PRESIDENTIAL ADDRESS. 629 
patients are ignorant, and spit everywhere, on bed, floor, aud walls. In the 
schools the heat and smell is most marked to one coming in from the outside air. 
In one school 50 cubic feet per child is the allowance of space. The children are 
eating all day long, and are kept in close hot confinement. They suffer very 
badly from decay of the teeth. Whole families are swept off with tuberculosis, 
and the child who leaves home early may escape, while the rest of a family dies. 
Here, then, we have people living in the wildest and least populated of lands 
with the purest atmosphere suffering from all those ill-results which are found 
in the worst city slums—tuberculosis, beri-beri, and decayed teeth. 
The bad diet probably impels the people to conserve their body heat and live in 
the over-warm, confined atmosphere, just as our pigeons fed on white bread sit, 
with their feathers out, huddled together to keep each other warm. 
The metabolism, circulation, respiration, and expansion of the lung are all 
reduced. The warm, moist atmosphere lessens the evaporation from the respira- 
tory tract, and therefore the transudation of tissue lymph and activity ot the 
ciliated epithelium. The unexpanded parts of the lung are not swept with blood. 
Everything favours a lodgment of the bacilli, and lessens the defences on which 
immunity depends. In the mouth, too, the immune properties of the saliva are 
neutralised by the continual presence of food, and the temperature of the mouth 
is kept at a higher level, which favours bacterial growth. Lieutenant Siem in- 
forms me that recently in Northern Norway there has been the same notable 
increase in tuberculosis. The old cottage fireplaces with wide chinmeys have 
been replaced with American stoves. In olden days most of the heat went up the 
chimney, and the people were warmed by radiant heat. Now the room is heated 
to a uniform moist heat. The Norwegians nail up the windows and never open 
them during the winter. At Lofoten, the great fishing centre, motor-boats 
have replaced the old open sailing and row boats. The cabin in the motor-boat 
is very confined, covered in with watertight deck, heated by the engine, crowded 
with six to eight workers. When in harbour the fishermen used to occupy ill- 
fitted shanties, through which the wind blew freely ; now, to save rent, they sleep 
in the motor-boat cabins. 
Here, again, we have massive infection, and the reduction of the defensive 
mechanisms by the influence of the warm, moist atmosphere. 
The Norwegian fishermen feed on brown bread, boiled fish, salt mutton, mar- 
garine, and drink, when in money, beer and schnapps ; there is no gross deficiency 
in diet, as in Labrador, and beri-beri does not attack them. They return home 
to their villages and longshore fishing when the season is over. The one new 
condition which is common to the two districts is confinement in stove-heated, 
windless atmospheres. In old days the men were crowded together, but in open 
boats or in draughty shanties, and had nothing but little cooking-stoves. 
The conditions of great cities tend to confine the worker in the office all day, 
- and to the heated atmosphere of club, cinema show, or music-hall in the evening. 
The height of houses prevents the town dweller from being blown upon by the 
wind, and, missing the exhilarating stimulus of the cool, moving air, he repels 
the dull uniformity of existence by tobacco and by alcohol, or by indulgence in 
food, e.g., sweets, which are everywhere to his hand, and by the nervous excite- 
ment of business and amusement. He works, he eats, and is amused in warm, 
windless atmospheres, and suffers from a feeble circulation, a shallow respiration, 
a disordered digestion, and a slow rate of metabolism. 
Many of the employments of modern days are detestable in their long hours 
of confinement and monotony. Men go up and down in a lift all day, and girls 
in the bloom of youth are set down in tobacco stalls in underground stations, 
and their health and beauty there fade while even the blow-flies are free to bask 
in the sun. In factories the operatives feed machines, or reproduce the same 
small piece of an article day after day. There is no art, or change, no pleasure 
in contrivance and accomplishment. The miner, the fisherman, even the sewer- 
man, face difficulties, changing risks, and are developed as men of character 
and strength. Contrast the sailor with the steward on a steamer, the drayman 
outside with the clerk inside who checks the goods delivered at some city office, 
the butcher and the tailor, the seamstress and the market woman, and one sees 
the enormous difference which a confined occupation makes. Monotonous seden- 
tary employment makes for unhappiness because the inherited functional needs 
