The Use And Abuse Of Tobacco. Part 1

The agreeable effects of smoking. Smoking tobacco is known from time immemorial to produce the following agreeable and enjoyable reactions:

1. Smoking is part of the social life from the days of primitive man. It introduces a note of friendliness, relaxation, and sociability. It often creates a subtle bond between strangers, or may help "cut the ice" in a hostile atmosphere. It has its origins in ancient rites and religious ceremonies and so is most welcome to both primitive and civilized man on social occasions. To extract every possible enjoyment and benefit from tobacco, man has smoked it, swallowed it, chewed it, drunk concoctions of it, gargled it, sniffed it up his nose, licked it during ceremonies, smoked it through the nose instead of the mouth, used enemas of it, applied poultices of it, and healed wounds with it. Man has even used tobacco to commit suicide and murder. Now hundreds of thousands, probably millions, of people the world over earn their "daily bread" thanks to tobacco.
2. Smoking "soothes" the nerves for many people, and will often help tide them over anxious periods of emotional crises.
3. Smoking often is used to relieve pain and shock, as seen after an accident, in war, or in disasters. It may act for many as a sedative and even permit the smoker to go to sleep after a smoke, which might have been impossible without one. Some of my patients who were addicted to smoking could not sleep through the night without getting up at least once during the night for a smoke. (More about this later.)
4. Smoking is known to cause a "cooler" sensation in the skin due to the temporary constriction or tightening up of the blood vessels in the skin of the body. This temporary "cooling" sensation is momentarily welcome in times of hot weather or when people are nervous, excited or generally "hot under the collar."

5. Smoking may, temporarily, give enjoyment by the action of nicotine, coal-tars, or other ingredients contained in tobacco, by the resultant rise in blood pressure, increase in heart action, release of adrenalin, and consequent increase in blood sugar. These latter physiological and pharmacological effects often cause a temporary feeling of lightness or light-headedness, mental clarity, and what appears to feel like increased physical and mental efficiency.
6. Smoking after meals has been considered one of the most enjoyable aspects of dining. For centuries, it has been regarded as an aid to digestion, and a fitting end to each meal. Even in 1599, Henry Buttes, in his "Dyets Dry Dinner Consisting of eight severall Corses" placed tobacco as the last course of the meal, because of its value in overcoming "sorrow, pain, and constipation."
7. Smoking often establishes a habit, which, like other habits, gives a certain sense of security and expectancy to many people who look forward to their "smoke." It may give a rhythm-like pattern to daily living, just like the rhythm involved in smoking a cigarette, cigar, or pipe; a kind of "ebb and flow" in the breathing process itself.

The indifferent effects of smoking. Millions of people smoke tobacco merely as an incidental habit, which they adopt solely to be sociable in the business world. Like some of my patients who may be businessmen, salesmen, or in other walks of public life, they smoke to put their business associates, colleagues, clients or customers at ease. Some of my patients, following my caution, will merely light the cigarette necessary for social or business amenities, keep it burning, and simply hold it without smoking. Similarly, the woman who smokes at a bridge game, or who smokes after meals to keep their husbands or friends "company," can "take" smoking or "leave it." These smokers usually do not smoke to excess and frequently avoid the toxic effects of tobacco smoking. It is very easy for them to stop smoking and when they have done so, they rarely miss it. As a rule, these individuals have strong will-power and are not "compulsive," as habitual smokers are apt to be.

The effects of smoking on health. Tobacco is a poison. If you were to consume 2 or 3 cigarettes, the effect might easily prove fatal! This is because nicotine, one of the main ingredients of tobacco, is an old established toxin, or poison, affecting the brain, the heart, and other vital organs. The tobacco plant is directly related to the deadly nightshade family of plants. The average cigarette weighs one gram and contains only from 1 to 2 per cent of nicotine - 100 to 200 milligrams (thousandth of a gram). The lethal dose of nicotine required to kill a man usually is only from 60 to 120 mg! In smoking a cigarette the average amount of nicotine inhaled is generally about 2 milligrams. There are thousands of cases of suicides, accidental deaths, and murder recorded in the United States by the U.S. Department of Commerce, Bureau of Census, as a result of consuming nicotine preparations. Some investigators have found that only a few drops of nicotine base kills wild animals, such as the lion or wolf, within a few seconds. Some animals, like sheep, can tolerate large doses of tobacco. Fortunately, the body excretes or gets rid of nicotine rapidly, not allowing the average amount inhaled to accumulate, unless heavy or excessive smoking is indulged in. If the latter is permitted, then the clinical symptoms of nicotine poisoning often occur, even in the habitual, heavy smoker, who may have developed some tolerance to nicotine. Even when the cigarette is not continually inhaled, there is still at least about 1/2 to 2/3 of the nicotine absorbed into the system through the lining of the mouth, the tongue, and the saliva. Aside from the chief poison, nicotine, there are other well-known poisons present in tobacco: carbon monoxide (when tobacco is burned), arsenic, and coal tar substances are some. The latter contribute to the formation of cancer of the mouth, the esophagus (the gullet) and the respiratory tract, including the larynx, bronchial tubes, and the lungs. Let us consider some of the actions of these poisons that may occur in man from excessive tobacco smoking.

The effect of smoking on the heart. Like many other physicians, in my 25 years of practice I must have treated literally thousands of patients who at one time or other suffered from symptoms of some degree of tobacco poisoning. Some were dramatic, some resistant, some funny and some tragic. Usually the toxic effects on the heart will be noticed by the patient from "skipped" heart beats or palpitations of the heart, nervousness, or a rapid heart rate often producing dizziness, shortness of breath, especially on exertion, headaches from rises in blood pressure, or pains and distress over the front portion of the chest. As described in Chapter 3, I had the opportunity of studying the effects on the heart of various stimuli in a series of volunteers. I examined the effects of stomach distention on the heart through an apparatus I devised at the time, as published m the Journal of the A.M.A. One male patient of mine, in particular, was an instructor in our own medical school, and had a mild case of coronary artery disease. This showed itself by chest pain after exertion or excitement. A habitual smoker, he had improved so greatly under treatment, which included his abstaining from tobacco, that he was now itching to get back to the "weed". In order to demonstrate to him the effects of smoking on his own heart, I asked him to resume smoking for one test period, a habit which I had asked him to stop, because of his angina. After smoking and delightedly inhaling two and one-half cigarettes he developed severe anginal pain over the chest, which reflected itself in striking abnormalities in his electrocardiogram, which I was running continuously during the smoking experiment. Fortunately, I abolished the anginal pain immediately by placing a tablet of nitroglycerine under his tongue. This relaxes and dilates the coronary arteries promptly, thereby stopping the pain.

This experience has been reduplicated in countless patients, since it is well known that tobacco will produce pain and em-harassment of the heart when it is already damaged or weakened by some condition, particularly coronary atherosclerosis. Here additional constriction of the coronary arteries by tobacco smoking, in the already narrowed passageways of the coronary arteries, can lead to further damage to the heart. The term "tobacco angina" or "tobacco heart" was originally employed to describe these chest pains due to the toxic effects of tobacco on the heart. Like many physicians, I advise my patients with heart conditions to refrain from smoking, even in moderation, because of the injurious effects of tobacco on their hearts. The blood pressure is known to rise on an average of 38 points (the systolic, or higher one) in patients with normal but unstable, sensitive blood pressure. And in patients with high blood pressure, tobacco smoking in moderate to heavy amounts has a strong tendency to send the blood pressure even higher than the above mentioned 38 points.