accommodations can be improved upon, as many were hastily fitted up, but all are decided improvements on old methods, and as the beneficial results of the changes are more generally appreciated, improvements will follow; indeed, since the first arrangements, several counties have already made permanent and more satisfactory improvements. The Commission cannot help referring to the beneficial changes made under the law in the County of San Francisco, where comfortable rooms, decently furnished, have been fitted up; male and female nurses are on duty at all hours of the night and day, and proper arrangements are made for caring for and feeding the sick. Although the Commission. could not get just what it wanted in San Francisco, it has brought about a very decided improvement in the care of those charged with insanity in that city. Under the present arrangements in the various counties, the Commission receives reports from the hospitals of the improved condition of the patients received, and the evidence of greater care. The work in this connection has made necessary a good deal of traveling by members of the Commission, and has required, on some occasions, much labor and trouble. The old system of bookkeeping in the hospitals was not uniform; every hospital had in some measure a distinct system, and when, in accordance with the provisions of the new law, the Commission endeavored to have formulated a uniform system of books and accounts, it became a question of much moment to decide upon the proper system and the extent to which the new system should be introduced. Two principal points would have to be made clearly manifest in a system of books: First, the expenditures of cash in detail, and the disbursements of supplies and utilization of services bought with that cash, should be made so clear that any hospital steward could quickly, from his books, tell what the institution was costing, what departments were costing, where supplies were going, and how much stock should be on hand. Second, the books to show the movements of patients, their history, their possessions in the hospital, the register of wards, sick reports; in fact, a general history of the house, its inhabitants and their belongings, must be provided for. After considerable deliberation, the Commission concluded that the business and financial accounts should be first provided, that similar methods of keeping accounts of expenses should be in use by all. Acting on this belief, Mr. George E. Housken, an expert accountant, was engaged to formulate a system, with the advice that a system was wanted that would economize labor, that would clearly show all the business, that would avoid too much repetition of entries, and yet provide an absolutely safe index of what money was being received or spent, where it was coming from, where it was going, and what was being done with what was bought. More details could readily have been made a part of the system, but more detail requires more skilled labor, and more labor requires more money. As a central or parent system, to which subordinate books might be added from time to time, it is distinctly a marked improvement. The second series of books, or those covering the workings of the population of the house, should have been taken up next, but after conference with the Senate committee investigating public institutions, and learning that they were preparing an elaborate system, about which they would probably consult with the Commission, this matter was deferred, awaiting their action. Supplies for the State hospitals are for the most part bought by annual or semi-annual contracts, the fact that bids are desired by the hospitals being advertised in every county in which a hospital is located, and in San Francisco, Los Angeles, and Sacramento. The contracts are awarded to the lowest satisfactory bidder, and generally low prices are obtained. Right here it might be stated that the Commission saves about $800 yearly on advertising. Supplies not bought on regular contracts are bought by a system of competitive bids, or after careful inquiry in the open market. The Commission has no authority to award contracts, nor to buy anything for the hospitals, that power still being vested in the local Boards of Managers. Excessive amounts of supplies are not bought, and careful attention is given to holding contractors up to the quality contracted for. The purchasing is honest, the distribution and utilization of supplies are economical and careful, and the result has been that at all times our hospitals have been conducted at a low per capita cost, much lower than the great majority of similar institutions throughout the United States. Many, looking only at the large appropriations required for their maintenance, and failing to investigate how many people are maintained with that money, fail to realize that economy is shown in the management. Extravagance has obtained in California in the erection of some of its hospital buildings, but not in their maintenance. The Commission, viewing the situation in all its bearings, has made no effort to gain a reputation for economy by cutting off supplies that were actually needed. What was asked for was allowed when needed. Where cuts in estimates were made, or estimates were rejected, it was done only after due deliberation and investigation, and the Commission. has allowed more increases in food supplies than it has cut off. The Commission is now receiving monthly reports showing the distribution of food supplies, with the purpose of ascertaining definitely the difference in the per capita cost of feeding officers, employés, and patients. It has not been possible heretofore to obtain this information, which is important, for it is the only way in which a thoroughly satis factory explanation can be given as to how well the patients are fed and what it is costing. The per capita cost for food, as given ordinarily in asylum reports, is only relatively correct so far as individuals in the concrete are concerned. It takes time and work to ascertain these neces sary facts, and not all agree that the results justify the extra work demanded. Before closing this brief review it is necessary to speak of the expenses of the Commission and its collections. It is probably unnecessary to remark that the expenses of its first year were added to very materially by the necessary traveling that had to be done in the examination of quarters for the insane, and by the large amount of work thrown upon it in searching the records of County Clerks' offices, investigating and searching for estates of the insane, hunting up property and bank accounts, and investigating the various claims that were sent to us for collection by the different hospitals. Some idea of the magnitude of the work is shown by the statement that there are now on file in the office of the Commission, undergoing examination or collection, claims amounting to $250,000. It took some time and much labor to get this collection business in thorough operation, and the early returns were not large, but at the present time it is in full operation, and we are now collecting for the hospitals, the State and counties, over $1,200 monthly. Up to June 30, 1898, the Commission had collected or caused to be paid to the hospitals, $6,530 89; and to the State and counties, for commitment and transportation expenses, $1,115 50; a total of $7,645 80. For the five months from June 30, 1898, to December 1, 1898, we have collected for the same purposes, $6,146 99. FINANCIAL STATEMENT. Amount Expended during the Forty-eighth Fiscal Year, ending June 30, 1897. Traveling expenses...... Box rent and postage. Telegraphing. Expressage Stationery Salaries.. Seal Typewriter Mimeograph Ice Advertising Total $263 25 52 40 22 42 11 07 113 40 1,469 00 6 50 100 00 45 00 21 50 1. 00 4.50 127 90 2 25 6 00 1 50 $2,247 69 Amount Expended during the Forty-ninth Fiscal Year, ending June 30, 1898. John F. Carrere, Secretary of the State Commission in Lunacy, being first duly sworn, deposes and says that the above financial statement is correct. JOHN F. CARRERE, Secretary State Commission in Lunacy. Subscribed and sworn to before me, this 28th day of December, 1898. J. C. GORMAN, Secretary State Board of Examiners. REVIEW OF ASYLUM SYSTEM OF CALIFORNIA. It has always been the policy of California to care for its insane with State money, in contradistinction to the plan of forcing the counties to pay a part of the cost, the State appropriating the balance. In August, 1851, the State Hospital was opened in Stockton for the reception of all classes of patients, as well as the insane. It is impossible to segregate the cost of caring for the insane while they were in the general hospital supported by the State. Owing to the necessity for separate care of the insane a new institution became necessary, and at Stockton the first asylum under separate and distinct management was opened for the care of the insane, in July, 1853. At the end of the first year of its existence, the Stockton Asylum contained 102 patients; at the end of ten years it had 583 patients, and after twenty years its population had increased to 1,156. The crowded condition of the Stockton Asylum having made it necessary to provide further accommodations for the insane, on November 15, 1875, another State asylum was opened at Napa. At the end of another decennial period the number of patients at Napa had increased to 1,219, and in the two State asylums to 2,403, and another asylum was in process of erection, that the rapidly increasing insane might be given the proper care and treatment. This third asylum was located at Agnews, and was intended, when first authorized, to be an asylum for the chronic and hopelessly insane, but the policy of supporting an institution to be used solely for the care of those considered as hopelessly lost was not received kindly, either by the people or the lawmakers, and as soon as the Legislature could make the change, Agnews was made an asylum for the reception of all classes of mental disease. In five years from its opening, or in 1893, Agnews had increased its population to 902, and the three State asylums together aggregated 4,004 patients. The necessity for more accommodations being apparent, Southern California appealed for an asylum to care for the insane in that section of the State. The rapid development of population and the distance the rapidly increasing insane had to travel before being able to obtain asylum treatment, rendered argument unnecessary to insure the location of an asylum in San Bernardino County. At the same time provision was made for the erection of an asylum at Ukiah, Mendocino County, to provide for the insane from the northern section of the State. The two new asylums were opened in 1893, and have rapidly been filled, and on June 30, 1898, Southern California had 582 patients, and Mendocino 477. It is now forty-five years since the first asylum was opened in California, and our five State hospitals (asylums) contain 5,001 insane patients. There has been appropriated since this State began to make preparation for the care of the insane, $4,282,399 18 for buildings, land, and improvements. For maintenance and other purposes there has been expended $13,085,546 87. The hospitals have spent out of the noneys earned by them (contingent fund) $545,837 82, making a grand total of $17,913,783 87. This sum, however large it may seem, has enabled the State to care for and treat 107,732 patients in the period covered by our synopsis. During the forty-five years of the existence of State asylums, 15,109 have been discharged recovered or improved, and 8,225 have died. The State has always been liberal in the care of its insane. It has provided money when it was needed, it has cheerfully responded to all calls for assistance, and has made provision for all who are defective mentally. The Stockton State Hospital now maintains a patient at the low cost of 35 cents per day, not because the State has been niggardly and cut them to that sum, but because those managing the asylum, voluntarily, by careful management, gradually reduced the cost to that figure, and by force of example the other State hospitals have brought their per capita to nearly the same low figure. The question may well be asked, have we not done too much? |