Opening on November 15, 1876, the Napa State Hospital is California's second-oldest mental hospital. For years, the 500-bed hospital was the largest state mental hospital, hence had the problem of dealing with more deceased patients over any other similar facility. Starting with 192 acres, the campus is now 2,000 acres. A two-acre piece of land on the eastern portion of the campus behind the administration building was designated as a cemetery for indigent patients from about 1875 through 1923 and became the final resting place for 4,368 patients' remains. The families of these patients did not claim, for a host of reasons, the patient's remains, hence the responsibility of burial fell on the State of California. For research purposes, the original name Napa State Asylum can be found on old death certificates issued prior to 1924 when the name was changed to Napa State Hospital. At one time, the cemetery did have wooden crosses marking each grave, but in the 1920s after the burials stopped, the land became a pasture; by the 1940s a dairy farm was on it; and today, the site has an unused barn and an outbuilding on it. In the 21st century, two old grave markers from this era were found. In 1983 a single marker was place in remembrance of those buried on the hospital's grounds. Since land for burial on the campus was limited, an on-site crematorium was built at Napa State Hospital in the mid-1920s and was in use until sometime in the 1960s. No bodies were ever exhumed from Napa State Hospital grounds, but the unclaimed cremated ashes of patients have been transferred elsewhere: The ashes of 440 patients were buried with numbered markers in the pauper's section at St. Helena Cemetery; and at least 5,100 patients' ashes were buried in a mass grave on October 28, 1968 at Napa Valley Memorial Park on Napa-Vallejo Highway. Napa Valley Memorial Park has in the past used the names of Inspiration Chapel and Chapel of the Chimes. Twenty-eight patients were buried in unmarked graves in the pauper's section at Tulocay Cemetery. Today, the few patients who do die at the Napa State Hospital are transferred to their county of residence for funeral arrangements to be made by the family or an appointed representative. The hospital has an annual memorial service in remembrance of the patients who died that year as well as the others of earlier years.