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Notes, Short Comments, and Answersto Correspondents.

HEALTH, THE BUSINESS MAN’S CHIEFASSET.1

BY SIR NAPIER BURNETT, K.B.E., M.D. GLASG.

HITHERTO we have been too prone to regard health merelyas the negation or antitheses of disease, accepting it as partof the ordinary routine of daily life until attention is suddenlydirected to its interruption by some indication of diseasein either of its two forms-namely, functional disturbanceor organic change. Then we realise for the first time thatwe have lost something that we formerly possessed, and gavelittle heed to. I want you to look at this matter of healthfrom an entirely different standpoint and to realise that itis not merely the absence of disease, but is in itself a definiteentity-a positive state that can be preserved and maintained.Health has its symptoms just as much as disease, but we

so frequently fail to recognise them, largely because of theirs2tent’ nature, whereas those indicating disease are more

insistent and arrest our attention in the form, it may be,of pain, or discomfort, or lack of energy. Health is thesum total result of delicate chemical changes taking placein the millions of individual cells that make up the humanorganism. The maintenance of this chemical adjustment,known in the gross as health, constitutes the great defenceor resistance of the human body to the invasion of disease.The development of the science of bacteriology has

given results of inestimable value in revealing the cause ofinfectious diseases and has furnished most valuable remediesfor treatment ; but these fascinating results must not beallowed to obscure the other and even more important factorin the study of health-namely, the degree of resistance ofthe human organism to the invading germs. When we hearthe statement that health can be purchased, we are to under-stand that the knowledge of how to maintain the chemicalbalance in the human body is available if we will but applyit. It is an underestimate to say that a third of the diseasesfrom which people die to-day are preventable by makinguse of the knowledge that we already possess. The oldproverb that " a man is as old as his arteries " requires tobe brought up to date, and may now be expressed as a man’sarteries are as oldas he cares to make them.

The Health of the Business Man.There are few more tragic experiences in the life of a doctor

than that of being consulted by a business man, carryingheavy responsibilities and organising large industries, whohas been suddenly pulled up by the refusal of the humanmachine to carry on its functions. Long neglected andabused, the chemical balance of health fails him, and whenthe medical adviser gives his decision that there must bethree or six months’ cessation from all work and that he cannever again carry on at the old pace and live, the patient isaghast at the apparent harshness of the verdict. The

tragedy need not have occurred had there been prudentobservance of the ordinary laws of health, for only theminority of diseases occur as a bolt from the blue, the greatmajority are preceded by repeated warnings, but thesewarnings are ignored and treated merely as tiresomeincidents.

Let me give some illustrations of such warnings :—

Insomnia.-The business man, in his worries over badtrade and strained finance, follows his routine of going tobed at the usual hour, but merely to lie awake for hours,going over the details of the day’s work. Such mental activity deprives the brain and heart of that period of quietso essential for the readjustment of the chemical balanceand the restoration from the wear and tear of the previousday. The sleeplessness continues for nights and weeks,and some " dope " is sought as a remedy-the real issue,removal of the cause, being avoided. Such symptoms ofdisturbed health all have a definite causation.

Insomnia should be regarded as a warning that the brainis being supplied with an excess of toxin from its own over-work, or toxins supplied from some other source, and thewarning should be correctly interpreted ; a week’s cessationfrom business and congenial exercise in the open air willfrequently restore the balance, but more necessary still it isto have the guidance and direction of the health adviser.My plea is that the business man will not postpone seekingadvice until a more serious condition has developed, butwill consult the doctor early, not as a physician in disease,but as an adviser in health.

1 An abstract of an address recently delivered to the LondonRotary Club.

Dyspepsia.-This is a very common complaint amongstbusiness men. One of the interesting developments ofmodern business life is the widespread habit of utilisingthe lunch hour as a time for transacting a piece of businesswhich has been crowded out of the ordinary hours of theoffice. " Come and have lunch and let us discuss this mattermore fully " is a phrase, I suggest, that is not unknown tomany of my audience. The intrusion of business worriesinto the meal hour exercises a most sinister influence on thedigestive processes, with the result that dyspepsia is sooncomplained of, and from that results not merely injury tothe digestive organs, but also the development of toxinsor poisons that disturb the chemical balance of the generalsystem.

Shortness of Breath.-This warning is often treated verylightly, especially by the business man over forty years ofage. This symptom may result from a variety of differentcauses, some slight and others serious. For instance, itmay be the first indication of chronic kidney mischief, orit may be, on the other hand, merely the result of a toorapid accumulation of adipose tissue owing to the neglectof regular exercise.

Individual Health Limitations.-Man still retains to somedegree the imitative faculty so pronounced in his earlyancestors, and to-day it is not without interest to see howone individual moulds his habits according to those of hisneighbours, without consideration as to whether such habitsare conductive to his own individual health or not. Aman sees his friend enjoying the pleasures of a certain formof physical exercise, and he seeks to follow the example,with the result that he injures his health because that formof exercise is entirely beyond his individual health limitations.Or again, two brothers, both in perfect health, attend apublic dinner and partake of the same foodstuffs and thesame quantity of alcohol. Next day one feels perfectly fitand full of energy, whereas the other feels miserable, head-achy and depressed. The same result follows each time thisman touches alcohol in any form. The interpretation isthat one brother is prohibited by the nature of his individualchemical balance from taking alcohol, whereas the other’sindividual chemistry appears to be unaffected by alcohol.Each individual, therefore, has to ascertain and study hisown health limitations.

Value of Periodic Medical Examination.In touching on these illustrations of interference with the

chemical balance of health, my main object is to put beforeyou a practical proposition-namely, a plea for the value ofperiodic medical examination. The doctrine that we haveto wait until we are the subject of some disease before weconsult a doctor is altogether out of date and obviouslyfoolish. A systematic medical examination, say, once a

year, should be the regular routine of business men. Suchan examination should be a great mental asset, and is thesurest way of detecting disease in its early and curable stage.To recognise your medical man as your adviser in health asu,ell as your physician in disease is a commercial propositionwell worthy of consideration. The wise engineer does not drivehis machinery constantly until a breakdown disorganiseshis whole plant ; he institutes periodic surveys withthe object of detecting the early evidences of wear andmaladjustment. Why do we persist in treating differentlythe greatest machine of all-the human machine ?

Annual Stocktaking of Health: An Experiment.In this connexion an interesting experiment has recently

been carried out by an insurance company in America. Thecompany during the years 1914 to 1920 granted a periodiccomplete physical examination, free of cost, to some 6000of its policy-holders. The exact period was five-and-a-halfyears per person. The medical director of the companystudied the after-history of these individuals and found(here I quote from the report) that " up to the end of theobservation period there actually occurred 217 deathsamong the examined 6000 persons. There should have beena total of 303 deaths if the mortality expected from personsof this class had actually occurred." There was a saving,therefore, of 28 per cent. in the mortality over a period offive years. This result was confirmed by independent inves-tigation, and the monetary value of the saving in mortalitywas calculated to be in excess of$126,000. From thisamount must be abstracted the cost of the original andsubsequent examinations made for this group of 6000policy-holders. The cost was approximately$40,000. Itwould appear, therefore, that the company, on this particulargroup of policy-holders, had its principal returned and madea gain of about 200 per cent. on its investment during aperiod of approximately five years.

This, however, was not the outstanding feature of theexperiment. The important point to remember is that therehas been a saving of life corresponding to 28 per cent. ofthe expected mortality in the short period of five years.It was to demonstrate the life-saving possibilities of suchhealth work that this activity was begun. It has been

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established to the satisfaction of this company that periodicmedical examination is justified buy the result in added lifeexpectancy to the policy-holders examined.The Business Man’s Concern in the Health of His Employees.There are three aspects of this subject that call for

reference, namely :-(a) The Legislative or Compulsory Aspecti.-Modern legis-

lation in the form of the Employers’ Liability Act, theWorkmen’s Compensation Acts, &c., has brought a newfactor into the business world, directed towards the protec-tion of the interests of the employee. The employer, inorder to meet certain risks, covers himself by insurance, andthe tariff rates for such insurance are based on actuarialcalculations of the average claims paid. Such legislationconstitutes a very wise provision in the protection of theinterests of the worker. More recently, additional legis-lation in

the form of the employers’

contributions under the

INational Health Insurance Acts has placed a further taxon industry.. , .

(b) Voluntary Effort.-The pressure of work in factoriesand workshops during the war gave a great impetus to theestablishment by employers of labour to what are knownas

" Welfare Schemes." One has been surprised and greatlyimpressed in finding how numerous and varied these schemesare throughout the country. So far as I can ascertain,there is no complete directory or list of such schemes availableto the student of social welfare. The facilities referred toinclude swimming baths, recreation fields, reading rooms,gymnasia, sports clubs, model cottages, model gardens,&c. These schemes are financed in whole or in part by theemployer, and their cumulative tendency must be to exer-cise a considerable influence on the health of the worker,not only in the form of healthy physical exercise, but alsoas a means of hygienic instruction.

(c) The Health of the Worker-an Important Factor inProduction.-This aspect, for which I specially ask theattention of the business men, has an importance bothhumanitarian and economic. Let me illustrate : A con-tractor has undertaken a piece of work, and through hismanager or foreman he engages workmen to carry out hisplans. The worker is engaged on his general appearance,and it may be occasionally by reference to the nature ofhis former job ; the engagement is on the basis of

"

piece "

or " time." The work proceeds satisfactorily for weeksand perhaps months ; then the foreman may have occasionto complain of some worker appearing to

" slack," and theman is reprimanded and, it may be, ultimately dismissed.This " slacking " is not infrequently due to defectivephysical health-to a demand on the worker’s strength thatis beyond his individual health limitations. The workerstruggles on, so as not to appear different from his fellows,but by the middle of the afternoon he is physically unfit forthe work expected of him, and the work that he thereafterpersists in is in all probability of an inferior quality. It isinteresting to contemplate the number of shop and factoryaccidents that occur as the result of the overstrained physicalcondition of some individual worker. The latter, when hewas engaged by the foreman, may have been the subject,say, of hernia or gross haemorrhoids, or was perhaps in theearly stages of tuberculosis of the lung ; so long as theemployer of labour relies on the present crude methods ofengaging his employees, so long will he be liable to sufferfrom not only diminished and defective output, but also toheavy claims for workmen’s compensation.My suggestion is that, in the interest of employer and

employee alike, the worker should be engaged on the certifi-cate of the medical officer of the works. The initial medicalexamination would decide whether the man had the physicalcapacity for the job to be undertaken ; it would also be themeans of detecting the early signs of disease, when suchdisease is at a curable stage. The interests of the employerswould be served by the knowledge that he was employinghealthy men, and, further, that he was not jeopardisingthe health of any one of his employees. I am cognisant ofthe recent views that have been put forward in the formof psychological studies applied to industry, such as thedevelopment of " rhythm " in the work of the shop, &c., butin suggesting to the employer the adoption of systematicmedical examination of the worker I merely plead theeconomic doctrine of making better use of the knowledgethat we now possess.

RURAL CHILD WELFARE.

AN interesting account! of rural life in West Virginia.,with a consideration of the causes of certain adverse con-ditions, with suggestions for their remedy, is included in arecent book on rural child welfare. The exposition of the

1 An Inquiry by the National Child Labor Committee, Basedupon Conditions in West Virginia, under the Direction ofEdward N. Clopper, Ph.D. New York: The MacmillanCompany. 1922. Pp. 355. 14s.

principles involved in giving children the best chance is sohelpful that all social and health workers may read it withbenefit. Attention is drawn to the unattractive surroundingsof many country homes, and the necessity for increasingtheir recreations and interests. Child labour, which isregarded as a factor in causing premature senility, is con-demned : children’s work, however, under proper conditions,is encouraged and directed into healthy channels by meansof boys’ and girls’ clubs. These clubs, which have been inexistence for ten years, centre round the schools, and haveachieved much success, the success depending largely onthe visiting agent or director. Some of the conditionsdescribed are almost impossible in a more densely populatedcountry, like our own : the difficulty in enforcing educationin Virginia lies not in the absence of schools, which seemto be within the reach of everyone, but in the fact that theschool attendance officers are not so effective as in thiscountry. We gather also that the teachers would compareunfavourably with ours.

In a chapter on Rural Child Dependency, Neglect, andDelinquency there will be found much useful information.For instance, in regard to illegitimate children, "unmarriedneighbours are fathers of 11 per cent., married men of 13per cent., and blood relations of 10 per cent." It is oftendifficult for the mothers of these children to get help at thecourts or elsewhere : officials and others sometimes insiston placing the children out in such a way as to separatethem from their mothers, a proceeding which can only becondemned. Both this problem and delinquency are shownto be largely due to lack of protection, neglect, and absenceof wholesome recreation. For delinquency the writerurges the juvenile court and probation, but draws attentionto the necessity of the probation officer being well qualified.The advantage of a. medical and psychological examinationin special cases does not seem to have been realised. Thecompilers of this book-for it is a compilation,-are full ofhuman sympathy and understanding and have much to sayof value to all social workers.

DOMESTIC SMOKE.

IN his annual report for 1021 on the health of BethnalGreen, Dr. G. E. Oates tells us that 85 observations ofsmoke shafts were made, and in nine cases black smokewas observed in such quantity as to be a nuisance. Fiveintimation notices and two statutory notices were served.That will not help much to make the sky bright, because.as he adds, it is the private dwelling-houses in countlessnumbers which are responsible for the unhealthy soot-ladencondition of the London atmosphere, and at present nolegal steps can be taken to prevent this serious nuisance.There is a clause in the Smoke Abatement Bill authorisinglocal authorities to make provision for smokeless heatingarrangements in buildings other than private dwelling-houses. But the Bill, having been read a second time in theHouse of Lords, stood over until the autumn, after a remarkfrom Lord Newton, chairman of the Smoke AbatementCommittee. that it was hardly a genuine fulfilment of thepromise made to those interested in smoke abatement.Some local authorities have on their own initiative beenintroducing smokeless methods in their new housing schemes ;4025 Glasgow houses, finished or nearly finished, each havea gas-cooker and a gas wash-boiler along with the alternativeof gas-heater and a coal-burning register grate in the livingroom. But Councillor William B. Smith, Glasgow’s repre-sentative at the Conference of the Royal Sanitary Institute,still felt that an opportunity had been lost in not providingthe houses with a modern form of coke boiler. Putting in acoal fire and leading a gas pipe to it is only perpetuating thedifficulty of adapting old conditions to new. A valuable con-tribution towards the solution of the domestic smoke nuisanceis the appearance of a book of 80 pages entitled " The Smoke-less City" (Longmans, Green and Co. 1922. Is. 6d.), byMr. E. D. Simon, Lord Mayor of Manchester, and Miss MarionFitzgerald. The frontispiece is one of the best things in thebook, for it is a photograph taken in Manchester on June 23rd,1922, showing how large a part the house chimney plays inpolluting the atmosphere, even in summer time. Taking thecountry as a whole, the authors claim that the domesticchimney is responsible for three-quarters of the smokeand more than tbree-quarters of the damage done by smoke.Without pressing for entire smokelessness as a practicalsolution, the authors hold that in the standard house, wherecentral heating is not available, the scullery should beprovided with a gas-cooker and a coke fire-boiler, with aconvertible grate in the living room and gas fires in thebedrooms. Universally adopted, this arrangement wouldreduce domestic smoke so much that it would hardly be aserious nuisance. The book, which has a preface by LordNewton and an appendix on the comparative cost of house-hold washing in Manchester and Harrogate. is attractivelywritten and should help in the education of popular opinionbetween now and the adjourned discussion in Parliamentof the Smoke Abatement Bill.