prefix in making it so; negatives are usually difficult of demonstration. Insanity is opposed to sanity. In order to define insanity it is necessary, first, to determine the standard of sanity; this is not a fixed quantity, but depends upon many conditions-first, upon what may be called the standard of the environment, which varies not only with every stage of civilization and barbarism, but also with each social station and each grade or phase of education. What would be natural and commonplace in one state of society or in one community, would be altogether aberrant and unusual in another, and this difference exists even in the same persons under various circumstances. This environmental standard varies in time as well as in place, in peoples or races, or in differing social ranks for example, what might have been considered normal a century or two ago, might be evidence of mental failure

now.

Further, as helping to make up this problem of the definition of sanity and insanity, there is what might be called the standard of the individual, the shaping of which is begun even before birth-in inheritance and is not completed until the end of life. Every one thinks and acts in his own way, and thus there is formed a special standard of normality, which is made up of habits, social instincts, education, training, and more especially by those moral traits that constitute what we call character. In these respects the individual must be compared with himself-he must be tested by what he ought to be and by what he was in his normal condition-before an accurate decision can be arrived at in any case of suspected mental disease. As a rule, this is not difficult, the variations from the standard of environment and the individual's normal self being usually so patent that insanity can be recognized almost at a glance. It is only in doubtful cases that comparisons must be made even in minute details before one can positively assert that mental

derangement exists; such cases occur sufficiently often to make the recognition of these factors of alienation most important. There are no hard-and-fast lines separating sanity and insanity, and it is this that renders a precise definition almost, if not quite, an impossibility.

Notwithstanding this, it is of some importance to establish a clearly stated, albeit an imperfect, definition of insanity, if only for legal purposes. When examining a medical witness, it is a common practice for lawyers to ask him to define insanity; his inability to do this may affect the value of his testimony. Although, as has been said, a rigidly correct medical definition is impossible, one that will fairly, if not completely, meet the legal requirements, which is its principal utility, may still be offered. The medical concept cannot well be narrowed down to the limits of a brief statement and yet include all the possibilities of mental derangement. Even if we follow certain French authors, who, like Marcé and Regis, make a distinction between mental alienation and insanity, including in the former the congenital teratologic defects and the transient deliriums and intoxications, and confine the term insanity to the acquired, more or less permanent, disordered mental conditions, the task is but little lightened, and the ground is still too extensive to be easily covered. All definitions heretofore attempted, even the elaborate one of Spitzka, are open to many objections: they are inevitably incomplete, imperfect, and therefore to a certain extent misleading. Insanity is especially a disease or derangement of the functions of the cerebral cortex, and this is so intimately connected with every other bodily organ and function that it is easy to see that the range of its symptoms is practically infinite. Its definition, being of necessity incomplete, must be, therefore, somewhat indefinite; it is useless to attempt to make

it comprehensive or exact. We cannot specify particular pathognomonic symptoms; we symptoms; we cannot say with Esquirol that it is afebrile, or with Griesinger that it is a condition in which a true appreciation of the facts that come before the consciousness is impossible, or with a much more recent author that it is a disorder characterized by a more or less permanent accidental and unconscious disturbance of the reason. All these are but partial definitions; there are at present markedly febrile forms of insanity recognized, there are many of the insane who fairly appreciate the facts. within their experience, and there are many others who are more or less fully conscious of the morbid character of their feelings and of the fact that they are mentally deranged. There is no one feature that is pathognomonic; insanity is a general and a protean derangement of the mind. A definition must therefore be a general one; it must not go into particulars, but must merely broadly outline the condition. As already stated, its chief value is for forensic purposes; the law demands a definition, and the partial ones that have satisfied lawyers have been responsible for many judicial murders and mistakes. The simplest and clearest possible definition is therefore the best, and perhaps the following will as nearly meet the demands as any: "Insanity is a disease, derangement, or defect of the brain, causing disordered action of the mind." This has the advantage of stating nothing that can be disputed, but it is indefinite and covers certain conditions that are not always included in the popular or possibly the legal conception of insanity. If it is desired to make the distinction between mental alienation in general and insanity proper that is made by some authorities,-notably Marcé and Regis,— excluding from the latter certain aberrant mental conditions, idiocy, and temporary intoxications and delirium that are not commonly included in the con

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cept, this definition may be modified by inserting the words "more or less permanent," making it read, Insanity is a more or less permanent disease or derangement of the brain producing disordered action of the mind." If it is thought advantageous to carry the definition a little further, and to indicate how the mental disorder affects the individual and his conduct, it may be supplemented by the statement that it puts the subject into a condition aberrant to his normal self and out of relation to his environment. An imbecile is a subject of mental alienation, but he may fit into a niche in society and to a certain extent harmonize with his surroundings. But he may also,. as Regis says, be the victim of an attack of mania superimposed upon his existing mental deficiencies, and then he is in the restricted sense of the word a lunatic. In the same way we make a distinction between the effects of intoxicants, which practically derange the cerebral function as much as does an attack of insanity, and the insanity itself, on account of their transitory and generally voluntary character. The sympathetic delirium of febrile diseases is also excluded for similar reasons. Practically they all fall under the general category of mental derangement or defect, but the customary and the legal distinctions must be borne in mind.

As a definition of insanity, therefore, we may offer: "Insanity is a more or less permanent disease or derangement of the brain producing disordered action of the mind in such a way as to put the subject in a condition varying from his normal self and out of relation with his environment," and we may add generally "in such a way as to render him dangerous or inconvenient to himself or others." Understanding by the words "dangerous or inconvenient" all the moral and legal disabilities of the insane, of every kind and degree, this definition fairly fills the requirements of the law, and will not

often be disputed. In a medical point of view it is vague and incomplete, but, as stated, a satisfactory medical definition of insanity is an impossibility.

The increase of insanity is one of the living questions in modern civilization. The statistics of countries where a reliable system of registration exists show this increase. In Great Britain the figures of the English commissioners in lunacy show that in 1860 one in every 523 of the population was insane; in 1870, one to 411; in 1880, one to 360; and in 1890 the ratio had risen to one in 320. In thirty years insanity had therefore increased from one in 523 to one in 320, or had come unpleasantly near to doubling the ratio to population in that period. The figures may be accepted as accurate, and a similar increase has been noted in nearly every civilized country where registration of the insane exists. In our own country we cannot go back so far with perfect confidence in our figures, but the general facts are very nearly the same, allowing for the difference of conditions. The ratio of insane to the general population, according to the latest figures, in the State of New York is one to 340, and in the State of Illinois it is about one in 400; rather less than the figures given for Great Britain. The older the country, within certain limits, the greater the proportion of insanity as a general rule. This is notable in the comparative figures of New York and Illinois; and if we take some other Western States with a less proportion of their population living in great cities than is the case in New York or Illinois, the difference would be still more striking. Insanity is a disorder that thrives in urban populations; great cities are hotbeds of degeneracy, and this is one of the forms in which it manifests itself most prominently.

It is possible that there is a certain fallacy in these figures of the increase of insanity, but not enough to vitiate them to any great extent. The better and