We desire to recommend the necessity for increased appropriations at Napa State Hospital. The Board of Managers in its previous report recommended the appropriation of $440,000. We do not deem this excessive. With a continued increase in the number of patients we do not believe that the necessities of the institution and its inmates can be We believe that a greater variety of food should be provided for the patients, and this would involve some increase in expenditure. The Napa State Hospital should receive the same considerate attention in the line of repair work as is demanded by the best interests of private ownership. In the matter of the exterior of the building the appropriations for the last year have not been sufficient to secure the attention and expenditure that the best interests of the State demand.

given proper consideration for a less amount.

Some enlargement of the accommodations of the Napa State Hospital is imperative. The building was originally planned to accommodate 800 patients; with no extension it now holds 1,550 patients. This involves crowding the wards to an extent that is objectionable, and even necessitates patients employed in the tailor-shop occupying it as a sleeping apartment.

The Board of Managers have heretofore brought to your attention. a proposition involving an increase of the agricultural lands owned by the Hospital. We deem it advisable that the Smith Brown ranch should be acquired. It will permit the extension of the dairy, and by providing additional land for the raising of vegetables will prove of economic value to the Hospital. There is no reason why the dairy products of Napa State Hospital cannot be almost indefinitely extended. By the purchase of the land, as recommended by the Board of Managers, and the increase of the dairy herds, we deem it possible to furnish to the Hospital its entire requirement of dairy products. The acquisition affords the additional advantage that it will furnish employment of a peculiarly satisfactory character to a larger number of the patients of the Hospital.

The clinical records of an institution of the character of Napa State Hospital are very important. We urge upon the Commission such action as will most speedily place in the hands of the officers of the institution clinical records which shall provide that detailed history of patients always required by successful hospital management and a regard for public interests.

We desire again to recur to the proposition of an increase in the watersupply of the Napa State Hospital. During the warm months of summer there has been a lack of water required for proper sanitation of the building. The Board has heretofore recommended to your Commission the acquisition of the waters of Wild Horse Cañon. The expense of this would be about $17,000. It is estimated this would supply about 50,000 gallons daily additional. Its acquisition would, however, not satisfy

the necessities of the Hospital. It would be but a temporary and partial relief. During the present summer about 25,000 gallons daily has been secured through the instrumentality of the pumping plant recently installed. We regard this also as temporary and insufficient. If the necessities of the Napa State Hospital in the future are to be considered, there is but one available supply of water; this is through the acquisition of the lands owned by the Kruse estate and the construction of a dam at the entrance of Kruse Cañon. Through its instrumentality alone can sufficient water for the necessities of the inmates of the Hospital be secured, and any surplus provided for irrigation or the development of power. In the report heretofore made by the Board of Managers as to the water-supply, will be found the details which justify the position of the Board of Managers as to the water-supply, and we trust we may have your cooperation in any future effort to secure it. It will permit the substitution of electric light for illuminating gas and lessen materially the cost of the power produced at the Hospital. It will guarantee perfect sanitation and render available by irrigation considerable land of the Hospital now unutilized.

All of which is respectfully submitted.

E. Z. HENNESSEY,
E. E. WASHBURN,
ROBERT P. LAMDIN,
J. L. MARTIN,

RALEIGH BARCAR,

Board of Managers Napa State Hospital.

OBLIGATIONS.

We are under obligations to the following persons for donations of books, papers, etc., viz: Mrs. J. E. O'Neill, Mrs. J. F. Zollner, Mrs. G. M. Francis, J. Rausch, S. E. Holden, J. J. Sweet, Miss Mary M. King, Mrs. E. W. Hottel, Hensley Davis, Mrs. G. N. Cornwell, Mrs. Laurel Jones, Miss Lola Parker, Miss A. Lonergan, Miss Mollie Loney, Mrs. A. Evers, Mrs. L. F. Dozier, Mrs. J. T. Johnston, Mrs. T. Lilienthal, Mrs. C. T. Patriarche, C. T. Raychester, Miss A. Pelham, Rev. A. Wylie, J. E. Walden, Miss S. B. Miner, Mrs. C. E. Marsh, Dr. C. H. Farman, A. T. Moss, A. C. Turner, Dr. I. E. Cohn.

We have received regularly through the mail the following newspapers for distribution among the patients, for which the publishers will accept our thanks: Calistogian, Napa; German Post, St. Louis, Mo.; Oakland Journal (German); Sacramento Weekly Bee; Abend Post (German), San Francisco (daily); St. Helena Star, Napa; Redlands Citrograph (weekly); San Francisco Hebrew; Petaluma Courier; Cloverdale Reveille; San José Daily Herald; La Voce del Popolo (Italian); Dixon Tribune; Napa Weekly Journal; Sacramento Record-Union (weekly).

REPORT

OF THE

AGNEWS STATE HOSPITAL

NOTE: For statistical tables, see Appendix.

REPORT OF THE BOARD OF MANAGERS.

For Fiscal Year ending June 30, 1899.

To the Honorable Members of the California State Commission in Lunacy: GENTLEMEN: In compliance with Section 4, Subdivision 7, Article II, of the State Lunacy Law, we, the Board of Managers of Agnews State Hospital, again offer you our report for the year, from July 31, 1898, to July 31, 1899.

Of course, our report will necessarily be in substance what we have observed in previous reports; but we deem it both proper and useful that a report treating of subjects which directly affect a thousand unfortunate inmates and the diversified interests of this class of our population, social, moral, and material, cannot fail to be of interest to those engaged in conducting the same.

Again, we think it is of interest to the taxpayers to know how the lunacy laws of the State are administered from year to year, and how far the object for which the public money is expended is attained.

As far as has been found practicable to do so, we shall confine this report only to those subjects which have presented themselves during the year above referred to. It has been estimated by alienists that the annual cost of supporting and maintaining an insane person is approximately $200, and since we have in the neighborhood of a thousand people here, you will see, gentlemen, that it is not a difficult matter to estimate as to what becomes of the money; nor is the moral and material interests of this class of our population lacking in interest to the public; for the problems of the preventability, curability, and dependency of the insane is a matter that is of vital interest to any common

wealth, as insanity, in so far as it is understood now, is not preventable and with few exceptions not curable, and apparently increasing with the progress of civilization. It is, we say, of vital interest not only to the taxpayers, but to you, gentlemen, who are, in common with us, appointed to see to those matters.

It would be, we think, of interest to you and to all of us were we to consider, first, the cause of insanity; second, the classification; third, curability, treatment, etc. But as these subjects are more medical than political, we are compelled, for the present time at least, to leave these matters to the medical profession; but as far as we could we have done everything in our power to better the condition and improve the surroundings of this poor, irresponsible, dangerous, restless, and difficultto-manage class of humanity committed to our charge.

There are, in our opinion, a good many things needed for the institution, as, for instance: When medical superintendents and medical men generally who deal with the insane know that there is a positive relation between heart disease and insanity, and between pelvic diseases and insanity, it is high time for Lunacy Commissioners and Managers to take a hint and impose correct clinical observation on the medical staff instead of superstition; and common-sense diagnosis in place of routine. and guesswork.

MINUTES OF BOARD.

August, 1898. In the month of August, 1898, 932 patients were cared for; $970 was collected for pay-patients, and $1,232.56 for the receipts of the farm.

In discussing the "civil service reform," it was decided to hold examinations of applicants for positions, with the consent of the Lunacy Commission, on the first Tuesday in January and the first Tuesday in July, in keeping with the customs of the Federal Government.

The Hospital was visited by all the members on Board day, and by Dr. Curnow and Mr. Gould on August 28th.

September, 1898.-The number of patients for September was 938; the cash collected from pay-patients amounted to $431.10, and $1,374.38 was realized from the farm. At the suggestion of Mr. Gould, one hundred pictures were ordered for the wards. A superintendent of construction for the new cottages, at a salary of $100 per month, was appointed. Upon the advice of Mr. Hale, it was decided to purchase a better grade of dress goods for the patients, with a view to comfort and

wear.

The charges for patients were fixed upon, at from $15 per month to $40 per month, the amount to be left to the judgment of the Medical Superintendent.