1-48 



NATURE 



[October 3, 191; 



through such waste products as lactic acid impels the 

 formation of rod corpuscles and haemoglobin. The 

 products of muscular metabolism in other ways not 

 yet fully defined modify the metabolism of the whole 

 body. 



lixpoiure lo cold, cold baths, and cold winds has a 

 like effect, accelerating the heart and increasing the 

 heat production, the activity of the muscles, the out- 

 put of energy, the pulmonary ventilation, and intake 

 of oxygen and food. In contrast with the soft pot- 

 bellied, over-fed city man the hard, wiry fisherman 

 trained to endurance has no superfluity of fat or tissue 

 fluid. His blood volume has a high relative value in 

 I)roportion to the mass of his body. His superficial 

 Veins are confined between a taut skin and muscles, 

 hard as in a racehorse trained to perfection. Thus the 

 adequacy of the cutaneous circulation and loss of heat 

 by radiation rather than by sweating is assured. His 

 fat is of a higher melting point, hardened by e.xposure 

 to cold. In him less blood is derived to other parts, 

 such as adipose tissue, skin, and viscera. He uses 

 up the oxygen in the arterial blood more completely 

 and w'ith greater efficiency; for the output of each unit 

 of energy his heart has to circulate much less blood 

 (Kreogh); his blood is sent in full volume by the well- 

 balanced activity of his vasomotor system to the 

 moving parts. Owing to the perfect coordination of 

 his muscles, trained to the work, and the efficient 

 action of his skin and cutaneous circulation — the 

 radiator of the body — he performs the work with far 

 greater economy and less fatigue. The untraihed 

 man may obtain 12 per cent, of his energy output as 

 work, against 30 per cent., or perhaps even 50 per 

 cent., obtained by the trained athlete. Hence the 

 failure and risk suffered by the city man who rushes 

 straight from his office to climb the Alps. On the 

 other liand, the energetic man of business or brain 

 w-orker is kept by his w-ork in a state of nervous 

 tension. He considers alternative lines of action, but 

 scarcely moves. He may be intensely excited, but the 

 natural muscular response does not follow. His heart 

 is accelerated and his blood pressure raised, but neither 

 muscular movements and accompanying changes of 

 posture, nor the respiratory pump materially aid the 

 circulation. The activity of his brain demands a rapid 

 flow of blood, and his heart has to do the circulatory 

 work, as he sits still or stands at his desk, against 

 the influence of gravity. Hence a high blood pressure 

 is maintained for long periods at a time by vaso- 

 constriction of the arteries in the lower parts of the 

 body an^ increased action of the heart ; hence, per- 

 haps, arise those degenerative changes in the circu- 

 latory system which afi'ect some men tireless in their 

 mental activity. We know that the bench-worker, 

 who stands on one leg for long hours a day, may 

 sulTcr from degeneration and varicosity of the veins 

 in that legr. Long-continued high arterial pressure, 

 with systolic and diastolic pressures anproximately the 

 same, entails a stretched arterial wall, and this must 

 imjjfde the circulation in the vaso-vasorum, the flow 

 of tissue lymph in, and nutrition of, the wall. Since 

 his sedentary occupation reduces the metabolism and 

 heat production of his body very greatly, the business 

 man requires a warmer atmosphere to work in. If 

 the atmosphere is too warm it reduces his metabolism 

 and pulmonary ventilation still further ; thus he works 

 in a vicious circle. Exhausting work causes the 

 consumption of certain active principles, for example, 

 arin-nin. and the reparation of those must be from 

 the food. To acquire certain of the rarer principles 

 cxijindi (1 in the manifestation of nervous energy more 

 food ni.iv \\:\\r. to be eaten by the sedentary worker 

 than can be diiresled and metabolised. His digestive 

 organs lack the kneading and massage, the rapid 

 circulation and oxidation of foodstufi's which is given 



NO. 2240. VOL. go] 



' by muscular exercise. Hence arise the digestive and 

 ! metabolic ailments so common to brain workers. 



Mr. Robert Milne mforms me that of the thousands 

 of children who have passed through Barnardo's 

 Homes — there are 9000 in the homes at any one time 

 — not one after entering the institution and passing 

 under its regimen and the care of his father, Dr. 

 Milne, has developed appendicitis. Daily exercise and 

 play, adequate rest, a regular, simple diet have en- 

 sured their immunity from this infection. It pays to 

 keep a horse healthy and efficient ; it no less pays 

 to keep men healthy. I recently investigated the case 

 of clerks employed in a great place of business, whose 

 working hours are from 9 to 6 on three days, and 



7 to 9 on the other three days of each week, and 

 working such overtime, they make \l. to 2/. a week; 

 these clerks worked in a confined space — forty or fifty 

 of them in S200 cubic feet, lit with thirty electric 

 lamps, cramped for room, and overheated in warm 

 summer davs. It is not w'ith the chemical purity of 

 the air of such an office that fault is to be found, for 

 fans and large openings ensured this sufficiently. 

 These clerks suffered from their long hours of mono- 

 tonous and sedentary occupation, and from the arti- 

 ficial light, and the windless, overwarm and moist 

 atmospliere. Many a girl cashier has worked from 



8 to 8.30, and on Saturdays from 8 to 10, and then has 

 had to balance her books and leave perhaps after mid- 

 night on Sunday morning. Her office is away in the 

 background — confined, windless, artificially lit. The 

 Shops Act has given a little relief from these hours. 

 What, I ask, is the use of the .State spending a 

 million a year on sanatoria and tuberculin dispen- 

 saries, when those very conditions of work continue 

 w-hich lesson the immunity and increase the infection 

 of the workers? 



The jute industry in this town of Dimdee is carried 

 out almost wholly by female and boy labour. "The 

 average wages for women are below 12s. in eight pro- 

 cesses, and above 125., but under i8x., for the re- 

 maining five processes." The infant mortality has 

 been more than 170 per looo. The Social Union of 

 Dundee reported in 1905 that of 885 children born to 

 240 working mothers no few'er than 520, or 59 per 

 cent., died — and almost all of them were under five 

 years of age. The life of these mothers was divided 

 between the jute factory and the one-roomed tene- 

 ment. Looking such conditions squarely in the face, 

 I sav it would be more humane for the State to 

 legalise the exposure of every other new-born infant 

 on the hillside rather than allow children to be slowly 

 done to death. The conditions, as given in the report, 

 contravene those rights of motherhood which the 

 meanest wild animal can claim. 



Isolation hospitals, sputum-pots, and anti-spitting 

 regulations will not stamp out tuberculosis. .Such 

 means are like shutting the door of the stable when 

 the horse has escaped. Fliigs'e has shown that 

 tubercle bacilli are spread by the droplets of saliva 

 which are carried out as an invisible spray when we 

 speak, sing, cough, sneeze. Sputum-pots cannot con- 

 trol this. The saliva of cases of phthisis may teem 

 with the bacilli. The tuberculin reaction tests carried 

 out by Hamburger and Monti in Vienna show that 

 94 per cent, of all children aged eleven to fourteen 

 have been infected with tubercle. In most the in- 

 fection is a mere temporary indisposition. I believe 

 that the conditions of exhausting work, and amuse- 

 ment in confined and overheated atmospheres, tocether 

 with ill-regulated feeding, determine largely whether 

 the infection, which almost none can escape, become 

 serious or not. Karl Pearson suggests that the death 

 statistics afford no proof of the utility of sanatoria 

 or tuberculin dispensaries, for during the very years 

 in which such treatment has been in vogue, the fall in 



