The California asylums have done their work quietly and well. They have had about the average rate of cures, when compared with similar institutions in other States, and their death-rate has not been above the average. The patients have been comfortably cared for, due efforts have made for their cure, and the institutions have been honestly maintained. They have been free from conflagration or serious calamities, have not been subject to epidemic diseases, and have at all times been a credit to the State. They have the confidence of the people, and, though not free from some criticism, are generally acknowledged to be doing good work, and to be legitimately and honestly managed. Up to June 30, 1898, there have been received in the hospitals 28,359 cases, and, taking the yearly count of the number treated, there have been 107,732 cases under treatment.

In April, 1897, a uniform law for all State asylums was put into operation. Asylums became State hospitals, and the Lunacy Commission was given a confirmatory power over the actions of the State hospital management. The purpose of the new lunacy law and its active agent, the Commission, is good, and its results are bound to be beneficial when Hospitals and Commission work with that harmonious unanimity of purpose which should be the aim of all bodies engaged in charitable work at the expense of the State. Any Commission endeavoring to change existing methods and to limit the powers of those previously in full authority will doubtless be handicapped to some extent. The Commission, having no patronage to dispense, may well believe that the desired concert of action will gradually be brought about and with good results. This brief history of the creation, population, and expense of the State hospitals brings us up to the present point, where consideration may be given to their operations for the two years ending June 30, 1898.

EXPENSES OF MAINTAINING THE STATE HOSPITALS.

One object of the creation of the State Commission in Lunacy was the belief that it might bring about economy in the management of the five State hospitals.

In considering the subject of cutting down the expense of any undertaking, the first point is to ascertain in what particular branch of the business extravagance obtains.

In order that we may ascertain the manner in which the appropriations are expended, let us consider the various sources of expense in maintaining one patient for one day, one year, and for maintaining all the patients for one year, in any of the State hospitals.

Taking the hospital located at Stockton, as the oldest and one of the most economically managed hospitals, it is found that it cost for the year ending June 30, 1898, to pay officers and employés, to feed patients

and all others, to heat and light the building, to provide clothing, furniture, and bedding, to make repairs, to supply water and medicines, and to utilize and beautify the farm and grounds, at the rate of $126 81 a year for each patient, or a total of $196,291 52 for all the patients.

Taking up the various principal sources of expense incurred in caring for one patient a day, or a year, we find:

First-That it costs for physicians, attendants, mechanics, cooks, and other help the sum of 17.1 cents for one day, or $62 57 a year. These amounts are the daily and yearly per capita for salaries and wages, the total for all the patients for a year being $93,383 60.

Second-To feed this one patient a day costs 9.2 cents; for a year the cost is $33 64; the total for all the patients a year being $51,703 45. Taking up these two items, payroll and food, as the two principal items of expense, let us consider them a moment with a view of ascertaining if the cost is unduly large and deserving of pruning.

PAYROLL.

In a total yearly cost of $126 81, it would seem at first glance that $62 57 is a large proportion to be paid out for salaries and wages, but if considered in comparison with the sums expended for the same purpose in Eastern institutions it will be found. that our proportion of employés to patients is very small. As a matter of fact, we care for the same number of patients with about half the number of employés they do in Eastern institutions.

It is true that in California higher wages are generally paid, but it is believed that our hospitals get a better grade of help, who, expecting to make hospital work their life vocation and thus having an incentive, put forth their best efforts to do good work and thus hold their positions.

FOOD.*

It is not likely that any one would care to assert that the expense of feeding our patients should be cut down-a fraction over 9 cents a day, or $33 64 a year, for each patient, is not high, and instead of seeking to reduce it in cost, it might be added to with some advantage. Lest the idea might become prevalent that at such a small expense they cannot be fed enough, it can be safely asserted that the patients are fed abundantly, that the food is of good quality, that there is meat, bread, butter, potatoes, etc., with fresh, dried, and canned fruits, and vegetables in abundance. As a matter of fact, each person has provided for him at least 3 pounds of food daily.

*NOTE.-The cost of food, expressed above, is based only on the supplies purchased. The food products of farm, garden, and dairy will add from 1% to 21⁄2 cents to the above cost of food.

The one way in which it is possible to reduce still further the cost of food is by increasing the products of farm, garden, and dairy. Of milk we have not enough now, and our dairies should be enlarged and more land added for their maintenance.

While the food provided is abundant in quantity and of good quality, sufficient for health, it might be given a greater variety with advantage. Possibly in improving the diet there would be no distinct advantage other than the promotion of comfort and satisfaction, but if any item of expense connected with the hospitals is worthy of increase it is food.

In this connection it may be stated that out of fifty-two State asylums in twenty-four different States there is but one that feeds its patients as cheaply as the lowest of our hospitals, and not to exceed four that are as low as the highest of ours.

CLOTHING.

Of the other large sources of expense, clothing may need some attention. It costs to provide clothing, shoes, dry goods, and bed linen for each patient one day, one cent and eight mills; for one year, $6.80; for all the patients one year, $10,547 69.

The clothing provided for the male patients, while warm, comfortable, and durable, is not sightly and cannot be reduced in cost with justice to the patients. As a matter of fact, it is being gradually improved, and there is room for still further improvement. The dry goods, bed linen, etc., are of good quality, and answer all the purposes well.

FUEL AND LIGHT.

Another source of considerable expense is fuel and light, in which is included, of course, steam for heating the wards, cooking and laundry work.

The Stockton State Hospital, having a large supply of natural gas from its own wells, is enabled to produce heat, power, and light at about half the cost of the other hospitals.

The daily cost of these items for one patient at Stockton is one cent and four mills; the yearly cost $5 11, and the total yearly cost for all is $7,856 77. The other hospitals cost $10 80 to $16 77 per patient per

year.

Two of the hospitals are lighted by coal gas, manufactured on the premises, at a cost of $1 15 per thousand feet. One uses gas made from gasoline, and one, the Southern California State Hospital, purchases electric light at a cost of $200 per month.

Heating and ventilation being intimately connected, it may be safely said that there is but one of our State hospitals that has a thoroughly efficient system of heating and ventilation, and that is the

Southern California State Hospital, which has a system of forced ventilation that is excellent. The rest of the institutions rely on natural ventilation, which certainly does not always accomplish the desired results in many of the crowded wards and dark pantries. The heating system in many of our hospitals has to be supplemented by stoves.

An improvement in the heating and ventilation system is more generally needed in our hospitals than any one single improvement, and while it cannot all be done at once, a start should be made on one hospital and continued from time to time until all are properly equipped in this direction.

For the purposes of comparison it may be stated that out of forty-five asylums located in twenty-one different States, there are but nine whose yearly per capita cost for fuel is lower than the highest of our State hospitals-the other thirty-six asylums compared being higher than ours in all cases, a number of them being twice as high.

REPAIRS.

Ordinary repairs may be said to cover a multitude of expenditures, from patching up an old pipe to putting in a new system of pipes, or from repairing the roof of an old barn to building a new barn from an old one and still calling it repairs. It is undoubted, though, that constant repairs to pipe systems, machinery, sewer system, buildings, and appurtenances are necessary for the preservation of the State's property. The daily per capita cost for this purpose is one cent and seven mills; the yearly per capita cost, $6 49, and the total yearly cost, $9,974 17.

This item of expense might be reduced somewhat by confining the expenditure strictly to repairs and having extensions or additions charged against permanent improvements and estimated on in advance in such detail that it may be clearly known what was intended before the expenditure is authorized.

In discussing the various items of expense, the remarks, while using the Stockton State Hospital as a basis, are general, as they refer to all the other State hospitals as well.

In order that the cost may be shown in the same manner for all the hospitals, the following tables for the forty-eighth and forty-ninth fiscal years are submitted. The tables show the total amount expended for each hospital, the daily and yearly per capita on the moneys expended, and the various sources of expense:

Total Cost of the Five State Hospitals, Together With the Average Number of Patients and Stock on Hand, for the Year Ending June 30, 1897.

Total Cost of the Five State Hospitals, Together With the Average Number of Patients and Stock on Hand, for the Year Ending June 30, 1898.

The total expenditures of the five State hospitals for the year ending June 30, 1897, based on support, payroll, and contingent fund, was $713,271 55, and during the same period 4,742 patients were taken

care of.

The total expenditures of the five State hospitals for the year ending June 30, 1898, based on support, payroll, and contingent fund, was $708,643 23, while during the same period 4,909 patients were cared.

for.

It will be seen from the above figures that the expenditures for the year ending June 30, 1898, were $4,628 32 less than for the previous year, while at the same time 167 patients more were taken care of. The cost of caring for this increase of patients was $25,471 98, which, added to the $4,628 32, makes a total saving of $30,100 30.

The expenditures of the five State hospitals for the year ending June 30, 1897, based on support and payroll, was $658,382 93, while for the year ending June 30, 1898, the expenditures were $674,376 18. This shows an increase during the latter year of $15,993 25, but it should be borne in mind that during the latter year 167 patients more were taken care of, at an expense of $25,471 98, thus making a saving on this basis of $9,478 73.