GENERAL PAPERS 71 
prematurely, at an age when, as a result of training and ex- 
perience, they should be most productive and of the greatest 
value to society. 
In 1913 there were over three hundred thousand deaths due 
to diseases of the kidneys, heart, and blood vessels. 24.2 per 
cent of all the deaths due to Bright's disease and 21 per cent 
of those caused by organic heart trouble occurred in individuals 
under fifty years of age. Cerebral hemorrhage and arter- 
iosclerosis have increased during the last ten years. 
The strenuousness of modern life, the intemperance of food 
and drink, exposure, and the intoxications of occupation play 
a part in the production of renal, cardiac, and vascular de- 
generation. In many cases, however, we see the hand of 
syphilis, the sequel of rheumatic fever, tonsillitis, chorea, and 
of pneumonia, or the probable latent injuries of scarlet fever, 
diphtheria, typhoid, or malaria. 
In the acute cases of kidney, heart, or vascular disease, the 
virulence of the invading organism, the reduction of the re- 
sistance of the individual, or both, so favor the spread of the 
infection that signs of disease are early apparent. In the 
chronic cases the injuries may be comparatively latent, the 
symptoms slight or absent, yet the organs may be so damaged 
that under the stress of modern life their period of activity 
may fall short ten or twenty years. 
On the basis of the last statistics, there are 78,900 deaths 
due to cancer annually in the United States. The mortality 
rate has steadily increased from 63 per 100,000 population in 
1900 to 78.9 in 1913. Do these figures represent an actual in- 
crease? Statisticians and notably Hoffman believe that the 
mortality rates "unconditionally confirm the conclusion that 
cancer is relatively on the increase throughout the civilized 
world and the increase is affecting practically all important 
organs and parts of the body." Physicians and surgeons are 
somewhat skeptical and are inclined to attribute the increase 
largely to better methods of diagnosis of internal cancer and 
to the lengthening of the average life which increases the 
number of individuals reaching the cancer age. 
The two great predisposing causes of cancer are age and 
irritation. Cancer usually occurs after forty, but it may not 
