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THE TREASURER IN ACCOUNT WITH RESERVOIR FUND FOR THE FISCAL YEAR

ENDING JUNE 30, 1882.

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THE TREASURER IN ACCOUNT WITH FUND FOR INCLOSING BAY WINDOWS AND FOR STOVES IN SAME, FOR THE FISCAL YEAR ENDING JUNE 30, 1882.

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THE TREASURER IN ACCOUNT WITH FUND FOR WATER TANKS FOR THE

FISCAL YEAR ENDING JUNE 30, 1882.

Receipts. September, 1881, received from the State.

$1,000 00

Expenditures. Paid out on order of the Board of Trustees

$1,000 00

THE TREASURER IN ACCOUNT WITH THE FUND FOR MAKING ELEVATOR

WAYS FIRE PROOF FOR THE FISCAL YEAR ENDING JUNE 30, 1882.

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RESIDENT PHYSICIAN'S REPORT.

5 54 1 83 9 55 6 81 34 48 10 35 16 08 16 86

96 97 0 71

To the Board of Trustees of the Napa State Asylum for the Insane :

19 18

19 18

OWS 82.

GENTLEMEN: In Appendix "A" you will find my report for the year ending with June 30, 1881, submitted to you at the July meeting of your Honorable Board in that year.

In accordance with the requirements of law, custom, and propriety, it ag becomes my duty to submit to you my report for the year ending with June 30, 1882, and to call your attention to such matters, and to make such suggestions, as may seem needful for the best interests of the institution confided to our care.

The following summary exhibits the number of patients in the Asyluin June 30, 1881, number admitted, number under care and treatment, number discharged and died during the year, and the number remaining in the Asylum June 30, 1882:

36 60 39 00 38 86 39 58

3 00 26 21 25 00 34 25 17 50

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Number of patients June 30, 1881..
Number admitted during the year.
Returned escapes

99 87

Number under care and treatment.

13

Number discharged recovered.
Number discharged improved.
Number discharged unimproved
Number discharged not insane.
Number died.

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Number discharged and died ---

Number remaining June 30, 1882

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51 12 36 01

22 87

By a comparison of this table with the corresponding one for the previous year (Appendix A) it will be seen that the admissions were twenty less, the discharges thirty-one in excess, and the death rate two

per cent. less than in that year. Of course there are many circum40 stances influencing the death rate of all asylums, and especially the

character of the diseases with which those committed are afflicted. Last year there were but twelve deaths from paralysis and five from consumption; the previous year twenty-two succumbed to paralysis and nine to consumption. Last year we were blessed with immunity

from suicides, while the year previous it was our misfortune to have 50 00 to record three deaths from this cause.

Of those discharged 125 were supposed to be cured, and 147 improved. Thus it will be seen that the percentage of recoveries grow less, and of those discharged as improved become greater each year. The two combined make a percentage of 54.13 on admissions,

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and is, I believe, about equal to the discharges, under their two heads, to that of the best institutions in the country.

The smaller number under the head of cured, in my reports, only goes to show that I have less faith in the permanent curability of insanity than most persons engaged in the specialty, and less than I had in the earlier years of my studies and investigations upon this subject.

It is true that a larger majority of those discharged “as improved" appear to be well; indeed, so far as one can judge froin the acts, conversation and appearance of these persons at the time of their discharge they are well, but from some things connected with their manner, history or previous habits, I believed there would be recurrence of their maladies; and for this reason have deemed it more prudent to put them on the improved list instead of pronouncing them “cured and restored to reason. Those discharged as

ed as “unimproved” were only six, and were removed by their families or friends, either to be sent to their distant homes or kept in the State.

Those discharged (8) as "not insane" were mostly cases of acute alcoholism, who are always sane when sober, and were kept here only a month or two.

Of the whole number (1,172) 1,140 are in the Asylum and 32 are absent on leave, with their families, with the view to test their ability to get along without confinement in an asylum. These persons are usually returned by those having them in charge within thirty or sixty days, or a discharge is forwarded to them. I believe the customn of letting many of them leave on trial a good one, as they are not well enough to be discharged when taken out, and yet inany of them continue to iinprove while at home and never return to the Asylum

Of the 543 patients received during the year, 207 were born in this country, 322 in foreign countries, and the nativity of 14 were unknown. It will thus be seen that while the residents of this State of foreign birth constitute but one third the population, they furnish three fifths of the inmates of our Asylums; and I am still of the opinion, previously expressed in my reports, that the change from the vegetable diet, to which they had been accustomed in their native lands, to excessive indulgence in animal food, after arriving in this country, will account for their greater susceptibility to derangement of the intellectual faculties. It is the only cause that is applicable to them and not to the natives of this country. It is at least a satisfactory reason to my mind, and if not correct I would be glad to learn the real cause. The susceptibility of the foreign born to attacks of insanity is a fact not applicable alone to California, but to all the States of the Union.

It may be that many of this unsettled and vitiated class are encouraged to leave their native lands, and are aided in coming to this “asylum for the oppressed and afflicted of all the world and the rest of mankind.". But, whatever be the cause, they must be taken care of, and suitable places provided for their maintenance. At this time, one person out of every 383 of the entire population is insane, and if the ratio of increase continues as it has done during the last twenty years one third of the population will be insane in the year of our Lord 2000. Nor must it be overlooked that at least 95 per cent. of these people come from the adults of the State.

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ANNUAL INCREASE.

In my report of 1880 I said:

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The average annual increase, since the Asylum was opened, has been 1674. The increase during the last year—125—being the smallest. These, added to an already crowded Asylum, has sorely taxed our ingenuity, and has rendered proper classification more impossible than ever. The attics now being fitted up will, ere long, afford accommodations for nearly 200 patients ; but as more than half of this space will be occupied before the close of the fiscal year ending June 30th, 1880, the question again arises as to what is to be done with the increase for the next two years, which no reasonable estimate can place at less than 250. To my mind the remedy is perfectly clear. Steps should be taken and appropriations made by the Legislature, soon to convene, for the construction of another Asylum, to be located in the First or Fourth Congressional District. Its pressing demands will be required long before it can possibly be completed, and we had as well, and better, meet the issue now as hereafter. There is nothing more certain in the future than that there will be not less than 1,200 patients in this Asylum at the end of the fiscal year ending June 30th, 1883. This will be just double the number that this Asylum was originally intended to accommodate, and many more than should ever be packed beneath one roof, and to store these away, even with tolerable comfort, it will, in addition to the sum necessary to defray the ordinary expenses of the Asylum, require an appropriation sufficient to carry out the recommendations in your last biennial report.

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As already stated, the number had reached 1,172 on the first of July, and it now seems positively certain that it will reach 1,200 before the Legislature convenes in January next.

The $18,000 appropriated by the last Legislature has been expended in fitting up attics and making partitions in some of the wards, whereby we are enabled to accommodate 126 additional patients. This space, with the exception of one ward for 40 patients on the female side of the Asylum, has already been occupied. Hence we are as much, if not more, pressed for room than when the appropriation was made.

The power of expansion in this Asylum has at last come to an end, except to a limited extent, and that in two, possibly three, directions only.

First-Again quoting from my report of 1880:

INFIRMARIES.

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The construction of two infirmaries, one for each sex, in which the sick and bed-ridden patients can be made more comfortable, and be better treated than it is possible amid the noise and confusion of the wards as at present arranged, is of the first importance.

In my report to Governor Haight, in 1871, after visiting the best asylums in the world, I recommended infirmaries as necessary adjuncts to any asylum that might be built, and at my suggestion, they were made a part of the plan for this Asylum, but unfortunately, were never built. I again renewed the recommendation in my last report to your Honorable Board, and will continue to do so in each succeeding report, until the desired end shall have been accomplished.

Dr. John P. Gray, Superintendent of the State Lunatic Asylum at Utica, New York, in his last report to the Board of Managers of that asylum, says: “I would call your attention to the importanee of building a small wing, or hospital, for the special care of the more feeble and sick class of patients. Our arrangements for taking care of the sick, though probably as good as in other similar institutions, must be regarded as very imperfeet. All sick patients should be immediately removed from the wards to a hospital department, properly arranged, when every attention demanded by their conditions could be bestowed; where the physician could visit them frequently through the day, and in the night if necessary, without disturbing others; where those very ill could be visited, and if advisable, nursed by their friends. The experience of the great benefit of the small hospital wing for women makes the need of the one for the inen seem more urgent.”

The estimated cost for building, equipping, and finishing these infirmaries, for thirty patients each, is $10,000 for the two, or $750 for each patient to be accommodated.

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SecondThe construction of residences for the Medical Officers and their families would vacate the rooms now occupied by them in the center building of the Asylum. One of these floors could

be used to great advantage by the Seamstress and the patients who assist her, and would constitute a sewing-room ward. At present, the sewing-room is in the ward where the laundry women sleep and eat, and it is too small for both; the patients have to be daily brought from the other wards in the morning and returned in the evening, making it inconvenient and unsatisfactory. The other floor coud be used to advantage for the better class of the convalescent patients. These wards would accommodate thirty patients each, which, added to the two infirmaries, would enable us to take care of 120 patients more, or about 1,300 in all. This, it seems to me, is as far as prudence and sound discretion will permit us to go, and certainly as far as I can advise those in authority to go.

As will be seen from the continuation of Table I, Appendix "B" that of the 543 patients admitted during the year, 259 were from San Francisco alone. This annual contribution from one great metropolis is sufficient to fill any Asylum that can be built in a short time, and every consideration of convenience and economy would dictate the establishment of a hospital on the Peninsula for their accommodation, and whatever my opinion is worth, it is given with earnestness and emphasis for the establishment of an Asylum there. It will do more to relieve the pressure upon this Asylum than any other plan that could be adopted; and as this pressure must be relieved by some means or other, by the next Legislature, I will suggest the third direction in which it is possible to extend the capacity of this institution, viz: by the construction of plain, substantial, but cheap brick buildings to accommodate fifty or sixty patients each, for the quiet, harmless, and helpless cases of mental unsoundness. These buildings could be located on the Coombs or Spencer tracts, recently purchased by the State for the use of this Asylum. There are good sites for building purposes on either place, whether the buildings be constructed in groups, with a central kitchen and dining rooins, as in the pavilion plan, or as separate and distinct structures. At least three buildings for fifty patients each would have to be constructed every year to accommodate the inevitable increase of this unfortunate class of helpless and dependent people. Should this mode of relief be adopted, no additional Board of Managers would be required, and only one additional physician, which would make it by far the most economical plan that could be adopted. Yet I do not consider it the best method, and would only recommend it in the event of a failure to establish another independent Asylum on the Peninsula, near San Francisco.

SITTING-ROOMS.

Since the sitting-rooms in ten of the wards were fitted up and furnished with stoves, a marked difference in the comfort of the patients is observable. It is one of the most gratifying improvements that has yet been made.

ELEVATORS.

Four of the food elevator-ways have been encased with heavy sheet iron, and are now considered fire-proof, which has relieved us of one of the greatest sources of anxiety. The appropriation of $1,250 was not sufficient to reach the other, and only remaining elevator-way.

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