Increase of Insanity and Consumption among the 
Negro Population of the South since the War 
BY 
THOMAS J. MAYS, A.M., M.D. 
Professor of Diseases of thb Chest in the Philadelphia Polyclinic and 
Visiting Physician to the Rush Hospital for Consumption 
in Philadelphia 
Reprinted from the Boston Medical and Surgical Journal of 
June 3, i8qy 
BOSTON 
DAMRELL & UPHAM, Publishers 
283 Washington Street 
X897 INCREASE OF INSANITY AND CONSUMPTION 
AMONG THE NEGRO POPULATION OF THE 
SOUTH SINCE THE WAR.1 
Professor of Diseases of the Chest in the Philadelphia Polyclinic, and 
Visiting Physician to the Rush Hospital for Consumption in Phila- 
delphia. 
During the last ten or fifteen years there appeared 
various contributions on the disproportionate increase 
of insanity and consumption among the negro popula- 
tion of the South since the close of the Civil War. 
This literature 2 emanates from the best minds in the 
medical profession of the South; and, believing that it 
pertains to a question which is of the most vital con- 
cern to social science, and also believing that it will en- 
list the attention of every student who is interested in 
the physiology of man's development, and in the pre- 
vention and cure of disease, I have seen proper to 
bring it before this meeting for a full and free dis- 
BY THOMAS J. MAYS, A.M., M.D., 
1 Read before the Section of Neurology and Medical Jurisprudence 
of the American Medical Association, at the Philadelphia Meeting, 
June 3,1897. 
2 Report on the Increase of Insanity and its Supposed Causes. By 
Dr. T. O. Powell, Superintendent of the Lunatic Asylum of the State 
of Georgia, October 1, 1886. 
Tuberculosis in Asylums. By Dr. J. W. Babcock, Superintendent 
of State Hospital for the Insane, Columbia, S. 0. Published in Amer- 
ican Journal of Insanity, October, 1894. 
The Increase of Insanity and Tuberculosis in the Southern Negro 
since 1860; Their Alliance and Supposed Causes. By Dr. T. O. 
Powell, Superintendent of the Georgia Lunatic Asylum, November 
21, 1895. 
The Effects of Emancipation upon the Mental and Physical Health 
of the Negro of the South. By Dr. J. F. Miller, Superintendent of 
Eastern Hospital, Goldsboro, N. C. Published in North Carolina 
Medical Journal, November 20, 1896. 
Private Correspondence. 2 
cussion. I believe that such a consideration of the 
facts and figures which are here presented will serve 
to set into a new light the mechanism of some of the 
most powerful factors which are engaged in the pro- 
duction and perpetuation of two of the most deadly 
enemies of mankind. 
In speaking of the increase of insanity in the colored 
population of Georgia, Dr. Powell, Superintendent of 
the Georgia Lunatic Asylum, makes the following 
comments: " There has been a radical change in the 
susceptibility to certain diseases, notably insanity, 
phthisis and similar maladies in this class of our popu- 
lation, from which they were almost entirely exempt 
up to 1867. . . . The census of i860 will show that 
there were only 44 insane negroes in the State of 
Georgia, or one insane negro in every 10,584 of the 
population, and consumption in the full-blooded negro 
was rarely seen. The census of 1870 shows 129 in- 
sane negroes in this State, or one to every 4,225 of 
the population. The census of 1880 gives 411 colored 
insane, or one to every 1,764 of the population ; while 
in 1890 there were 910 colored insane, or one to 
every 943 of the population." 
Dr. J. F. Miller, Superintendent of the Eastern 
Hospital of North Carolina, for colored insane, says: 
" From close personal observation, embracing a pro- 
fessional life of nearly forty years among the negroes, 
and from data obtained from professional brethren in 
different sections of the South, I have no hesitancy in 
declaring that insanity and tuberculosis were rare dis- 
eases among the negroes of the South prior to emanci- 
pation." 
The Eastern Hospital of North Carolina was opened 
August 1, 1880, for the exclusive accommodation of 
the colored insane, and this same writer furthermore 
states that during the first year there were admitted 3 
91 insane negroes, which number represents the ac- 
cumulation of this class of patients in that State dur- 
ing the first decade and a half after the Civil War. 
In 1885 there were under treatment in this institution, 
144; in 1890, 244; in 1895, 307, and in December, 
1896, 377 insane negroes. 
Dr. J. W. Babcock, Superintendent of South Caro- 
lina Insane Asylum, says: "We cannot lose sight of 
the fact that on the basis of the census, as compared 
with insanity in the whites, mental disease in the 
negro has arisen from one-fifth as common in 1850 to 
one-half as common in 1880 and in 1890." 
Dr. Miller also states that in the hospital in his 
charge the average mortality from consumption since 
its opening to 1896 is 25 per cent, of the total number 
of deaths. However, the death-rate from this disease 
was much less in its early management. Thus, up to 
1884, it caused 14 per cent, of the total number of 
deaths ; while in 1895 it produced 27 per cent, of all 
the deaths, and this in spite of a reduction of the gen- 
eral mortality-rate. 
Dr. Powell (op. cit.) says: "From observation and 
investigation I am forced to believe that insanity and 
tuberculosis are first cousins, or at least closely allied. 
The sudden outburst of insanity with the colored race 
of the South came associated with tuberculosis, hand- 
in-hand, keeping pace one with the other ; hence, in 
obtaining histories of cases as they are brought to our 
institution, the hereditary predisposition to consump- 
tion is carefully inquired into. The prognosis of 
phthisical insanity is unfavorable. I am not surprised 
at any time to find insanity in a family strongly pre- 
disposed to phthisis, and phthisis in a family strongly 
predisposed to insanity-" 
Dr. T. J. Mitchell, Superintendent of the Mississippi 
Lunatic Asylum (cited from Dr. Miller's able paper), 4 
states that among the negro patients of this institution 
the following number of deaths occurred in the years 
named: In 1892 there were 44 deaths, and 14 of 
these, or about 32 per cent., were caused by consump- 
tion. In 1893, there were 29 deaths, and 16 of these, 
or about 55 per cent., were caused by consumption. 
In 1894 there were 40 deaths, and 18 of these, or 45 
per cent., were caused by consumption. In 1895 there 
were 35 deaths, and 11 of these, or about 31 per cent., 
were caused by consumption. In ten months of the 
fiscal year of 1896 there were 48 deaths, and 20 of 
these, or about 48 per cent., were caused by consump- 
tion. These data show that about 42 per cent, of the 
total number of deaths in this institution were caused 
by consumption during these years; and estimating 
the death-rate among the white population from this 
disease at 20 per cent., the death-rate among the insane 
negro population is 22 per cent, greater. 
Dr. E. D. Bondurant, Assistant Superintendent of 
Alabama Insane Hospital (cited from Dr. Miller's 
paper), says: ''During three years and nine months, 
beginning October 1, 1890, 295 deaths occurred among 
the 1,700 patients treated in this 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 dis- 
covers the fact that in the colored race the disease as- 
sumes a much more active and rapidly progressive 
form, the average duration of fatal cases being mark- 
edly shorter in the negro." 
Dr. W. H. Barnes, First Assistant Physician in 
Arkansas Lunatic Asylum, states, in a private com- 
munication, that neither insanity nor pulmonary con- 
sumption were especially prevalent among the negroes 
while they were slaves. 5 
Dr. R. J. Preston, Superintendent of the South- 
Western Hospital of Virginia, says, in a private com- 
munication, that there has been a great increase in 
both insanity and phthisis among the negro population 
since emancipation. 
Dr. Jas. D. Moncure, Superintendent of the East- 
ern Hospital of Virginia, informs me, in a private 
communication, that the health of the negro with re- 
gard to insanity and phthisis was very much better 
before emancipation than since. Before that time 
there were about 60 insane negroes in the asylums of 
Virginia. Now (1896) there are over 1,000. In all 
hospitals the insane seem readily to contract tubercu- 
losis ; and this is a frequent cause of death among 
the insane. 
From the foregoing the following conclusions may 
be safely drawn : (1) that insanity and consumption 
were comparatively infrequent in the negro race be- 
fore the war ; (2) that both of these diseases have 
disproportionately increased in the same race since 
the war ; and (3) that in all probability the causes 
which give rise to one of these diseases also produce 
the other. 
Now what is the cause for this rapid and remarka- 
ble transformation in the health of these people during 
the short period of three decades? Why should in- 
sanity and consumption develop side by side, and at 
an equal pace, and why should the former frequently 
precede the latter in the same individual ? Are these 
diseases acquired through contagion, or are they due 
to other conditions and influences inherent in the 
changed environment of this race ? These are ques- 
tions which appeal to the very root and marrow of 
this matter; and until we solve them we cannot hope 
to grapple successfully with either the cure or preven- 
tion of the diseases under consideration. 6 
First, in regard to contagion, it is needless to say 
that even at present there is not a trace of well- 
grounded suspicion that insanity is acquired through 
contagion ; and hence nothing need be said on that 
side of the subject. In the next place, is there any 
evidence to show that consumption's contagion was 
lying dormant before the war, and that it sprang into 
sudden and most virulent activity after the close of 
this period ? So far as I know there is none, and aside 
from the untenability of such a position Dr. Powell 
testifies (op. cit.) that the opportunity for contagion 
was most favorable before the war. " It should be 
remembered," he says, " that up to the war and dur- 
ing the war the negroes were the principal nurses for 
the consumptives of the South. They washed the 
spittoons, bedding and clothing of the consumptives, 
swept and dusted their rooms, and in many instances 
slept in the rooms with them - literally living with 
them night and day, and were more exposed to the 
tubercle bacillus than now as a general thing: still 
they resisted the disease." 
I think the whole question of the origin of con- 
sumption will be solved most easily if we study the 
causes which lead to both insanity and consumption 
together; for though on superficial inspection these 
two diseases have nothing in common, yet deeper 
study teaches us that the former is a perfect analogue 
of the latter. During the last ten years I have been 
engaged in collecting material-clinical, experimen- 
tal and pathological - which demonstrates that pul- 
monary consumption is not primarily a disease of the 
lungs, but a sercoudary manifestation of impaired in- 
tegrity of the nervous system in general, and of the 
pneumogastric nerves in particular. 
This view did not originate with me, for in 1842 
Cheneau attributed this disease to disordered pneumo- 7 
gastric innervation. In 1850 Dr. J. C. Holland de- 
fined pulmonary consumption as a disease of the ner- 
vous system. In 1862 Dr. Laycock stated that de- 
fective pueumogastric innervation consequent upon a 
loss of cerebro-spinal power was a very common pre- 
disposing and exciting cause of phthisis. Dr. Clif- 
ford Allbutt said in 1871 : "The more I study this,, 
the more I am satisfied that the lung mischief is also 
a neurosis - by which I mean that the lesion is one 
not originating in the local tissues, but in the nervous 
system." In 1891 Dr. T. S. Clouston delivered a 
course of lectures in which he stated that facts " seem 
to show that if tuberculosis cannot itself be called 
a neurosis, it is in most cases dependent for its exist- 
ence on a trophic neurosis, or has the closest affinity 
to it." 
There is also a richness of clinical material scat- 
tered throughout the literature of medicine which 
confirms the pathological view that phthisis is a neurotic 
disease. Thus, in my brochure* on "Pulmonary 
Consumption a Nervous Disease," I collected and 
tabulated a large number of cases of phthisis in which 
the pueumogastric nerves were compressed by tumors, 
aneurisms, or otherwise disintegrated, prior to the 
onset of the disease in the lungs. In other papers 4 
since published, I believe that I have succeeded in 
demonstrating the following propositions concerning 
the close affiliation that exists between insanity and 
pulmonary consumption: (1) that both of these 
diseases are most liable to occur at the same age- 
period, that is. between twenty and thirty years ; (2) 
that the family which is burdened with one is also 
3 Published by George S. Davis, Detroit, 1891. 
4 Pulmonary Phthisis in Relation to Insanity, etc. Medical News, 
July 16,1892. 
Toxicosis of the Nervous System as a Cause of Consumption. 
Journal Nervous and Mental Diseases, November, 1896. 8 
liable to produce the other ; this liability being greater 
in the case of insanity than in that of phthisis ; (3) 
that they are both closely related in personal and 
family history to idiocy, hysteria, epilepsy, asthma, 
and to other diseases of the brain and the spinal 
cord; (4) that they are both produced by syphilis, 
alcohol, overwork, business vicissitudes, domestic 
trouble, mental anxiety, grief, disappointment and ex- 
cesses of all sorts - in fact, by any agent or influence, 
such as those named, which vitiate the brain or the 
nervous system; (5) that the insane, the idiotic, the 
epileptic, the hysterical, the asthmatic and the mem- 
bers of their families, are from three to eight times 
more prone to become phthisical than persons who 
are not burdened in the same way; and (6) that those 
who are confronted by a new and higher civilization, 
and who are compelled to adjust themselves to these 
new relations are excessively liable to fall victims to 
pulmonary consumption. 
Let us now consider the question of the increase of 
insanity and of pulmonary consumption among the 
negroes in the light of these deductions, and see what 
interpretations can be given to the origin of these 
diseases. And in the first place we will discuss the 
effects on the nervous system which are wrought by a 
struggle between a higher and a lower civilization. 
At the very outset it must be conceded that a 
struggle for existence, even under the most uniform 
and favorable conditions, is accompanied by consider- 
able wear and tear of the body. What, then, is the 
outcome, if a lower is precipitated into the midst of a 
higher civilization ? Civilization is an accumulation 
of force ; and the older and higher the civilization the 
greater is its momentum. It is the meeting of two 
forces which differ in power and rate of motion. The 
higher civilization, backed by its many thousand years 9 
of organization and experience, cannot, except to its 
own detriment, change its upward career; and hence 
the lower must for the sake of self-preservation adapt 
itself, so far as this is possible, to the course and 
changes of the higher movement. The effort of ad- 
justment between the two may be compared to an 
animal which is confronted by a new geological era to 
which it must either adapt itself or forfeit its existence. 
The mandates which come from the changed geological 
environment to the animal are no less real and imper- 
ative than those which come to the negro from bis 
changed surroundings. 
If we fully realize that the negro came out of the 
darkness of Egypt and was brought face to face with 
a civilization-with its education, knowledge and in- 
ventions ; its advanced sanitation; its innumerable 
arts, sciences and manufactures; its multiplicity of 
industries and employments ; its burning life-struggles ; 
and its proneness to vices and excesses of all sorts - 
it cannot surprise any one that in many instances he 
is unequal to the task of adjusting himself to these, 
and falls a prey to disease. The point of greatest 
importance here is the fact that the brunt of the battle 
in this contest falls on and vitiates the brain and ner- 
vous system, since these structures are the instruments 
through which his efforts are chiefly made to bring 
himself in harmony with his changed relations. He, 
therefore, becomes insane and phthisical because his 
nervous system is undermined by and disintegrates 
under strains and burdens which he is unable to resist 
or to counteract. 
In regard to the effects of a changed social environ- 
ment on the negro, Dr. Miller (op. cit.) says : 
"The untutored savage, owing to a nervous organ- 
ization less sensitive to his environment, can exist and 
be healthy in mind and body under conditions that 10 
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. . . . Their habits of life were reg- 
ular ; 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 prop- 
erly cared for by physician and nurse. Freedom 
came to him, and a change came over his entire life- 
Under his former manner of living he enjoyed a 
wonderful immunity from brain and lung trouble; 
and I confidently assert that the germs of these 
troubles came to the same man and race in conse- 
quence of his changed environment 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 restrain- 
ing influences which had been such conservators of 
healthfulness of mind and body were removed, thou- 
sands left the quiet homes and regular life of the 
country for crowded and badly ventilated houses of 11 
the towns. These were often located in the midst of 
unhealthy surroundings, their occupants without regu- 
lar employment eking out a precarious existence." 
Dr. W. B. Barnes (before cited) says that the 
causes of the increase of insanity and consumption 
among the negro population are deprivation, exposure, 
poor hygiene, difficulty of self-preservation, and mental 
anxiety. 
Dr. R. J. Preston (before cited) states that the in- 
crease of these diseases among the negro since eman- 
cipation is due to the cares of life which are thrown 
on them, bad hygienic surroundings, crowding to- 
gether, and no restraint on dissipation and vice. 
Dr. Jas. D. Moncure (before cited) states that this 
increase is owing to crowding into cities, improvidence 
in living, and exposure to contagion. 
All the testimony goes to show, too, as has been 
intimated already, that the vices of alcoholism and 
syphilis are freely acquired by these people ; and there 
is abundant evidence to prove that both of these influ- 
ences have a special predilection for destroying the 
integrity of the nervous system, and in this way to 
bring about insanity and phthisis. 
Touching on these infirmities Dr. Powell says (op. 
cit.): " The ultimate results of alcoholic intemper- 
ance in this race is to be apprehended, perhaps, more 
than from any other influence, from the fact that 
there is a tendency to alcoholic intemperance, not 
only on the part of the men, but also on that of 
many women. Could we be justified in expecting a 
perfect mental and physical organism from parents 
both of whom were drunkards ? " 
He also says that " the direct and indirect effects of 
syphilis constitute one of the leading factors in the 
causation of insanity in the colored race. The large 
number that are tainted with syphilis in some sections 12 
is really alarming. I have ascertained from reliable 
sources that on some of the large plantations where 
there is a great number of negroes, there are few of 
the adults that are sound or free from the taint of 
syphilis. I have conferred freely with quite a num- 
ber of physicians who were actively engaged in gen- 
eral practice before the wrar, and they seem to be 
fully agreed in the statement that secondary or ter- 
tiary syphilis was almost unknown in the country 
negro at that time. 
He also gives the following very interesting account 
of the ravages of consumption among a settlement of 
negroes on three adjacent plantations in the Southern 
part of Georgia, and which was communicated to him 
by Dr. J. C. Patterson, in whose experience it oc- 
curred. Prior to the war these negroes enjoyed re- 
markable mental and physical health : Consumption, 
insanity and similar wasting diseases were altogether 
unknown among them. At the time of their emanci- 
pation there were upon these three plantations, in- 
cluding children, between 400 and 500 as healthy in- 
dividuals as could be found, and free from all 
hereditary taint or tendency to any disease what- 
ever. The negroes, as a rule, remained on the planta- 
tions where they were born. It was not long, how- 
ever, before syphilis appeared among them ; and it 
gradually spread over these plantations, the disease in 
nearly all cases going into the tertiary stage. Some 
ten or fifteen years later consumption and insanity be- 
gan among the adults, many of their children died 
from scrofula and tuberculosis, and it was the excep- 
tion rather than the rule that the children lived. 
Bodily deformities and idiocy were frequent among 
them. 
Viewing the present condition of the Southern 
negro, then, from the standpoint of his changed sur- 13 
roundings, and taking into consideration the structure 
of the body which is specially implicated in this 
change, it is perfectly obvious why insanity should de- 
velop as a necessary sequence in this soil. Upon the 
same ground, and upon no other, can we explain why 
pulmonary consumption should follow in the wake of 
insanity, and also increase in frequency. The truth 
is that those who were able to realize all the factors 
which would be called into activity by this environ- 
mental change of the negro could, at the time it was 
made, have foretold the inevitable results which are 
now but too evident to every one. It is a repetition, 
in part at least, of what happened, and happens now, 
to the aborigines of North America, Australia, and 
New Zealand, who, in their unequal warfare with 
modern civilization, have been, and are being fast 
decimated and exterminated by pulmonary phthisis.