•; 
[7-132.] 
TENTH CENSUS OF THE UNITED STATES. 
F THE INTERIOR, 
OFFICE, 
Washington , 1). C. 
)een sent to every practising 
d fill and return it as soon as 
CIS A. WALKER, 
Superintendent of Census. 
DIRECTORY J 
(1.) The name of each individual is asked to prevent the accidental counting of the same person! 
but no name given will be revealed to any one not engaged in the compilation and tabulating 
(2.) State the city, town, township, precinct, or other subdivision of the county in which the person res 
resident of any other State or Territory, name it ; and in that case it will not be necessary to nf 
(4.) For male, write M; for female, F. (5.) For white, write W; for black, B; for mulatto, Mu.; 
for Chinese, C. (6.) For single, write S; for married, M; for widowed, W ; for divorced, D. (7.) I J 
in the first column, state the ordinary profession, occupation, or trade, when sane, of each male person! 
of age ; in the second column, state any useful or profitable employment pursued by the insane persl 
time, notwithstanding his insanity. (8.) If a native of the United States, mention the State or Tea 
native, name the country. (9.) It is neither necessary nor desirable to make fine distinctions as to tho 
disease ; merely indicate the prominent fact, thus : mania, melancholia, dementia, general paraly 
dipsomania. (10.) Observe that it is the duration of the pi%sent attach only which is requested, (j 
HON. 
Place of birth. 
(8) 
Form of disease. 
(9) 
Duration 
of present 
attack. 
(10) 
j| 
(ii) 
(13) 
1 ' 
Restraint. \ 
(15) ( 
r Present employment, 
if any. ' 
How cared for. 
(13) 
■ Seclusion. 
(14) 
l ^ 
______ 
5 ££ 
s & 
1 f. 1 
'I 
. 
— - 1 
ns from physicians upon this subject as made 
is signed to any such return a copy of the publii 
l ered here.) 
strict professional confidence, and to hold the same inviolate, 
hed tables containing the aggregate statistical result of the present inquiry, 
Second , to make such thorough exa 
soon as those table 
county , State of 
Signed and 
0 1 
cm 
23456789 10 
copyright reserved 
