The Use And Abuse Of Tobacco. Part 2

How smoking affects the blood vessels. For many years scientists and physicians have studied the effects of smoking on the peripheral blood vessels, i.e., those particularly in the hands and legs. These studies were carried out by all kinds of ingenious instruments that measured the rate of blood flow, the temperature of the tissues around the blood vessels, the degree of narrowing and opening or constriction and dilation of the blood vessels - in all sizes and locations - as influenced by smoking. As a result of these studies it is thoroughly established now that tobacco causes a marked interference with the circulation in the hands, the feet, and the legs. These findings, of course, though very important, are not new to the practising physician, who has seen numerous instances of disease of the blood vessels caused by excessive smoking, mainly through prolonged spasm and constriction of these peripheral blood vessels. Nicotine is the most noxious substance that can effect the blood vessels in man. This is aptly demonstrated in certain diseases such as Buerger's disease (a condition of obliteration of the blood vessels, usually in the legs) which not infrequently require amputation due to gangrene. Still another disease associated with the excessive use of tobacco is Raynaud's Syndrome, a condition characterized by spasm of the small blood vessels in the hands, feet, nose, cheek, and ears. Patients with this disease suffer from blanching of the skin and local pain after exposure to cold, anxiety, fatigue, physical pressure, or shock. This condition may lead to other diseases of the blood vessels. In the conditions of peripheral arteriosclerosis and atherosclerosis, especially of the legs, nicotine has been shown to aggravate and increase the constriction already present in the peripheral blood vessels of human subjects. Patients with this condition are far better off without tobacco.

What smoking does to the digestive tract. Many people enjoy a good smoke after a meal. They get the impression therefore that smoking aids the digestion. A host of scientific studies carried on over a generation, however, are unanimous in demonstrating that tobacco is an irritant to all parts of the digestive tract, and often influences pathological or diseased states in it. In the mouth, one of the most dangerous reactions to smoking has been "smokers" or geographic tongue. In this condition, the tongue is marked up like a geography map and is very prone to cancer, which may spread from the tongue into the mouth. Tobacco smoking to excess is well known to precipitate and reduce the amount of necessary salts and enzymes in the saliva and the mouth, discoloring and affecting the enamel of the teeth. Much work is thus given to dentists and their assistants who must spend countless "man-hours" in chopping and hacking, drilling, and polishing away the injurious effects of tobacco on the teeth. Tobacco is often used to "kill hunger" or stay the appetite. By cutting the appetite down it can reduce weight. In those who have not developed a tolerance to tobacco, it will produce nausea and even vomiting (as witness many a boy's first attempt at smoking). Some 20 years ago I studied the effect of tobacco and alcohol on the stomachs of two series of patients who were heavy smokers and alcoholics. These investigations were carried out through a gastroecope, which is a long, flexible tube that is passed through the mouth into the stomach. Through a series of 29 lights and prisms in the tube the interior of the stomach can be inspected. As published subsequently, my associates and 1 found that a "gastritis," or local inflammation of the stomach, is often produced by smoking, due to the absorption of nicotine into the saliva and secretions of the mouth. These drain into the stomach and act as local irritants, producing inflammation, catarrh, and interference with normal functions of the digestive juices and stomach movements. Stomach ulcers, in particular, are aggravated by smoking, and it has always been my practice to forbid it in all patients suffering from active ulcers of the stomach.

The relationship of tobacco smoking and cancer of the lung. The increase of cancer of the lung in recent years is phenomenal. Many scientists, physicians, and statisticians have presented evidence showing that tobacco smoking is closely associated with cancer of the lung (as well as in the larynx). This has touched off a controversy that has raged in medical meetings, medical, journals, and the public press. Briefly stated, medical scientists and statisticians, such as those represented by the American Cancer Society, have shown the following striking figures on the death rate from cancer of the lung:
(a) Moderate cigarette smokers, from 10 to 15 cigarettes daily, have 5 times as many lung cancers as non-smokers.
(b) Heavy cigarette smokers, from 16 to 25 cigarettes daily, have 15 times as many lung cancers as non-smokers.
(c) Excessively heavy cigarette smokers, from 25 to 50 cigarettes daily, have 25 times as many lung cancers as non-smokers.

Smoking is not necessarily the sole cause of lung cancer. The fact that a goodly number of deaths from cancer of the lung occur in non-smokers indicates that tobacco smoking is not necessarily the sole cause of lung cancer. Additional factors associated with cancer of the lung are: air pollution, engine exhaust fumes, road dust, and industrial toxins. These are also heavily suspect as contributing factors. Prominent among factors involved in cancer of the lung are so-called "carcinogenic" substances (cancer-producing). These are linked to the coal tars released in the burning of the cigarette. Apparently about 50 per cent of the solid particles inhaled in the tobacco smoke are deposited in the bronchial tubes, and include nicotine, coal tars, and many other products. These act not only as irritants, producing the well known smoker's chronic cough, but are considered by many as the sole cause of cancer of the bronchial tubes and lungs.

Because of the alkaloids (poisons) and irritants in cigar and pipe tobaccos, the smoker does not ordinarily inhale them, in sharp contrast to the cigarette smoker. The result is a very marked reduction in the incidence of cancer from the smoking of pipes and cigars. As compared to the non-smoker, pipe and cigar smokers have, as a consequence, only a slightly increased susceptibility to cancer of the lungs. This slightly increased susceptibility among pipe and cigar smokers, however, becomes greater in the chronic, excessive, heavy smoker. Here we see an increase of occurrence of cancer of the lips, mouth, tongue, and gums. By excessive, heavy smokers is meant those who smoke from 10 to 15 or more cigars daily, or over 50 grams of pipe tobacco. (Remember that the average cigarette weighs about one gram.) The attempt to reduce the nicotine or coal tar content of smoking tobaccos by means of filters, denicotinized cigarettes and the like, has not been very successful to date. The toxic effects of the smoking tobacco are still present, though reduced from 10 to 30 per cent. The tobacco companies have launched powerful counter attacks and heavily subsidized campaigns of advertising to counteract evidence of the relationship of tobacco and cancer of the lung. The fight has largely devolved in a battle of statistics. If the reader will forgive the repetition, it has been pointed out by Mark Twain and Marilyn Monroe that "figures are often misleading." I therefore would like to fall back on my own experiences with cancer of the lung and larynx, when I was assistant many years ago in the early days of my practice, to Dr. Chevalier Jackson and his son, at the famous Jackson Clinic in Philadelphia. Dr. Chevalier Jackson, one of the greatest doctors of contemporary times and now in his nineties, was virtually the discoverer and creator of an entirely new science called bronchoscopy. He developed and invented many new instruments or bronchoscopes (hollow metal tubes) that could be passed into the lungs and enable doctors to remove foreign objects swallowed into the lungs. Thousands of swallowed coins, buttons, stones, glass, bones and what-not have been removed from the chest by the bronchoscope, thus saving the lives of countless grateful patients.

Among the other uses of the bronchoscope is its ability to inspect the interior of the bronchial tubes and lungs for cancer. After seeing hundreds of victims of cancer of the lung who passed through the clinic, I became utterly convinced, like Dr. Jackson and his son, that excessive tobacco smoking was an important cause in most cases of cancer of the lung. The clinical impression of this fact was so overwhelming that no amount of statistical calculations and mathematical figures could shake it. With very few exceptions, patient after patient who were victims of the disease gave the same monotonously tragic history of chronic tobacco habit. So, in conclusion, don't let your own conclusion be made by excessive tobacco!