The Commission has caused to be made a very careful investigation into the nationalities of the various patients in the five State hospitals, with the result that of the 5,001 inmates on June 30, 1898, 2,785 were foreign born. This does not include 112 "unknown" whose places of nativity are unknown, but a majority of whom are undoubtedly of foreign birth.

While it is true that a large number of these foreign born patients have taken out naturalization papers, and are therefore citizens of this country, nevertheless a large percentage are known to still acknowledge their allegiance to some foreign government, and to have come to this country simply for the purpose of bettering their circumstances, with the design of ultimately returning to the country of their birth. This is notably true of the Chinese, and a number of other patients who come from the southern part of Europe. A large number of these foreign born patients have expressed a desire to return to their native countries, and in many cases it is the opinion of the medical authorities having them in charge that if it were possible to send them home, where they would be environed by the surroundings of their youth and the mode and manner of life to which they were accustomed before coming to this country, they would undoubtedly, if not entirely recover, at least be very much improved. With this object in view, to improve the health of the patients, as well as to relieve the taxpayers of this State from the burden of caring for so many aliens, the majority of whom are not taxpayers and have paid nothing toward the support of the State government, the Commission has been actively engaged in trying to arrange for their return to the countries whence they came. The prospect for the return of the Chinese, particularly, is favorable, as the Chinese authorities at San Francisco are favorable to the project, and assure the Commission that there would be no opposition from the home government. However, the disturbed state of China for the past year, and the fact that there is not a single insane asylum in the Chinese empire, has occasioned an embarrassment on the part of the Commission which has not yet been overcome. The Commission, however, is at present in communication with the Chinese embassy at Washington, D. C., and hopes shortly to be able to report that it has succeeded in returning to China all the Chinese patients in the hospitals who are capable of making the voyage. In several cases, where patients were only in the country a very short while, arrangements have been made for their return through their Consuls. The British Consul-General in this respect has shown a great willingness to cooperate with the Commission, as has also Count Mutsu, the Japanese Consul at San Francisco.

While the cost of sending back the foreign patients in the hospitals, or at least so many of them as it will be found ultimately possible to return, will be large, it will still be a very economical measure, for the

reason that many of these patients would remain in the hospitals for the balance of their lives, if some such arrangement is not made; and the expense of caring for them for one year will be more than enough to return those whose homes are the most distant from their native land.

The accompanying table will show the number of foreigners in the five State hospitals, by nationality, and the total number of each nationality in all the hospitals. With the single exception of Great Britain and Ireland, natives of a country have been classed under the name of the dominating government, without regard to dependencies or provinces. Thus, the patients from Prussia, Saxony, and Bavaria have all been classed as Germans. Patients from Finland are classed as Russians. Patients from any of the five divisions of Australia are accredited to Australia.

Nationality of Patients in the Five State Hospitals, July 1, 1898.

It may be well to remark in this connection that the number of patients of any given nationality, as given in this table, should always be considered in connection with the ratio which that nationality bears

to the foreign population of California. Thus-based on the census of 1890-the insane of Irish birth shows a percentage of 1.13 per cent, while the percentage of Russians is 2.05 per cent. It is also a notable fact that the percentage of insane is larger among those of foreign birth who do not talk English, than among those who do; which may probably be accounted for on the ground that their ignorance of the English tongue tends to isolate those who do not speak it, and therefore makes their struggle for life harder and their mental depression greater. While the Commission has not completed tables as to occupations of patients, it may still be said that the largest percentage is of patients who come from the laboring and working classes; and the smallest from the business and professional classes. This is true, even when the relative ratios of these classes to the general population is considered.

In very many cases the foreign patients have no friends and no property, and, consequently, their entire support devolves upon the State. The United States Commissioner of Immigration, Mr. H. H. North, has been actively engaged in coöperating with the Commission in endeavoring to exclude from this State foreigners who are insane at the time of landing on our shores. The trouble, however, that the Commission has encountered in this direction is from patients shipped from the East, who are allowed to land in New York and other Eastern ports, and not from those who attempt to land at San Francisco and other ports on this coast.

In several cases parties have been sent to this State from the East who were confined in insane asylums in Europe before their arrival in this country, and who, if the United States immigration laws had been carefully enforced by the Eastern authorities at the ports, would never have been permitted to land at all.

The percentage of patients from the other States of the Union is very large. Of the 5,001 patients in our hospitals, only 605 are native Californians. Of the foreigners, a large proportion had been in this State for less than a year at the time of their commitment. This is true also, though to a less extent, of the patients who are natives of other States. In some cases it has come to the knowledge of the Commission that patients have been deliberately shipped to this State for the purpose of placing them in California asylums, not apparently so much because of supposed superior advantage in this State for treatment of the insane, as because here they would be a long way removed from their homes, and therefore less likely to be a trouble to their relatives and alleged friends.

EXAMINATION FEES AND TRANSPORTATION CHARGES.

A very important branch of the work of the Commission has been the collection of examination fees and transportation charges for nonindigent patients. The statutes have long provided that persons who

are able shall pay for their transportation to an asylum, or hospital, from the place where they were committed. The law of 1897 made it the duty of this Commission to collect this money, and also the money expended by the county for the examination of the patient before commitment.

This Commission prepared to undertake this work soon after it was organized; but there were several legal questions involved, and it was necessary to seek the advice of the Attorney-General before this department could be thoroughly organized. Difficulties were encountered, also, in securing the coöperation of the County Auditors, from whom, of necessity, the amount of the bills paid the medical examiners were to be obtained. Many of them had not noticed the provisions of the insanity law on this subject, and even when their attention was called to the matter many explanations were necessary before the information sought was received.

In the case of the San Francisco Auditor, after repeatedly promising to furnish the bills, and delaying the work of the Commission in collecting the amount due the State from San Francisco patients for months, he finally refused to comply with the law, and the Commission was forced to proceed without attempting to collect the money due to that county, with the result that San Francisco lost over $1,000 she might easily have had. Collections aggregating $1,641 25 have been turned into the State Treasury, and $293 75 has been collected and returned to the several counties since October 18, 1897, making a total $1,934 95 collected to December 1, 1898.

PAY PATIENTS.

It has long been a matter of gossip that there were patients in the hospitals who could pay, but who were being carried as indigent patients, the State paying all their expenses. The Commission determined to make a thorough examination of this matter, and began the work by requesting from the hospital authorities any information they might have concerning patients who should pay, but who were not contributing anything toward their support. Lists aggregating 98 names were sent to this office, and in every case the financial responsibility of the patient was thoroughly investigated, with the result of discovering a number of patients who could, but who were not paying.

Another method of discovering non-paying patients was adopted by the Commission, i. e., by compiling complete lists of all the guardianship appointments for insane and incompetent persons that had been made in the several counties of the State, and then comparing the names of persons having estates, thus obtained, with the lists of patients who are or had been in the several State hospitals.

This work was begun in San Francisco, and a list of 776 cases was obtained. Similar lists have been made for Alameda, Solano, Napa, Marin, Santa Clara, Sacramento, Yolo, Sonoma, Santa Cruz, San Joaquin, and San Mateo counties; and the Commission now has a list of 1,778 names of persons, insane or incompetent, whose estates have appeared on the probate records of the counties named. As a result of this work the estates of over 400 former or present patients have been discovered.

A complete investigation of the property brought by patients on their persons, when committed to the hospitals, has been made for all of the hospitals except Southern California. Nearly a hundred bankbooks, besides certificates of deposit, checks, drafts, deeds for property, etc., have been discovered by this systematic search. Some of the accounts. exceed $1,000 in value, and many amounted well into the hundreds.

A comparison of the list of unclaimed deposits published by the banks has also been made with the lists of patients on the rolls of the hospitals, and considerable money has been recovered in this way.

The Commission also filed with San Francisco, and the other counties having criminal insane in any of the State hospitals, claims for the board of such patients, aggregating $25,000. In some cases these claims have been allowed by the counties without dispute; but in others it has been found necessary to refer them to the Attorney-General to bring suit for the recovery of the amounts claimed. These suits are now pending.

Bills aggregating $250,000 have been placed in the hands of the Commission for collection. All these bills are against patients who have or had estates, and a good percentage of this money will probably be ultimately collected. Most of them could have been collected with ease if there had been some central body, like the Commission, that would have looked after these collections, as is now being done, and collected the accounts promptly as they fell due. The importance of keeping up these collections, and of making all those who are able to pay for their maintenance do so, will be very evident when it is stated that if this work is thoroughly and conscientiously attended to the Commission is of opinion that the receipts from this source will be sufficient to enable the various hospitals to erect cottages from time to time as they are needed by reason of the increase of patients. In this way it will be possible to provide for any increase of the insane population of the State without applying to any future Legislature for any appropriation for the erection of additional buildings or accommodations for the insane.

Claims to the amount of $161 have been allowed by the guardians of patients, or the courts, and will be paid as soon as the necessary money is on hand to meet them. Whenever patients had property or money,