Tobacco and Humanity

Improvement Era Vol. XXXI NOVEMBER, 1927 No. 1 Tobacco and Humanity By L. Weston Oaks, M. D. JUDGING from the mass of literature to be found dealing with the subject, one might be led to conclude there is virtue on both sides of the question of tobaccoism. Volumes have been pro- duced to extol as well as to condemn it. Reading much of the mat- ter excites one's curiosity as to the motive actuating each writer; and one is compelled to include it, along with politics and weather predictions, in the category of subjects upon which every person, informed or otherwise, is entitled freely to express himself. Men from many stations of life have offered written opinions and ob- servations. Among these we find educators, physicians, inventors, manufacturers, tobacco venders, lawmakers, ministers, novelists, poets, humorists, and even kings. Some of this material is deserving of highest praise, because of the incentive stimulating its production; and some of it is unspeak- ably contemptible for the same reason. We have no condemnation for the man who renders an honest opinion, even though it be in error; but the individual who will deliberately preach his fellows into retrogression and mental stupefaction, that his earthly fortunes may fatten, is a felonious menace to humanity. A desire to crystallize and make more available material of im- portance from these many sources is responsible for this further ad- dition to matter already in print. All of us number among friends we hold most dear at least a few who have become addicted to the use of this narcotic drug. Likewise, none of us would for an in- stant consider saying or writing anything to wound or offend their feelings, usually sensitive upon the subject. Hence, it is understood that whatever is offered in this paper is set forth in an earnest effort to present the truth to our boys and girls, that they may more clearly

6 IMPROVEMENT ERA understand the workings of this destroyer of mental and bodily health. Nor does any statement hereinafter set down carry a spirit of criticism of any one's conduct; but whatever, in the nature of example, is mentioned represents a desire to clarify, for those who may read, the somewhat intricate reactions involved. Powerful tendrils of the tobacco habit so fasten themselves into the sensitive network of the smoker's nervous system that suddenly to uproot his narcotic habit is almost to tear him asunder, as it were. The drug nicotine becomes so intimate a companion as actually to govern his mental balance; and the frenzied agony he suffers from its sud- den interdiction cannot in any sense be appreciated by one inexpe- rienced in its torment. Realizing this fact, the writer wishes to repeat that this humble offering results from a desire to inform, and not in any sense to stimulate the mistaken philosophy of prohibitive suppression. However, available literature has been carefully scrutinized in trying to sift out truth; and no apology is made for the subject matter presented. Here are some illuminating, timely thoughts on tobacco. The kind of plain talk on a vital, every-day subject, which will tend readers among young men to think and act for themselves — not just a preachment or argument, but a readable statement full of valuable information. It is popularly supposed that civilized man's use of tobacco extends back only to the time when America's many treasures were first discovered. There is, however, historical data to indicate that its use in China reaches many hundreds of years beyond Columbus and his memorable voyage. The word "tobacco" is derived from an Indian term denoting the tube or pipe in which the dried leaves were smoked. White men first cultivated the plant in Virginia in 1614, though its moderate use by the Indian is known to go as far back as the Mound Builders, in whose caches smoking implements have usually been presented. Nicotine, an alkaloid, which is the chief poison principle in tobacco, was named after a French diplomat, Jean Nicot, who is said to have introduced smoking of it into France in 1530 from Spain. It was taken to Spain first from Santo Do- mingo. In a comparatively short time after smoking was taken up by the elite of English society following in the wake of Sir Walter Raleigh, King James wisely foresaw its habit-forming power and set up an edict against its use. Even in that day of belief in divine right of kings to rule, desire for their drug was stronger than respect for their sovereign; and tobacco was used freely despite threatened im- prisonment and heavy fines. However, it is quite possible that hu- man nature was the same then as now, and the very prohibition of

TOBACCO AND HUMANITY 7 their using tobacco furnished strong incentive to become intimate with it. At the present time there is a considerable uneasiness apparent, among educators of all stations, with regard to the tremendous in- crease of tobacco users among young boys and even girls of Amer- ica. Various persons ascribe divers causes to this. Percival I. Hill, President of the American Tobacco Company, said, in a letter to Mr. Henry Ford : "The increase of cigarette smoking in "This tremendous popularity, which is the United States in recent years is sig- growing all the time, is possibly only be- nificant. In 1910, two billion six hun- cause millions of American men have con- dred thousand cigarettes were made in this vinced themselves that cigarettes are good country. In 1913, fifteen billion eight for them." hundred million cigarettes were made here, an increase of 700%. Such inane stuff, with such patent intent to deceive, could possibly come from none but people whose dollar interests lie in lulling any agitation that might stimulate their dupes to think for themselves. Mr. Hill further proceeds to dub any who write against the use of his company's product as "well-intentioned, ignorant peo- ple," "notoriety seekers" and "thrifty legislators." In the eyes of any intelligent person who cares to investigate medical literature, this man stands convicted by his own pen of either ignorance or malicious intent to deceive. The statement that "millions of American men have convinced themselves that cigarettes are good for them," was surely thoughtlessly written. Certainly no man with the welfare of American youth — which means the future of our American na- tion— at heart could bring himself to write such a thing, with his eyes open. No man or woman with average normal intelligence will attempt to question that the tremendous increase of tobacco- ism in America represents the advent of the drug habit among mil- lions of high school boys and thousands of high school girls. Mr. Hill's representation that this great addition to the volume of his business betokens a conversion of "millions of American men" to the cigarette's virtues is a bald deception. His immense satisfaction over tobacco's extending popularity is had at the expense of the mental and bodily vigor of young America — of those almost-in- fants who are as yet too inexperienced to have any conception of what this thing will do for them. Mr. Hill and his organization should be proud of their achievement! The science of advertising has today reached a high state of efficacy. To its standard have been called psychologists, artists, scientists, and all others whose faculties and training can lend aid in finding means to fix human attention. Ways have been found

8 IMPROVEMENT ERA to reach and impress, sharply or gradually — through constant repeti- tion,— man's subconscious mind. Every emotion, desire, experience and incentive influencing or bearing upon our daily lives is used in this business of selling to us both the good and the bad. As an ex- ample testifying that such is the case, direct your attention toward the propaganda used to increase the sales of tobacco. The most in- sidiously insistent, and the most constantly present of all advertising in the world is that paid for by American tobacco interests. This material has been specially designed to appeal to the young and impressionable; and there is little wonder in the result when one observes its nature. Seductiveness is the keynote of their whole ad- vertising plan; and the modern business ideals of service to man have absolutely no place in it. To get the dollar — devil take the rest — is their whole objective. Than the American Tobacco inter- ests, there has never been a greater octopus — feeding itself bloated upon those things vital to life and joy of youth in the world. Tobacco is a habit-forming drug of the narcotic or depressant class. It takes its place, in type of action, along with opium, alcohol, aconite and others which effect a lowering of body function. In habit-making power, it is stronger than alcohol, and occupies a position very near to opium. In fact so strong is its hold upon those who have fallen under its ban that one is tempted to say, with Dr. Lorand of Carlsbad: "I fear that, in the face of such an over- of the partial success, if this lenten sermon powering habit, my admonitions will not were to induce inveterate smokers to a be of great avail, and am far from hopeful certain degree of moderation, especially in of complete success; but I would be glad the use of strong tobacco." Like that of alcohol, the effect of the use of tobacco extends itself into so many phases of our daily lives, as individuals, com- munities and nations, that any readable discussion of it must needs ignore much of importance. The thing we are most deeply in- terested in at this time is its effect upon the human body; but we must perforce touch upon some matters concerning its psychologic, moral, aesthetic and social aspects as well. Nicotine itself is a deadly poison. When extracted from the tobacco plant it may be obtained as a clear, colorless liquid, which turns brown upon prolonged exposure to light. According to the best authorities, two or three drops of this liquid constitute an average fatal dose for a human being, if it be taken into the stomach. It is recorded that murders have been committed by forcing the victims to take into their mouths larger quantities. In such cases unconsciousness is almost instantaneous and death from failure of the heart follows within five minutes. If we speak in metric terms the fatal dose is said to be about

TOBACCO AND HUMANITY 9 six milligrams of the pure alkaloid, according to Dr. Blyth in his book Poisons. Dr. N. Asherson, who designed an apparatus artificially to smoke cigarettes and analyzed results, says that the average cigarette contains nineteen milligrams of nicotine. That part of the cigarette which is actually smoked yields around four- teen milligrams of the alkaloid, of which about seven milligrams en- ter the mouth. Smokers frequently explain to us that it is only through inhaling that one gets much nicotine from smoking; and that the one who merely puffs gets a very little. According to Dr. J. P. Baumberger, writing in the Journal of Pharmacology and Experimental Therapeutics, inhaling gives 36 milligrams and puff- ing 27.5 milligrams an hour. As regards the ultimate result, this is a very small difference indeed. It is scarcely necessary to note that much of the nicotine of a given cigarette is expelled in the exhaled smoke, so that an in- dividual fails to retain in his body anything like the whole amount available. However, sufficient is absorbed to give the desired effect, as is attested by all who use the drug. Especially is this true of the novice, venturing upon the habit. His resulting nausea, vomiting, giddiness, numbness, cold, clammy skin and rapid pulse are symp- toms of acute poisoning. In his pride-driven determination to suc- ceed as his fellows have, he repeats this process until Nature's infinite power of establishing toleration for untoward things we come into constant contact with is invoked. Nicotine is destroyed, in the body, mainly by the liver. If toleration is to be maintained, this great organ, so important in elimination of the many poisons we con- sciously or unconsciously take into our bodies, must speed up its activity of destruction to keep pace with our willful ingestion of the drug. As regards the amount of nicotine taken into the body from the various preparations of tobacco, it is evident that no other method of use even approaches in this particular the chewing of it. Besides representing the most offensive practice, this also yields practically all the nicotine present in the quid used. Next in yield comes the cigar, mainly because of its size; and the larger the cigar smoked the more poison absorbed. Hinging upon this fact is the insistence of physicians that their patients suffering of high blood pressure shall smoke very few cigars. Cigarettes and other smokes furnish poison in direct proportion to the weight of their contained tobacco, other things being equal. Though quite sufficient in itself, nicotine is not the only harm- ful constituent of tobacco smoke. A number of substances may be isolated from it, chief among which are carbon monoxide, acrolein, various aldehydes such as furfural and others, and ammonia.

10 IMPROVEMENT ERA Carbon monoxide is the chief poisonous constituent of illu- minating or cooking gas used in cities. When inhaled it enters the blood, by the way of the lungs, and forms a stable compound with the hemogoblin of the blood. Hemogoblin is that part of the red blood cell which has for its job the carrying of oxygen from the lungs to body tissues, and the transporting of carbon dioxide from the tissue cells to the lungs where it may be eliminated. Whenever carbon monoxide combines with some of the hemogoblin, that por- tion of this precious substance is permanently prevented from carry- ing any more oxygen or carbon dioxide, so that it must be destroyed and replaced by new. If the amount of disabled hemogoblin should rapidly increase, as in gas poisoning, the victim's lips, ears, and later whole body, become bluish in color, due to lack of oxygen. That carbon monoxide is a death-dealing poison is readily shown by the number of deaths occurring every year from inhalation of illuminat- ing gas. Dr. Holland says of it that it * * * imparts an exceedingly poisonous character to an atmosphere containing more than one-tenth of one per cent; when as much as five-tenths of one per cent is present birds are killed in three minutes." It seems cer- tain that much of the headache, mental dullness and even nausea, experienced by a non-smoker who is detained for any length of time in a tobacco-smoked room, is due to the carbon monoxide present in the smoke. This gas is produced as a result of the incomplete burning of substances comprising the cigarette, cigar or pipe-load. It cannot be eliminated, because only part combustion will yield the smoke sought; and were the materials entirely burned, the smok- er's desire would be frustrated and his nerve-anguish unassuaged. Acrolein, taken alone, resembles the odor of burning grease. Of it Mr. Thomas A. Edison says: "It has a violent action upon nerve cen- Unlike most narcotics, this degeneration is ters, producing degeneration of the cells of permanent and uncontrollable." the brain, which is quite rapid among boys. Of the aldehydes and their poisonous properties we have al- ready made note in the discussion of alcohol. Needless to say, none of them merit classification as desirable boon companions. Tobacco has never, to any marked extent, been found useful in medicine. Some years since, there were two or three preparations which were occasionally used by some medical men. The conditions in which it was prescribed included dropsy, asthma, some other forms of difficult breathing, hiccough, itch, and to induce vomiting. The value of the remedy was questionable, at best; and, as its deadly properties became better known, it was entirely discarded by physicians. So widespread is the exertion of tobacco's effect upon the

TOBACCO AND HUMANITY 11 human body that we shall proceed by mentioning separately each group of structures affected as a unit. Following this plan, we may consider its effect upon those mucous membranes lining the air pass- ages, upon the lungs, the digestive system, the muscular system and its control, the heart and blood vessels, the visual apparatus, the organs of hearing, the nervous system as a whole and the mental mechanism. Effects Upon the Mucous Membranes.1 Tobacco smoke is alkaline in its reaction, as well as having other irritating properties which help to produce the characteristic throat of the smoker. The type of alkali is peculiar in that it is not soothing to the membrane, as most weak bases are. Resentment of delicate tissues against this more or less constant offense causes blood vessels in the membrane to become dilated. More or less inflammation develops. The small mucous glands which furnish a thin secretion to lubricate the surface are driven to greatly increased effort, in try- ing to wash away the irritation. Combination of these factors pro- duces the angry, inflamed, wet appearance of the smoker's throat. Extension of this irritation toward the larynx, or voice box, together with the contact of excessive secretions upon very sensitive tissues of that region, gives the smoker's cough, which racks the individual when he lies down at night. During sleep, a gradual accumulation of the stringy mucus occurs in the throat. The first movement upon awakening changes the material to a new area of membranes, not gradually dulled in its sensitiveness by the slowly increased weight of the fluid, and instantly the morning "spell" of coughing begins. That cancer of the lips, tongue and voice box is often initiated by the chronic irritation of inveterate smoking seems an accpted fact, though there are still some few men who doubt the connection. However, no informed person has any misgivings as to the more frequent occurrence of these dread troubles among men addicted to smoking. President U. S. Grant and Emperor Frederick, the Kaiser's father, each died of cancer of the larynx in culmination of a life of immoderately heavy smoking. Cancer in this location is especially deadly; and, even though discovered early in its course, few indeed are they who survive it. Upon the Lungs. Naturally enough, some extension of the marked irritation from the throat into the bronchi or passages leading to the lungs will occur. Quite possibly this accounts for part of the smoker's cough- *"A membrane — lining those canals and cavities of the body which communicate with the external air, such as the digestive tract and its branches and the breathing passages. — Dorland.

12 IMPROVEMENT ERA ing. Indeed, Dr. G. B. Webb, writing in Military Surgery, says that physicians giving special attention to diseases of the chest have clear- ly recognized a cigarette bronchitis; and that the majority of cigar- ette smokers show it, upon examination of their lungs. Later in his paper, Dr. Webb also makes this statement: "Regarding the soldiers who were found Boards, the table shows a somewhat larger tuberculous by xhz author and his co- per cent of non-smokers was discharged workers in War Department Tuberculosis than of smokers." This simply indicates that men whose lungs are free of the effects of tobacco have been shown to stand a better chance of re- covering from the dread tuberculosis of the lungs, which annually slaughters so many of our American people. Physicians in the actual practice of medicine invariably recog- nize that a man with tobacco-sodden body is a poor risk in any acute infection of the lungs, such as pneumonia. Dr. P. K. Holmes, in the American Journal of Public Health, states that the mortality among smokers is higher than among non-smokers, in tuberculosis sanitoriums; and that smoking lowers resistance of mucous mem- branes of the lungs, thus making them more susceptible to infection. Dr. Seaver, director of the Physical Laboratory of Yale Uni- versity, tabulated the physical measurements and records of men entering the University over a period of nine years. Summary of his records showed, among other things, that the lung capacity of smok- ers averaged thirty cubic centimeters less than that of non-smokers. According to other observers, the decrease amounts to 9.4% of the normal volume for such individual. Upon the Digestive System. Not much data is yet available concerning any specific action of tobacco upon the digestive apparatus. The most definite pub- lished material comes from Dr. T. Hayashi of Shanghai, whose ex- perimental work strongly indicates that nicotine has a decided ef- fect upon the stomach, at least. He has shown that injection of minute quantities of nicotine beneath the skin of a guinea pig promptly produces an ulcer of the stomach. It is also a common observation that smoking dulls the appetite for food, which prob- ably means that there is a certain degree of depression of the glands which provide the digestive juices. Of course, nausea and vomiting are always included in the picture of acute poisoning from tobacco, as almost anyone who uses the drug can testify. However, as body tolerance to it is acquired, the insult is accepted without any particular excitement on the part of the stomach.

TOBACCO AND HUMANITY 13 Effects Upon the Glands of Internal Secretion.1 Consideration of tobacco's effect upon the glands of internal secretion must of necessity overlap the discussion of its action in other places. However, there are several points that belong here and do not fit in elsewhere. Part of these glands are known to control growth and normal development, of body as well as of mind; and there is strong evidence to indicate that the failure of a young boy to attain reasonable physical and mental stature under the influence of cigarette smoke is in part, at least, due to nicotine's effect upon this system. Regarding this aspect, Dr. T. H. Barnes, writing for the Medical Times, has the following to say: "Between the ages of ten and eighteen, develop into a strong, vigorous man. Dur- boys pass through the period of greatest ing this period of greatest development, one physical development. The bony frame- has no right to do anything which will work enlarges and becomes more compact, prevent the best use of one's physical and the muscles round out, weight increases, mental powers. Whatever hurts the body and the body begins to show the first signs certainly has its influence on the brain; of oncoming manhood. This is the time and if dissipation of any kind is carried when one must be most careful, if he is to on. the body as a whole must suffer." Certain others of this little-understood group of glands have to do with determining sex characteristics. While recognized evi- dence of tobacco damaging seriously the sexual apparatus of the human male is meagre, there is undoubted proof of its action upon that of the female. Women who have long been addicted to smoking undergo a coarsening of feature, with marked increase of hair upon the face. This hair, which normally is fine and usually almost un- noticeable, becomes more plentiful and less fine, approaching the nature of the man's beard. There are also other effects, which we shall discuss under another heading. Acting upon the adrenals,3 nicotine exerts an influence to in- crease their activity. Additional secretion from these structures has much to do with the increased blood pressure and added load placed upon the heart, which is common among persons addicted to the use of tobacco. Upon the Heart and Blood Vessels. Next to the nervous system, the heart and blood vessels of man are called upon to endure and resist the most direct action of tobacco's poisoning. Being one of the most vital systems of a living 2The glands of internal secretion comprise a system of secreting bodies, the cell structure of which is similar to that of glands producing saliva and tears. However, these structures which are placed about in different parts of the body, have no ducts to carry their secretions to the place they are to be used. From them the blood stream absorbs their products and carries them throughout the body. The thyroid gland in the neck is a member of this group. 3A little gland located upon the upper end of each kidney. Also called "supra-renals;" and from them comes adrenalin, a solution much used in medicine.

14 IMPROVEMENT ERA body, the circulatory apparatus is made up of several parts, each of which is finely adjusted and minutely balanced with its fellows to accomplish the exactness of functions so necessary, if each cell of the many billions in man's body is to receive its required portion of at- tention at the proper instant. True, heart and blood vessels neces- sarily depend upon other vital auxiliary groups or systems; but allow the heart to stop its ceaseless effort for as few as two or three minutes and life naturally ends. All other divisions of the physical and mental structure may, and do, rest at intervals; but not so the heart and its helpers. Given a tremendous job at best, they are compelled to keep unfalteringly at it throughout every minute of the individual's life. Any necessary repairs must be accomplished with the machinery going full speed. Such a mechanism seems al- most super-natural; and it is indeed not strange that its component parts should sometime wear out, even with the best of care. How much greater, then, is the likelihood of this where the individual's carelessness subjects them to unnecessary strain or injury. Tobacco exerts its effect upon the human heart in at least three ways: First, it directly poisons the heart muscle cells so that they lose a certain percentage of their normal ability to do with ease the work placed upon them. Second, it acts upon the adrenal glands to increase blood pressure slightly, thus adding to the resistance which the heart must overcome in pumping blood through the vessels. Taken together, these mean that it decreases the heart's power of doing its work, and at the same time increases the load, making its work more difficult than normal to do. In other words, it is the same as feeding our horse poisoned rations, then adding more burden to the wagon which we will force him to pull. Third, tobacco acts upon the nerves which control the heart rate; and cause it to be- come more or less irregular in its action. Mr. W. L. Holt, in the Journal of the American Statistical Association (1922-23), says that, in a study of two groups of college students, one of smokers and one of non-smokers, it was found that sixteen per cent of the smokers had abnormal hearts. Among the non-smokers only five and six-tenths per cent showed such abnormality. This seems a striking difference; and were it supported by the testimony of only one observer, its accuracy might justly be doubted. However, all investigators, who are looking for facts regarding this particular phase of tobacco's action, are agreed that it does markedly affect the heart. The rate of the heart beat is affected by many things, in health. An infant's pulse rate usually runs about 140 per minute, at birth. As development proceeds toward adult life, gradual slowing of the pulse occurs until it strikes a normal pace for the individual. This

TOBACCO AND HUMANITY 15 is usually between sixty and seventy-six per minute. Excitement, grief, physical exertion, anger and other such factors increases the heart rate. In illness it is usually decidedly more rapid, where there is fever, or where blood pressure is either raised or much lowered from the normal level. If we take sixty-four beats per minute as an average normal speed, we have a heart beating 3,840 times an hour, or 92,160 times in twenty-four hours. Should we then take into the body some drug which constantly effects an increase of only five beats per minute, we have added an extra task of 300 beats per hour, or 7,200 for each twenty-four hour day. It is a well-known fact in physiology that the heart muscle, into each beat or contrac- tion, places its whole energy. There can be no half-way action of this organ — it either contracts with all the power it possesses at that particular instant or it does not contract at all. Consequently, the addition of 300 such heroic efforts to each hour of a person's life can have but one result — to shorten the length of time over which such a heart may continue to do its work, even if no dire emergency in the form of severe illness should come along. The use of tobacco does increase the heart rate. How many beats faster it will go depends upon the individual vitality, tem- perament and state of health; but it has been estimated that the in- crease averages from two to ten or more contractions per minute. Naturally, too, when we speed up the heart, we shorten proportion- ately the rest period of the muscle, and thereby add another factor to the already great number tending to wear out this most vital organ. To sum up then, we have a poisoned muscle forced to do more than normal work with lessened time for rest and nutrition. Is it any wonder that the cigarette smoker's heart gives way under sud- den strain, leaving him drawn and pale, with staring eyes and struggling fanatically for sufficient air to oxygenate his long-abused blood stream? The great marvel is that it happens so seldom, ex- cept that a smoker's nervous system is so affected as to make him less anxious for any undue exertion. Dr. P. K. Holmes, in The American Journal of Public Health, remarks that the use of cigarettes has increased seven hundred per- cent in the United States, in the course of the last forty-five years. During that period, he states, diseases of the heart and blood vessels, such as apoplexy ("strokes") and Bright's disease have grown much more common. In fact, these conditions, together with hardening of the arteries, are more prevalent among American men between forty-five and sixty years of age than in any other race in the civil- ized world. So many more men than women are affected by those diseases that thinking people are beginning to ask if there is not some conection with the immoderate use of tobacco.

1 6 IMPROVEMENT ERA To quote Dr. Lorand again: "Tobacco exerts a very harmful in- type of this condition, that which involves fluence upon the condition of the blood hardening of the coronary" arteries, sup- vessels, both in animals — according to a plying blood to the heart muscle and which series of investigation in them — and in results so exceedingly often in sudden, pre- man. Perhaps even more than alcohol, it mature death, is commonest among heavy is, next to syphilis,1 the most frequent smokers, particularly if syphilis has pre- cause of arteriosclerosis.5 The most serious viously been present." During our recent World War, great enthusiasm was shown by many well-meaning ladies' organizations in America, in sending veritable shiploads of cigarettes to our soldiers overseas. Being under tremendous strain of anxiety and uncertainty, the American soldier consumed these furnished smokes at a terrific pace. As a direct result of this circumstance, it was necessary to establish a spe- cial hospital camp to care for hundreds of tobacco heart cases, due to excessive smoking. Disabled and unfit for service, these men were sent to the hospital and their smoking restricted, which resulted in prompt recovery and return to the front. In certain sections, especially of the South, a great deal of "Copenhagen" snuff is used. This is pulverized tobacco; and is per- nicious in its effects, being used by young as well as old. According to Dr. J. A. Heilscher, in the Saint Paul Medical Journal, this pro- duces a type of heart trouble in which there occurs palpitation or discomfort especially when lying down, increased blood pressure, and shortness of breath. The heart sounds of such a person are harsh and abnormal; and upon exertion, there is decided evidence of leakage of blood through the closed valves. Headache, dizziness, loss of ap- petite and trembling of the hands are common among snuff users. In summarizing the action of tobacco upon the heart and vessels, Dr. A. E. Gibson, in the Medical Standard, of Chicago, says: "The ring of potency, the flush of the heart, which, like a muffled drum is power, the buoyancy of freedom is lost to beating funeral marches to the grave." Tobacco and Human Sight. Tobacco's ability to impair human sight was long debated. Some men maintained that the peculiar loss of vision observed in certain smokers was due to some other factor. However, it is now commonly recognized that there is a form of blindness due wholly to man's addiction to this drug. To say that it, even in a slight degree, attacks all smokers, or even all who smoke heavily, were not 'Syphilis is the most terrible of all venereal diseases. 'Arteriosclerosis means hardening and degeneration of the arteries, large and small. 'The coronary arteries are those which carry blood to the heart muscle itself; and are the only source of its nutrition.

TOBACCO AND HUMANITY 17 to tell the truth; but certainly all who use tobacco in any form in any degree are liable to loss of vision. Nor is it limited to the smoker alone; but is found among the users of snuff and those who chew tobacco. For some singular reason, this form of vision loss is scarcely known in Turkey and Spain, where tobacco is smoked in tremendous quantities; but in North America it is rather frequently met with. This is probably a question of race susceptibility. Affection of the eyes by tobacco takes two forms, one acute and rapid in occurrence, the other slowly appearing and chronic in nature. The acute form is likely to appear after a smoking debauch in a person who has not formerly smoked heavily. It is not uncom- mon among young women who adopt smoking, and as in other things, take to it with amazing immoderation. In this type of af- fection there is almost total blindness, coming on over night. Separa- tion of such an individual from the drug, together with measures for elimination of absorbed poison, usually results in return of vision after only a few days. Should such a person fail to refrain from tobacco thereafter, she is a good prospect for the chronic form. The second type of blindness affects only that part of the eye having to do with most acute vision, or, as it is called medically, central vision. The minute macula, or yellow spot, of each retina is the most highly developed portion of that extremely delicate structure; and with it alone are we able to see the object we look directly at. Other elements of the retina surrounding this are concerned with more gross vision, or the seeing rather indefinitely of objects circumferential to that upon which we, for the moment, fix our attention. In other words, if one looks at a pencil lying upon the table, one sees minute details of the pencil; but, while looking directly at it, is able to ob- serve very little of the exact properties of a book at one side, or of a letter upon the opposite side of the pencil. As nicotine first manifests itself upon the nerves of vision, there is a loss of the ability to tell accurately the color of an object looked at, unless it be so large as to extend outside the field of central vision. With such disability, all too often unsuspected, a locomotive engineer does not recognize the red signal light, and carries his train swiftly into disaster. Dr. Edward Jackson, than whom there is no more scholarly authority upon matters of vision, says this condition, which may come on within a few days after the eyes have been tested and found normal, undoubtedly accounts for some of the accidents where trainmen have failed to obey signals. The earliest evidence to the individual of his trouble is the appearance of a little cloud over any small thing he looks directly at. This is nearly always present in both eyes, though it is said

18 IMPROVEMENT ERA frequently to be worse in one than in the other. Such a person is at once unfitted for such work as is done by draftsman, bookkeeper, artist, machinist, editor, dentist, surgeon, or any other work whose duties require accurate vision. As time goes on the cloud grows larger, until it covers so much of the visual field that the individual is entirely disabled from any kind of effort except the most gross, in which he can almost feel his way. This does not mean total blind- ness, however. Such an individual may get about with ease, and may remove himself from the path of any danger coming from either side; but for all that he is industrially blind! Upon reading this, many will no doubt remark that, among the hundreds whom they personally associate with who use to- bacco they have never found one such case. This may be quite true. It is a generally recognized fact that drug action varies with- in extremely wide limits, upon different individuals. There are many who might literally smoke themselves to death, and not ex- perience this destruction of vision. Upon the other hand, it is well known that as little as one ounce of tobacco used per week will bring on blindness in other persons. For some reason, this con- dition is not usually found in early life; but comes on later. Dr. Edward Jackson, in his little pamphlet from the Conservation of Vision Series of the American Medical Association, entitled How Whiskey, Tobacco and Drugs Affect the Eyes, remarks: "The patient's age has an important half before the trouble with seeing be- influence in causing such blindness. The gins. Apparently with age the power of great majority of cases occur in men over the optic nerve to resist the poison be forty years old. They may have smoked comes less. — When this failure of vision or used tobacco from boyhood and never occurs before the age of forty, the general have had the sight affected by it. They health has mostly been impaired, either by may not at the time be using any more excessive use of tobacco, or alcohol 'stimu- than they have used for years; or may even lants,' or by other excesses." have reduced the amount as much as one- While it is undeniably true that hundreds of persons smoke throughout life without ever having their vision impaired, it is also certain that there is no mortal way of determining to which ones of a given group the lot may fall. Man, and especially youth- ful man, is always ready to take certain risks and defy the caprice of Fate; but when he finds himself enmeshed in unexpected mis- fortune which may make of his life an unsalvagable wreck, he is usually inclined to bemoan the punishment of an "unjust God" instead of placing the blame upon his own ignorant carelessness. As to the remedy for tobacco amblyopia, as this form of blind- ness is called, there is only one in the early stages, and in the more advanced none. If the victim of such trouble stop his use of tobacco

TOBACCO AND HUMANITY 19 as soon as he finds his eyes being troubled, his vision will prob- ably return to normal. Should he be so fortunate, he must for all time forswear tobacco; because any further use of the drug will bring on actual degeneration of those particular fibres of the nerves of vision and their replacement by scar tissue. Effect Upon Hearing. Just what tobacco does to the nerves of hearing, is as yet little understood, and is at present the subject of experiments being car- ried on by some most able men. Dr. Otto Glogau, of New York City, in a recent paper, reported observations pointing conclusively to the fact that nicotine poisoning leads to hearing defects and vertigo or dizziness. These conclusions are borne out by the daily experiences of specialists in diseases of the ear who attempt to treat deafness. In fact they know full well they can do little for im- paired hearing in the smoker until he has completely abandoned his use of the drug. In the realm of discomforts not actually classed as pain, there are indeed few things so annoying and distracting as noises in tht head or in the ears. The condition is the more terrible, in that it is always worse during the quiet hours when the affected one would compose himself to rest. Many observers have noted that, in peo- ple addicted to the use of tobacco, this is likely to be due to nicotine poisoning, granting, of course, that it might come from other causes, as it does in the non-smoker. (Concluded in December number) No Tragedy Save in Sin With your shoulders bowed and your heart grown numb. O Boy, in your first dismay! You wonder: O why should such grief come, To darkle your springtime day? I hold you close as the tide sweeps in, But there is no tradegy save in sin! Your eyes search mine for enlightenment. O Boy, in your crushed romance! And I wonder, too, why the innocent Must battle with circumstance; But I know, as I scan your soul within. There is no tragedy save in sin ! In the welter of doubt your senses reel, O Boy, in your early woe! But your dean-spun life is its own appeal. And of this, my dear, I know — You mount through sorrow, and. Boy. you win — There is no tragedy save in sin! Mesa, Arizona. BERTHA A. K.LEINMAN.