but no guardians, the District Attorneys of the counties from whence they were committed were asked to comply with the provisions of the statutes of 1887 on this subject, and apply for the appointment of a guardian. Guardians have been appointed in over thirty cases. Where patients had died leaving property, the attention of the Public Administrator in the county from whence they were committed was called to the case, and letters of administration have been taken out. Over two hundred cases of this kind have been called to the attention of Public Administrators, and a large sum of money will be recovered by the hospitals as soon as the necessary formalities are complied with and the estates can be settled up. Besides these cases which have been called to the attention of the Public Administrators in several counties of this State, the Commission has investigated personally nearly five hundred cases, as a result of the lists of names which it has secured of guardians for insane persons from the several counties. In some cases a similarity of name was discovered, and it was ascertained that the ward had never been a patient. In other cases the estate was entirely exhausted, and in a number of other cases some money has been recovered. There is a large number of cases which are now pending. These include, among others, a number of cases in which guardians were appointed to act for patients, but have never made any returns of their trust. The Commission has now arranged to cite these guardians into court for the purpose of having them account for money and property which has been in their hands. There will probably be over one hundred of these cases connected with the four northern hospitals alone, and undoubtedly a considerable sum of money can be recovered for the hospitals, as well as for the estates of patients. In several cases large sums of money— in one instance, aggregating nearly $15,000-was in possession of a guardian who died several years ago, leaving no kind of assets or estate, and it has been found impossible to trace the money. Either nothing has been paid for these patients, or very little. There is no question of there having been thousands and thousands of dollars due insane patients which have been absorbed by their guardians without any of it going to the benefit of the patients or any of it being paid to the State for the patients' care. At present, as soon as a patient is admitted to the hospital, a careful investigation of his financial responsibility is made, and, if necessary, a guardian is at once appointed. Another matter to which the Commission is now giving its attention is the question of pensioners. There are several patients in the hospitals entitled to Government pensions. In some cases it would appear that the guardians have drawn these pensions and made no return whatever of their trust. The United States Pension Agent at San Francisco has shown a great willingness and readiness to cooperate with the Com mission in tracing up cases of this kind, and there is a prospect of some important discoveries of money in a number of this class of cases. The Commission is a subscriber to the Press-Clipping Bureau, and in many cases the financial responsibility of patients has been discovered by reference to the matter in the local papers of the places from which they were committed. Not only has the action of the Commission in this matter added thousands of dollars to the treasuries of the several hospitals, but it has resulted in saving much valuable property belonging to patients, and in the cases of deceased-patients with valuable estates, will add materially to the State School Fund from the unclaimed balance of the estates which escheats to that fund. If the Legislature were to pass a law allowing the Commission to apply directly for the appointment of guardians for insane persons who have no relatives present to take care of their estates, it would greatly simplify and facilitate the work of the Commission; although, almost without exception, the Commission has found the county officials. willing to do all that lay within their power to assist the Commission in its efforts to protect the interests of the unfortunate insane. The Commission has so far collected, since March 1, 1898, From non-paying patients (collected by the Commission directly and paid over to the hospitals) From non-paying patients (through instrumentality of the Commission, but without the money passing through the office of Commission).... Making a total to its credit of... $9,641 85 $2,216 04 . $11,857 89 When the amount collected for transportation and medical examiners' fees is added to the above, the aggregate is $13,792 84, collected through the instrumentality of the Commission since October, 1897, to November 30, 1898. Up to the close of the fiscal year ending June 30, 1898, the account. stood as follows: $5,219 81 Board accounts (collected by the Commission) to June 30, 1898... Total... 1,115 50 $7,645 85 The collections of the Commission are shown by the above report. They average $1,229 39 per month for the current fiscal year to date; so that the Commission is more than paying all its expenses out of the collections of this department alone. All of this money has been collected without recourse to lawsuits or contests in the courts. There are many cases now pending, besides the estates above referred to, from which it can reasonably be hoped that several thousand dollars more of money will be collected for the State. It should be understood that all of this money collected for board of patients is in excess and separate from the amount regularly paid for the board of patients, or their friends, to the several hospitals. There is a large number of pay-patients on the rolls of all the hospitals whose board is paid regularly and without the necessity of any extraordinary means to collect. The collections of the Commission are all of money, the existence of which was unknown, and from estates of patients who were supposed to be indigent, or from relatives and guardians who have never paid anything. In other words, all of this money has been discovered and unearthed through the efforts of the Commission. THE MEDICAL CARE OF OUR INSANE IN STATE HOSPITALS. It can be safely asserted that an advance is being made in the medical care of the insane in the State's charge. Careful attention has always been given to patients, but it can be truthfully said that rather more rigid investigation and more attention to detail and care of the sick now prevails. Clinical records have been prepared and sent out to the different hospitals, in order that full histories of each case may be kept on file for reference and assistance in treatment. These clinical records are now on trial at the different hospitals, and suggestion will be later asked from each medical corps looking to changes that may be advisable to promote conciseness and save labor, after which the record will be permanently adopted. As it is, the clinical forms necessitate an early and careful examination of each case admitted, a continued study of it, and investigation (physical, chemical, and microscopical) of the patient, and a close inquiry into probable predisposing and existing causes. In considering the care and treatment of the insane it must be borne in mind that moral treatment is often of more importance than treatment by drugs, and that neither can be neglected at the expense of the other. Employment, amusement, and diversion will oftentimes do more to clear up a clouded brain than all the drugs in the pharmacopeia, and to neglect this form of treatment and to rely on medicine alone will bring about bad results. It is not always taken into consideration that a large proportion of those admitted to our State hospitals for treatment are not sent there except as a last resort after years of progressive disease. In such cases changes in organic structure have occurred that render cure out of the question and make the treatment largely palliative and simply promotive of comfort and the best possible general health. The time for successful treatment of insanity is in the early stages, and the present system tends to bring about the careful examination that promotes exactness in diagnosis and intelligence in treatment. The lack of special wards or buildings for the care of the acutely insane or those acutely sick from bodily troubles prevents that careful nursing, attention, and medical care which would prevail in specially arranged hospitals, but even with the lack of special arrangements more careful and constant nursing is gradually coming to be the rule. Some of the hospitals are further advanced in this regard than others, but all are improving. Under the present law medical internes have been appointed in some of the hospitals with benefit. Young men, generally those with a knowledge of microscopy, are selected, and close investigations are being made of diseased tissues. This is a distinct advance, and one that promises well. While an hospital for the insane cannot be conducted as a general hospital, there is no doubt but that our methods of diagnosis and treatment may with advantage be patterned to some extent after the method pursued in the best general hospital. Surgery can without doubt be called to the aid of medicine and moral treatment more than has been done in the past, with the hope of bringing about cures in many cases, and, failing in complete cures, of palliating and placing the subject of operative measures in a better physical condition. Surgery may be carried to extreme, but in the California State hospitals surgery and radical measures should be called into hospital or asylum practice more than in the past. In this connection it would seem proper to encourage the State hospitals in employing more skilled and trained nurses than has been done. Every hospital should have a few nurses trained in the modern methods of caring for surgical and medical cases. To sum up this subject the aim should be to individualize the patients, and to add to the methods of medical and moral treatment now prevailing, a closer investigation of possible physical causes and a more ready recourse to surgery for the removal of such bodily ailments as complicate or cause the existing mental trouble. CIVIL SERVICE. The civil service provision of the new lunacy law provides for appointment after competitive examination, and for continuance in office during good behavior and faithful service. As the result of the law, 163 persons have been examined for positions in the State hospitals, and 130 have successfully passed the examinations and made themselves eligible for appointment. In making these examinations, efforts have been made to have the questions practicable and with special reference to the positions sought for. In the examinations for physicians or medical internes the questions cover practical points in hygiene, medicine, and surgery, while the questions for attendants are of a character to develop the candidate's ability to read and write correctly the English language, and to show his knowledge of the rudimentary principles of arithmetic. A physical examination of the applicant and some inquiry into his knowledge of the principles that should guide him or her in their association with the insane complete the examination. The results obtained for the civil service examinations have undoubtedly been good. A more intelligent class seek the examinations, and by placing them in competition the Board of Managers and the Medical Superintendent are relieved from the importunities of those seeking places. To the credit of California it may be truthfully said that politics have never been a factor in discharging attendants-those who have the immediate care of the patients. All parties have heretofore recognized that the care of the patients was the first consideration, and that the men who had direct charge of patients or who were called upon to deal with their care, and who were faithful, deserving, intelligent, and kind, should not lose their positions by reason of politics. The civil service examinations have not been a source of unalloyed happiness to State hospital managers and superintendents. Some do not like the system at all, others admit its benefits, while others discourage its operation. The majority of those connected with State hospitals, however, are heartily in favor of the law, and at a meeting of representatives of Boards of Managers and the Medical Superintendents, held at Stockton December 29, 1898, the following resolution was unanimously adopted: "Resolved, That it is the sense of this meeting that civil service rules as applied to the State hospitals are beneficial, and should be enforced." Some confusion has resulted from the lack of clearness in civil service provisions of the new lunacy law, but even as it is the law is an excellent one and will produce better results as its provisions become more generally understood. It must be admitted that no competitive examination is a true test of an individual's merits for any business position. One theoretically or grammatically perfect may be lacking in that practical common sense knowledge that a verbal or written examination fails to bring out. While admitting the above, it is equally positive that you cannot tell a man's qualifications until he is tried, and that other things being equal, the man best informed theoretically in any line of business will generally be expected to be more successful than others not so well informed. The enactment and enforcement of a civil service law is a step ahead in support of the agreement entered into years ago, and should be encouraged. For twenty years boards of directors or trustees have been changing politically without corresponding changes in the medical officials or rank and file of asylum emyloyés. Educational and other qualifications developed by proper examination certainly insure an improvement in the class of people appointed by personal or other influences non-political, and the accumulated experience gained by years of service adds much to the efficiency desired. |