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In this group is included a great variety of maladies. Of some the causes are known, while in the case of others, origin, prevention, and remedy are still obscure. Here belong defects in structure of the body, both hereditary and acquired; insanity and other nervous diseases; new growths, like tumors and cancer; disturbances of bodily processes, as malnutrition and gout; and the important class of degenerative diseases, like arteriosclerosis, in which tissues become hardened and fibrous and hence less able to perform their normal functions.

The degenerative diseases are playing a menacing part in national health. The average length of life in the United States has shown a marked increase it is true, during the last 40 years. But this gain represents chiefly the saving of life through prevention of communicable diseases, especially among babies and children; among people who have passed the 30th year on the other hand, death rates are actually increasing. This increase is most marked after the age of 45, and is caused chiefly by the increase of cancer, and of degenerative diseases of the heart, blood vessels, and kidneys. Degeneration of tissues is normally a condition typical of old age, and in aged persons it may occur in any tissue. There is no elixir of youth, and for old age there is no cure. But the important facts in this connection are that degenerative changes now occur prematurely, and that among a vast number of people, in various classes of society and various occupations, the vital organs show a marked tendency to break down after the age of 45.

This condition is not inevitable. Before the beginning of the present war, death rates at all ages were decreasing in England, Sweden, and other European countries. In America also degenerative diseases can be checked or prevented to a large extent, and it is highly important that their causes should be generally understood.

The two groups following include some of the probable causes:

1. Conditions of life which result in continued overwork, and mental overwork in particular; worry, excitement, insufficient recreation and exercise, and other kinds of nervous strain typical of modern life, especially in cities.

2. Irritating substances in the body, including poisonous substances resulting from infectious diseases, and from syphilis in particular; poisons from chronic infections, alcohol, and industrial poisons such as lead and other metals; overeating and improper eating, especially of meat and other proteins, and rich or highly seasoned food; faulty digestion, constipation, and imperfect elimination through the kidneys.—(See Dr. A. E. Shipley, in bulletin of the N. Y. City Dept. of Health, Feb., 1915.)

The importance of early recognition cannot be overemphasized. In many of these troubles the symptoms are not pronounced, and the victims have no knowledge of their condition until they happen to be examined for life insurance, or until the disease is far advanced. And even when they realize that trouble exists, as for example constipation or overwork, most people absolutely fail to realize how serious the consequences may be. The first step toward remedy is periodic complete physical examination by a competent physician, in order to learn in time how to prevent these degenerative diseases, if present, from growing worse. The custom of undergoing an annual physical examination is becoming more common, and "such a course, conservatively estimated, would add 5 years to the average life of persons between 45 and 50."—(Winslow.)

"Recently, we have been making examinations of the employees of whole institutions, large banks and other industrial concerns in New York City, and we find almost the same conditions there. Out of 2000 such examinations among young men and women of an average age of 33, just in the early prime of life, men and women supposedly picked because of their especial fitness for work, only 3.14% were found free of impairment or of habits of living which are obviously leading to impairment. Of the remaining persons, 96.69% were unaware of impairment; 5.38% of the total number examined were affected with chronic heart trouble; 13.10% with arteriosclerosis; 25.81% with high or low blood pressure; 35.65% with sugar, casts or albumen in the urine; 12.77% with combination of both heart and kidney disease; 22.22% with decayed teeth or infected gums; 16.03% with faulty vision uncorrected. … The fact of greatest import, however, was that impairment, sufficiently serious to justify the examiner in referring the examinee to his family physician for medical treatment, was found in 59% of the total number of cases, while 37.86% were on the road to impairment because of the use of "too much alcohol," or "too much tobacco," constipation, eye-strain, overweight, diseased mouths, errors of diet, and so forth. …

"And what is the cause of this appalling increase, in the United States, of these and other degenerative diseases? I believe it can be shown to the satisfaction of any reasonable person that the increase is largely due to the neglect of individual hygiene in United States. …

"If a man were suddenly afflicted with smallpox or typhoid fever or any other acute malady, he would lose no time in getting expert advice and applying every known means to save his life. But his life may be threatened just as seriously, though possibly not so imminently, by arteriosclerosis, heart disease, or Bright's disease, and he will do nothing to prevent the encroachment of these diseases until it is too late, but will continue to eat as he pleases, drink as he pleases, smoke as he pleases, or overwork, and worry himself into a premature grave."—("Conservation of Life at Middle Age," Prof. Irving Fisher, Am. Journal of Public Health, July, 1915.)

Periodic physical examinations are as necessary for children as for adults, in order to detect physical defects. These defects are known to have such an immense bearing upon health that routine examinations of all children have become an integral part of the work of enlightened public schools.

Prevention of degenerative disease, then, as well as of the enormous numbers of preventable accidents and injuries, depends in large measure upon proper living conditions and proper personal habits. The infectious diseases, according to Dr. Hill, cost us annually at least 10 billion dollars in addition to the loss of life, and he adds: "The infectious diseases in general radiate from and are kept going by women."—(Hill—New Public Health, p. 30.) Women, it is true, can prevent many of the infections, but they can do still more, for hygienic habits to be effective must be acquired early, and mothers and teachers, because they have practically the entire control of children, have the power to prevent many cases of degenerative as well as of communicable disease.