishment, and medicine. However, several factors also undercut these influences. First, the Canadian penitentiary system was indeed far-flung, with each institution operating in an isolated and autonomous fashion throughout the nineteenth century. Inspection was difficult and intermittent because of the vast distances between each penitentiary in the dominion. Second, the penitentiaries themselves were ill-equipped to carry out the ideological projects promoted by reformers. The ad hoc administration of each institution undercut the cohesion of a federal system and disrupted attempts at standardization or regulation of how medical services were delivered across the country.

It was clear to penitentiary officials and administrators that not everyone in the institution could serve as a worker; some prisoners would never fill this role. Not only did this limitation disrupt the practical demands of labour in the penal system, but it called into question the moral imperatives of the penitentiary project itself. These questions were seldom explicitly stated but are evidenced by the abandonment of unproductive prisoners to the margins of penitentiary life when they could not play an economic role. Questions about the possibilities of their moral redemption remained unanswered. However, as part of a program of penitentiary reform, Canadian institutions began to recognize and organize social and medical responses to prisoners who could not meet the demands of the labour regime. Thus, prison medicine greatly expanded between 1867 and 1900, particularly in the medical response to mental illness. Its function evolved from merely policing and maintaining the penitentiary workforce to creating acceptable care for non-labouring prisoners. But in this response, medicine also continued to play a distinct role in the moral regulation of the penitentiary workforce. This history reveals the enduring effect of moral ideas about work and idleness in penitentiary medical practice. A prisoner’s relationship to the labour regime sometimes strongly determined his or her experience of confinement. For the sick, mentally ill, and intellectually disabled, this experience could be one of remarkable neglect. The spectre of these prisoners’ incurability, together with their inability to be productive, subjected them to both moral condemnation and marginalization.