Inventory of the Department of Mental Hygiene - Mendocino State Hospital Records

Processed by The California State Archives staff; supplementary encoding and revision supplied by Xiuzhi Zhou.

California State Archives

1020 "O" Street

Sacramento, California 95814

Phone: (916) 653-2246

Fax: (916) 653-7363

Email: ArchivesWeb@sos.ca.gov

URL: http://www.sos.ca.gov/archives/

Inventory of the Department of Mental Hygiene - Mendocino State Hospital Records

Collection Number: R318, F3886

California State Archives

Office of the Secretary of State

Sacramento, California

Contact Information:

California State Archives
1020 "O" Street
Sacramento, California 95814
Phone: (916) 653-2246
Fax: (916) 653-7363
Email: ArchivesWeb@sos.ca.gov
URL: http://www.sos.ca.gov/archives/

Processed by:: California State Archives staff

Descriptive Summary

Title: Department of Mental Hygiene - Mendocino State Hospital Records

Dates: 1887-1972

Collection number: R318, F3886

Creator: Mendocino State Asylum for the Insane, 1889-1893; Mendocino Asylum, 1893-1897; The State Commission on Lunacy - Mendocino State Hospital, 1897-1921; Department of Institutions - Mendocino State Hospital, 1921-1945; Department of Mental Hygiene - Mendocino State Hospital, 1945-1972

Collection Size: 88 bound volumes, 520 file folders, and 217 photographs

Repository: California State Archives

Sacramento, California

Abstract: Mendocino State Hospital, originally the Mendocino State Asylum for the Insane, was established in 1889. Major programs over the years have included treatment for the criminally insane, alcoholic and drug abuse rehabilitation, a psychiatric residency program, industrial therapy, and others. As part of a major reorganization by the Reagan administration, the hospital was closed in 1972. Records of the hospital are divided into three groups dating from 1887-1972: Superintendent's Records, Business Manager's Records, and Medical Records Division.

Physical location: California State Archives

Language: English.

Administrative Information

Access

While the majority of the records are open for research, any access restrictions are noted in the record series descriptions.

Publication Rights

For permission to reproduce or publish, please contact the California State Archives. Permission for reproduction or publication is given on behalf of the California State Archives as the owner of the physical items. The researcher assumes all responsibility for possible infringement which may arise from reproduction or publication of materials from the California State Archives collections.

Preferred Citation

[Identification of item], Department of Mental Hygiene - Mendocino State Hospital Records, F3886:[folder number], California State Archives, Office of the Secretary of State, Sacramento, California.

Agency History

Mendocino State Hospital, originally the Mendocino State Asylum for the Insane, was established in 1889 ( Statutes 1889, Ch. 23). By that law the Governor was authorized to appoint a board of directors of five members for a term of four years to select the site and to manage the institution.

In 1893, the name of the hospital was changed to the Mendocino Asylum ( Statutes 1893, Ch. 64). With the Insanity Law of 1897, the hospital took on the name of Mendocino State Hospital. The Insanity Law created the State Commission on Lunacy which was given authority to see that all laws relating to care and treatment of patients were carried out and to make recommendations to the Legislature concerning the management of hospitals for the insane. The 1897 law provided that each hospital should be controlled by a board of managers of five members appointed by the Governor for four year terms.

In 1921, the state hospitals were placed under the authority of the newly-created Dept. of Institutions. The board of managers continued, but only with advisory power.

The Department of Mental Hygiene was created by an act of the Legislature in 1945 ( Statutes 1945, Ch. 665). It was given authority over all state mental institutions. Boards of managers were replaced by boards of trustees with no change in function. Advisory boards were established in 1969 to take over the responsibilities of the trustees.

Mendocino State Hospital, located in Talmage near the city of Ukiah, formally opened its doors in July 1893. Dr. Edward Warren King was appointed first superintendent. The first patients, all male, were transferred from state mental institutions in Stockton and Napa. Female patients were accepted beginning in 1894.

Following the stock market crash in the late 1920s, patient population increased rapidly. By 1932, the hospital had over 1,900 patients and 300 employees. By 1935, the figure had risen to over 2,600 patients. Hospital population hit a high in 1955 at over 3,000 patients and 700 employees. Increasing discharges and transfer of the criminally insane to the Atascadero facility eased overcrowding. By 1966, population was back under 1,800 patients.

Building construction occured in spurts over the years. The original main building, completed in 1893, was razed in 1952. With the exception of two wards built in 1910 and 1918, the first major construction project took place between 1925-1933. Little construction was accomplished in the 1940s. Between 1950-1955, many new major structures were completed to replace old buildings and to provide facilities for new programs.

Major programs over the years have included treatment for the criminally insane (1929-1954), alcoholic and drug abuse rehabilitation, a psychiatric residency program, industrial therapy, and others. As part of a major reorganization by the Reagan administration, the hospital was closed in 1972.

Scope and Content

Records of the hospital are divided into three groups. The Superintendents' Records include minutes and correspondence of the board of trustees (directors, managers) dating to 1887; annual monthly reports, 1940s-1950s; files from various hospital committees, 1960s; historical materials collected by a history committee to celebrate the hospital's 75th anniversary; Pomo News (hospital newsletter) 1948-1972; and photographs of staff, buildings, patients, and activities.

The records of the Business Manager are largely fiscal in nature and cover the period, 1895-1915. In addition, the business manager's records include stock books, monthly reports on patient population, and abstracts of title to hospital property.

The Medical Records Division records relate to patients and include commitment registers (abstracts of commitments), 1893-1923; patient indexes, 1893-1955; patient summaries; 1893-1972; discharge registers, 1894-1955; and, patient case files, 1892-1972.

Accruals

No further accruals expected.

Related Collections at the California State Archives

Goodwin J. Knight Papers

Governor's Papers, Statement of Expenditures, 1897 (GP3:115)

Governor's Papers, Statement of Dairy Production and Costs, 1904 (GP3:159)

Governor's Papers, Statement of Recommended Salary Schedules, 1909 (GP4:99)

Legislative Papers, Investigation into management of State Institutions, 1897-1899 (LP9:1-9)

Earl Warren Papers

Dept. of Finance Records

Dept. of Public Works Records

Dept. of Mental Hygiene Records

Indexing Terms

The following terms have been used to index the description of this collection in the library's online public access catalog.

Mental health

California. Dept. of Mental Hygiene

Mental illness--Treatment

Superintendents' Records

F3886:1-8

Series 1 Board of Trustees Minutes 1887-1921, 1940-1972

Physical Description: 5 volumes and 3 file folders

Arrangement

Arranged chronologically by date of meeting.

Scope and Content Note

Originally called the Board of Directors, this chief administrative body of the hospital early on became known as first the Board of Managers and then the Board of Trustees. In 1969, it was changed to the Advisory Board. Minutes of regular meetings of the Board contain information on all aspects of hospital business. Includes date and place of meeting, members present and absent, reports of various committees, motions, resolutions, and nature of business. Early minutes also include a list of claims allowed and amounts. The minutes are incomplete for the years 1940-1972.

F3886:9-10

Series 2 Board of Trustees Correspondence 1898-1903, 1958-1969

Physical Description: 1 volume and 1 file folder

Arrangement

Arranged chronologically by date.

Scope and Content Note

Correspondence on all aspects of Board affairs. Letter press volume (1898-1903) of outgoing correspondence of Board secretary contains data on hospital construction, financial matters, and general business. Includes date, name of addressee, text, and signature of secretary. Indexed alphabetically by name of addressee. File folder (1958-1969) contains information relating to patient activity, publicity, appointments to Board, department memoranda, and hospital budget.

F3886:11-12

Series 3 Annual Reports 1950-1954, 1956-1959

Physical Description: 2 file folders

Arrangement

Arranged chronologically by year.

Scope and Content Note

Annual reports from hospital to Department. Includes information on procedures, policies, statistical analyses of patients, summaries of activities of hospital departments, descriptions of new methodologies and special programs, physical plant and foodstuffs, community relations, education, and training for staff.

F3886:13-18

Series 4 Superintendents' Monthly Reports 1940-1942, 1945-1947, 1954-1962

Physical Description: 6 file folders

Arrangement

Arranged chronologically by month.

Scope and Content Note

A monthly report based on information submitted to superintendent by all hospital departments. Includes name of department and department chief, date of report and narrative on statistical text relating to department activities. Usually contains information from the following departments: Education, Nursing Services, Rehabilitation, Dentist, and Chaplains.

F3886:19-26

Series 5 Departmental Monthly Reports 1963-1971

Physical Description: 8 file folders

Arrangement

Arranged chronologically by month.

Scope and Content Note

Monthly reports, statistical and narrative, prepared by department chiefs for hospital superintendent. Includes name of dept and department head, date of report, and summary of monthly activities. Usually includes following departments: Medical-Surgery, Plant Operations, Rehabilitation Services, Special Services (sports, outings, etc.), Service and Supply, Research, Chaplains, Volunteer Services and Nursing Services.

F3886:27

Series 6 Superintendent's Correspondence 1916-1952

Physical Description: 1 file folder

Arrangement

Arranged chronologically.

Scope and Content Note

Correspondence received or sent by hospital superintendent. Contains information on many aspects of hospital business including construction, supplies and equipment, financial matters, disinterment of patient graves and legal affairs. Includes date of letter, addressee text, and name of author.

F3886:28-29

Series 7 Departmental Correspondence 1941-1945

Physical Description: 2 file folders

Arrangement

Arranged chronologically.

Scope and Content Note

Subjects include fiscal matters, education and training, department policies, personnel, hospital programs, affect of World War II on the hospital, superintendent's conferences and construction. Includes date, addressee, text, and name of author.

F3886:30

Series 8 Accreditation File 1953-1971

Physical Description: 1 file folder

Arrangement

Arranged chronologically by date of record.

Scope and Content Note

Contains correspondence and reports relating to hospital accreditation with American Psychiatric Association and, later, the Joint Commission on Accreditation of Hospitals. Includes information on hospital administration, physical facilities, staff, patients, laboratories, nursing services, medical records, departments, education programs, and specific recommendations of inspection representing accrediting organization.

F3886:31

Series 9 Residency Program File 1963-1970

Physical Description: 1 file folder

Arrangement

Arranged chronologically by date of record.

Scope and Content Note

Contains correspondence, applications, reports, forms, and printed literature relating to hospital residency program in psychiatry. Includes correspondence with American Medical Association (AMA), information on staff involved in program, students selected for in-house training, outlines of curriculum, lengthy report on program, hospital, research projects, list of periodicals in medical library, hospital questionnaires, literature from AMA on internships and residencies, training for former osteopaths, and policies of the Department.

F3886:32-34

Series 10 Policy Group Minutes 1961-1972

Physical Description: 3 file folders

Arrangement

Arranged chronologically by date of meeting.

Scope and Content Note

Composed of division chiefs, the policy group met periodically to discuss issues relating to hospital policy. Includes date of meetings, names of members present and absent, topics considered, summary of discussion, decisions made and identification of responsible parties.

F3886:35

Series 11 Administrative Staff Meeting Minutes 1958-1971

Physical Description: 1 file folder

Arrangement

Arranged chronologically by date of meeting.

Scope and Content Note

Composed of division heads, the meetings were instituted in July 1958 as a means to promote free exchange of ideas and information among hospital administrations. Includes date of meeting, names of members present, summary of discussion.

F3886:36

Series 12 Clinical Services Committee Meeting Minutes 1962-1970

Physical Description: 1 file folder

Arrangement

Arranged chronologically by date of meeting.

Scope and Content Note

Chaired by the Associate Superintendent, the Clinical Services Committee had the responsibility for general administrative, non-technical areas of hospital business, such as hospital-community relations, patient activities, education, visiting staff, supplies, social activities, personnel, records-keeping, and religious services. Includes date of meeting, names of members present and absent, topics considered and summary of discussions and decisions.

F3886:37-41

Series 13 Utilization Review Committee Reports 1966-1972

Physical Description: 5 file folders

Arrangement

Arranged chronologically.

Scope and Content Note

Utilization Review Committee had the task of periodically reviewing patient histories to determine if further hospitalization was required. Reports include date of meeting, members present, discussion of particular cases, if warranted, utilization review check-list form with questions on patient status and recommendation of committee, patient name and number, birth date, date of admission, and unit designation.

F3886:42

Series 14 Application For Hospital Building Project 1933

Physical Description: 1 file folder

Arrangement

Arranged chronologically.

Scope and Content Note

In 1933, Governor Rolph made application to the Federal Emergency Administration of Public Works, under the provisions of the National Industrial Recovery Act of 1933, for new construction at Mendocino State Hospital. Application includes statistical summaries of hospital population, comparisons of state hospital populations with total state population, amount of funding requested, summary of facilities to be constructed with cost estimates, statement of state bonded debt, statement of state revenues and expenditures, and architectural drawings of proposed facilities.

F3886:43-44

Series 15 History Files 1892-1893, 1906-1968

Physical Description: 2 file folders

Arrangement

Arranged by type of material and chronologically thereunder.

Scope and Content Note

Files represent an artificial collection of materials assembled by history committee for 75th anniversary of the hospital. Includes report on 1906 earthquake at Agnews State Hospital, biennial reports of State Commision in Lunacy, first biennial report of Mendocino State Asylum for the Insane (1892), newspaper articles, reports about history of hospital, special insert from Ukiah Daily Journal on 75th anniversary (1968), correspondence from patients, reports on various hospital programs and projects, procedures manual, lecture outlines for psychiatric attendants "class" (1932), rules and regulations of hospital (1932), articles by hospital staff. Majority of records date from 1930s. See also, Photographs, Series 18.

F3886:45-53

Series 16 Pomo News (Hospital Newsletter) 1948-1972

Physical Description: 9 file folders

Arrangement

Arranged chronologically by date of issue.

Scope and Content Note

Pomo News was the newspaper of the hospital developed for staff and patients. The series contains nearly a complete run of the newspaper from its beginning in 1948 to closure of hospital in 1972. Includes information on staff, activities, programs, construction, funding and other aspects of hospital life. The format changed in July 1956 when photographs and typesetting became possible through technical services provided by a local Ukiah newspaper.

F3886:54

Series 17 Medico-Legal Conference Reports 1971-1972

Physical Description: 1 file folder

Arrangement

Arranged chronologically by date of report.

Access Information

Records in this series that are less than 75 years old are restricted under California Welfare and Institutions Code Section 5328 because they contain confidential patient information.

Scope and Content Note

Contains correspondence and reports relating to review of patient cases to determine if individuals charged with crimes are capable of participating in their defense. Includes date of correspondence on report, name of addressee (usually sheriff or judge), summary of findings concerning patient's condition and recommendation of physician as to court custody.

F3886

Series 18 Photographs 1890s-1960s

Physical Description: 217 items

Arrangement

Arranged by size of photograph.

Access Information

Records in this series that are less than 75 years old are restricted under California Welfare and Institutions Code Section 5328 because they contain confidential patient information. Photographs that do not reveal the identity of hospital patients are available for research.

Scope and Content Note

The majority of the photographs were gathered by the History Committee to celebrate 75th anniversary of the Hospital. Consists largely of black and white prints of Hospital staff, patients, buildings and grounds, activities, and various divisions. Includes a photo of E.W. King, first superintendent of Hospital (1892-1912) in various sizes mounted on cardboard, and seven color negatives of Hospital buildings.

Business Managers' Records

F3886:55-58

Series 1 Claim Registers 1895-1912

Physical Description: 4 volumes

Arrangement

Arranged chronologically by date of entry.

Scope and Content Note

Register of all bills filed and allowed. Includes date of entry, name of fund, voucher number, name of claimant, and total amount allowed. One volume is a treasurer's claim register, which covers a period contained in other volumes.

F3886:59-62

Series 2 Cash Books 1894-1913

Physical Description: 4 volumes

Arrangement

Arranged chronologically by date of entry.

Scope and Content Note

Treasurer's records used to list receipt and disbursement of cash funds. Includes date of entry, name of claimant, payee, purpose of transaction, amount received and portion of funds allotted to hospital divisions. One volume is a superintendent's cash book.

F3886:63-67

Series 3 Accounting Journals 1891-1907

Physical Description: 5 volumes

Arrangement

Arranged chronologically by date of entry.

Scope and Content Note

Basic fiscal record of fund transactions. Data includes date of entry, name of fund or claimant, amount received or disbursed, including figures on salaries, state support, and general operating expenses.

F3886:68-69

Series 4 Day Books 1895-1898

Physical Description: 2 volumes

Arrangement

Arranged chronologically by date of entry.

Scope and Content Note

Record of items purchased on a daily basis. Includes date of entry, name of item, number of items purchased, cost of items, and total costs for the day.

F3886:70-71

Series 5 Invoice Ledgers 1893-1897

Physical Description: 2 volumes

Arrangement

Arranged chronologically by date of entry, then by name of claimant.

Scope and Content Note

Record of invoices relating to purchase of supplies and stores for hospital. Includes date of entry, invoice number, name of claimant, list of items purchased and costs, and total amount of invoice.

F3886:72-73

Series 6 Expenditure Ledgers 1890-1898, 1904-1910

Physical Description: 2 volumes

Arrangement

Arranged chronologically by date of entry.

Scope and Content Note

Record of expenditures by hospital fund or department. Includes date of entry, name of fund or department, expenditures by category (supplies, services, salaries, property, equipment), name of claimant, and totals. Volume for 1904-1910 contains an entry relating to the 1906 San Francisco earthquake.

F3886:74

Series 7 Control Ledger 1913-1918

Physical Description: 1 volume

Arrangement

Arranged chronologically by date of entry.

Scope and Content Note

A list of fiscal transactions for various funds; used for budget control. Includes date of entry, name and number of fund, amount received or expended. Indexed alphabetically by subject with reference to page number.

F3886:75

Series 8 Department Register 1898-1912

Physical Description: 1 volume

Arrangement

Arranged chronologically by date of entry.

Scope and Content Note

A record, by hospital department, of requisitions allowed. Includes date of entry, requisition number and amount, and name of department.

F3886:76-81

Series 9 Patients' Cash Books 1895-1917

Physical Description: 6 volumes

Arrangement

Arranged chronologically by date of entry.

Scope and Content Note

Record of cash accounts for hospital patients. Includes name, date of entry, amount entered or withdrawn, items purchased, charges against board expenses, and balance. Later volumes indexed alphabetically by name of patient.

F3886:82-85

Series 10 Stock Books 1898-1902

Physical Description: 4 volumes

Arrangement

Arranged chronologically by date of entry and thereunder alphabetically by name of item.

Scope and Content Note

Stock books used to record purchase of items needed by hospital. Includes name of item, date of purchase, quantity, cost, and claim number.

F3886:86-91

Series 11 Inventory Ledgers 1893-1906, 1908-1909

Physical Description: 6 volumes

Arrangement

Arranged chronologically by date of entry.

Scope and Content Note

Ledgers used to record supplies and stores on hand at time of inventory. Includes date of inventory, name of item, count of item, quantity and size of items, and total cost. Inventories were usually taken monthly.

F3886:92-95

Series 12 Steward's Monthly Reports 1893-1912

Physical Description: 4 volumes

Arrangement

Arranged chronologically by month.

Scope and Content Note

Monthly report by steward relating to hospital population and basic costs. Includes date of report, number of patients by categories (male, female, received, discharged, died, eloped, under treatment, and returned escapees), number of people fed, per capita costs, costs of various categories or services with monthly total, and costs by department.

F3886:96-97

Series 13 Monthly Summaries 1893-1918

Physical Description: 2 volumes

Arrangement

Arranged chronologically by month.

Scope and Content Note

Monthly report used to record information on patients. Includes date (month and day), number of male and female patients received, discharged, died, eloped, or returned escapees, number of males and females present by day and daily average for month. Further data provided on elopements (name, where from and ward), and escapees (name, where from, by whom returned, and expenses).

F3886:98-101

Series 14 Abstracts Of Title 1859-1902

Physical Description: 4 volumes

Arrangement

Arranged roughly in chronological order by date of recording in county recorder's office.

Scope and Content Note

Record of title searches produced by title companies for hospital real property. Includes date of transaction and date of recording, type of document (deed, patent, mortgage, certificate of sale, power of attorney), names of parties involved, description of land, and text of transaction.

Note

Note: This series traces hospital land back to 1845 grant known as Yokayo Rancho to Cayetano Juarez by Mexican government.

Medical Records Division

F3886:102-117

Series 1 Commitment Registers (Abstracts of Commitments) 1893-1923

Physical Description: 16 volumes

Alternative Form of Materials Available

Due to the fragile condition of the original volumes, researchers are required to access this series on microfilm (MF8:11(8) - MF8:11(12)).

Arrangement

Arranged numerically by patient number, assigned chronologically.

Scope and Content Note

Record of patient information concerning identification, behavior, and initial diagnosis. Includes patient number and name, where from, type of commitment (voluntary, court, transfer), date of admission, nativity, sex, age, race, marital status, occupation, education, religion, number of children, genealogical information about parents, health history, in particular, as to types of diseases, illnesses and injuries and use of liquor, tobacco, and drugs, date and history of previous attacks, history of current infirmity, including suggested causes, categories of patient behavior (violent, homicidal, suicidal, incendiary), facts about insanity, diagnosis statement, discharge date and reason, and mental condition when discharged or dead.

F3886:118-127

Series 2 Patient Registers (Synopsis of Commitments) 1893-1972

Physical Description: 10 volumes

Arrangement

Arranged numerically by patient number, assigned chronologically.

Access Information

Volumes in this series that are less than 75 years old are restricted under California Welfare and Institutions Code Section 5328 because they contain confidential patient information.

Scope and Content Note

Summaries of information contained in the commitment registers (abstracts of commitments). Includes patient number, date of admission, name, nativity, county sent from, age, marital status, occupation, cause of insanity, classification, and date of death or discharge. For the period 1893-1958, the registers were called Synopsis of Commitments and divided into male and female sections.

Males, 1893-1957 (F3886:118-121)

Females, 1894-1957 (F3886:122-124)

From 1957-1972, both males and females are included in the same volumes (F3886:125-127).

F3886:128-132

Series 3 Patient Indices 1893-1955

Physical Description: 5 volumes

Alternative Form of Materials Available

Due to the fragile condition of the original volumes, researchers are required to access this series on microfilm (MF8:11(7)).

Arrangement

Arranged by gender, then chronologically by date of admission and alphabetically by surname thereunder.

Access Information

Volumes in this series that are less than 75 years old are restricted under California Welfare and Institutions Code Section 5328 because they contain confidential patient information.

Scope and Content Note

Includes patient name, date of admission, volume and page numbers in abstract of commitments, ward (later indexes replace this information with patient number), and date of discharge or death. Divided into male and female indices:

Males, 1893-1955 (F3886:128-130)

Females, 1894-1955 (F3886:131-132)

F3886:133-135

Series 4 Discharge Registers 1894-1955

Physical Description: 3 volumes

Alternative Form of Materials Available

Due to the fragile condition of the original volumes, researchers are required to access this series on microfilm (MF8:11(13)).

Arrangement

Arranged chronologically by date of discharge.

Access Information

Volumes in this series that are less than 75 years old are restricted under California Welfare and Institutions Code Section 5328 and Government Code 7927.7 (formerly Gov. Code section 6254(c)). because they contain confidential patient information.

Scope and Content Note

Registers of all patients discharged from hospital. Includes patient number and name, date of discharge, where they were sent, expenses, condition upon discharge, and remarks (usually relating to type of discharge).

F3886:136

Series 5 Dispensary and Autopsy Journal 1897-1912

Physical Description: 1 volume

Arrangement

Arranged chronologically by date of death.

Scope and Content Note

Lists drugs dispensed to departments, wards, and individuals in front of volume. A list of patients who died with accompanying data on autopsy begins on page 191. Drug information includes name of department, ward, or individual, date dispensed, and name of drug(s). Deceased patient information includes name, age, nativity, patient number, date of admission, patient history, and summary of autopsy. Description varies over time.

F3886:137-608

Series 6 Patient Case Files 1892-1972

Physical Description: 472 file folders

Arrangement

Arranged numerically by case number (assigned chronologically), and in reverse chronological order within.

Access Information

Records in this series are restricted for 75 years from the date of last activity under California Welfare and Institutions Code Section 5328 because they contain confidential patient information.

Scope and Content Note

Case files are the primary source of information on care and treatment of individuals at Hospital. Common records for each file may include, in order, commitment papers and related court documents, patient background information, nurse's admission reports, photographs (often a positive and negative), clinical conference reports, progress notes, social service reports, ward notes (nursing notes), behavior charts, hydrotherapy reports, electric shock treatment reports, intelligence test reports, release summaries, death certificates, permits for removal and burial of body, rap sheets relating to criminal activities, cumulative case summaries, autopsy reports, and correspondence.

Files have been heavily sampled and reflect only a small percentage of total patients. Files ending in zero and fat files have been retained. Fat files are large because either the patient was institutionalized over a long period or was admitted repeatedly for a specific illness, frequently alcoholism.