Hffi INSANE OF CALIFORNIA 
ifi) Teeis Needs 
A’v IV. H. MAYS. M. I). 
• • • 
Assistant Physician of State Asylum for Insane, Stockton, G?/- 
Howard & Parker, 429 Mont’y. The Insane of California and their Needs. 
By W. H. MAYS, M. D. 
( Assistant Physician of State Asylum for Insane, Stockton, Cal.] 
In approaching my subject I have something pleasant to say. 
True, my statement may conflict with what I believe to be the 
generally received opinion, not of the public alone, but of many 
of the medical profession who have never looked up the subject. 
It is, that insanity is largely on the decline in California. There 
has been a steady decrease, during the last nine years, in the 
annual number of persons consigned to the asylums. From a 
file of the biennial reports of the two institutions, Stockton and 
Napa, it will be found that the number of persons committed 
as insane has remained, since 1876, almost at a standstill, 
although the population of the State is increasing, according 
to accepted estimates, at the rate of roo.ooo every three years. 
In 1876, with a population of. in round numbers, 700.000, the 
commitments aggregated 735. Three years later, in 1879. with 
a population augmented to 800,000, the commitments were 721. 
In 1882. with a population of 900,000, there were but 722 com- 
mitments, and in 1884. last year, when our numbers had reached 
nearly a million, the commitments were only 764. In 1876, 735 ; 
in 1884, 764. Notwithstanding the addition to our population 
of nearly a quarter of a million, the actual number of persons 
attacked with insanity was scarcely any greater last year than it 
was nine years ago. Taking the ratio according to population, 
we find that in 1876, one person in every 950 was seized with 
insanity; in 1879, one in every 1,100; in 1882, one in every 
1,250’: in 1884, one in every 1,300. 
With these figures before us, how shall we account for the 
prevalence of the belief that mind disorders preponderate on 
this coast? It may be said in explanation that many things 
have contributed to foster the misconception. Particularly may 
be mentioned the undue publicity that is given to insanity com- 
mitments. It is the custom to publish in the daily newspapers 
the names of persons examined by the Insanity Commissioners, 
and the salient features of each case. Not only are the names of The Insane of California. 
these individuals paraded in public print, but the circumstances 
which led to their examination, their perverted acts and sayings, 
and the peculiar delusions they may have exhibited, are often 
recounted in detail. Consider the flagrant wrong that may be 
done here. A large proportion of those sent to the asylum are 
only temporarily afflicted; they are soon to be restored to their 
homes and to society. But we know that to him who has once 
been shut within those walls a stigma attaches in the eyes of the 
world—deplorable that this should be, but it is so—and that stig- 
ma remains through life, and may so militate against his success 
as to drive him to despair and back to mental ruin again. Yet in 
the face of this it seems that the utmost pains are taken whereby, 
if the patient be restored to reason, his ignominy and shame 
shall be the greater. Surely the first impulse of all concerned 
should be to shield these unfortunates from exposure as far as 
possible, to cover their irresponsible acts with the mantle of 
charity. I can conceive of no adequate reason why the world 
must necessarily be told the names of those stricken with mind 
disease, still less why the morbid imaginings of frenzied patients 
should be held up to public gaze. 
Again, the agitation of the matter of the overcrowding of our 
asylums, and the need for further provision for the insane, has 
engendered in some minds the erroneous idea that insanity is 
making rapid headway among us. But because the growth of 
the State has rendered such additional provision necessary, it is 
a little thoughtless and illogical to draw an inference therefrom 
unfavorable to the mental stability of the inhabitants. As long 
as our people continue to increase and multiply, as long as our 
land continues to attract new-comers, so long shall we be called 
upon to add to our asylum capacities every few years. One 
person in every four hundred is a lunatic, the world over, and 
it must needs be that as a community increases in numbers its in- 
sane population must necessarily increase too. The cry for new or 
larger receptacles for the insane can be heard in every State 
that is prosperous and growing. It may sound odd, but it is 
true, that the demand for additional asylums is really a proof 
of the prosperity of a State. When a people has reached its 
limit of expansion, those it possesses will be found to suffice, but 
not till then. 
There is another cause for the perpetual repletion of asylums 
that is sometimes overlooked. It is the remarkable longevity The Insane of California. 
3 
of the chronic insane.* Sixty years ago, Esquirol, in his well- 
known work, commented on this fact. The demented andhmbecile 
class, “stationary” cases, who form so large a proportion of the 
inmates of our asylums, often lead a purely automatic existence. 
Their being is ruled over by the sympathetic nerve-system, the 
brain having long since abdicated, or become functus officio. 
They eat, they bask in the sun, they sleep, they rise to eat 
again, and so their days go on. Free from care or worry, they 
lead a vegetative life, with a minimum expenditure oi the vital 
forces. At Stockton may be found many such, some of them 
hale octogenarians, committed back in the fifties, representatives 
of a former day and generation. Lingering on after all who 
once knew them have long departed, it would seem that even 
death had overlooked them, or thought them hardly worth the 
expenditure of a dart. These it is who by their accumulation 
cumber our wards to the hindrance of curable patients. The 
proposal, however, to gather these chronic cases into an institu- 
tion exclusively for them does not accord with the opinion of 
the best alienists, some of whom have had the opportunity of 
studying such an arrangement practically. It is condemned as 
neither wise, nor humane, nor economicaLf The plan which 
most commends itself is that of a main building for the acute 
or curable; and, on the same grounds, another, separate, 
though adjacent, for the chronic and incurable, built on a some- 
what different and cheaper scale. 
The extreme rarity of idiocy in our State is a matter the im- 
portance of which deserves wader appreciation. It is not per- 
haps generally known that the proportion of idiots to population 
* “ The large annual addition to the number of insane persons under 
care has produced the impression that insanity itself is much on the 
increase. On examination, however, it will be found that the increase is 
almost entirely due to accumulation of chronic cases of the pauper 
class ; so that the community at large does not appear more liable than 
formerly to be attacked with insanity.”—Report of Commissioners on 
Lunacy for Great Britain, 1884. 
t “ No physician can say with accuracy what class of patients are 
curable and what are not. We cannot say to which class at least one- 
third belong. We still indulge in hope of their restoration, but will 
probably be disappointed in the majority of cases; yet the hope we 
entertain, and which encourages us in our efforts to restore and cure 
them, would be destroyed by sending them to an incurable institution. 
No possible good could arise from such institutions, except that they 
might be managed at less expense; but even this is doubtful if they 
have proper officers and physicians.”—Dr. Brigham, Supt. of Somer- 
ville Asylum, Mass. 4 
The Insane of California. 
here is so small as to be almost unprecedented. It is true that 
California was for some time a frontier State, replenished largely 
by men without families, and that during that period the rate 
of childbirth was low. This may at one time have explained 
the fact under consideration, but not now. California so long- 
ago emerged from the frontier condition, it has for so many 
years been a land of settled homes and families, that to ascribe 
our present immunity from idiocy to a low birth-rate is mani- 
festly incorrect. No one can doubt that for the past fifteen or 
twenty years the number of births has proportionately equalled 
that of any other State. The last census gives California 507 
idiots. Compare this, for instance, with the State of Maine. 
Our birth-rate has unquestionably, during the last decade and a 
half, been the greater; yet Maine, with one-fourth less population, 
returns 1,325 idiots, or two and a half times as many as Cali- 
fornia. And, to make the inequality the more marked, Maine 
is far behind us in the number of families it possesses, the pro- 
portion there being one family to every twenty-one inhabitants, 
against one family to five inhabitants in California. In lowa 
idiocy is over twice as frequent, proportionately, as with us, 
while at the same time lowa has a smaller percentage of fami- 
lies than we have. Tennessee, with a little less than twice our 
population, has 3,533 idiots, or seven times as many. Michigan, 
with double our population, has 2,181 idiots ; Indiana has 4,725; 
Maryland, 1,319; and so on. 
Now, without claiming too much for these statistics, they cer- 
tainly mean something. The difference in our favor in the mat- 
ter of idiocy is no mere wavering of the balance below the 
average line, it is a disparity so wide as to entitle it to careful 
deliberation. Congenital idiocy is the sign and the outcome 
of ancestral taint. Tuberculosis in the parent may produce it, 
so may scrofula, or drunkenness, or a long course of semi- 
starvation. But more often the idiot is but the culminating- 
o 
point of a bad neurotic heredity that has been gathering- 
strength for generations. Coupling, then, the two facts that I 
have established, the infrequency of idiocy and the progressive 
decrease of new cases of insanity amongst us, the inference is 
as satisfactory as it is incontestible. 
For the people of whom such statistics are true, may fairly be 
predicated a share of mental recuperative energy beyond the 
average in activity and potency. There is nothing Utopian in 
such an assumption on behalf of our people, even were the evi- 
dence before us less clear and emphatic. There is a tendency The Insane of California. 
5 
everywhere, and in all things that live, towards a better and 
healthier type, when the environing conditions are not adverse. 
All through nature the tendency to the normal is stronger than 
the tendency to the abnormal. No law is more universal or irre- 
pressible. Given a conjunction of favorable conditions, climatic, 
hygienic and industrial, and the material betterment of the people 
subjected to those conditions must follow as surely as effect ever 
follows cause. To what extent such a conjunction of natural and 
other advantages is realized in this State J shall not attempt to 
determine. This, however, I hold to be proven from the facts 
adduced—that the conditions of life here tend demonstrably 
to a strengthening of mental fibre, a weakening of the tyranny 
of a bad inheritance. 
Glancing further afield, the outlook for insanity everywhere 
favors those who have faith in the steady progress of humanity. 
Throughout the civilized world at large, forces are at work tend- 
ing to lessen the outlying causes of mind-disease. One of the 
chief ameliorating factors is the striking change that is taking- 
place in the condition of the working classes. For, let it be 
remembered that it is mainly the poorer and more ignorant who 
fill our asylums. The higher wages paid to working men, the 
shorter hours of labor, the greater amount of leisure they enjoy, 
the better education they receive, leading them to put that leisure 
to more intelligent use, the better houses they live in, above all, 
the better food they eat, supplying the proper nutrition of body 
and brain; all give us hope that, as years and generations go 
by, insanity will become less and less the formidable thing it is. 
The Legislature of the State having wisely and by no means 
too soon provided for the erection of another asylum for the 
insane, a few words on the external construction of asylums may 
not be out of place. 
Fashion, which rules everything, has even in times past brought 
this subject under its imperious sway. The fashion regarding 
asylum exteriors has changed notably in the last seven years. 
The period before that was characterized by the erection of a 
costly class of buildings, pretentious in design and imposing in 
all the pomp of tower and turret, pinnacle and battlement. 
All of them would not of course come under this category, but 
the majority would. As late as 1878, the celebrated alienist, Dr. 
Isaac Ray, writing on this subject, maintained that SI,OOO or 
$1,200 per patient accommodated was not any too much. The 
State Asylum at Warren, Pa., finished in 1878, cost $1,500 per 
patient. That at Danvers, Mass., built eight or nine years ago, 6 
The Insane of California. 
cost the monstrous sum of $3,600 per patient; a monument to 
future ages of the submissiveness of tax-payers. Our own State 
Asylum at Napa was built in the hey-day of this era ol extrava- 
gance, having cost close to a million and a half; or, with a capacity 
of 1,000 patients, for which it was intended, $1,500 per patient. 
Such palatial structures are no longer held necessary for the 
care and cure of the insane. The class of buildings most ap- 
proved of late years is solid and substantial, without being prison- 
like, and of moderate cost; the comfort and home-like surround- 
ings of the inmates being the first requirement. The taste for 
architectural display has given way to a striving after a truer 
form of beauty—utility. State pride in its public buildings is a 
sentiment highly commendable in its place, but the piling up of 
superfluous ornamentation on the outside of a mad-house has 
always struck me as something grossly inappropriate. 
I will briefly call your attention to two instances of the later 
and more economical spirit in asylum construction, namely, the 
Illinois Eastern Asylum, at Kankakee, and our own new asylum 
building at Stockton. 
The Kankakee asylum, finished last year, is on a plan some- 
what experimental. There are, under the one management, 
separate and detached buildings for the different classes of the 
insane; the acute, the chronic, the violent, the filthy, the suici- 
dal, the epileptic, each having their distinct quarters, adapted to 
the varying requirements of their care and treatment. The sys- 
tem is found to work well. The total cost of construction, 
necessarily enhanced by the broken-up and detached style of 
building, was $664 per capita. The asylum accommodates 1,500 
patients. 
The new edifice recently built at Stockton was designed to 
take the place of some of the older buildings which had become 
unfit for habitation. It was opened for use at the beginning of 
the present year. It is not an imitation of a baronial castle, but 
a plain brick building with stone facings. In general appear- 
ance it impresses the observer as eminently suited for its pur- 
pose. It has, however, other claims for admiration; its simple 
yet stately outlines, its compact symmetry, its architectural and 
technical truth, to say nothing of its modest cost, render it as 
creditable a public building as will be found anywhere. It has a 
capacity of 500 patients, and cost $225,000, or $450 per patient. 
Being built on State grounds, there was no land to pay for, mak- 
ing the per capita less than it would otherwise have been, but 
only slightly less, As Jong as such structures as the Kankakee The Insane of California. 
Asylum at $664 per patient, and the Stockton building at $450 
per patient can be reduplicated, the question of hospital con- 
struction need no longer be considered a vexed one. 
Before concluding, there is a matter of central importance to 
which I desire to call the attention of the Society as a whole, 
and more especially the active promoters of medical education 
on this coast, of whom our honored President has long been 
recognized as one of the foremost. It is, the want of facilities 
lor the clinical study of mental disease. The efficiency of the 
California medical schools is conceded on all hands. In the com- 
prehensiveness of their respective courses of study, the rigor of 
their examinations, the zeal of their tutorial corps, are up 
to the standard of the oldest and best. In but one feature do they 
fall short, the teaching of mind disease, as it can only be taught 
—clinically. The modern graduate must have something more 
than a smattering of knowledge on insanity. It is estimated that 
one person in every 400 has mind disorder in some form. Is 
typhoid fever relatively more frequent? Yet what student would 
be held worthy a diploma who had never studied clinically a case 
of typhoid ? Is pneumonia more prevalent than once in 400 in- 
habitants, or syphilis, or tuberculosis ? Yet how necessary is 
held the familiarizing the undergraduate with the aspect of these 
disorders. But when disease attacking the brain affects the 
mind, his knowledge of this class of ailments may be rudimentary 
in the extreme, as there is no way provided for the proper study 
of them. That asylums are provided for the reception of the 
insane is no reason why the general practitioner shall not re- 
quire an intimacy with the phases of mental pathology. Many 
cases have to be treated at home; many cases need not be sent 
to the asylum at all. Not only this, but, as Dr. Clouston points 
out, the early recognition of mental disorder, the detection of its 
forerunning symptoms, and their treatment, the mental hygiene 
of those with a neuropathic history and the question of a career 
in life, the capacity for making a will, the responsibility for a 
criminal act, and, lastly, the examination of those charged with 
insanity, which often falls to the lot of the country practitioner, 
involving the serious question of depriving a fellow citizen of his 
personal liberty—these are matters that a physician should be 
made fully competent in before he can be said to have had a 
proper medical education. And this is not to be reached with- 
out systematic clinical teaching. 
Two prerequisites are called for ; First, an asylum within rea- 
sonable proximity to the medical schools; and second, a depart- Proceedings of Societies. 
merit therein to be set aside as a field for clinical teaching. The 
Legislature, at its last session, devoted considerable time to in- 
sanity matters, and if the friends of medical education had made 
concerted representation of the urgent need of facilities for this 
branch of study, I am sure they would have met with a favorable 
hearing. Every large city should have its insane asylum close 
by, the convenience and economy of such an arrangement being 
obvious. As the location of the new asylum is still undeter- 
mined, I hope an effort will yet be made to secure its erection 
somewhere within an hour’s ride of the metropolis. 
One word more. That a State should honor its great men 
may be set down as an axiom of civic morality. That a Society 
representing the medical learning and attainment of that State 
should sedulously cherish its gifted members, may equally be 
regarded as beyond cavil or dissent. It has been said proverb- 
ially that Republics are ungrateful; one of those idle phrases 
that so often serve to hand down a falsehood rather than per- 
petuate a truth. The benefits conferred on the people at large 
by the life-long toils of one of the members ot this Society, one 
who for more than twenty years has been closely identified with 
the management of the insane, and who is now resting alter his 
labors in honorable retirement, are not forgotten, though they 
can never receive their full meed of appreciation. I need hardly 
say, Mr. President, that I refer to the distinguished gentleman 
who a fewr years since filled with dignity the chair now occupied 
by yourself—Dr. G. A. Shurtleff. I will attempt no eulogy of 
such a man, for none is wanted; his virtues are too vivid in the 
minds of the people to need it. Such was his large-hearted 
sympathy for the unfortunates under his charge, his zeal, his 
skill, that there is not a town or hamlet from the centre of the 
State to its furthermost recesses, where his name is not known 
and revered. 
The State of New York, mindful of the similar services ol one 
of her talented physicians, showed her gratitude by naming in 
perpetuity one of the stateliest hospitals of which the State can 
boast, the Willard Asylum for the Insane. A new asylum is 
soon to rise in our midst, and I feel that I am but echoing the 
feeling of all of us in saying that no fitter name could be found 
for it than that of the Shurtleff Asylum for the Insane. A move- 
ment to that effect would come with peculiar grace from this body; 
and there can be no doubt that when forwarded to the proper 
quarter, the proposal thus to recognize the services of so eminent 
a public benefactor, will be welcomed with acclamation.