The expression "Cleanliness is akin to Godliness" is more appropriate to-day in our present conception of the aetiology of disease, than it was formerly. Uncleanliness is a condition under which disease germs flourish. In the construction of the Maryland penitentiary the principle of cleanliness was predominant. There are no places for the accumulation of dirt and disease germs, especially dark spaces, which are particularly attractive to the development of certain bacteriological products. The cells are well lighted and constructed so they can be thoroughly cleansed at regular intervals. The excrements are not allowed to remain in their depository; each apartment is supplied with running water, and the prisoners are encouraged to bathe daily, beside being compelled to take a shower bath at stated periods. In fact, "Cleanliness" is the watchword of the management.

We have found the prisoner's constitution vulnerable to all manner of diseases, and any let up in vigilance on the part of the authorities might lead to serious results. As an example allow me to relate an incident that occurred in the Maryland penitentiary on the advent of the present administration. It was found that mumps had visited the institution every spring, laying up fifty to 100 individuals. It was our endeavor to find the source of the epidemic. Examining carefully the records it was found that every year the trouble had started in the stone shop. Imagining that the cause was a local one the stone shop was thoroughly renovated. The next spring mumps appeared in the same shop. It then being evident that the trouble came from the outside, the materials brought to the stone shop were examined. We found that the rags supplied by the contractor to rub stone, were gathered off the streets. The authorities ordered that said rags be thoroughly boiled before entering the prison. For the past eight years we have been perfectly free from this disease.

In connection with this incident I desire to call your attention to the liability of the prisoner to contract mumps, and the danger of the prison authorities overlooking the source of infection. As we all know, mumps is generally considered a child's disease. Yet in the Maryland penitentiary from 50 to 100 adults annually contracted this disease, superinduced by the use of outside or extraneous substances incidental to their employment. This gives us a slight idea how liable the prisoner is to infection when he comes in contact with diseases. Outside the stone rubber uses the

same rags. Are they boiled for him? No. Yet the free stone rubber does not contract mumps in the performance of his work. The danger of the prison authorities overlooking sources of infection is very great, especially in an institution where the industries. are various and the implements and goods used are many Each and every thing should be scrutinized to ascertain whether it can possibly be the source of infection. However diligent we may be, infectious or contagious diseases at times appear in our prisons. These diseases are thoroughly isolated as soon as diagnosis can possibly be made. The patient is entirely separated from the rest of the institution, and after recovery everything that has come in contact with him is destroyed and the room he has occupied fumigated and renovated. Erysipelas is unfortunately too common a disease to penal institutions. It is begotten by the utilization of infectious substances carried in the institution. By constantly being on the alert we keep the number of cases very small; the least irritation of the skin being subjected to the most rigid examination. Tuberculosis, a disease recognized as a malady capable of being carried from one individual to another, is the nightmare of all prison physicians, especially where the negro predominates; every acute disease tending to end in some form of tubercular trouble. Though we cannot refuse to accept tubercular patients as most of the outside hospitals do, we isolate them and destroy everything they come in contact with, especially the sputa, so that they will not be a menace to their fellow prisoner. The same can be said of typhoid fever. We endeavor to protect our water supply, which is the source of infection and the excrement are rendered harmless before leaving the institution, thereby not only protecting the institution, but also the outside. community from this dreadful scourge. Vaccination is compulsory, every prisoner being thoroughly protected against smallpox. We are constantly on the alert for trauchoma, every case being isolated and treated on its reception to the institution. What has been said about trauchoma applies to syphilis.

I will not lengthen the list of diseases we are constantly guarding against, the foregoing being the most prominent. In calling your attention to these diseases, I desire to bring out the point that we, as prison physicians, are constantly on the watch, protecting from some contagious or infectious disease, the unfortunates under us, our chance of success being greater in the

prisoner than in the free man, as the prisoner is absolutely under our control, while the free man is not. Then is the tendency to contract contagious or infectious diseases greater in the prisoner than in the free man? Having found that the previous history of the prisoner tends to decrease the power of resistance to disease, as also do the loss of liberty, of outside exercise and friends and relatives, and having found that the prisoner's regular life, correction of bad traits in character and constitution, etc., tends to rehabilitate this resistent power and having also found that as far as medical science permits, the diseases themselves are kept away from the prisoner, the answer to the title of this paper can only be that the tendency to contract infectious or contagious diseases is not as great in the prisoner as it is in the free man. Therefore, though our prisoners if left unprotected like the free man would fall easy victims to contagious or infectious diseases, protected, the tendency to contract these diseases, is not as great as it is in the not as well protected free man.

"Let us, then, be up and doing
With a heart for any fate,
Still achieving, still pursuing,
Learn to labor and to wait."

As physicians, as prison authorities, let us be up and doing. These poor unfortunates under our care need every safeguard thrown around them that science gives us, and when the time. comes that ends all things may He who presides over the destiny of all, find that we have acquitted ourselves acceptably of our stewardship.

MENTAL AND PHYSICAL EFFECT OF RECREATION AND PRIVILEGES.

BY JOHN T. BIRD, M. D., PHYSICIAN OF THE IONIA

REFORMATORY, MICHIGAN.

In order to fully appreciate the effect, mentally and physically, of recreation and privileges upon the inmates of our penal institutions, two factors must be given due consideration:

First, the condition of the men, mentally and physically, when they are received. Second, the condition of the inmates of prison and reformatory at a time when such privileges as are now enjoyed were unknown, and, indeed, seemed about as remote as the dawn of the millennium; for until recently the only recreation allowed the men was ten hours' work each day, and marching to and from their cells and the shops; and, to aid in muscular development compelling them to carry a ball and chain; discipline being maintained by the aid of the cat-o'-nine tails, hanging by the thumbs, the pump, paddle and dungeon. According to the records. of penal institutions, about 50% to 70% of the men when admitted are more or less physical wrecks as a result of heredity, vicious habits, long continued dissipation, improper food, and confinement in unsanitary jails; and not infrequently their mentality has been perceptibly impaired by these conditions, to which must be added their anxiety as to what fate has in store for them, an anxiety relieved only by the verdict of the jury and the edict of the judge.

Under the old system their condition, with the one exception, that they were no longer uncertain as to the length of time they must remain in prison, was not an improvement in their environment before they were removed from jail to prison or reformatory. Rather it was worse, for while they were uncertain there remained a faint hope. After sentence has been passed it was one ceaseless grind, with nothing to give them strong and well exercised bodies, ready to be put at the shortest notice at such labor as strong bodies are capable of and to do it well.

To meet the varying conditions which I have briefly outlined is the problem which has confronted humanitarians and philanthropists.

To better a man's moral nature it is necessary, first, to effect a radical change in his physical condition. The question of recreation, mental and physical, so far as it relates to prison reform, is yet in its infancy. Indeed, its importance is too little considered by the majority of those who have to do with the training of the young outside of the reformatory and prison. It is strange, then, that as a factor in the prevention and cure of crime, which, it seems to me, is the only object for which these penal and reformatory institutions are maintained, that recreation should have received so little attention in the past, or that it should come to the foreground now as a potent factor in the elimination of the cause of crime, as well as the one factor which solves the question of prison discipline.

That recreation for and privileges granted to the inmates of the Michigan Reformatory practically controls the discipline therein is no longer a question. It has long since passed the experimental stage, and is now an indisputable fact. It is imperative that the first steps in reformatory or correctional treatment shall be such as will put the prisoner in as perfect physical condition as possible. Men physically afflicted are hardly reached by reformatory influences and satisfactory results can be attained only when their ills have been cured or relieved. We have not done all, although much, toward the attainment of this object, by making a practical application of the hackneyed phrase, “Cleanliness is next to Godliness". The salutary (and sanitary) effect of soap and water cannot be denied, but these, supplemented by allopathic doses of everything known in the Materia Medica can not bring about the desirable result-"a sound mind in a sound body"-if the objects of our solicitude and care are, per force, compelled to toil incessantly in a treadmill, with no relief for strained muscles or nerves. There is nothing more certain than this. We must have changes in diet, employment and in methods. of thinking and acting to allow development both mental and physical and prevent degeneration. Without these to help him, the physician's office must still be the one most frequently sought and that official the one most over-worked, while the list of excused men shows no perceptible diminution.

Work in itself not hard becomes so by being pressed day after day with unvarying, unrelenting sameness, with not even the consciousness of freedom to take from its tediousness. For men who