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The Day's Work

Probably even more important than details with regard to the early
hours of the day, is detailed information as to the day's work, the
kind and character of the occupation and the length of time spent at
it, the interruptions that may occur, the habits with regard to
luncheon, and, above all, the state of mind in which the occupation is
pursued. The physician will only learn these details when he sets
before himself a definite schedule of what he wants to know, and then
proceeds to secure information with regard to it. With this sufficient
can be learned in a short time to ascertain the source of the
affection or the symptoms complained of. In some cases it is, however,
only when the whole day's occupation is reviewed that proper
suggestions can be made.

Getting to Work.--Many a man, especially if he has been accustomed to
much exercise in younger years, craves muscular exercise, feels much
better whenever he has the opportunity to take it, yet rides down to
business every morning and back every evening. On his vacation in the
summer time, he gets up early for the sake of a morning walk, but he
scarcely has time to take his breakfast and ride to business at other
times, though the main reason for his better feeling during his
vacation is his exercise. There is usually the story of crowded cars
in the busy hours, often with annoying thoughts pestering him that he
may not be in time and with a constant call on nervous energy while he
stands up in the train, jolted, pushed, crowded, or unable to read his
paper with satisfaction, even if he has a seat. The discomfort
experienced during a ride in crowded cars to business is about as bad
a way to begin a day for a nervous person as could be imagined.

As a rule, it will take more than half an hour to get to business in
this way. If an extra twenty minutes were taken, it would be possible
to walk the distance. On at least two out of every three days in the
year this would give a magnificent opportunity for exercise of the
best kind, for fresh air, for diversion of mind, for the route
could be frequently changed, and, during the spring and fall, if there
are parks on the way, these would provide occasion for pleasant
thoughts to replace the annoyances which too intimate contact with
over-strenuous humanity in overcrowded cars is likely to occasion.

This seems almost too trivial for a doctor to talk about, but it is on
the care of trivialities that good health often depends. It is easy to
assume that this amounts to little for health but tempt a dissatisfied
patient, whose digestion and sleep are disturbed, to do it, especially
in the spring and in the fall, and see what a difference it makes in
all his physical functions. If he is not used to walking, he will have
to begin by walking only a mile or two, but after a time he will do
his four-mile walk in about an hour, with no waste of business time,
and with a renewal of energy that will seem little short of marvelous.

Details of the Day's Work.--If patients are to be benefited through
mental influence it is extremely important that details as to
occupation be completely secured. This must include, especially in
cases where there are objective but obscure symptoms, minute
information that may seem trivial, and yet which often proves to be of
great importance. In recent years there has been profound study of the
dangers of trades and occupations. Anyone who wants to treat nervous
patients, must know much about these occupations, for otherwise
symptoms may be ascribed to old infections, to obscure rheumatic
conditions, to intestinal auto-intoxication, or to nervous weakness or
exhaustion, when they are really the result of occupation-conditions.
The various poisons must be carefully looked for, or affections will
be wrongly treated. I have had a series of cases of lead poisoning
[Footnote 22] under most unexpected conditions which have taught me
much as to the possibilities of obscure plumbism. Lead poisoning from
new lead pipes--with no one else in the household suffering from it,
lead poisoning from frequent drinking of carbonated waters, the
bottles of which had the old-fashioned lead stoppers, lead poisoning
from the painting of a flat by a settlement worker who could not get a
painter to do it, show how carefully such things must be looked for.

[Footnote 22: "Curiosities of Lead Poisoning,"
International Clinics, Eighth Series, Vol. II.]

Dust and Respiratory Affections.--Mechanical conditions connected
with trades are especially important. Workers in dusty trades are
almost sure to suffer severely from bronchitis at times, and to have
the affection oftener than others, to have it "hang on longer," as
they say, and eventually to have tuberculosis develop. There are some
of the polishing trades in the metal industries in which it is
impossible to maintain the ordinary death benefit fund that workmen
have in other trades, because the men die so frequently and at such an
early age from consumption that the drain on the treasury makes it
impossible to maintain the fund. Practically all of the dusty
occupations have this same tendency. This is true often in occupations
where dust is sometimes not supposed to be much of a factor. Railroad
trainmen suffer more frequently from colds than do those in other
trades because of the dust to which they are exposed, and a trainman
with incipient consumption will be greatly benefited by getting out of
the dust during the summer months. Sweepers in large buildings,
janitors and janitresses have colds that are often untractable because
of the dust in their occupations. It is to be hoped that the new
vacuum cleaning system now becoming so popular will obviate these
dangers, though like all improvements, it will probably bring its own
dangers with it.

Lack of Light.--People who work at occupations that keep them from
the light are likely to suffer from lung symptoms and to have quite
intractable colds which will not clear up until they get more
sunlight. Workers in theaters and like places who do their sweeping
where sunlight does not penetrate, are in more danger than others from
respiratory disease. Those who work in gloomy lower stories,
especially in narrow but busy and dusty streets, suffer the same way.
Attendants at moving picture shows who work much in the dark where the
frequently changing crowd brings in dust which cannot be well removed,
and in quarters where the sun does not penetrate, are almost sure to
have persistent repeated respiratory troubles.

Habitual Movements.--After the question of dust comes the mode of
the occupation. Many occupations demand certain habitual and repeated
movements. When people come complaining of pains in muscles in and
around joints, or of achy conditions in the limbs, it is important to
know every detail of their occupation movements, if the physician is
to appreciate just what pathological causes are at work. It is not
enough, for instance, to know that a man is a clerk, or a bookkeeper,
but it should be asked whether he stands much at his occupation, or
walks considerably, or whether he sits practically all the day. If he
stands much, we can expect that he will have various painful
conditions in his feet and legs, unless he takes care to change his
position frequently, to wear the most comfortable shoes obtainable
and, above all, to provide against any yielding of the arch of the
foot. Often it will be found that people who complain of discomfort in
the feet stand much on a cold, and sometimes damp and draughty floor,
and this needs to be corrected or their symptoms, often carelessly
called rheumatic, will not disappear. If he sits down always during
his occupation, he will need exercise and air or he will suffer from
many vague discomforts, over sensitiveness and irritability of nerves,
as well as from physical conditions.

Most patients prefer to think that they are suffering from some
constitutional condition, rather than from a merely local
manifestation due to their occupations. Those who have to stand much
can often make such arrangements as will permit their sitting down
from time to time. They may, if they are standing at a desk, have a
high stool; they may during their hour of lunch sit down restfully, or
even to recline for a time, so as to restore the circulation in the
legs. For many people who suffer from the achy discomfort connected
with varicose veins in the leg, a rest of half an hour in the middle
of the day with the feet a little higher than the head, will do more
than anything else to make them comfortable. This same thing is true
for people with flat-foot, and there are many occupations with regard
to which advice of this kind will be appreciated. The well known
tendency of many men to sit with their feet higher than their head is
not a mere caprice, but is due to the fact that this is an extremely
restful posture and thoroughly hygienic for those who have been
standing much.

Unfortunately, it is not so easy to secure such relief for working
women, but occasionally the advice to lie down during the middle of
the day on the couches of the retiring rooms may be the best medical
prescription that can be given. This will carry young women over
trying periods of the month when everything seems to be going wrong.
In women particularly, if there are complaints of the pains in the
lower limbs, footwear must be investigated. When the heels are too
high those who have to stand much are thrown forward and there is a
strain of the muscles of the thighs and on the muscles of the back.
Many young women suffer from backache supposed to be due to internal
conditions usually of gynecological character, when it is only due to
high heels or a combination of high heels and constipation. On the
other hand, heels that are too low are not comfortable and women's
shoes, in spite of the outcry against them, have been better adapted
than men's to prevent them from developing flat foot. Fewer women than
men suffer from this affection. Shoes that are too loose are almost as
bad, sometimes it would seem worse, than those that are too tight.

Habitual Motions and So-Called Rheumatism.--The habitual movements
of various trades are extremely important for the diagnosis of
conditions that develop in the muscular system. Much of the so-called
rheumatism of the working people is really due to the muscular
over-activity demanded by their trades. This affects all kinds of
working people. Men who have to work foot-lathes, or women who have to
work sewing machines, or men or women who have to use their arms much
in repeated vigorous movements, are likely to suffer from achy
discomfort. The strong and healthy ones do not suffer, but the
delicate do. The suffering is much more prevalent in rainy, damp
weather; it is worse during the spring and fall than at other times.
It is particularly noticeable whenever the patient is run down
physically, is worrying about many things, or, above all, is getting
insufficient nutrition. The discomfort is particularly likely to recur
in those who do not know how to use their muscles properly, who are
naturally awkward, and who perhaps have from nature an insufficient
control over opposing and coodinating muscles, so that they do not
accomplish movements quite as readily as would be the case if they
were normal. The personal element enters largely into these
affections. Many patients, however, can be trained to do their
habitual movements under the best possible mechanical conditions,
whereas very often they are found accomplishing them under the worst
possible mechanical conditions.

Men who have to do much writing may have to be taught the application
of Gowers' rule, that the forearm should so move as a whole during
writing that if a pen were fastened to the elbow it would execute
exactly all the movements of a pen held in the hand. The writing must
all be done from the shoulder. People who do typewriting may have to
be instructed not to allow the machine to be too much above them, nor
on the other hand, too much below them when they sit down. Young
people particularly who, from long hours of practice on the piano,
suffer from neurotic conditions, may have to be instructed to do this
under good mechanical conditions.

Men who do much filing of metal will often suffer from painful
conditions in the arms. These will be much worse in case the filing is
done at a table or workbench so high that pressure has to be brought
to bear upon the file by the arms instead of through the weight of the
body. This same thing is true for women who iron much. If the ironing
board is so high that the additional pressure applied is made by the
arms, then painful conditions will almost inevitably develop if
the work is long continued. These details are discussed in the
chapters on joint and muscular affections.

Night Work.--In a large city there are many workmen who are on night
duty. They will be disturbed in many ways in health, unless they make
special arrangements to live under conditions that enable them to have
full eight hours of sleep every day and, above all, to have their
meals regularly. When they come home in the morning they usually have
a rather hearty meal. Most of them can sleep very well with this, but
very few of them sleep the full eight hours, and all need this amount.
Usually they have another full meal about five in the evening. Very
often it will be found that the third meal of the day consists of a
sandwich, with a glass of milk or a glass of beer, and some cake or
some crackers and cheese, or the inevitable pie. Every workman should
have three full meals, and a man who is suffering from almost any
symptoms will be improved at once if the third good meal is insisted
upon. At one time I had occasion to see a number of men whose work
began not later than seven in the evening and did not finish until six
or seven in the morning. They were sufferers from all sorts of
complaints. Most of them were under weight. Not a few were
constipated. Some were suffering from severe headaches that came
rather frequently, and a few from a headache that was severe but came
only every two or four weeks. These patients alternated night and day
work, and it was the week after they had been on day work, and first
went on to night work, that they suffered from headache.

In every one of these cases instructions with regard to eating and
sleeping proved to be the best remedy. Nearly all of them were not
eating enough, and were skimping the third meal. Three of them were
taking only between four and five hours of sleep. They stayed up after
breakfast to read the paper, went to bed about nine and got up about
two o'clock. Just as soon as two or three hours was added to their
sleep, they began to feel better, and various symptoms, digestive,
rheumatic and nervous, of which they complained, began to disappear.

Nearly always night workers are more prone than the ordinary run of
workmen to some indulgence in spirituous liquors. Cold and shivery on
the way home from work in the early morning, they take a nip of
whiskey to brace them up. Alcoholic cirrhosis of the liver is a little
more common among sea captains, policemen, printers and night workmen
on the railroads than among the average of the population. The reason
for it seems to be that undilute whiskey is thrown into the
circulation by being taken into the stomach at a time when that viscus
is empty and all the cells are craving food and drink. It is carried
directly to the liver, and there either produces or predisposes to the
bad effects upon liver cells which we know as cirrhosis.

It is usually useless to treat such men for the indigestion and other
symptoms that are likely to develop as a consequence of their habits,
without getting at their story completely. It is easy, as a rule, to
relieve them of certain of their symptoms by ordinary drug
therapeutics. Unless their habits are changed, this relief, however,
is only temporary. It must not be forgotten that in recent years women
have come to do a good deal of work at night that was not usual to
them before. In the telephone service of certain cities, as cashiers
in restaurants, as ticket sellers in various places of entertainment,
as office help at busy seasons of the year, women may be kept
occupied either all night or at least until quite late. Not
infrequently during times when rehearsals are on, chorus girls are
kept until the wee small hours. They are particularly likely to suffer
from such variations in normal habits, and no treatment is so
effective with them as pointing out how they must live, if they want
to preserve their appearance and continue in such exacting
occupations. A healthy young woman can burn the candle of life at both
ends with less protest from nature at the beginning than man, but she
suffers more for it and the suffering begins sooner.

Positions During Occupations.--The question of position during
occupation, especially as regards its influence upon digestive
processes, has always seemed to me much more important than most
people think. Our idea of digestion has been so largely one of
digestive secretions, to the neglect of the motor side of the gastric
and intestinal functions, that we have missed some important points.
If a person leans over a desk shortly after a meal, there is no doubt
that the crowding of the abdominal viscera hinders peristalsis, at
least to some degree, not of course in the robust and healthy, but in
those who already have some irregularity or sluggishness in this
region. The old high desks at which many clerks used to stand, at
which even proprietors did not hesitate to take their position, had a
reason in common sense that has been forgotten in the modern times,
and the variation of position thus permitted seems to have been good
for the workers.

A good deal of comfort may be obtained by having a suitable desk and
chair for business hours. Not infrequently it happens that a desk is
too high for comfortable writing. Any discomfort that is continuous
and makes itself felt intrusively during occupation with other things,
will have an unfortunate effect. Such things seem trivial by contrast
with serious disease and may seem safely negligible. Trivial they are,
but little things count both in themselves and as to the attitude of
mind which they occasion. It is the attitude of mind that we try to
modify by psychotherapy, and even the removal of little sources of
annoyance help a patient materially to get through life more happily
and through work more efficiently and without any more discomfort than
is absolutely unavoidable.

Positions After Meals.--While we have talked thus of business
people, what is said refers, also, to the positions assumed out of
business hours, as, for instance, at home after dinner. A Morris chair
that permits of a somewhat reclining position, or a rocking chair that
temps one to sit back, pretty well distending the abdomen and giving
all due play to the internal viscera, will be found not only much more
comfortable than a straight-back chair which tempts a man to lean
forward, but also there will be less interference with gastric
motility, the most important digestive function of the stomach.
Arm-chairs which really support the arms, and therefore tend to keep
the shoulders up, have something of the same effect. We naturally
assume these positions, though occasionally social usage forbids them.
The tendency, for instance, for elbows to be put on the table,
especially toward the end of a meal, represents a natural instinct to
lift up the shoulders and keep the weight of the upper part of the
trunk off the abdominal organs. Children's instincts often curiously
guide their postures--as is illustrated by the story of the little boy
who, when asked by his grandmother if he could manage another
tart, said that he thought he could if he stood up. (See chapter on

Mental Conditions of Occupations.--While the details of manual
occupations have to be learned with great care if we are to modify the
conditions so as to prevent certain unfortunate effects, just as much
care has to be exercised, with those not employed manually, in finding
out details as to mental worries, and the various disturbances
consequent upon business conditions. Many a man has not brain enough
to run his business and his liver. This is the old English expression,
and the liver, as the largest of the abdominal organs, is taken for
the physical life generally. Many people have not vital energy enough
to waste any of it on worries and then be able to complete their
digestion and other physiological functions with success. The
preceding mental condition is a predisposing cause of many a purely
physical ailment. It used to be said that during a cabinet crisis in
England, or rather just after it was over, attacks of gout were most
frequent among prominent politicians. Mental influence usually kept
the attacks off until the very end of the crisis. Merchants come down
with pneumonia or digestive disturbances more frequently during
periods of acute business depression. Physicians are attacked by
pneumonia, or influenza in bad form, after they have been wearing
themselves out in an epidemic and worrying about patients. Just after
a mother has nursed a child through a severe ailment she herself is
prone to suffer from some acute infection. Such common-place
infections as boils, styes, abscesses and even the more serious
osteomyelitis are likely to come at these times.

It is important, then, to know as much as possible about a business
man's affairs. Any one who has had a series of tuberculous patients
(who were getting along quite well in spite of latent or even active
lesions) disturbed by anxieties of one kind or another, knows how much
worries may mean. Men will lose weight and appetite and weaken in
their general condition as a consequence of some serious business
incident, while all the time physical conditions are the same as they
were when they were improving. And it must not be forgotten that even
in those who do no physical labor, there may be physical conditions of
their occupation that are important. Many a business man does his work
cooped up in a small office, with insufficient ventilation, and
sometimes, especially where his business is on the ground floor of a
large building, with so little sunlight that his environment is quite
unhygienic. The great air purifier is sunlight. Unless sunlight is
admitted for hours every day to the rooms in which people live, the
dust that is inevitably breathed will contain living germs, active and
noxious, though had they been exposed to sunlight these germs would be

Especially then for people with respiratory defects of any kind,
whether these be tuberculous or of chronic bronchitic character, the
conditions surrounding the occupation should be carefully inquired
into. Once the family physician knew such things as a matter of
course. Now he is likely to know very little. The lack of such
information may not be important for the more serious conditions that
he has to treat at patients' homes, but they usually mean much for the
submorbid conditions, so to say, the discomforts and chronic
conditions, which come for office treatment. They mean much for
comfort in life, and for the conservation of health and strength. They
represent that newer medicine which people are asking of us now
so much more than before, which shall keep them in good health and
prevent them, as much as possible, from suffering even from minor

Business Habits.--The modern idea of having a flat-top business desk,
instead of a roll-top desk, and having it thoroughly cleared off every
evening, so that each day's work does not accumulate, is an important
psychic factor in the strenuous life, which in recent years many
corporations have been taking advantage of. It is well for those who
are their own masters to realize the value of this principle. Nothing
so disturbs the efficiency of work, nor adds so much to the incubus
that work may become, as having a number of unfinished things which
keep intruding themselves. It is not always possible to dispose of
problems, but discipline is necessary to keep us from pushing business
matters aside. Then they have to be done in a rush, very often at a
moment when other things are also pressing. The result is poor work,
but, above all, a waste of nerve force and energy that leads up to
nervous symptoms and eventually nervous exhaustion. The orderly man,
who has learned to settle things as they come up, or at definite
times, can accomplish an immense amount of work. Some men are born
orderly, but any one who wants to do much work must have order grafted
on his makeup--a habit which can be made a second nature. It may seem
that a physician is unwarranted in intruding on a man's business
affairs thus to inquire about the ways he does things, but this is the
difference between psychotherapy and the regulation of life as
compared with cures by more material but less effective means.

Personal Hygiene.--Expert Advice.--For many men who are much occupied
with business, the best possible safeguard for health, as well as the
best guarantee against nervous or physical breakdown, would be a
detailed consultation once a year with a physician regarding their
habits of life and their business in relation to their health, present
and future. In recent years many a business firm has found it not only
expedient but profitable to turn to an expert accountant or auditing
company and ask advice with regard to the management of its business.
It is often found that certain business customs are causing serious
drains, and that there are newer ways of doing things that save time
and money. Sometimes a reorganization of the accounting system, or of
the method of dealing with credits and debits, or the receiving or
shipping department, proves advantageous to the business. Sometimes it
is found that the capital invested will not justify the extension of
business that is proposed, and not infrequently it is shown that a
proposed extension adds to business movement but does not add to
profits. Sometimes there are departments that can be dropped to
advantage, though they seem to be adding to both business and profit.

All of this may well be transferred to the question of health in its
relation to business. Not infrequently it is found that the capital of
strength of the business man is not sufficient to justify the
extension that he is planning or has already attempted. Sometimes
suggestions can be made with regard to the mode of doing business, the
hours employed and the hours of relaxation, that will make business
less of a drain on the system. Occasionally arrangements for sleep and
exercise, as well as for afternoons or special times of diversion, may
save a man from that concentration of attention on one thing
which frequently leads to nervous breakdown. Not infrequently business
men who are of neurotic habit have customs of doing business which add
to their nervous irritability, and these might be modified so as to
lessen the call on nervous energy. There is need that the physician be
looked to as an expert in personal health and its relation to
business, just as the expert accountant or auditing firm is looked to
for advice with regard to business methods.

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