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