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There are more congenital defects among the negroes as demonstrated by the large number of symmetrically developed crania.

I here express the opinion that the mental inferiority of the negro as thus shown in the midst of the environments which have surrounded him since the war is a leading factor in the development of his insanity.

The untutored savage can exist and be healthy in mind and body under conditions that will seriously affect the man of finer sensibilities from culture and education. The negro in slavery had "no thought for the morrow, wherewithal he should be fed and clothed," nor did the claims of family press upon him to worry and affect his mind; no ambitious hopes stirred his brain as to the possibilities of his future; but "far from the madding crowd's ignoble strife," he spent his quiet, humble life in his little log cabin, with his master to care for every want of self and family, in sickness and in health. It is an undisputed fact, known to our Southern people that no race of men ever lived under better hygienic restraints or had governing their lives rules and regulations more conducive to physical health and mental repose. Their habits of life were regular, their food and clothing were substantial and sufficient, as a rule, and the edict of the master kept indoors at night and restrained them from promiscuous sexual indulgence and the baneful influences of the liquor saloon. In sickness, he was promptly and properly cared for by physician and nurse. Freedom came to him and a change came over his entire life.

Having shown that under his former manner of life the negro enjoyed a wonderful immunity from brain and lung trouble, I confidently assert that the germs of these troubles came to the same man and race in consequence of his changed environments and the manner of his life which followed.

In his ignorance of the laws of his being, the functions of citizenship and the responsibilities and duties which freedom imposed, demands were made upon the negro which his intellectual parts were unable to discharge. In his former condition none of these things disturbed his mind. Immediately the restraining influences which had been such conservators of healthfulness of mind and body were removed, thousands left the quiet homes and regular life of the country for crowded and badly ventilated houses of the towns. These were often located in the midst of unhealthy surroundings, their occupants without regular employment ekeing out a precarious existence, utterly unmindful of the laws of health.

It is a matter of surprise that the sudden and wonderful revolution in the social and political condition of the negro should have turned the heads of many and in their roseate dreams of the future, bade them hope for even better things than "forty acres and a mule."

Man is an organized being and is subject to certain laws which he cannot violate with impunity. These laws affect him in the air he breathes, the food

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he eats, the clothes he wears and every circumstance surrounding his habita tion.

In the wholesale violation of these laws after the war, as previously stated, was laid the foundation of the degeneration of the physical and mental constitution of the negro. Licentiousness left its slimy trail of sometimes ineradicable disease upon his physical being, and neglected bronchitis, pneumonia and pleurisy lent their helping hand toward lung degeneration.

It is true there was comparatively little insanity among the negroes during the first decade after the war, but the seeds of disease were being sown which in succeeding years have brought a beautiful harvest of mental and physical degeneration and he is now becoming a martyr to an heredity thus established.

During the flush times immediately after the war, while cotton and all farm products and farm labor commanded the highest prices known to this country, the negroes of the South who remained on the farms in their accustomed pursuits were comfortable and many of them accumulated some property; and during this period there was comparatively little insanity among them. This writer had a large clientele during this period among this class of negroes and he had no better paying patrons according to their ability. But as farm products lowered in price and labor became cheaper and the general hardness of the times increased, their ability to pay diminished and many of them began to suffer not only for the comforts, but for the means of healthful existance.

I am informed by physicians practicing among the same people that only a few negroes are now able to pay for professional services.

The mental worry for simple existence has increased with the tightness of the money market, the depreciation of farm products and the price of labor. We all know that worry and trouble coupled with failing physical health are potential factors in causing insanity. I do not believe the negro is an exception to the rule, though he may not be affected by such causes to the same degree as the Caucassian. But he is the mudsill of social life of the South and in times like the present this class of people must necessarily suffer most. I am fully aware that the negro is proverbially improvident and that even now, after thirty years or more of freedom, he takes out little thought for to-morrow, but to-morrow, nevertheless, comes to him and oftimes finds him wholly unprepared to meet its exacting demands for support of self and family. While it may be assumed as a fact that the negro can exist and be comfortable under less favorable circumstances than the white man, having a nervous organization less sensitive to his environments, yet it is true that he has less mental equipoise, and may suffer mental alienation from influences and agencies which would not affect a race mentally stronger.

From a brochure on Tuberculosis among the Insane, by by Dr. E. D.

Miller-The Effects of Emancipation Upon the Mental and Physical, etc. 291 Bondurant, assistant superintendent Alabama Insane Hospital, I gather the following:

"During three years and nine months, beginning October 1, 1890, 295 deaths occurred among the 1,700 patients treated at the Alabama Insane Hospital.

Of the 179 deaths among white patients, 51, or 28 per cent., were due to tuberculosis; of 116 deaths among negro patients, 49, or 42 per cent., were due to tuberculosis.

In addition to this, a study of our clinical records discovers the fact that in the colored race the disease assumes a much more active and rapidly progressive form, the average duration of fatal cases being markedly shorter in the negro.'

In the report of the South Carolina Hospital for the Insane for the year 1895-4, Dr. J. W. Babcock says: "From 1888 to 1893 the deaths from tuberculosis were distributed as indicated by the following table:

White-males 38, females 52; total 90.

Colored-males 43, females 165; total 208.

The colored women who died from the disease outnumbered the other three classes by 32. This too when the smallest part of our population consists of colored women. In his report for 1894-5, Dr. Babcock states: During the year the large number of fifty-nine patients died of some form of tuberculosis. Of these fifteen, two men and thirteen women, were whites; while forty-four were colored, eighteen men and sixteen women."

Abundant data similar to the above doubtless could be obtained from other hospitals; but the above I respectfully submit is amply sufficient for the purposes in view.

ETIOLOGY.

Having thus shown by testimony, ample and conclusive, that insanity and tuberculosis were almost unknown diseases of n groes prior to 1865 and having also shown by the same testimony that they are common among the negroes of to-day, the question of greatest interest to the alienist and physician is: What is the relation of freedom to these diseases?

We sometimes see the last straw that breakes the back of the camel, but fail to discover the many others previously imposed upon the burdened beast. Every asylum superintendent knows how misleading are the causes of insanity as stated in the papers of application. In papers committing negroes to the Eastern Hospital, religion and religious excitement are frequently set forth as assignable causes of the insanity of the applicant. this is sometimes true, it is often untrue. The error is a natural one, owing to the fact that his disease is manifested through his highly emotional, relig ious nature.

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To arrive at a correct conclusion as to the effects of the changed political and social relations on the mental and physical constitution of the negro, it is necessary to know his manner of life during the ante-bellum and postbellum periods of his history.

To understand and properly judge any man or race of men, it is necessary to know his heredity, the environments of his life and many other circumstances that are factors in the formation of his mental, physical and moral constitution.

A native of Africa and a savage a few generations ago, then a slave for several generations afterwards; this is the man and the race upon whom the high responsibilities of freedom were thrust; a nation literally born in a day.

The history of the world, so far as I know, furnishes no condition similar to that in which the negroes of the South were placed the first few years after the close of the war. Without education of self or ancestry and without preparation of any sort, the new negro was invested with the highest functions of citizenship before the healing of the marks of the chains that had bound him.

It is not my purpose or desire to be offensive to our Afro-American citizens, or to make them odious by comparison with the Caucasian; but the question of mental capacity is germane to the question under consideration.

I am fully aware that among the Afro-Americans of the South may be found some orators, eloquent in speech; some who have attained to ripe scholarship, and many others who have demonstrated considerable capacity in the learned professions and in business circles; but as a rule such are of mixed blood.

Remaining in contact with the superior Caucasian race, with the uplifting influences of its high civilization, it is confidently believed the Afro-American will yet reach higher mental developments. But as a class, their mental calibre is small; the convolutions of their brain are few and superficial; their cranial measurement small and other anatomical facts demonstrate his inferiority.

The color of his skin is a mark of inferiority, and not the result of climatic influence, as has been declared by some.

We are informed that four thousand or more years ago, the Caucasian was white, the Mongolian, yellow and the negro, black. The Aryan-Hindoos of pure blood have preserved their fair complexion in a hot and moist climate for some three thousand years, and the color of the Egyptain has not changed for more than forty centuries. We certainly know that for three hundred years the negro of unmixed blood in the temperate climate of the United States is now near the color of his African progenitors.

It is a anatomical fact that the average weight of the negroe's brain is forty-two ounces, while forty-nine ounces is the recognized average of the Caucasian.

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WHY MORE INSANITY AMONG FEMALES THAN AMONG THE MALES.

In all ages and among all peoples of an inferior race, females suffer most from the worry, labor and privations incident to their pecuniary and social condition. I believe this statement is emphasized and illustrated by the large increase of female patients over males in the Eastern North Carolina Hospital. Applications for the admission of females for the past ten years have been about 40 per cent. greater than those for the males.

In my report to the Board of Directors for the year 1888, I made the following statement: It is an interesting question in psychological medicine why this disproportion of insanity in sexes among the colored people. It may be said in general terms that women have a more highly wrought nervous organization than men; their emotions are more easily aroused; their sympathies are more tender; their love is stronger; and while they have more fortitude under physical suffering, their spiritual nature suffers more than man's under a sense of abandonment by those to whom they naturally and of right look for reciprocal affection, protection and support. It is a melancholy fact that among many of the colored people the sanctity of the marital relation is lightly esteemed and its solemn obligations but indifferently re garded. How often do husbands when the cares of an increasing family begin to press with weight upon them, abandon their wives and children under the pretext of going South to work in turpentine fields, leaving their wives to struggle alone for self and children until excessive labors, an aching heart and utter destitution drive her with a crazed brain within these walls. Cruelty of husband; thus manifested and manifested in many other ways largely accounts for this disproportion.

In the light of succeeding years, I have no reason to change the opinion then expressed.

It is not my purpose to enter into the treatment of insanity of the AfroAmerican. Insanity in the negro and its treatment are practically the same as in the Caucasian. The habits, education and emotions of the negro in his same condition differ as a class from the Caucasian.

The negro laughs louder, sings louder, prays and preaches louder, than the Caucasian; and is more vulgar in speech and less cleanly in his person. He carries these characteristics into his insane condition and is therefore more noisy, more vulgar and beastly in his habits.

Mania is the prevailing form of mental derangement and suicides are rare. I have seen but one well defined case of suicidal melancholia in the Eastern North Carolina Hospital for nine years.

Dr. Berkley, of Baltimore, who has written on Paresis in the Negro, thinks paresis as common to the negio as to the white man, conditions of life being Paresis being a metropolitan disease, this statement is probably

the same.