Ep. 44: History of Napa State Hospital, Part 2 (1901-1950)

Episode 44 discusses the history of Napa State Hospital from 1901 until the demolition of the Castle in 1950. Find out how the hospital was impacted by events, like the 1906 San Francisco earthquake, WWI and WWII, and the Influenza epidemic of 1918. Learn about some of the treatments used during this time period and what finally led to the California Governor saying the Castle was unsafe.

Most of the information from today's episode was drawn from the Images of America book called Napa State Hospital by Patricia Prestinary, as well as the Napa County Historical Society website. All other sources are listed in the episode transcript.

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Transcript

Hello, hello, hello, and welcome back to Behind the Walls of the World’s Psychiatric Hospitals! I’m your host, Dr. Sarah Gallup, and, this episode is not only the last one of 2023, but it also marks one year since I released the very first episode. I had planned to release episode one on January 1st, but I just couldn’t wait any longer, so I posted it on December 31st. Some of you have been listening all year, and some of you have just started, but I’m so thankful that you’re all here and listening to my little show. I appreciate it sooooo much!

If you haven’t already seen it on Facebook or Instagram, I’ve started a Patreon page for the show. I just launched the site, so please be patient – I’ll work on building it over the coming months. I’ll include a link in the show notes if you’d like more information.

This week we’ll be jumping back in to the history of what was originally called Napa Asylum for the Insane. Once again, I’ll be using information from the Napa County Historical Society website and the Images of America book entitled Napa State Hospital by Patricia Prestinary as my primary sources. All other sources will be listed in the episode transcript.

For now, come on in and get comfortable as we go behind the walls of Napa State Hospital…

We left off in the previous episode around 1901. The Castle was consistently overcrowded but only had 200 employees at that time (Prestinary 33). Patricia Prestinary includes a copy of an affidavit of insanity for a local Napa Valley man, Henry Allen, from the Yountville Veterans Home. The affidavit is a template, with fill-in-the-blanks for specific individual information. In this case, some of the easier to answer questions (like the date) are left blank. Seems like that would be an important detail to include. It was signed on April 10, 1902, so that gives us an approximate timeframe. The affidavit reads as follows: 

In the Matter of Henry Allen, an Alleged Insane Person. W.T. McAllister, MD, being duly sworn, deposes and says that there is now in said county, in the city or town of Veterans Home, a person named Henry Allen, who is insane, and is so far disordered in mind as to endanger his or her health and person, or to endanger or cause the destruction of the property of himself or herself, or of others the lives of other persons, and that he, at [BLANK] in said county, on the [BLANK] day of [BLANK], 19[BLANK], threatened and attempted (state actions, etc.) “Imagining Sergeant of Company ‘G’ is trying to shoot him.”

That by reason of said insanity, said person is dangerous to be at large; Wherefore, affiant prays that such actions may be had as the law requires in the cases of persons who are so far disordered in mind as to endanger health, person, and property. (Qtd in Prestinary 22)

Now, granted, we have no other available information about Mr. Allen, so what I’m about to say is me clinically speculating. We know from this record that he was a veteran living at the Yountville Veterans Home. We don’t know his age. If he had fought in the U.S. Civil War, he would be at a minimum in his mid-50s. So that’s possible. If he had fought in the Spanish-American War in 1898, he could be in his 20s or 30s. I did find an LA Times article from January 1902 that referenced a Major Henry Allen who was fighting in Manila in the Philippines, but I’m not sure if it was the same person. Henry Allen is a fairly common name.

The affidavit says that Mr. Allen believed the Sgt of Company G was trying to shoot him. That sounds paranoid, sure, but it could also be a result of what we now know as PTSD. Regardless, that had to be a terrifying feeling. Those symptoms may have looked a lot like psychosis – or what they understood as psychosis – back then. But it does not necessarily make him a danger to himself or others, though. Again, all this is speculative, but from the very little amount of information we have, we can string together some theories.

Remember that in the 19th and early 20th centuries, a person didn’t necessarily have to have a good reason to be committed to an asylum. As we mentioned in the previous episode, some of the common reasons for admission to Napa were pretty average: being disappointed in love, suffering a sunstroke, having “domestic problems” (that’s pretty vague), or losing mining stocks (Prestinary 31). These so-called ailments didn’t necessarily make the person a danger to themselves or others or to property, but remember that the affidavit for Henry Allen directly stated this. I have patients who are frequently paranoid but that doesn’t necessarily make them a danger to themselves or others. I would say that this speaks to how far we’ve come in our understanding of mental illness, but there still is a common misconception that folks with schizophrenia or bipolar disorder are more dangerous than those without, and research has consistently found that to be inaccurate. Instead, folks with severe mental illness are far more likely to be victims of violence than perpetrators of violence. And I think it’s really important to remember that.

Getting back on track…treatment around the turn of the century consisted primarily of work around the hospital. And there were many types of jobs that patients could perform. We discussed the role of patient labor on the farm and in the vegetable garden in the last episode. By the early 1900s, around 40 or 50 patients were assigned to the nursery or other landscaping positions. Patients working in the nursery would learn the art of arranging flowers, and their bouquets would be placed around the asylum in order to brighten the wards (Prestinary 35).

Other patients worked at the hospital dairy with up to 200 Holstein-Friesian cattle. Prestinary notes that it was the largest accredited herd in the state of California – and one of the best, winning awards for breeding and high butterfat content (39). Yum.

When patients weren’t working, recreation was emphasized. There was a baseball diamond where men could play alongside community members (Prestinary 37). Although the text doesn’t mention this, I wonder if it operated similarly to Ionia State Hospital in Michigan, where men’s recreational opportunities were generally physical, like sports, whereas women’s recreational opportunities were more docile, like picnics and car rides. That’s speculative, but it seems to be a pattern I’ve noticed at many asylums around this time.

What also seems extraordinary to think about now, each year patients were loaded into wagons and taken into Napa for the circus at the Fourth of July parade (Prestinary 41). There’s a photograph in Prestinary’s book of patients loaded into wagons, and all of them, men and women, are wearing stylish hats and nice clothing. The fourth of July celebration at the hospital included a parade, a boxing contest, various races, greased-pole climbing, tug-of-war, an ice cream contest, a pie-eating contest, and dancing from 9 AM to 1 PM (42). Most of those activities I wouldn’t recommend for our patients today, but I’m sure they had fun at the time. 

And then, disaster. Most U.S. West Coast residents today know the story of the 1906 San Francisco earthquake – even people like me who aren’t even originally from California are familiar with it. Early in the morning on April 18, 1906, an estimated 7.9 magnitude earthquake (“1906 San Francisco Earthquake”) ruptured through San Francisco for what probably felt like the longest 60 seconds in history. The earthquake was felt from southern Oregon down to Los Angeles and as far east as central Nevada. The quake confounded geologists at the time, as nothing of this magnitude had been known beforehand. Analysis of the quake would later produce one of the principal models of the earthquake cycle that we still use today (“The Great 1906 San Francisco Earthquake”). The death toll was estimated to be around 3,000 people, and over 80% of San Francisco was destroyed – either in the initial quake or in the days-long fires that followed (“1906 San Francisco Earthquake”).

One of the largest casualties from the earthquake was at Agnews State Hospital, located in Santa Clara. The main patient residence collapsed, killing 117 patients and staff and resulting in the largest loss of life at one site (“Agnews Developmental Center”). 

The asylum at Napa, fortunately, escaped extensive damage from the earthquake, but the devastation at Agnews State Hospital led to structural changes at the Castle. Most notably, the imposing bell tower at the center of the castle was lowered 60 feet due to damage sustained in the quake. Also, the four round towers that were used to store water for fire protection had the tower caps removed and replaced with a flat roof (Prestinary 20). 

The fallout from the earthquake caused widespread devastation of property but also of livelihoods. If you think about it, 80% of San Francisco was destroyed in a matter of days. Chances are, most people’s work places and work products were also lost. 

One example of this is Carleton Watkins, who is still considered one of the greatest photographers of the American West. Born in New York, he traveled west and took incredible snapshots of landscapes in places like Yosemite Valley, the Columbia River, the Sierra Nevadas, and the Oregon Coast (“Carleton E. Watkins”). His works are stunning, and I will include some on the Facebook and Instagram pages for you to see.

But Carleton Watkins’ studio, located on Market Street in San Francisco, was entirely destroyed by the 1906 earthquake and subsequent fires. “He lost countless pictures, negatives, and the majority of his stereo views” (“Carleton Watkins”). He had no choice but to retire early – or, rather, earlier than he had planned, since he was already 77 years old. Within three years following the earthquake and the loss of his studio, Watkins’ family had him committed to the asylum in Napa for senile dementia (Prestinary 45). He remained there until his death on an unrecorded day in 1916 and was buried on grounds in an unmarked grave. It was a very unceremonious end for the man whose photography is said to have influenced Abraham Lincoln’s decision to formally preserve Yosemite Valley. A mountain within the now National Park is named Mount Watkins in his honor (“Carleton Watkins”).

During the time that Carleton Watkins lived at Napa Insane Asylum, overcrowding continued to plague administration. The asylum adopted the growing trend of the Cottage Hospital Model, which we’ve talked about in previous episodes. The idea was that smaller buildings – cottages – could serve as a better environment for patients. They could be more easily separated by need – patients with acute medical concerns, patients with tuberculosis, violent patients, and the like. And so in 1913, one of these cottages, called B Ward or the Acute Quiet Hospital, was built. It was initially an admissions unit but also used for hydrotherapy treatments. Similar to the original Castle, one wing housed men while the other wing housed women. An enclosed patio separated the buildings (Prestinary 46). B Ward is still standing today and part of it continues to be used for training. I went through several trainings in that building. It’s kinda funny to look at these pictures from 1913 and think about how not much has changed – the trees have grown up around it, and that’s pretty much it.

When World War I began in 1914, staffing was short, as many hospital workers left to help with the war efforts. The hospital increasingly relied on its patient workers to help with tasks around the facility, as well as managing other patients. When the influenza pandemic broke out in 1918, low staffing made it difficult to manage the increasing cases of flu. Beds were brought out into the courtyard in an attempt to isolate healthy patients from those who were sick. At the height of the epidemic, there were about 400 cases of the flu, including patients and employees (Prestinary 40).

I want to deviate from the history for just a moment to tell three quick patient stories. I don’t have a lot of information about these women, but the Napa County Historical Society includes some information about their time at the hospital, as well as pictures of them. The context seems to be showing how work therapy had a curative effect on these patients.

The first patient is identified as Margaret H., who was admitted to Napa in September 1916. There’s a snapshot of her at admission: she’s sitting in a chair, hands clasped in her lap, though more like she’s been anxiously wringing her hands, since one hand appears to be cupping the other. She’s wearing a large overcoat buttoned over a dress. Her hair is neatly pinned back and parted down the middle. She looks very young – if I had to guess, I’d say 16ish, but the text doesn’t say one way or another. She looks like she was either confused or caught off-guard when the picture was taken because she’s looking straight up – but she has a strong gaze, like she’s looking directly at someone standing behind the photographer (Prestinary 56). She looks a little lost or unsure of what’s to come.

The second picture of Margaret H. is labeled May 1918 – so over a year and a half after her admission to Napa – and says, “Entered work therapy class March 1917.” In this picture, she’s wearing a white, button-up work shirt with what looks like leather suspenders. Her arms are crossed in front of her hips. I can’t tell if her hair is pinned back or cut bluntly short, but it doesn’t look as neat and tidy as in the first picture. She looks more masculine or tomboyish in this photo than in the previous one. Here she’s looking just slightly to the right of the camera with a solemn gaze. Her eyebrows are just slightly raised. I get the sense that she’s rushing to take the picture and get back to work.

The final picture of Margaret H. is labeled, “May 1918. Dismissed from hospital Jan. 1918.” This picture is strikingly different from the others. Here Margaret looks like a glamorous lady – she’s wearing a dress with a lacy trim around the neck, dark thick belt around her waist, and flowery motif on the chest. She’s seated in a chair with one elbow on the arm of the chair and her index finger on her cheek; her other arm is in her lap. She’s wearing gold bangles on both arms and a dark choker around her neck. Her hair is neatly and stylishly pinned back, with a part deep on the side. She looks relaxed and calm and stares straight into the camera. She’s not smiling, exactly, but there’s a brightness and confidence in her eyes. There’s a decorative curtain behind her. This seems like the 1918 equivalent of an online dating profile picture. It’s clear by her face that this is the same woman, but she looks very different in each photo. The implied message seems to be that the work program can turn a naïve young girl into a beautiful woman.

The second woman has more information available. She is identified as Susan R., age 39. The first picture of Susan R was likely taken at admission, although that’s not clear. She’s got what looks like a wool blanket wrapped around her, as if to restrain her arms. She’s tipped back so that the camera is looking straight at her chin and throat. She has to look down in order to see the camera lens. It seems entirely possible that she was just restrained – her eyes are wider than I would expect for that strange angle, and her nostrils look somewhat flared. Her mouth is a tight, thin line. She does not appear relaxed at all.

The text beside this picture says, “Diagnosis – manic depressive maniacal form. This case illustrates another form of mental disease benefited by our work therapy department. The patient was excited, violent, and had to be kept in restraint from December 1916 until February 1917. She was sent to work therapy class in February 1918 and enjoys the work. She has been particularly interested in the cooking and housekeeping part of the work. She takes charge of the rooms, sees that they are kept in order. She has now acquired poise and calmness of manner” (Prestinary 57).

The second picture of Susan R. was taken outside. She’s seated next to some flower bushes on a wooden seat. There is a table next to her with linens on it and materials for basketweaving. Susan R. is wearing a long white dress, almost like a nurse’s uniform, and is working on a project. She’s holding the item with both hands and looking at it carefully. She appears relaxed.

The third woman is identified as Hazel W. The text indicates the first picture was taken in 1916 upon entering the hospital. She was 19 years old. In the first picture, Hazel W. is sitting slouched in a chair and slightly askew, as if hunched over. She’s wearing a dress with a frumpy sweater over the top. Her long brown hair is separated into two long pigtails and parted in the center. The expression on her face makes her appear somewhat disoriented. Her face is turned up and away, and she’s staring toward the ceiling. It doesn’t look like she’s looking at anyone or anything in particular. Her mouth is open slightly. Either she was somewhat disoriented as the picture was being taken or she was starting to stand up right as the picture was taken. I’m not entirely sure.

The second picture of Hazel indicates it was taken upon her entering work therapy class in January 1917. In this picture, it looks like she’s sitting in a chair on a covered porch. She’s wearing a similar white dress to the one Susan R. was wearing – very nurse like. She’s also working on a project – maybe the start of a basket, which is in her lap. Her hands surround it, and she’s looking down at her project. She appears busy at work.

The final picture of Hazel was taken in May 1918. Here she is inside, seated at a table with basket weaving materials on it. She is looking at the camera and smiling, her right hand resting on items on the table. She looks sure of herself here. And it’s notable that this is the only picture of all of them where the woman is smiling.

I thought those short success stories of work therapy were interesting. Obviously, they’re only snapshots (literally) of moments in time, but I hope that those women were able to progress and heal and return to the community.

By 1921, there was a growing number of patients and staff at the hospital. In order to house more staff, the married nurses’ dorm was opened, with room for 17 single women, five married couples who were both employees, and night attendants. This building is also still on campus and used for lodging. Apparently, back in the day, it was offered to psychology interns as a cheap housing option but now it’s…not in great condition.

The influx of people at the hospital also caused mail services to be backed up, so in September 1921, the Imola Post Office was established. All mail sent to the asylum was addressed to Imola, California (Prestinary 33).

By this time, the asylum in Napa was the largest state institution and the largest employer in Napa (Prestinary 47). That same year, in 1921, the Department of Institutions was formed. Their task was to modernize the treatment of mental illness. In an attempt to destigmatize the term, “insanity” was changed to “mental illness,” and the name of Napa Asylum for the Insane was officially changed to Napa State Hospital in 1924. Other asylums around California did the same (Prestinary 47). 

But name changes didn’t change the fact that patients were crowded into wards, sleeping on mattresses in hallways, attics, and basements. A typical ward in the Castle had a capacity of 26 patients but often housed 64 (Prestinary 62). A superintendent’s report indicated that 386 patients were jammed into Dozier Cottage. Since there were only a few chairs to use, many patients had to stand or sit on the floor. The superintendent noted, “The noise and confusion is bedlam” (62). Obviously, a crowded and noisy environment isn’t conducive to anyone’s recovery.

Throughout the 1910s and 1920s, treatment relied on methods like hydrotherapy and malaria fever therapy. We’ve discussed these in previous episodes, but if you’re just joining the show, I’ll briefly mention them here. 

I always thought hydrotherapy would be nice – just taking a bath in a warm tub. Sign me up. Sounds relaxing. But these old hospitals had to make even good things horrific. Patients who were prescribed hydrotherapy were often placed into baths, covered, and essentially zipped up so that only their head stuck out of a hole in the covering. They would be left there for hours and unable to get out on their own. The worst part is that after one person got out of the tub, the next person would get in directly after them. By the end of the day, someone could be using the same tub water and towels as five or six people before them. If you are eating, I’m so sorry.

We discussed malaria fever therapy in the episodes on Oregon State Hospital. This was generally a method of treating the psychiatric symptoms of syphilis. Patients would be injected with malaria, which would induce a high fever and supposedly kill off the syphilitic spirochetes. I don’t know how effective it actually was, but that’s what they used for a long time.

We discussed the rise of eugenics at length in our episodes on Oregon State Hospital. Napa was a large proponent of forced sterilization in the early 20th century. Patricia Prestinary points to the work of Joel Braslow who found that, by 1921, California had performed 80% of all state hospital patient sterilizations in the United States (47). Between 1919 and 1952, so the span of 33 years, about 20,000 people were sterilized in California’s state institutions (Stern, et al). And I find this abhorrent for many reasons, but namely because (a) these were involuntary procedures and (b) the criteria for getting sterilized seemed to be a consistently moving target. It included anyone who was deemed to be “dangerous to public health.” 

Think for a second about who you might believe would be someone dangerous to public health. Is it because of something they’ve done, something they’re capable of but haven’t done, something they are, something they have or may have inherited genetically? Because the list of conditions that qualified someone for sterilization included, among many other reasons, their IQ score (if it fell below a certain number, they were sterilized), sexual history (if someone were deemed to be promiscuous that could qualify), family history of adultery (so someone could be punished for a family member’s actions), general recklessness (so basically every teenager ever), or family poverty (Stern et al). These were all deemed valid reasons to sterilize a patient in order to protect the community. It wasn’t about safety; it was about control. And forced sterilizations continued in California state hospitals until 1979; for prisons, the practice ended in 2010 (La). Yep. The eugenics laws were finally repealed in 2010.

By the 1940s, the Castle was showing extreme signs of wear. It was almost 70 years old and had been overcrowded for most of its history. It was complaints of overcrowding in all the California state hospitals that prompted Governor Earl Warren to tour each state institution in 1942. After visiting Napa State Hospital, he declared it a “firetrap” (“Brief History of Napa State Hospital, 1875-1975”). The state director of institutions, Dora Shaw Heffner, recommended that bedridden patients be immediately transferred to temporary quarters (Prestinary 82). It was time for the Castle to be torn down.

But plans for its demolition were put on indefinite pause when the U.S. entered WWII. Once again, many hospital staff left to help with the war efforts. And because workers and construction materials were scarce, building a new facility was impossible – at least for the time being (Prestinary 59).

In a move that doesn’t make a whole lot of sense to me (and perhaps I’m missing some context), a children’s center was opened on the grounds of Napa State Hospital in 1943. Now I say that it doesn’t make sense because the hospital was already overextended in terms of patients and understaffed, especially during the war. I would assume that during that time they’d want to conserve their resources and put all available buildings, funding, and staff toward the patients they were currently working with. But instead, Dr. Theo K. Miller developed the Children’s Center, which was intended primarily for teenage boys and girls (“Brief History”). Now, there’s a good chance that there were children and teenagers residing and being treated with adults, so this might have alleviated some of the younger patients from the general population. But starting a new center requires a lot of work and attention, so I’m surprised they opened during the war. I don’t know for sure, but I wonder if this unintentionally set back construction of a new hospital even further.

After WWII ended, efforts expanded to demolish the Castle and start building a new facility. The first step was removing part of the Castle façade to make room for a new administration building, which would be situated directly in front of the old Castle. While the new administration building was under construction, the wings of the Castle were demolished. By the time the new admin building was complete, only the original bell tower and central structure were standing, including the kitchen, chapel, and library (Prestinary 92). Patricia Prestinary noted that salvagers took away 10 million bricks; one million board feet of lumber; 250,000 square feet of one-inch-thick hardwood flooring; over 1,000 squares of slate roofing, flashing, and metal ornamentation; and up to 1,000 tons of steel and iron products (90).

Next, the old central structure was demolished until only the bell tower remained standing. A report from a 1949 newspaper on the tower’s demolition stated, “Four attempts were made to pull down the ornamental wooden tower-tip and each time the heavy cable broke. On the fifth try, it was loosened from its moorings, tilted, and then fell point downward in a graceful arc before crashing to earth in a pile of splinters” (qtd. in Prestinary 93). 

Demolition of the central tower became a community affair. Residents and employees stayed all day to observe its demolition (Prestinary 94). “The tower weighed 3,000 tons with solid brick walls that were eight feet thick on the second floor” (94) – taking it down would be a challenge. Workers spent nine hours constantly pounding at the tower with two steel wrecking balls weighing 2,300 and 3,400 pounds each (94). After a full day of work, they knew they weren’t going to bring down the tower without extra effort.

The next morning, on September 23, 1950, workers came back with what was probably an absurd amount of dynamite. With one charge, the dynamite took out not only what was left of the bell tower but the windows of the brand-new administration building, too (Prestinary 96). Ooops!

But with that, the old Castle was officially gone. It was a bittersweet moment for many people – the loss of a regal old structure but the hope of a new and modern facility, with elevators and better water pressure and smaller wards (Prestinary 59). It was truly the end of an era.

And that’s where I think I’ll end part two of the history of Napa State Hospital. Next week I’m going to briefly go over some of the history since 1950. I want to be extra mindful because Napa is still a fully-functioning hospital, so I’ll stay away from more recent history. 

I hope you enjoyed learning about the Castle as much as I did! I know when I was there for my internship, I loved looking at the pictures of the old hospital. I know it wasn’t in a good state by the time it was demolished, but gosh darn it, it was a stunning building! Such a shame it couldn’t have been preserved and renovated like the Kirkbride building at Oregon State Hospital was. Sigh.

Anyway, I’m excited to bring you more stories next week and see what else we can learn together! Once again, feel free to check out my brand new Patreon page. You can support the show for $5/month like Samira started doing – thanks, Samira! J Any contributions support the show by helping me buy books on the various hospitals, pay my fees, and whatnot. If you have ideas for special features on Patreon, please let me know. I have a few ideas in mind, but I’d love to see what you would be interested in. Send me an email at behindthewallspodcast@gmail.com.

But, as I always say, the best way you can support me is by rating and reviewing wherever you listen, but super-duper extra bonus points if that’s on Apple Podcasts. I seem to be stuck at only 26 ratings, and I know there’s a whole bunch more of you out there who listen. Oh, just kidding – I have 27 ratings now. Woohoo!

So like I mentioned at the top, this episode marks a year of recording this show. I really had no idea what to expect when I started. I figured my mom and, like, two people would listen, but I am truly surprised and delighted by how many of you tune in each week. My little show has reached people in 56 countries and is in the top 25% of all podcasts, according to Buzzsprout. So that has been very, very exciting, and that’s because you are listening. So thank you, thank you, thank you. I can’t wait to see what 2024 brings.

Most importantly, remember the words of Maya Angelou: “Do the best you can until you know better. Then, when you know better, do better.” Until next time…

“1906 San Francisco Earthquake.” Wikipedia. https://en.wikipedia.org/wiki/1906_San_Francisco_earthquake

“Agnews Developmental Center.” Wikipedia. https://en.wikipedia.org/wiki/Agnews_Developmental_Center

“Brief History of Napa State Hospital, 1875-1975.” Napa County Historical Society. https://napahistory.org/programs/local-history/timelines-of-napa-county-history/brief-history-of-napa-state-hospital-1875-1975/

“Carleton E. Watkins.” Fraenkel Gallery. https://fraenkelgallery.com/artists/carleton-watkins

“Carleton Watkins.” Wikipedia. https://en.wikipedia.org/wiki/Carleton_Watkins

La, Lynn. “More Pain for California’s Forced Sterilization Patients.” Cal Matters, 22 March 2023. https://calmatters.org/newsletters/whatmatters/2023/03/forced-sterilization-california/

Prestinary, Patricia. Napa State Hospital. Charleston, SC: Arcadia Publishing, 2014.

Stern, Alexandra Minna, et al. “California's Sterilization Survivors: An Estimate and Call for Redress.” American Journal of Public Health 107.1 (2017): 50-54. doi:10.2105/AJPH.2016.303489

“The Great 1906 San Francisco Earthquake.” United States Geological Survey. https://earthquake.usgs.gov/earthquakes/events/1906calif/18april/