795THE EFFECTS OF FATIGUE ON INDUSTRY AND EFFICIENCY.

THE LANCET.

LONDON: SATURDAY, NOVEMBER 4, 1916.

The Effects of Fatigue on Industryand Efficiency.

THE effects of fatigue on industry and efficiencyhave been the subject of many articles and com-munications in our columns since this nation

began to apply itself seriously to the business of

winning the war, but the physiological aspect ofthese effects has never been put more aptly thanit was last week in the Chadwick lecture delivered

by Professor WILLIAM STIRLING before the RoyalSociety of Arts. Fatigue may be due to overworkof the whole organism or of its individual parts,and, as Professor STIRLING pointed out, both objec-tive and subjective symptoms have to be reckonedwith and the appropriate tests applied. Fatigue is auniversal concomitant of life, but the diminishedoutput associated therewith is not necessarilyaccompanied by any sense of fatigue recognisableby the worker. The loss of excitability may beunconscious, and, indeed, in mental work the senseof fatigue may be present when facts show thatan actual increase of work is being done. This

apparently illogical happening is observed incertain workers when- within sight of the endof the task; feeling that so far all has gone on

well, and noting that only for a space of timewill the strain be continued, the worker finds thathe can make a last but great call upon his un-suspected reserves-like the long-distance runnerhe can sprint to the tape. The phenomenonexactly contradicts the more common experiencethat in the closing stages of work the output diesquickly down and time is wasted. This is the diffe r-ence between a conscientious worker, who takes aninterest in and feels responsibility for his work, andthe beast of burden. jProfessor STIRLING attributed the physiological z,

process of fatigue to two causes : the using up oforganic forces or energy, and the wear and tear ofthe organs which are overworked, so that matterand energy are consumed while restitution does not

keep pace with work. These words, though thereis nothing whatever novel in their teaching, whichis closely supported by the report of ProfessorA. F. S. KENT to the Chief Inspector of Factoriesupon the association between fatigue and output,call for particular attention at the moment. Weall know that to keep our Army at its presentstate of efficiency, and to replace the wastagewhich, however carefully thought out the manage-ment of our forces may be, remains terriblylarge when such masses of men are concerned,a regular influx of recruits is required from

day to day. The age-limits for recruiting havemore than once been extended as our opera-tions have grown in magnitude, and a rigorousprocess of inquiry into the various headings underwhich exemption can be obtained from militaryservice is proceeding to-day. This is an absolute

necessity of the situation in which we stand-a

very strong situation, be it remembered, if allclasses of the community can be brought intoline for extended cooperative effort. Those whowould point to the overwork which various

" combing out" processes may entail upon theresidue are apt to forget that to be a soldier intime of war, and in such a war as that wherein weare involved, is also a very fatiguing occupation;and they should remember not only this fact, butalso that the work of the soldier, like that of thecivilian, will assuredly be subject to physiologicallaws and will decrease in quality and quantity ifproper intervals of rest are not forthcoming. Atthis moment the physical conditions of our Armyare of paramount importance to the nation, whilethe authorities are making their net as inclusiveas possible. But it is necessary that recruitingshould be carried on under a vigilant medicaleye, for there is no economy in paying a man tofight for his country whose physical condition is sobad, or rapidly becomes so bad, that time and moneyhave to be spent in trying unsuccessfully to bringhim to a reasonable standard. The stories whichhave appeared in the daily press now and againdetailing the recruiting of grossly unfit persons,must not be taken as a fair sample of what is goingon generally; it is inevitable that all such instancesof negligence or of pig-headedness should obtainpublicity and should thereby gain an importance towhich their numbers do not entitle them. But

with our growing knowledge of the effects of

fatigue upon the organism and upon the result-ing work, we must all see the necessity ofnot supplying to the Army material that cannotreasonably be depended upon to stand the strainto be exacted.

It will be remembered that last year a committeewas appointed with the concurrence of the HomeSecretary and under the chairmanship of SirGEORGE NBWMAN, the principal medical officer tothe Board of Education, with the following refer-ence : " To consider and advise on questions ofindustrial fatigue, hours of labour, and othermatters affecting the personal health and physicalefficiency of workers in munitions factories and

workshops." This committee has made a numberof valuable reports to the Ministry of Munitions,the gist of which was to point out that the

management of our factories has hitherto beenless based on experimental science than hasbeen the case in the business concerns of

Germany; and the scientific and physiologicalaspects of fatigue as described in Memorandum 7show that much more could be done to deal withthe problems of industrial fatigue and modify theill-effect and reduced efficiency of the want of

proper organisation. Strenuous efforts, we haveevery reason to believe, have been made to remedythis condition of affairs, and it is with the plight

796 THE PROHIBITION OF ALCOHOLIC BEVERAGES.

of the munition workers that we have so far beenmost concerned; but it is not here probably thatthe effects of shortage of man power will befirst felt, for the risk of depleting the munitionfactories and reducing their output is so obviousthat it will not be taken. A large host of clerks,typists, and other sedentary workers have beenemployed since the war broke out in operationsrequiring unremitting attention and for spellswhich have no parallel for similar occupations intimes of peace. Here women have come forwardand relieved male labour to a very appreciableextent, but here also will the first effects of drasticrecruiting be seen. Great responsibility may bethrown in this connexion upon the civilian medical

profession-a sadly reduced body of workers. For

from them will much help and information be

expected if any general investigations should becarried out with a view of arriving at conclusionsbased upon larger evidence than any yet forth-

coming ; and it seems to us that some more far-

reaching inquiries than any which have hithertotaken place will have to be instituted into the

effects of fatigue on industry and efficiency.

The Prohibition of AlcoholicBeverages.

A MEMORIAL which is in preparation, and whichhas already appeared in the public press with athousand influential signatures attached, asks theGovernment to suspend all drink licences through-out the kingdom for the period of the war. The

appeal is based on a plea to put the nation at its fullstrength by removing " a danger which holds backthe hour of early victory and throws a shadow overthe vision of peace." With the weakening powerof alcohol removed, the signatories claim that thenational effort against the enemy will gather in-creased strength. It is not drunkenness alonewhich endangers the supply of munitions, but, saysthe memorial, " the constant sapping of men’s

energies by alcohol." The suspension of the liquortraffic during the war and the conversion of thepublic-houses into houses of refreshment will, it

adds, quicken up the civil and fighting populations,will raise new fire of resolution in the people, andwill give to millions the first opportunity they haveever had of breaking old habits of weakness andforming new habits of strength. The appeal isnot made by temperance reformers as such, but bythoughtful men in every sphere of business andprofessional life.The sapping of men’s energies by alcohol is, of

course, a medical commonplace, and there cannotremain many people who refuse to endorse thestatements in the memorial regarding this danger.If we accept it as critical at the present time wecan only picture two classes from whence opposi-tion to the suspension of the traffic will come.First there are some-but we cannot think many-who do not believe that self-control can be

strengthened by limitation of temptations toexcess. A study of the rapid fall in convictionsfor drunkenness in nine English cities and towns

1 since the restrictions imposed by the Centralb Control Board may help to convince them to the contrary. But those who are financially interestedl in the production or sale of liquor have in many3 instances a private code of self-control so strict

, that it is not easy for them to comprehend the weak-. ness of others. Secondly, there are some who believe! that the consumption of alcohol has advantagesI which compensate for the admitted dangers. For thel latter class the case may be stated thus: Alcoholic. liquids may be taken as food, medicine, or luxury.i It is established that about one ounce of absolute

alcohol is the limit which can be burned up in the

body within a period of 24 hours without paralysingor narcotic effect and without the appearance of

unchanged alcohol in the excreta, and one ounceof alcohol supplies about as much fuel as one ounceof margarine-that is, 200 calories. Now one ounce ofalcohol, as we pointed out many years ago, costs inthe form of cheap spirit 1<%., in the form of beer 3d.,in the form of heavy wines 4d. to 6d., in the formof light wines about ls., and to these prices some40 per cent. must be added during war-time. Oneounce of margarine costs less than 2d. Alcoholin the quantity which can be taken as food isa wasteful food. There is little doubt in theminds of hospital staffs and committees about thevalue of alcohol as a drug; it has its place, butin the past it was over-estimated. The quantityof alcohol used in treating the sick poor mayfairly be taken as a criterion, and a recent

example is suggestive. In reply to a Parlia-

mentary question on Oct. 18th last it was pointedout that the cost of alcohol administered to patientsat Guy’s Hospital had been reduced from JE157&

per annum toJE151,at Leeds Infirmary from 6s.6d.perhead per annum to 2d., and at Wandsworth Infirmaryfrom 5s. 3d. per head per annum to half a farthing.As a drug, therefore, alcohol is found to-day to havea much restricted application. But we are here

leaving out of count its use as an adjunct to diges-tion, and one of the weak points in the argumentsof the strict teetotaller has always been his inabilityto believe in the existence of such an effect of a.

small dose of alcohol in a pure and agreeable form.In normal times the claim for the use of alcohol asa luxury cannot be passed over. One of our greatthinkers stated the case reasonably when he saidthat wine used in moderation seems to add to the

agreeableness of life, and whatever adds to the

agreeableness of life adds to its resources and

power. With the major part of our young manhoodserving under conditions in which life is the reverseof agreeable, those who remain can hardly be wrongin forgoing this agreeableness as part of theircontribution to the cost of the war. If theabstinence produces real ill-effects, then will be thetime to fall back upon alcohol-alcohol as a drug.For the useful employment of alcohol, when pro-

hibited as a beverage, there need be no fear. Thememorialists look to the cessation of its manufac-ture and the utilisation of its raw materials-

potatoes and grain-as immediate sources of food.supply. And true it is that there is an inevitableloss of energy in the conversion of these more

highly organised bodies into the simpler alcohol: