Table II
(Registration States as constituted in 1900)
| Cause of Death | 1900 | 1910 | Per Cent. Increase |
| 1. Cancer (all forms) | 63.5 | 82.9 | 30.6 |
| 2. Diabetes | 11.0 | 17.6 | 60.0 |
| 3. Cerebral hemorrhage and apoplexy | 72.5 | 86.1 | 18.8 |
| 4. Organic diseases of the heart | 116.0 | 161.6 | 39.3 |
| 5. Diseases of arteries | 5.2 | 25.8 | 396.2 |
| 6. Cirrhosis of liver | 12.6 | 14.4 | 14.3 |
| 7. Bright's disease | 81.0 | 95.7 | 18.1 |
| Total | 361.8 | 484.1 | 33.8 |
It has, therefore, been assumed quite generally that the deterioration observed after age 40 is due to the increase in the incidence of these so-called "degenerative" diseases. Indeed, much of the propaganda for better personal hygiene at middle life has received its impetus from the discussion of this tendency in American mortality. We must not forget, however, that our returns for causes of death are still far too inaccurate to warrant complete confidence. Only a small proportion of our statements of cause are confirmed by autopsy. Yet, the changes that have occurred in our medical practise with reference to statements of cause of death have not been of such radical character during the last ten years as to invalidate the conclusions drawn. The figures are apparently confirmed by independent analyses made in a number of specialized areas in which it appears that these degenerative diseases have increased at about the same rate as in the registration states. We are warranted in concluding, therefore, in spite of the lack of absolutely accurate data, that the trend of our mortality in middle life is at present unfavorable and that this condition is accompanied by an increasing incidence of the degenerative diseases.
The question we now desire to put squarely is this: What are the forces at work in American life which have made for this increased mortality at the adult ages? In a recent paper entitled "The Possibilities of Reducing Mortality at the Higher Age Groups" the writer pointed out some of the conditions of present-day life which he believed tended to increase the death rates from the so-called "degenerative" diseases. In this paper reference was made to the greater use of alcoholic beverages and especially to the deleterious effects of modern conditions of industry. It was assumed that the changing conditions of American industrial life involved a greater strain on the organism, causing it to break down at an earlier age than was formerly the case under the less intense conditions of labor. In the present paper I wish to refer to another element which is apparently at work in the causation of these higher death rates from the diseases above mentioned.
