OCCUPATION AND DISEASE.*
A REVIEWER of this book naturally looks for information about those who follow the occupation of letters. This he does not find. Apparently, it is impossible to isolate literary men as a separate class the statistics of which can be col- lected and tabulated. Nor is it difficult to understand why this should be so. Literature is but to a very small extent, • The Hygiene, Diseases, and Mortality of Oocupallona. By J. T. Arlidge M.D. Loud. London : Percival and 0o. 1892.
a much smaller extent than was the case a century ago, a separate occupation. Everybody writes, from the Sovereign down to the pauper. To find the death-rate of an employment so universal, one might as well take the death rate of the general population.
Passing on to more distinct occupations, we find, of course, the clergy at the head of the list, in regard to health and longevity. It is true that they are surpassed by a small picked class, titled persons who have insured their lives ; but these are a select number, with their average unnaturally raised by the exclusion of unsound lives. Dr. Arlidge quotes from the interesting tables drawn up by Dr. W. Stone, for many years medical officer to the Clergy Mutual Insurance Society. The deaths during a period of fifty-eight years came to two- thirds only of the number to be expected, according to the Carlisle tables. And yet, it is melancholy to reflect that even among this favoured class natural decay accounts for only one in sixteen of the deaths. All the others were due to some more painful cause, one in five being caused by nervous disease. Curiously enough, the violent deaths are found to be unusually numerous, accidents accounting for one in three, and suicide (qualified by the suggestive adjective, " acknowledged ") for one in 124. Heart-disease is also unusually fatal. Roman Catholic priests seem to show less favourable figures; Nonconformist ministers are not mentioned (an index, by-the-way, would have been a useful supplement to the table of contents, ample as this is). Barristers come below the clergy, and solicitors, again, below barristers. Here, however, there is a qualification to be stated : "A large pro- portion of the legal profession live to advanced ages." Hence we get two classes, more or less coincident, it is probable, with the successful and unsuccessful,—one long-lived, the other short-lived ; and this agrees with popular belief. Medicine, again, comes below law. Physicians seem unable to heal themselves. The figures for the three professions, church, law, and medicine, are 556, 842, and 1,122 respectively, the doctors being as badly off, it would seem, as slate and stone quarry- men. As to teachers, the opinions of experts seem to vary. Dr. Ogle puts their figure at 719, thus ranking them next to the clergy. But our author remarks that female teachers are not included in the return, and that if they were taken into account, the figures would be less favourable. He believes that phthisis is very common among pupil- teachers, and adds his general impression that " the business of school-teaching is not conducive to health and longevity." It involves, he says, conditions of worry and confinement to the house. We are unwilling to differ from so high an authority, but yet must remark that in this case he sets his own experience, necessarily limited, against the authority of statistics. Clerks follow a calling not wholly unlike that of teachers,—indeed, some observers have classed them together. They show unfavourable figures, especially in the case of law-clerks, whose mean mortality (the average being 1,000) rises as high as 1,151. It is satisfactory to learn that things are improving, opportunities for exercise having been largely increased of late years. Nor must it be forgotten that persons of weak constitution often choose this occupation, or have it chosen for them, and that the occupation is thus made responsible for some amount of illness due to other causes. This consideration is, indeed, of large application. Some occupations demand picked lives, and thus appear to be healthier than they really are. The figures of the police, for instance, would be less favourable than they are, if the force did not consist of individuals selected, more or less carefully, for health and strength. It is curious that gout prevails much more among the City than among the Metro- politan police. Dr. Arlidge suggests that the "festive character of the City population" may have something to do with it. It seems, however, that it attacks abstainers nearly as often as others. But that alcoholic liquors have a most sinister influence on health and life, is evident when we turn to the statistics of inn-keepers and publicans. Their mortality is, to use Dr. Ogle's strong, but not too strong, expression, "appalling." The figure for publicans rises to the height of 1,521; while that of inn and hotel servants is 2,205. Putting this into a concrete form, we find that the man who serves in a bar is four times worse off than a clergyman. Liver diseases are the cause of about one-sixth of the whole mortality, and are six times more fatal than they are to the population at large. Brewers, by which term we are tp understand
the men employed in breweries, seem to suffer considerably ; the occupation of maltsters, on the other hand, is tolerably healthy. Alcohol naturally suggests tobacco. Here the sale of the article appears to be far more dangerous than the manufacture. In the eleven retail trades " fairly repre- sentative of the great class of shopkeepers," to use Dr. Ogle's phrase, tobacconists stand fourth in order of danger. Phthisis is peculiarly fatal among them,—that they are " inveterate smokers" is one of the reasons suggested. As to phthisis among tobacco manufacturers, opinions seem to differ. Dr. Richardson holds that it is widely fatal; other physicians have maintained that it is rarer than in the general popula- tion. These artisans certainly seem to be " remarkably exempt from epidemic, infectious, and cutaneous diseases." On the whole, opinion is favourable to the healthiness of the occupation, although incessant smoking is almost universal. The statistics of commercial travellers are not wholly satis- factory, though they show a great improvement on those of former times. The traveller works under different con- ditions, living, for instance, much more at home than he used to do, thanks to railway conveniences. The exaggerated hospitality of the " commercial room " is largely a thing of the past. An exception to the change for the better is found among the liquor trades. Travellers for brewers, and wine and spirit merchants, show a mortality nearly on a level with that of publicans. Of all manual occupations, that of the gardener seems to be the most healthy, especially if he has nothing to do with glass. The farmer might surpass him, but for the pernicious habit of " wetting bargains." As it is, gardeners come next, in order of healthiness, to the clergy ; and are fol- lowed at no great interval by "farmers and graziers," the figures standing at 556, 599, and 631. Agricultural labourers, worse housed and worse fed as they are, come not far behind. Even miners, so great is the advantage of laborious work with the hands, seem to be fairly well off in this respect. Their figure in Lancashire is as low as 729, though in Monmouth- shire and South Wales it rises as high as 1,081.
We have given a few examples from the enormous mass of facts which Dr. Arlidge has marshalled, and marshalled, we may say, with great skill, in this most interesting volume. The whole is well worth careful study, not only by the medical profession, who will find in it many valuable suggestions, but by the lay public. Many of the evils here enumerated—and the catalogue is appalling in its length and minuteness—are beyond all remedy. Some occupations, and these necessary occupations, are intrinsically unhealthy. But where remedy is impossible, alleviation is within reach. Much has been done already ; much remains to be accomplished. One conclusion may be drawn most certainly,—that, in face of such facts, the doctrine of laisser faire is absolutely untenable.
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