and viscera. He uses up the oxygen in the arterial blood more completely and with greater efficiency; for the output of each unit of energy his heart has to circulate much less blood (Kreogh); his blood is sent in full volume by the well-balanced activity of his vasomotor system to the moving parts. Owing to the perfect coordination of his muscles, trained to the work, and the efficient action of his skin and cutaneous circulation—the radiator of the body—he performs the work with far greater economy and less fatigue. The untrained man may obtain 12 per cent, of his energy output as work, against 30 per cent, or perhaps even 50 per cent, obtained by the trained athlete. Hence the failure and risk suffered by the city man who rushes straight from his office to climb the Alps. On the other hand, the energetic man of business or brain worker is kept by his work in a state of nervous tension. He considers alternative lines of action, but scarcely moves. He may be intensely excited, but the natural muscular response does not follow. His heart is accelerated and his blood pressure raised, but neither muscular movements and accompanying changes of posture, nor the respiratory pump materially aid the circulation. The activity of his brain demands a rapid flow of blood, and his heart has to do the circulatory work, as he sits still or stands at his desk, against the influence of gravity. Hence a high blood pressure is maintained for long periods at a time by vasoconstriction of the arteries in the lower parts of the body and increased action of the heart; hence, perhaps, arise those degenerative changes in the circulatory system which affect some men tireless in their mental activity. We know that the bench-worker, who stands on one leg for long hours a day, may suffer from degeneration and varicosity of the veins in that leg. Long continued high arterial pressure, with systolic and diastolic pressures approximately the same, entails a stretched arterial wall, and this must impede the circulation in the vaso vasorum, the flow of tissue lymph in, and nutrition of, the wall. Since his sedentary occupation reduces the metabolism and heat production of his body very greatly, the business man requires a warmer atmosphere to work in. If the atmosphere is too warm it reduces his metabolism and pulmonary ventilation still further; thus he works in a vicious circle. Exhausting work causes the consumption of certain active principles, for example, adrenalin, and the reparation of those must be from the food. To acquire certain of the rarer principles expended in the manifestation of nervous energy more food may have to be eaten by the sedentary worker than can be digested and metabolized. His digestive organs lack the kneading and massage, the rapid circulation and oxidation of foodstuffs which is given by muscular exercise. Hence arise the digestive and metabolic ailments so common to brain workers.
