Riis visits a penitentiary, where the “toughs” described in Chapter 19 often appear as repeat offenders. Next, he describes a workhouse filled with “broken-down hordes from the dives, the lodging-houses, and the “tramps’” nests,” where “patrons drift back periodically” and “take their chances on the island when there is no escape from the alternative of work in the city” (256-57). At an almshouse, Riis finds impoverished old women and men, many of whom “have been sent to the almshouse to die by their heartless children” (258). None of these scenes, however, appear to Riis as “[p]itiful” as the “hundred upon hundreds” of women he observes at Blackwell’s Island psychiatric facility, “taking their afternoon walk” while tied to a wagon because they have “suicidal mania” and “cannot be trusted at large for a moment with the river in sight” (259). Riis does not attempt to diagnose the mental health conditions these women exhibit, but he does blame poverty, claiming that “these are all of the poor” (260). Having observed and described the bleakest of human existences, Riis concludes Chapter 22 with hard statistics: “the first cost of maintaining our standing army of paupers, criminals, and sick poor, by direct taxation, was last year $7,156,112.