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deadly poisons. Few people know that one drop of nicotin on the unbroken skin of a rabbit will produce death.[54] Two drops on the tongue of a dog or cat will prove fatal; moreover, fatal poisonings have occurred in man from swallowing tobacco and even from external application of strong solutions. A case was recently reported from New Haven of fatal poisoning in a baby,[55] who had been fed from a milk bottle and milk-mixture in which some tobacco had been accidentally spilled. SUMMARY

From the mass of evidence and opinion with which medical literature is loaded, a few salient facts stand out:

First: Tobacco and its smoke contain powerful narcotic poisons.

Second: It has never been shown to exert any beneficial influence on the human body in health, and it is not even included in the United States Pharmacopœia as a remedy for disease, notwithstanding the claims that are made for its sedative effects and its value as a solace to mankind. If these benefits are real and dependable, they should be made available in exact dosage and applied therapeutically. If they are not real and dependable in a medical sense, they are not real and safe as a mere drug indulgence.

Third: The symptoms following tobacco-smoking are identical with the effects of tobacco-chewing among those not accustomed to its use; hence, any collateral psychic effect, such as the sight of smoke, the surrounding, etc., are of minor importance in establishing the habit. The main charm to the smoker is the drug effect, as in any other similar indulgence. Nicotinless tobacco is not popular, notwithstanding the efforts of the French and Austrian Governments to make it so.

Fourth: Fortunately, the sedative drug effect is so slight, as compared to that of other narcotics—opium, alcohol, cocaine, etc.—that the tobacco habit is less seductive and may be broken with comparative ease and is therefore less harmful morally. Men who have smoked or chewed steadily for 40 years have been known to give up the habit without experiencing much physical discomfort. Like any other habit, however, there is a tendency to increasing indulgence, and this is a risk that the smoker takes, just as does the alcohol user or the opium habitué who begins with so-called moderate indulgence.

Fifth: The well-known effects of tobacco on the heart and circulation should lead one to pause and consider the possible cost of this indulgence, especially as—

Sixth: It is difficult to determine, years in advance, whether or not one is endowed with sufficient resistance to render so-called moderate smoking comparatively harmless.

Seventh: The vital statistics show that diseases of the heart and circulation are rapidly increasing in this country in which—

Eighth: The per capita consumption has rapidly increased in recent years, while—

Ninth: In the United Kingdom, where these diseases are decreasing, there has been no material increase in the use of tobacco, and the per capita consumption is less than one-third that of the United States.

Increase of Smoking

In 1880 the annual per capita consumption of tobacco in the United States was about 5 lbs., while in 1914 it had risen to more than 7 lbs. In the United Kingdom the per capita consumption is about 2 lbs., and there has been no material increase in recent years.

The cigaret bill, in particular, has grown enormously, having more than doubled in the past five years, while there has been a slight increase in the consumption of cigars, smoking tobacco, chewing tobacco and snuff, as shown in the following table:[56]

Fiscal Year Cigars Cigarets Tobacco, Chewing
and Smoking Snuff 1910 8,213,356,504 7,884,748,515 436,608,898 31,969,111 1911 8,474,962,786 9,254,351,722 380,794,673 28,146,833 1912 8,350,119,103 11,239,536,803 393,785,146 30,079,482 1913 8,732,815,703 14,294,895,471 404,362,620 33,209,468 1914 8,707,625,230 16,427,086,016 412,505,213 32,766,741 Total 42,478,879,326 59,100,618,527 2,028,056,550 156,171,635

Tenth: The poetic effusions of the lovers of the weed are no safer guide than the exaggerated and intemperate denouncements of people who have idiosyncrasies against tobacco and simply hate it.

Eleventh: Those who now smoke should have a thorough physical examination to determine the condition of the heart and blood vessels. This examination should be repeated at least annually, in order to detect any adverse influence on the circulation.

REFERENCES

[38] The Toxic Factor in Tobacco, The Lancet (London), 1912, I, p. 944.

[39] French Department of Agriculture, Compt. Rend. Acad. de Science, CLI, p. 23.

[40] Garner, W. W.: The Relation of Nicotin to the Burning Quality of Tobacco, U. S. Department of Agriculture, Bureau of Plant Industry, Bulletin No. 141, Sept. 30, 1909, p. 15; A New Method for the Determination of Nicotin in Tobacco, U. S. Department of Agriculture, Bureau of Plant Industry, Bulletin No. 102, July 6, 1907, p. 12.

[41] Lehmann, K. B.: Untersuchungen über das Tabakrauchen, Munchen, med. Wchnschr., 1908, LV, pp. 723–25; The Physiological Action of Tobacco Smoke, Med. Rec., 1908, LXXIII, pp. 738, 739.

[42] The Toxic Factor in Tobacco, The Lancet (London), 1912, II, pp. 944–947.

[43] Garner, W. W.: The Relation of Nicotin to the Burning Quality of Tobacco, U. S. Department of Agriculture, Bureau of Plant Industry, Bulletin No. 141, Sept. 30, 1909, p. 15.

[44] Zhebrovsky, E. A.: The Effect of Tobacco Smoke upon the Blood Vessels of Animals, Russky Vratch, 1907, VI, p. 189; 1908, VII, pp. 429–431; Med. Rec, 1908, LXXXIV, pp. 408, 409.

[45] John, H.: Editorial, Jour. A. M. A., 1914, LXII, pp. 461–2; Ueber die Beeinflussung des systolischen und diastolischen Blutdrucks durch Tabakrauchen, Ztschr. f. exper. Path. u. Therap., 1913, XIV, pp. 352–365; Pawinski, J.: Ueber den Einfluss unmassigen Rauchens (des Nikotins) auf die Gefässe und das Herz, Ztsch. f. klin. Med., Berl., 1914, LXXX, pp. 284–305.

[46] Pack, Frederick J.: Smoking and Football Men, Popular Science Monthly, 1912, LXXXI, p. 336.

[47] Fisher, George J. [Monograph not yet published.]

[48] Bush, Arthur D.: Tobacco Smoking and Mental Efficiency, N. Y. Med. Jour., 1914, XCIX, pp. 519, 529.

[49] Mayo, Wm. J.: Personal communication.

[50] Dwight, Edwin Wells: Proc. Assoc. Life Ins. Med. Dir., Oct., 1911, II, p. 474.

[51] Favarger, Heinrich: Experimentelle und klinische Beiträge zur chronischen Tabakvergiftung, Wien. klin. Wchnschr., 1914, XXVII, pp. 497–501; Experimental and Clinical Study of Chronic Tobacco Poisoning, Jour. A. M. A., 1914, LXII, p. 1764; Pekanovits. Effects of Tobacco Smoking, Jour. A. M. A., 1914, LXXII, p. 1907.

[52] Bangs, L. Bolton: Some Observations on the Effects of Tobacco in Surgical Practice, Medical Record, LXXIII, March 4, 1908, pp. 421–23–51.

[53] Cannon, Aub. Binger: Effect of Nicotin Injection on Adrenal Secretion, Jour. Pharm. and Exper. Therap., 1912, p. 381; Editorial, Nicotin and Adrenals, Jour. A. M. A., 1912, LXIII, p. 1287.

[54] Hare, Hobart Amory: Fiske Prize Dissertation, No. 34, p. 1884. Dixon, A. S.: Proceedings of the Academy of Natural Sciences, Philadelphia, Nov. 11, 1884.

[55] Reynolds, H. S.: Jour. A. M. A., May 30, 1914, LXII, p. 1723.

[56] Annual Report of the Commissioner of Internal Revenue, 1914, p. 34, Government Printing Office, Washington, D. C.

Bamberger, J.: Hygiene of Cigar Smoking, Abstr. Jour. A. M. A., 1904, XLIII, p. 706; Zur Hygienie des Rauchens, Munchen. med. Wchnschr., 1904, LI, pp. 1344–1345.

Current Comment: Some New Evidence on the Tobacco Question, Jour. A. M. A., 1912, LIX, p. 1798.

Editorial: The Pharmacology of Tobacco Smoke, Jour. A. M. A.. 1909, LII, p. 386.

Editorial: The Use of Tobacco, Jour. A. M. A., 1910, LX, p. 32.

Editorial: Tobacco-Smoking and Circulation, Jour. A. M. A., 1914, XLII, p. 461.

Hochwart, L. Von Frankl: Die Nervösen, Erkrankungen der Tabakraucher, Deutsch. med. Wchnschr., 1911, XXXVII, pp. 2273, 2321.

Index Catalogue of the Library of the Surgeon-General’s Office, second series, XVIII, pp. 297–306.

Larrabee, R. C.: Tobacco and the Heart, Abstr. Jour. A. M. A., 1903, XLI, p. 50. Read before the Massachusetts Medical Society, June, 1903.

Pel: Un cas de psychose tabagique, Ann. med. Chir., 1911, XIX, p. 171.

SECTION VI
AVOIDING COLDS
Infection

Bacteria play a part in most colds. In some cases there is a general infection, with local symptoms, as in grippe; in others there is a local infection, with mixed classes of bacteria. It is probable that these various forms of bacteria are constantly present in the nasal secretions, but do not cause trouble until the local resistance or the general resistance is in some way lowered.

Nasal Obstruction

In many, the susceptibility to colds is due to abnormalities in the nose or throat. Nasal obstruction is a very common condition. The nose, like the eye, is usually an imperfect organ. These obstructions are often the result of adenoids in childhood, which interfere with the proper development of the internal nasal structures. Malformation of the teeth and dental arches in childhood are frequent and often neglected causes of nasal obstruction. Such malformations are caused by the arresting of the growth of the upper jaw and nasal structures. Correction of the deformity of the arches often renders nasal surgery unnecessary. Such conditions not only predispose to colds, but increase their severity and the danger of complicating infection of the bony cavities in the skull that communicate with the nose. They also increase the liability to involvement of the middle ear and of the mastoid cells which are located in the skull just behind the ear. The importance, therefore, of having the nose and throat carefully examined, and of having any diseased condition of the mucous membrane or any obstruction corrected must be apparent. All who suffer from recurrent colds should take this precaution before winter sets in.

General Resistance

If the nasal passages are put in a healthy condition, strict obedience to the rules of individual hygiene will almost wholly prevent colds. In fact, except where actual nasal defects exist, the frequency of colds is usually a fair indication of how hygienically a person is living. The following points need especial emphasis, though they repeat in some cases what has already been said in the text.

Skin Training

It is a familiar fact that exposure and chilling will often produce a cold. This is usually due to the fact that the nerve centers controlling the circulation of the skin are over-sensitive, and exhibit a sort of hair-trigger reaction to exposure, causing a disturbance of the circulation, and of the heat-regulating machinery of the body of which the spongy shelf-like turbinated bones in the nose are an important part. Skin training, then, appears to be the first hygienic steps toward establishing a resistance to colds.

Such training for the skin may be secured by various means. One should first accustom himself to a gentle draft.

Cool bathing, to a point that produces a healthy reaction, is another important feature of skin training.

Cold bathing, by those affected with kidney trouble, is not advisable, but delicate individuals, who cannot react well to the cold bath, can greatly increase their resistance by graduated cool bathing performed as follows: Standing in about a foot of hot water, one may rub the body briskly with a wash cloth wrung out of water at about 80 degrees F. and reduced day by day until it is down to 50 degrees F. Following this the cold douche or affusion may be taken (water quickly dashed from a pitcher) beginning at 90 degrees F. and daily reducing until 50 degrees F. is reached, or just before the point where an agreeable reaction ceases to follow.

Light Clothing

The wearing of loose, porous clothing, and the air bath—exercise in a cool room without clothing—are also valuable measures in skin training. Very heavy wraps and fur coats should be worn only during unusual exposure, as in driving or motoring. Outer clothing should be adapted to the changes in the weather, and medium-weight underclothing worn throughout the winter season. Office-workers and others employed indoors are, during the greater part of the day, living in a summer temperature. The wearing of heavy

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