brated school of medicine as well as a museum and hospital. Hence it would seem that while St. Luke is best known to us as the apostle and minister, added to his thorough medical education, he must have had an unusually comprehensive idea of the state of medical science at that time from a visit to the chief centers of medical education of that day, and association with men prominent in his profession. As a physician his practice was not Esculapian or Jewish, but Greek, according to the best principles of that day. The universal testimony is that St. Luke was a most faithful, pious, and self-denying Christian; that he had a cultivated intellect, and was throughly honest and impartial in all of his descriptions of persons and events. He described nothing but what he witnessed himself or received direct from those immediately concerned in what he so faithfully recorded. He met his death about the year A. D. 67, at the age of eighty-two. It seems a great misfortune that more is not known with regard to his medical career." (N. Y. Medical Journal.)

INSANITY AND CIVILIZATION.*

By J. T. Searcy, M. D. Superintendent of Alabama Insane Hospitals.

When the white races were rude savages roaming over the plains of Europe, muscularity was the most advantageous accomplishment and brain ability held not nearly so promi nent a place as it does today. After those races, who occupied the peninsulas of Greece and Italy, first came in contact with, then appropriated the civilizations of Western Asia and Northern Africa, many radical civilizing changes gradually extended over the whole of Europe, and brain abilities came more and more into prominence. In the practices of the civilizing so. ciety each succeeding generation was subjected to greater and greater mental stress and effort. Under the new order of things, the environment in which every man, in the succeeding generations, had to make his living, gradually changed into one in which more and more improved mentality became the most essential accomplishment.

Since the invention of printing and since the greatly increased use of reading, and especially since the study and ac

*Reprinted from Biennial Report of the Alabama Insane Hospitals.

quisition, as much as possible, of the vastly accumulated stores of human knowledge, has become a prevailing necessity, from childhood up, in the life of every civilized person, there have arisen very radically changed methods of mental effort and thought. Particularly because of this comparatively recent kind of education, or necessary mental preparation for the struggles of life, and since the engrossing competitions, in making a living, require more and more mental exercise and effort, the production of more complex convolutions in the cerebral cortex is the result. A brain working race alone improves in inherent intelligence.

It is a biologic principle, however, that newly acquired structures are unstable in composition. They are only kept normal by continued exercise along the same lines that have begotten them, and they are inherently unstable by reason of their newness. Such structures are more liable than others to deterioration by idleness or disuse, to defectiveness or deformity by any accident or injury, and to disease by any toxic or pathogenic agent.

Physiologic explanation, in this way, can be given for an increase in civilized countries of mental abnormalities, more than in uncivilized. In civilized countries, there is an increasing proportion of mental aberrances found prevalent, which, when they become extreme, are classed as insanity.

The eyes, in modern civilized society, are presenting a similar condition of variability, instability and frequent abnormality

Distant-vision was once the most frequent way in which the eyes were used, now near-vision, in reading and study and in the arts, in a larger and larger proportion of the population, is becoming the way the eyes are frequently brought into use, and undergo most effort and exertion. This very radical change in the use of the eyes, in the past few generations, has brought about attempts at re-adjustability of structure, and as a consequence, we see an increasing number of abnormalities in them. We may say these eye defects are concomitant in modern civilization with the instabilities and abnormalities of the brain.

There is another changed custom, which prevails more and more as a race becomes gradually civilized, and tends to increase the number of the insane. The continuance of prolongation of life is always the fundamental principle of human

effort. It underlies personal and social effort of all kinds. In crude states of uncivilized society, each individual works self ishly for this object for himself alone, but, as he becomes civilized, his selfishness more or less disappears, and he works more and more, privately and socially, for the prolongation of the lives of others as well. Finally, the community and the whole State work for the prolongation of all human lives alike. In this way, the prolongation of the lives of the less capable becomes more and more a public as well as a parental and private concern and duty. Altruism-the care for others—is the highest evolution of modern civilization. The less capable form the majority of mankind. The majority live below the midway line drawn half-way between the person of highest and the one of lowest capabilities. Those measures that increase the general bulk of the population increase most the less capable portion. This results, in time, in saving a great many of those who are hereditarily and accidentally predisposed to weaknesses and defects, particularly to mental deficiencies and defectiveness.

Especially is this the case in the prolongation of the lives of weakly, unstable and partially deficient children, until they reach adult life, when they propagate, and increase the number of the defectives. Hygienic, sanitary, scientific and medical measures, with all the force of public opinion and government behind them, in this, another way, tend to increase the proportion of mental deficiencies and insanities in civilized communities. Old civilizations notoriously deteriorate this is abundantly illustrated in the world's history.

Again:-"Bad Habits" have the effect to deteriorate and degenerate mens' mental abilities. One bad habit for a number of generations, in civilized countries, more than others, has had this effect particularly. I allude to the so general use, as luxuries, of agents that ought to be held solely as medicines; they are anodyne and anæsthetic in effect and classification, and have chemic and, in time, toxic effect upon the brain. They have a pleasant effect because they dull sensation and relieve discomfort. To this kind of agents belong nicotine and alcohol, which are the ones most generally taken. Those members of society who, from causes already mentioned, are degenerating, are most liable to acquire these habits and are most injured by them. The deteriorating ill-effects, in time, of these drugs, are not only apparent in the habitués themselves but in their posterity. The drugs hasten along and

increase milder forms of nervousness and defective thinking and more rapidly bring them to a grade, which becomes insanity. An anesthetic like alcohol is more rapidly toxic in this way than as mild an anodyne as nicotine.

THE NEGRO INSANE.

In this part of the United States, we are much interested in the increasing insanity among the negroes. When they were first imported from Africa, as a rule, they were young and healthy adults, selected specimens of their tribes. During the two or three hundred years of their servitude, they were subjected to an environment of European civilization, much more sanitary and salutary than they had ever occupied before. The very discipline they were subjected to, more rapidly forced them to assume the language and habits of the whites, and to imitate in large part the civilization surrounding them. The selfish interests of their masters enforced sanitary, regular and moral habits, and the practice of higher methods of thought, as well as regular muscle exercise, more than and better than the negroes had ever practiced before. The naturally docile disposition of the negroes, has, as far back as history goes, been the trait which has made them sought for as slaves; they have proved the most suitable people, anywhere in the world, for that purpose, and their docility makes them amenable to disciplinary improvement. The Africans in America came out of their servitude an inherently improved people, mentally and physically. While they were slaves, there was very little deterioration among them, and, consequently, little insanity. Since then, their rapidly increasing insanity is a result and an indication that many among them are mentally degenerating. It is very evident, the care of the negro insane in the South will rapidly become more and more a public care and expense. In 1870 there were 33 negroes in our hospital, in 1880 there were 71, in 1890 there were 241, in 1900 there were 451.

These several reasons, with others, explain why we have increasing insanity in the country. Alabama, in common with the other states and the civilized world, will have to meet the growing necessity of making provision for this most unfortunate class of her population. Along with several similar questions, the matter calls for scientific consideration.

WHAT IS INSANITY?

What is insanity ?-is often asked. A satisfactory answer to the question is embarrassed by the fact that the State reserves to itself the right to answer it,-or, to say who are the insane. The State alone decides who belong to the criminal class; in like manner the State alone makes the insane class. A court alone is authorized to call a person insane or criminal. Nevertheless, there is much truth in the assertion that though the State makes the insane class, its classification is only one of degree, because mental aberrancies pervade humanity in varying and milder grades, in all directions.

There is a growing inclination among physicians, who treat mental troubles, to abandon the word insanity as a scientific term and substitute the word PSYCHOSIS, which covers any grade of mental aberrancy of any kind; or. to regulate the term insanity to those cases alone, which are thought sufficiently grave to come within the jurisdiction of the law. In this sense insanity would mean that grade of any PSYCHOSIS, which brings a person within the jurisdiction of a court.

The law takes cognizance of the mental deficiency or defectiveness of a person, and orders an investigation of the grade of it, for a number of purposes. For instance, for the purpose of absolving a person, who has committed a crime, from the penalty of the law; or, for the purpose of sending a person to an insane hospital for care and treatment; or, for the purpose of invalidating a will, a contract, or a conveyance of property; or, for the purpose of preventing a person from marrying, voting, or testifying. The object of the investigation is to determine the grade of the person's mental disqualification; in almost every case some disqualification is apparent, and the question is, to determine whether it is sufficiently great to warrant legal interference, for the purpose for which the trial is called.

In psychiatry, there are many designated psychoses; in each kind there are all grades of mental disqualification. In hysteria, for instance, which is a very common mental malady, there are all grades. There are sometimes extreme grades of it readily pronounced insanity by court. The same may be said of neurasthema, or nervousness, very prevalent in America; and of paranoia, or crankiness; and of paresis, or progressive paralysis; and of the many manias, melancholias, and de