Damnation Island: Poor, Sick, Mad & Criminal In 19th-Century New York

Author: Stacy Horn
Publisher: Chapel Hill, NC: Algonquin Books of Chapel Hill, 2018. 304p.
Reviewer: Sara Deffendoll | January 2019

Stacy Horn presents an account of New York’s most vulnerable populations from the early 1800s to 1895 in Damnation Island: Poor, Sick, Mad & Criminal in 19th– Century New York. Occupying a two-mile strip in the East River, Blackwell’s Island was envisioned as a retreat for the “sick, mad, and punishable” who would be classified by affliction or crime, housed in progressive institutions, controlled, and reformed. These ideals were, however, abandoned almost immediately as the commissioners sought to save as much money as possible and refused to listen to the individuals who actually worked in or were in charge of the institutions. In all the institutions on the island, disease was common, temperatures were freezing in the winter and sweltering in the summer, abuse by staff and other patients or inmates was common, and patients and inmates were often confined to their rooms, restrained, or crudely medicated to keep them manageable. Many of the patients and inmates understood that riding the boat to Blackwell’s was often a one-way trip.

The prologue offers an overview of why Blackwell’s was needed and the reasons for choosing the intervention methods that created its ideal treatment philosophy. The landscape of Blackwell’s was described as “lush, pastoral” ground “thick with fruit trees,” making it easy to see why early reformers had high hopes for the therapeutic possibilities on Blackwell’s that were, unfortunately, not realized.

Section One describes the Lunatic Asylum constructed in 1839 to house the “lunatic poor.” Mental illness was once thought to be caused by a lack of faith or demonic possession and was treated with bleeding, starvation, confinement, and strait jackets. “Moral treatment” was the philosophy presented by the creators of Blackwell’s. Moral treatment involves treating patients more humanely with therapy based on the patient’s emotional and spiritual needs. Patients were to receive exercise, self-esteem building, and amusements. But these ideals were quickly abandoned for two main reasons: the demand was underestimated from the beginning resulting in immediate and continued overcrowding, and the lack of public support. Housing all the poor, sick, and imprisoned together, under the same management, reinforced the stereotypes that the mentally ill were dangerous and that the poor were criminals. These stereotypes were further reinforced as inmates were used as nurses and orderlies in the other institutions on Blackwell’s, and by the practice of housing the poor, sick, and insane together due to overcrowding at all of the institutions.

The average citizen of that time believed there were two types of poor: the worthy poor deserving of charity, and the unworthy poor who were deemed morally inferior. The worthy poor included orphans, widows, the insane, the sick or wounded, the crippled, and the old. The unworthy poor consisted of everyone else. Society’s attitudes toward the poor and mentally ill were influenced by the aforementioned stereotypes. Much like today, early social welfare opponents believed that “if everyone played by the rules the system would work” (p. 49). Sadly, that has rarely been the case. There were several vocal supporters of reform who sought to improve the lives of the mentally ill and poor housed on Blackwell’s. Most notable was Reverend French, who spent over 20 years, until his death in 1895, advocating for improved conditions. He was a firm believer in caring for a person’s body as well as their soul, and took steps to improve the conditions in the institutions. He took great pride in establishing and expanding libraries in each institution, in providing food and clothes to patients, and in providing church services.

Others also tried to improve the conditions in the Asylum and the other institutions, usually with disappointing results. Moses Ranney, working as the resident physician at the Asylum, often opposed policies created by the commissioners and, in 1848, invited Thomas Kirkbride to tour the asylum. Kirkbride was an authority on moral treatment and was a founding member of the Association of Medical Superintendents of American Institutions for the Insane. Dr. Ralph Parsons spoke out against the practice of housing patients together. John D. Townsend was an attorney who became famous for representing patients wrongfully confined in Asylums, including for example Sister Mary Stanislaus. Dr. William Strew replaced Dr. Parsons and made several improvements to the buildings and grounds on Blackwell’s. A journalist, Elizabeth Cochran, had herself committed, and then reported on the conditions of Blackwell’s under the name Nellie Bly. Her reporting resulted in increased funding, which went to building improvements and more clothes for patients.

The Workhouse is covered in Section Two of the book. Built in 1852, it housed men and women convicted of minor crimes and sentenced to less than one year, with most sentences being less than ten days. The creation of the Workhouse resulted in the able-bodied poor being turned away from the Almshouse; their only option was then to voluntarily commit themselves to the Workhouse. Conditions in the Workhouse were kept intentionally difficult to discourage laziness. The Workhouse also failed almost immediately because the space needed was greatly underestimated. The large numbers and short sentences meant that very little reform occurred. The mismanagement and greed of the men in charge also caused problems as Horn points out, “dispensing punishment and charity at the same time is a balancing act that is nearly impossible to achieve…when other needs, like economy, trump everything else, it is impossible” (p. 96). Reformers also tried to eliminate aid to the poor outside of institutions so they would not “expect more handouts” (p. 111). Reverend Stocking became the superintendent of the Workhouse in 1886 and changed how inmates were released. Previously, inmates were released before dinnertime on the last ferry of the day. Stocking changed these procedures so that inmates were released on the first ferry of the day and given enough food for the day.

Section Three covers the Almshouse built in 1848 to house the poor and disabled under voluntary commitments. The Almshouse was constantly overcrowded and, in 1875, a new policy was enacted calling for the Almshouse to be made unpleasant, in an attempt to discourage people from being poor “intentionally.” The Medical Board of Visitors to the Charitable Institutions of the City compelled the commissioners running Blackwell’s to provide the poor with more food, warmer clothes, and better hygiene facilities. These recommendations were ignored in favor of lowering costs.

Blackwell’s hospitals are covered in Section Four. Known under several names, the hospital facilities evolved and expanded as the needs grew. The first hospital, Penitentiary Hospital, built in 1832, consisted of the top floor of the penitentiary. In order to be admitted, patients had to first be inmates of the Penitentiary, which created situations were individuals would have to be voluntarily incarcerated to gain access to treatment. A separate building was constructed between 1847 and 1853. It was renamed Island Hospital after the imprisonment requirement for admittance was lifted. In 1866, the name was again changed with the creation of a Medical Board on Blackwell’s. Now called Charity Hospital, expansions occurred in the form of a Hospital for Incurables in 1867, an Asylum for the Indigent Blind in 1867, and a Maternity Ward in 1877. A training school for nurses was established in 1875, improving the quality of the nurses employed by the various institutions. New medical practices, such as antiseptics and sterile surgery, were pioneered on Blackwell’s. In 1892, the name was changed to City Hospital.

Section Five describes the Penitentiary. Finished in 1832, the Penitentiary housed more serious criminals with sentences ranging from a few months to a few years. The Penitentiary was the first institution built, and it too was quickly overcrowded. Horn provides accounts of such individual high-profile inmates as Adelaide Irving, William H. Ramscar, and Reverend Edward Cowley.  A short epilogue then covers important events on Blackwell’s after 1895. These include the acquisition and building of Riker’s Island in 1936, the tearing down of the Penitentiary in 1936, and the tearing down of the Workhouse in 1937.

Stacy Horn provides a thoroughly researched and expertly presented account of the mistreatment and mismanagement of society’s most vulnerable populations on New York’s Blackwell’s Island during the 1800s. The only criticism is the order in which the institutions were presented. Instead of presenting the sections in chronological order by the year built, they are presented based on, it seems, which institutions have the most available history. This creates situations where institutions are referenced before they are presented, and consequently creates a confusing timeline. Regardless, criminal justice students and academics as well as modern day prison reformers and healthcare reformers would benefit from knowing the history presented in Damnation Island.

Sara Deffendoll, PhD

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