G. D. Maynard 
291 
true value of the results. The report deals only with the insane in institutions. 
"No institution for the insane, except a very few small private institutions, refused 
to give information. Therefore so far as all classes of institutions are concerned 
the present enumeration is practically complete," p. 6. " To offer any estimate of 
the probable number of the insane that would have been disclosed by an investi- 
gation which included those not in institutions in addition to those in hospital on 
31/12/03 would be a mere guess. But it is certainly within the truth to say that 
there were as many on that date as were found outside of hospitals in 1890, some 
30,000," p. 8. This number refers to the whole of the United States and not alone 
to the 15 States dealt with in this paper. "In many cases the high rank given 
some States, for instance, Massachusetts, New York, Connecticut, New Jersey, 
California, &c., probably approximate actual conditions," p. 4. 
Two correlation tables were prepared so that the matter might be viewed in 
somewhat different lights, and as much information as possible obtained from 
the figures. It seemed probable that yearly admission might be an even better 
guide to the prevalence of insanity than the actual number in hospital on any 
given day ; because where accommodation was insufficient for the pressure 
occasioned by cases waiting for admission, it would be possible to mitigate this 
by discharging chronic and convalescent patients somewhat earlier than would be 
done by hospital authorities where there was more ample accommodation. If this 
were so then the admissions would be a better guide to the prevalence of the 
disorder than the actual number in the institutions. The values of the correlations 
for cancer death-rates with the insane are as follows : 
Insane enumerated 31/12/03 p = -8711 ± -0420. 
Insane admissions 1904 p = -9173 ± -0278. 
Diabetes and Insane admissions p = "8074 + "0608. 
These values seem to give additional support to the theory of a nervous factor 
in the aetiology of cancer, and it would be interesting to find an independent 
measure of the stress of life in the different districts, that could be used as an 
index to the intensity of the struggle for existence. 
In a general way one would expect that in the larger cities the competition 
would be greater than in the smaller ones, although this would probably not be 
true of cities with only small differences in population, and other factors besides 
mere size would have to be taken into consideration. No small cities occur in 
the tables here used, and the correlations between population and cancer or 
diabetes death-rates are scarcely significant : 
Cancer death-rate and population p = '1049 + '1055. 
Diabetes death-rate and population p = '3007 + •0970. 
I thought that a rough measure of the social and economic conditions pre- 
vailing in a district might be obtained by reducing the number of periodicals 
