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 efinite 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

Position.)





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

harmless.



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

ills.





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.