
Art. XXXI.—Insanity: Some Comparative Statistics.
[Read before the Auckland Institute, 17th August, 1908.]
Introduction.
The purpose of this paper is to supply some answer, to three questions: Are the native-born of this country less liable to insanity than the remainder of the population? Is that portion of the population which is not New Zealand-born more liable to insanity than the people they have left behind in the countries of their birth? And have the women of this country an exceptionally small liability to insanity? The answers which this paper will supply to the first two questions are in the negative, and the answer to the third, while in the affirmative, will not indicate a very great difference between the women of this country and those of England and Wales.

The answers being of so negative a character, some explanation or apology would appear necessary to justify the existence of this paper. This is supplied by the report on the mental hospitals of the colony for 1906, issued by Dr. F. Hay, Inspector-General of Mental Hospitals. In that report are given some remarkable deductions from the statistics of insanity in New Zealand, and the questions above are not merely raised and answered in the affirmative, but in each case the differences represented as existing are of a character that may fairly be described as sensational. Dr. Hay further theorizes on the influences that have brought these differences into being, and goes so far as to consider the advisability of Governmental action with a view to giving these influences less free scope in the future. If, then, Dr. Hay's deductions are more or less unfounded, it is highly important that the fact should be clearly demonstrated, both in the interests of statistical and sociological science and of public policy. It is the more necessary as Dr. Hay's conclusions on two of the questions here raised are again brought forward in the report for 1907.
The New-Zealand-Born and The Immigrant.
The report represents the native-born in New-Zealand as far less liable to insanity than the immigrant. “The outstanding feature disclosed by these calculations,” it says, “is the remarkably low incidence of insanity among New-Zealand-born.” The figures finally given as representing the situation are:—
| Not New-Zealand-born | 1 insane in 118-9 |
| New-Zealand-born | 1 insane in 246-9 |
indicating, apparently, a tendency to insanity in the immigrant more than double that in the native-born.
Now, in spite of these figures, I may say at once that this or any similar deduction will be shown to be absolutely unfounded in fact. But I shall first endeavour to make clear the nature of the mistake made in the report. Dr. Hay himself modified his figures and moderated his conclusions in comparing the immigrant with the native-born by allowing for the facts that (1) there is comparative immunity from insanity below the age of twenty, and that (2) the age of the large majority of immigrants is from twenty upwards, nearly the whole of our population under twenty being native-born. He did this by eliminating those under twenty and comparing only the populations of the two classes over twenty years of age. This altered his first figures considerably. The original figures were—
| New-Zealand-born | 1 insane in 613.6 |
| Not New-Zealand-born | 1 insane in 129.2 |
The modified figures are, as before stated,—
| New-Zealand-born | 1 insane in 246.9 |
| Not New-Zealand-born | 1 insane in 118.9 |
This amendment was in the right direction. It removed the influence of that portion of the New-Zealand-born population under twenty, amounting to considerably more than one-half of the total, to which corresponded only a very small fraction of the immigrant population, and which was under the age of substantial liability to insanity. But this manner of correction was not carried nearly far enough. The report deals with the question as if

(1) liability to insanity were independent of age once the age of twenty is reached, and as if (2) the age-distribution for ages above twenty were the same for both the native-born and immigrant populations. Now, this is very far from being the case in either particular. For instance, at the ages 20-25 there are only 13.32 lunatics to 10,000 of population; at 65-70 there are 133.34, an increase in the ratio of 1 to 10; and the increase is steady from the one age-period to the other. Again, in the former of these age-periods the native-born population is more than five times the not-native-born; in the latter it is less than one-seventieth; and again there is a steady change from the one position to the other in between the two age-periods. Fig. 1 represents by graphs the age-distribution of the whole population and also that of the native-born. It represents also the lunacy-rate—that is, the number of lunatics to 10,000 of population at each age-period. The diagram shows clearly how, as the lunacy-rate increases, the ratio of the native-born to the whole population of the same age-period becomes less and less, until by the time the lunacy-rate has reached its maximum this ratio is very small. Consequently, in the two populations of over twenty, the native-born are to a far greater degree than the others concentrated in the earlier age-periods, in which the liability to lunacy is much smaller than in the later ones, and consequently the number of native-born lunatics is to be expected to be very much less than it would be if with the same populations these differences did not exist. We have further to allow for the population not New-Zealand-born containing a large majority of males, with their greater liability to insanity.
In Table I, I have made an attempt to allow for these differences. The table gives the whole population and then the native-born population in quinquennial age-periods. The fourth and fifth columns give the latter divided into males and females. The next two columns give the number of lunatics per 10,000 of population for each age-period. On the hypothesis of equal liability to lunacy at the same ages in both classes of population it is now a simple matter to calculate the proper number of native-born lunatics of each sex in each period. The results are entered in the last two columns.
This method, it should be noted, still exaggerates the estimate of the number there ought to be of native-born lunatics if they had the same liability to insanity as the remainder of the population. For the condition of things we are trying to allow for still holds for each of our age-periods. The proportion that is native-born is greater in the earlier than in the later years of each age-period, and up to about seventy years the liability to lunacy is continually on the increase as the age increases, while after this age the contribution to the number of lunatics is small by reason of the smallness of population. It is impossible to allow for this feature with perfect accuracy. If we took yearly age-periods the error would be smaller, but the problem is hardly worth this, and it is sufficient for our purposes that it should be clearly understood that the estimate in the table is distinctly an overestimate. The figures in the table are all taken from or based on the census returns for 29th April, 1906. The lunacy-rates quoted here and elsewhere are those for New Zealand as determined by this census, but their general character is in no way peculiar. Their main feature is general—namely, an increase in the rate up to sixty-five or seventy years of age, after which there is a not very great reduction, due to the greater mortality of he insane causing a reduction in their relative numbers.

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| Ages. | Population. | New-Zealand-born. | Number of Lunatics per 10,000 of Population. | Proportionate Share of Lunatics for New-Zealand-born. | ||||
|---|---|---|---|---|---|---|---|---|
| Total | Males. | Females. | Males. | Females | Males. | Females. | ||
| 0-5 | 102,745 | 100,117 | 51,229 | 48,888 | 0.19 | 1 | 0 | |
| 5-10 | 90,288 | 85,827 | 43,542 | 42,285 | 2.18 | 2.02 | 9 | 9 |
| 10-15 | 86,758 | 80,875 | 40,778 | 40,097 | 4.56 | 1.40 | 19 | 6 |
| 15-20 | 87,117 | 79,587 | 39,955 | 39,632 | 7.46 | 5.83 | 30 | 23 |
| 20-25 | 94,608 | 78,849 | 38,478 | 40,371 | 15.39 | 11.05 | 59 | 45 |
| 25-30 | 92,448 | 68,388 | 33,278 | 35,110 | 25.74 | 22.95 | 86 | 81 |
| 30-35 | 70,419 | 44,087 | 21,975 | 22,112 | 41 80 | 33 72 | 92 | 74 |
| 35-40 | 60,123 | 33,026 | 16,610 | 16,416 | 60.32 | 48.93 | 100 | 80 |
| 40-45 | 45,381 | 17,945 | 9,096 | 8,849 | 75.66 | 63.54 | 69 | 56 |
| 45-50 | 38,427 | 8,504 | 4,364 | 4,140 | 86.35 | 92.92 | 38 | 39 |
| 50-55 | 31,899 | 4,406 | 2,264 | 2,142 | 105.26 | 103.96 | 24 | 22 |
| 55-60 | 24,942 | 2,458 | 1,268 | 1,190 | 120.85 | 114.07 | 15 | 14 |
| 60-65 | 21,894 | 1,452 | 745 | 707 | 145.36 | 105.91 | 11 | 8 |
| 65-70 | 19,123 | 263 | 133 | 130 | 138.84 | 125.02 | 2 | 2 |
| 70-75 | 12,183 | 77 | 42 | 35 | 111.01 | 106.15 | ||
| 75-80 | 6,071 | 40 | 21 | 19 | 127.10 | 92.71 | ||
| 80 and over | 3,411 | 11 | 4 | 7 | 112.60 | 97.02 | ||
| Total | 887,837 | 605,912 | 303,782 | 302,130 | 39.47 | 30.50 | 555 | 459 |
| 1,014 |
According to this calculation the number of native-born lunatics there should have been in this colony at the time of the last census, if the liability to insanity in the native-born were the same as in the rest of the population, would be substantially less than 1,014. Now, the actual number of registered insane of New Zealand birth on the 31st December, 1906, was 988—a very noteworthy agreement. We may make some allowances for the interval of some months between the time of taking the census and the end of the year, for the possibility of the registered insane including a small proportion of idiots, and for some discrepancy between the census and registration returns, and still the conclusion appears reasonable and certain that the statistics indicate that there is no appreciable difference between those of the population of this country that were born in New Zealand and those not born in New Zealand with respect to liability to insanity. The argument justifying this conclusion may be put in another form. Our investigation shows that if the native-born has the same lunacy-rate at each age as the remainder of the population the native-born lunatics should constitute materially less than 0.328 of the whole: according to the numbers of registered insane on the 31st December, 1906, the native-born insane constituted 0.311 of the whole. There is thus absolutely no basis for any argument designed to show that the native-born are less liable to insanity than the immigrant population of the country.
The Immigrant And His Countrymen.
But in the report the immigrant is compared to his disadvantage not only with the New-Zealand-born, but also with his countrymen remaining behind in his native country. The deduction is drawn “that he is not an average type of the country of his origin,” but, on the contrary, is “below

the average of the country of his origin.” This is said first of all to be suggested by the comparison of the immigrant with the New-Zealander, in which it is pointed out that the insane of the immigrant population above the age of twenty is as great as 1 in 118-9. After the inquiry in the preceding section of this paper, this suggestion would appear to cease to have any force. It is then stated to be verified “by contrasting our figures with the English figures (only approximate) of 1 insane person below twenty to 2,069 of the population of the same age, 1 in 173 of the population above that age, and 1 in 283 of all ages.” Now, in arguing from these bare figures serious mistakes have been made similar to those made in contrasting the New-Zealand-born with the immigrant. The remarkable age-distribution of those of our population not born in this country, combined with the increasing liability to insanity as age increases, is not taken any account of above the age of twenty.
To illustrate the extent of this peculiarity that has to be allowed for, let us compare the age-periods 20–25 and 45–50. The number of lunatics per 10,000 in the later period is more than six times as great as it is in the earlier. Our total population in the later period is about two-fifths of that in the earlier, whereas our immigrant population of the later period is almost double that of the earlier. Further, whereas in the period 20–25 our immigrant population only constitutes one-sixth of the whole population of that age-period, in the later age-periods it practically constitutes the whole population of the periods. We have further to take into account the very considerable excess of males in our immigrant population, amounting to nearly 50 per cent., and their greater rate of insanity, and also the excess of females in older countries. In fig. 2 we have the graphs representing the population of New Zealand not New-Zealand-born. The excess of males stands out clearly, and a comparison of these graphs with those in fig. 1 for the whole population reveals clearly to the eye the exceptional character

of the age-distribution of those not born in New Zealand. The graphs representing the rates of lunacy for the two sexes are also repeated in fig. 2, and two other graphs are given representing how our population above twenty years of age and not New-Zealand-born would be distributed in age and sex if such distribution were the same as that of the population of England and Wales as given in the census of 1901; or, in other words, representing the age and sex distribution of a portion of the population of England and Wales over twenty equal in number to that of our population over twenty not New-Zealand-born. A comparison of these graphs with the others in the same figure again reveals clearly the exceptional character of the age and sex distribution in question. It is obvious, then, that, in view of the very different rates of insanity prevalent in the various age-periods, the figures as presented by Dr. Hay cannot be accepted as any indication of the comparative insanity of the immigrant and his countrymen at home.
In Table II I have made an endeavour to roughly measure the correction that must be applied to allow for the features I have pointed out. The first column gives the age-periods beginning at 20-25, the next two give the population of New Zealand according to age-period and sex, and the next two again our immigrant population classified in the same way. The sixth and seventh columns give our total immigrant population above the age of twenty redistributed in respect to both age and sex proportionally to the population of England and Wales according to the census of 1901. The next two columns again give the New Zealand rates of lunacy, which have been already shown to apply generally to the New-Zealand-born and the immigrants as a whole. The last two columns give the number of immigrant lunatics there would be if our immigrant population of twenty years and over were distributed in age and sex as the population of England and Wales is distributed.

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| Population. | Not New-Zealand-born. | Number of Lunatics per 10,000 | Number of Lunatics in Distributed Population | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Actual. | distributed. | |||||||||
| Ages | Males | Females | Males | Females | Males | Females | Males | Females | Males | Females |
| 20-25 | 49,370 | 45,238 | 10,892 | 4,867 | 20,542 | 22,994 | 15.39 | 11.05 | 32 | 25 |
| 25-30 | 49,308 | 43,140 | 16,030 | 8,030 | 18,528 | 20,872 | 25.74 | 22.95 | 48 | 48 |
| 30-35 | 37,798 | 32,621 | 15,823 | 10,509 | 16,147 | 17,766 | 41.80 | 33.72 | 68 | 60 |
| 35-40 | 32,329 | 27,794 | 15,719 | 11,378 | 14,430 | 15,496 | 60.32 | 48.93 | 87 | 76 |
| 40-45 | 24,451 | 20,930 | 15,355 | 12,081 | 12,519 | 13,295 | 75.66 | 63.54 | 95 | 85 |
| 45-50 | 21,424 | 17,003 | 17,060 | 12,863 | 10,601 | 11,342 | 86.35 | 92.92 | 92 | 106 |
| 50-55 | 18,336 | 13,563 | 16,072 | 11,421 | 8,874 | 9,662 | 105.26 | 103.96 | 93 | 100 |
| 55-60 | 13,984 | 10,958 | 12,716 | 9,768 | 6,939 | 7,742 | 120.85 | 114.07 | 84 | 88 |
| 60-65 | 12,452 | 9,442 | 11,707 | 8,735 | 5,725 | 6,698 | 145.36 | 105.91 | 83 | 71 |
| 65-70 | 11,524 | 7,599 | 11,391 | 7,469 | 3,938 | 4,853 | 138.84 | 125.02 | 55 | 61 |
| 70-75 | 7,567 | 4,616 | 7,525 | 4,574 | 2,725 | 3,498 | 111.01 | 106.15 | 30 | 37 |
| 75-80 | 3,698 | 2,373 | 3,677 | 2,354 | 1,648 | 2,111 | 127.10 | 92.71 | 21 | 19 |
| 80 and over | 1,865 | 1,546 | 1,861 | 1,539 | 977 | 1,494 | 112.60 | 97.02 | 11 | 14 |
| Total | 284,106 | 236,823 | 155,828 | 105,508 | 123,593 | 137,823 | 799 | 790 | ||
| 520,929 | 261,416 | 261,416 | 1,589 |
The result is to give us 1,589 lunatics, to which ought to be added the share of idiots to get the total insane for comparison with English figures. But, even ignoring these, this is at the rate of 1 in 164.5—a very considerable change from the actual 1 in 118.9, and approaching pretty closely to the 1 in 173 of England and Wales which Dr. Hay takes for comparison, especially when we remember that the dealing with quinquennial age-periods does not make by any means a complete correction.
The design of Table II is not perfect, but perfection cannot be attained with the statistics available. The immigrant population contains large numbers born in Scotland, Ireland, and Australia. Those born elsewhere are relatively so few as to make no material difference in the argument. The Scotch differ from the English only slightly in respect to liability to insanity, and the population of Scotland is distributed with respect to age very similarly to that of England and Wales. Those of English, Welsh, and Scotch birth form the great majority of our immigrant population. Those of Irish and Australian birth are not very unequal in numbers—their contributions to the insane when combined are about equal proportionally to that of the other nationalities—and the age-distributions of the populations of Ireland and Australia vary in opposite directions from that of Great Britain, Ireland having a greater proportion of older and Australia of younger people. So the table does not altogether fail in taking the immigrant population of New Zealand and finding what the position would be if their age-distributions were similar to those of the native countries of the immigrants. The inference is that there is no appreciable evidence that in the total the immigrant is any more liable to insanity than the people of his native land; and, even if there were in the mere statistics, the question would arise to what extent the apparent differences were really due to differences of classification and of circumstances in the different countries leading to more or less perfect returns, and differences of asylum accommodation and treatment of the insane leading to greater or less longevity.

There appear to be exceptions in the particular cases of the Irish, and Australians, the former appearing to contribute far more and the latter very many less than their proportional share to the insane of this country. It is possible an investigation would not prove the contrary, but it probably would show that the situation is not as extreme as it appears. The necessary statistics for such an investigation, however, are not available.
The Females Of New Zealand.
The report further calls attention to the fact that the smaller number of women relatively to men in our mental hospitals contrasts strangely with the numbers in the United Kingdom. This is partly explained in the report by the fact of there being 53,438 fewer women than men in this country, and by the fact that nearly all this deficiency of females obtains in that part of our population which is not New-Zealand-born, and to which the report, as we have seen, attributes a far higher rate of insanity than to the nativeborn. The proper statement of the case is that the deficiency of males, being almost entirely amongst those not New-Zealand-born, comes mostly in the age-periods where the rate of insanity is greatest. But not only is this generally so, but in the quinquennial age-periods, as we take later periods and the lunacy-rate becomes greater, the deficiency of females also becomes greater, until we come to the last few periods, which do not supply any large portion of the total. We have also to take into account in the comparison that in the United Kingdom and other old countries there is an excess instead of a deficiency of females, due to the greater longevity of females and the greater loss by emigration of males, and that this excess is relatively greatest generally in the ages of maturity, and specially in the later age-periods. The result is that the ratio of females to males in New Zealand for the age-periods at which the lunacy-rate is very high is less than three-quarters and in some periods actually less than one-half of the corresponding ratio in England and Wales.
Table III gives for quinquennial age-periods the lunacy-rates for New Zealand, and the ratio of females to males both in New Zealand and in England and Wales.
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| Ages. | Number of Lunatics in 10,000 of Population. | Ratio in Population of Females to Males | Ages. | Number of Lunatics in 10,000 of Population. | Ratio in Population of Females to Males | ||||
|---|---|---|---|---|---|---|---|---|---|
| Males. | Females. | New Zealand. | England and Wales | Males. | Females. | New Zealand. | England and Wales | ||
| 0-5 | 0.19 | 0.96 | 1.00 | 50-55 | 105.21 | 103.96 | 0.74 | 1.09 | |
| 5-10 | 2.18 | 2.02 | 0.97 | 1.01 | 55-60 | 120.85 | 114.07 | 0.78 | 1.12 |
| 10-15 | 4.56 | 1.40 | 0.98 | 1.00 | 60-65 | 145.36 | 105.91 | 0.76 | 1.17 |
| 15-20 | 7.46 | 5.83 | 0.97 | 1.02 | 65-70 | 138.84 | 125.02 | 0.66 | 1.23 |
| 20-25 | 15.39 | 11.05 | 0.92 | 1.12 | 70-75 | 111.01 | 106.15 | 0.61 | 1.28 |
| 25-30 | 25.74 | 22.95 | 0.87 | 1.13 | 75-80 | 127.10 | 92.71 | 0.64 | 1.34 |
| 30-35 | 41.80 | 33.72 | 0.86 | 1.10 | 80 and over | 112.60 | 97.02 | 0.83 | 1.53 |
| 35-40 | 60.32 | 48.93 | 0.86 | 1.07 | |||||
| 40-45 | 75.66 | 63.54 | 0.86 | 1.06 | |||||
| 45-50 | 86.35 | 92.92 | 0.79 | 1.07 | Total | 39.47 | 30.50 | 0.89 | 1.07 |
Fig. 3 also illustrates the same features. It represents the male and emale populations of New Zealand, and also the population of twenty years

and over, redistributed in respect to both age and sex proportionally to the census of 1901 for England and Wales.
The question now arises, Will these differences fully account for the deficiency of female lunatics as compared, say, with England and Wales? Some attempt has been made to answer the question in Table IV. In this table is calculated the number of male and female lunatics over twenty years of age there should have been returned at the various age-periods in the census of 1906 if our population over twenty had been distributed in age and sex as was that of England and Wales at the census of 1901.
| Age-periods. | Population of New Zealand. | The Same redistributed. | Lunatics per 10,000 of Population. | Number of Lunatics. | ||||
|---|---|---|---|---|---|---|---|---|
| Males. | Females | Males. | Females. | Males. | Females. | Males. | Females. | |
| 20-25 | 49,370 | 45,238 | 40,947 | 45,831 | 15.39 | 11.05 | 63 | 51 |
| 25-30 | 49,308 | 43,140 | 36,933 | 41,603 | 25.74 | 22.95 | 95 | 95 |
| 30-35 | 37,798 | 32,621 | 32,190 | 35,415 | 41.80 | 33.72 | 135 | 119 |
| 35-40 | 32,329 | 27,794 | 28,763 | 30,889 | 60.32 | 48.93 | 173 | 151 |
| 40-45 | 24,451 | 20,930 | 24,954 | 26,502 | 75.66 | 63.54 | 189 | 168 |
| 45-50 | 21,424 | 17,003 | 21,191 | 22,613 | 86.35 | 92.92 | 183 | 210 |
| 50-55 | 18,336 | 13,563 | 17,690 | 19,262 | 105.26 | 103.96 | 186 | 200 |
| 55-60 | 13,984 | 10,958 | 13,812 | 15,434 | 120.85 | 114.07 | 167 | 176 |
| 60-65 | 12,452 | 9,442 | 11,412 | 13,347 | 145.36 | 105.91 | 166 | 142 |
| 65-70 | 11,524 | 7,599 | 7,854 | 9,656 | 138.84 | 125.02 | 108 | 121 |
| 70-75 | 7,567 | 4,616 | 5,435 | 6,976 | 111.01 | 106.15 | 60 | 74 |
| 75-80 | 3,698 | 2,373 | 3,144 | 4,210 | 127.10 | 92.71 | 40 | 39 |
| 80 and over | 1,865 | 1,546 | 1,949 | 2,979 | 126.60 | 97.02 | 25 | 29 |
| Total | 284,106 | 236,823 | 246,212 | 274,717 | 1,590 | 1,575 | ||
| 520,929 | 520,929 | 3,165 |

The result of this calculation is to give 3,165 unatics of specified ages, of twenty years and over, of which 1,590 would have been males and 1,575 females—that is, the two sexes would have been almost exactly equal in numbers. The number of such actually returned at the census of 1906 was 3,026, of which 1,793 were males and 1,233 females. Instead, then, of the number of the female lunatics being 0.61 of that of the males, it would have been 0.99, a relative increase of 62 per cent. It must, further be borne in mind here, as elsewhere, that the dealing with quinquennial age-periods does not make by any means a complete correction, which would undoubtedly give an actual excess of female lunatics.
The result we have obtained does not, however, explain the whole of the apparent difference between this country and England and Wales, for in the latter there is returned a substantial excess of female lunatics, the numbers recorded in the census of 1901 being—
| Lunatics. | Imbecile and Feeble-minded. | Total. | |
| Males | 37,583 | 24,480 | 62,063 |
| Females | 46,189 | 24,402 | 70,591 |
But the allowances we have made make the contrast very much less marked, and bring it more within the uncertainties of such international statistics. The difference remaining unaccounted-for affords a rather unsafe foundation for argument and speculation.
In conclusion, we may consider briefly how the female really stands with respect to the male in New Zealand in the matter of liability to insanity. At the census of 1906 there were returned, at specified ages of twenty years and over, 1,793 male and 1,233 female lunatics. I shall not trouble the reader with another table; but if, in the manner of previous tables, we allow for the difference in numbers and in age-distribution of the sexes by supposing there had been a female population equal in numbers and similar in age-distribution to the male population, but retaining the female lunacy-rate at the various ages, we find that there would have been 1,567 instead of only 1,233 female lunatics. The comparison of this number 1,567 with 1,793, the actual number of male lunatics, is the best way of comparing briefly the liability of the two sexes to lunacy, since in it both the inequality in the numbers of the sexes and the dissimilarity in their age-distributions are allowed for.
It is interesting further to notice the influence of alcoholism. In 1906 there were admitted to the mental hospitals of this country 401 males and 277 females. Amongst these cases seventy-three of the former but only eleven of the latter were attributed to alcoholism. In 1907, again, the numbers of admissions were 421 males and 279 females. Of these cases, seventy-one of the former but only eleven of the latter were attributed to alcoholism. In the two years the excess of male over female cases due to alcoholism is greater than one-seventh of the total number of male cases. Unless the proportion of recoveries is much greater for this class of patient than for those that owe their insanity to other causes, these numbers would indicate that the difference remaining between the insanity of the males and females in New Zealand that has not already been accounted for by the differences in numbers and age-distribution is entirely explained by the greater excessive indulgence of the male sex in alcohol, and the ravages this indulgence makes on the sanity of the sex.
