Within the last quarter of a century, the growth of the tobacco habit in all parts of the world, and particularly in the United States, has been phenomenal.

The world's production of tobacco was in 1894, 1,560,000,000 pounds; 1913, 2,722,000,000 pounds.

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Increase, 1,162,000,000 pounds or an increase of 74 per cent in 19 years.

In the United States the production of tobacco was in 1894, 360,000,000 pounds; 1914, 1,034,000,000 pounds; 1930, 1,508,000,000 pounds, an increase in 26 years of 319 per cent.

The per capita consumption of tobacco in the United States in 1880 was 80 ounces; in 1914, it was 112 ounces, and in 1920, about 180 ounces.

The following table compiled by the Census Bureau shows the enormous increase of the cigarette habit in ten years as shown by the number manufacured:

The above figures show an increase of more than 59,000,000,000 cigarettes in 38 years or nearly 2,000 per cent, an unparalleled example of rapidity in the spread of a disease-producing vice. Continued increase at the same rate will produce in the year 1930. seventeen cigarettes daily for every one of the 115 million men, women and children now living under the American flag.

Of the 62,000.000,000 cigarettes manufactured in 1920, 46,000.000,000 were consumed in this country (Department of Commerce), or 460 cigarettes for every man, woman and child in the United States.

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The Properties of Tobacco

The several varieties of tobacco differ greatly in the amount of nicotine which they contain, as shown by the following table published by the American Druggist:

Nicotine Content of Different Tobaccos

From the above it appears that the nicotine content of tobacco varies between 1 and 9 per cent. according to the variety of tobacco. In general, pipe tobacco contains the most nicotine.

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The average nicotine content of all tobaccos is probably about 3 per cent. The billion pounds of tobacco raised in the United States annually, contains, then, 20 to 30 million pounds of nicotine, each drop of which carried death-dealing properties second only to those of prussic acid, the deadliest of drugs.

The Composition of Tobacco Smoke.

The burning of tobacco in pipe, cigar or cigarette, gives rise to various substances which are not originally found in the tobacco leaf. According to Dr. J. Dixon Mann, F.R.C.P. (British Medical Journal, 1908) tobacco smoke contains a formidable 1ist of poisons among which are the following:

The United States Dispensatory notes in addition to the above

Three other poisons, pyrrol, formic aldehyde and furfurol are mentioned by Arnold.

Nicotine Not Destroyed in Smoking.

It thus appears that tobacco smoke contains not less than nineteen poisons, every one of which is capable

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of producing deadly effects. Several of these, nicotine, prussic acid, carbon monoxide and pyridine are deadly in very small doses so that the smoker cannot possibly escape their toxic effects. To these poisons are attributable the various destructive effects upon heart, lungs, liver, kidneys and other bodily organs that are described in succeeding chapters.

The idea generally held that the nicotine is practically destroyed so that little of the poison is absorbed has been shown to be an error. The London Lancet, one of the leading medical journals of the world, a few years ago made a careful study of the composition of tobacco smoke as determined by improved methods of chemical analysis. It was found that tobacco smoke always contained nicotine, the amount varying with the variety of tobacco and the mode of using. Some tobaccos gave off in the smoke only 10 per cent of their nicotine content, while the smoke of others contained four-fifths of the total nicotine present. Pipe smoke contained most nicotine, sometimes more than 2 per cent. Cigar smoke contained less and the cigarette least.

Cavendish smoke contains more than 4.00 per cent of nicotine and Perique 5.3 per cent.

But the cigarette was found to contain another active poison, furfurol, which though less active than nicotine is fifty times as toxic as alcohol (Lancet). In very minute doses it produces staggering, trembling and twitching. Larger doses

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produce convulsions resembling those of epilepsy and muscular paralysis. So what the cigarette lacks in nicotine it makes up in furfurol.

Furfurol is the characteristic ingredient of bad whisky. It is highly pungent and acts as a powerful irritant to the mucous membrane of the throat. There is as much of this poisonous furfurol in the smoke of one Virginia cigarette as in two ounces of whiskey. (Lancet.)

It is interesting to note that the symptoms characteristic of furfurol tally closely with those which result from cigarette smoking. (Lancet )

The British Medical Journal has shown that cigar smoke contains less nicotine than pipe smoke because the nicotine is condensed in the stump. Analysis shows that a cigar stump contains five times the original amount of nicotine. After the first half of the cigar has been smoked, the remaining half contains most of the nicotine of the whole and further smoking results in the inhalation of much nicotine.

Carbon monoxide and ammonia are other poisons found in very appreciable quantities in tobacco smoke. The first named is a highly active blood poison; it damages the red cells of the blood and thus produces a condition akin to suffocation.

Acrolein, a highly irritating poison, is produced by the burning of cigarette paper.

A cigarette weighing one gram gives off, when smoked, more than half a grain of nicotine, half a grain of ammonia, and one-seventh of a grain of pyridin.

An ounce of tobacco produces, when smoked, one-fifth pint of carbon monoxide.

Tobacco smoke contains one-sixteenth of 1 per cent. of formaldehyde, according to Dr. Arnold (London Lancet).

According to Dr. Spitzka, the smoker of cigarettes who "inhales," may absorb so much as 79 per cent. of the nicotine of the smoke, which in turn may contain half or even more of the nicotine content of the tobacco, besides pyridine, carbon monoxide and other worse poisons.

Tobacco More Poisonous Than Deadly Nightshade.

Deadly nightshade belongs to the same botanical class of plants, but is less poisonous than tobacco; yet who would think of smoking this noxious weed.

The habitual smoker lives in a chimney, or rather, he himself becomes a part of a chimney in which is burned a poisonous weed.

In view of the above facts it is evident that every package of cigarettes ought to bear a skull and cross bones and should be marked "deaidly poison" like "Rough on Rats" and other deadly drugs.

Poisonous Effects of Tobacco on Plants.

In an article published in Die Umschau a few years ago (1911), Prof. Mölisch, an eminent scien-

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tific authority, summarized the results of an exhaustive research upon the effects of tobacco smoke upon growing plants. We quote the following condensed summary of these interesting observations from the Scientific American Supplement (Sept. 23, 1911):

Tobacco Intoxicated Plants

"Very young seedlings of peas (Vicia Sativa), about one-tenth-inch high, were placed on a piece of tulle, which was stretched over the mouth of a jar so nearly filled with water that most of the roots were immersed, while the stem and seed leaves were above the cloth. A large beaker glass of more than one gallon capacity was inverted over the jar, with its mouth resting on a plate and sealed by a shallow layer of water. The operation of covering the jar with the beaker was conducted in front of an open window, in order to fill the vessel with pure air. The beaker was then slightly tipped and three mouthfuls of tobacco smoke were blown into it through a bent glass tube. Another jar similarly planted and covered, but not smoked, served as an object of comparison. Both beakers with their contents were covered with zinc covers which completely excluded the light, and were kept in the green-house at a temperature of 60 to 65 deg. F. Six days later the two Jars presented the appearance shown (see cut) in which the injurious effect of the tobacco smoke is startlingly evident.

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"The plants in the left hand jar, which had been exposed to the smoke, were greatly stunted and their thick stalks grew obliquely, horizontally, or even downward, while their buds showed scarcely a trace of the red tint of anthocyan which tinged most of the buds of the plants which had grown in pure air.

"When the seedlings are grown in water, a single mouthful of tobacco smoke is sufficient to produce a marked effect and, what is more surprising, if the beaker is filled with tobacco smoke, rinsed with water, allowed to stand 24 hours, and then filled with pure air and inverted over the young plants, an appreciable effect is produced by the vaporisation of ingredients of the tobacco smoke which have condensed on the inner surface of the beaker and have not been removed by washing.

"Very similar results were obtained with seedlings of peas, pumpkins and beans. The accompanying cuts show the enormous effect upon the growth of these plants.

"The experiments show plainly that tobacco smoke greatly diminishes the length and increases the thickness of the stem, and destroys its natural negative geotropism. i.e., its tendency to grow vertically upward. The smoked seedlings often assume a horizontal or inclined position, an appearance quite similar to that observed by Nel-

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jubow and Richter in young plants growing in laboratory air.

"The effect of laboratory air upon plants has been attributed, probably correctly, to traces of illuminating gas and the products of its combustion. Tobacco smoke unquestionably exerts a similar effect and in future experimentation with plants more attention must be paid to this influence.

"The fact that greenhouse plants are apparently not injured by fumigation is due to the circumstance that the influence of the tobacco smoke is usually exerted only for a night, after which the house is thoroughly ventilated, and that the damp walls and soil purify the air by absorbing the smoke.

"But in ill-ventilated rooms in which tobacco is often smoked in large quantities, and in which no such rapid absorption takes place, plants must suffer greatly. The peculiar morbid appearance exhibited by plants growing in dwellings, restaurants and shop windows is due partly to darkness, dust, and dryness, and partly to impurities derived from illuminating gas and tobacco smoke."

It is probable that the toxic effects of tobacco smoke upon plants was not due to nicotine, but to pyridin, sulphuretted hydrogen and carbon monoxide, which are found in the smoke of all varieties of tobacco and in about the same proportions, and which must act as injuriously upon human beings as upon plants, and especially upon young children and infants.

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The Destructive Effects of
Tobacco upon the Lungs

The lining of the air tubes and cells of the lungs presents an extraordinarily extensive absorbing surface, about 1000 square feet of surface under which a volume of blood equal to all the blood m the body courses every minute. Through the extremely delicate covering of this "respiratory field", gases of all sorts pass into the blood with the greatest facility. So rapid is this absorption that nicotine or any other poison introduced into the body in gaseous form enters the blood and saturates the tissues far more quickly than when introduced in liquid form into the stomach or by hypodermic injection.

A single cigarette may contain a grain of nicotine, at least half of which enters the lungs and in part, at least, the blood. A cigar contains three or more times as much tobacco as the cigarette, hut less nicotine is absorbed because the smoke is not inhaled.

Besides the nicotine there are all the other poisonous products which are always present in smoke, creasote, pyridine, Prussic acid, furfurol. The complacency with which smokers and sometimes nonsmokers, ladies, perhaps, often sit for hours in a room the air of which is blue with tobacco smoke, is an evidence of the blunting effect of nicotine upon the normal sensibilities. Smoke from any other source

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would not he tolerated. Yet smoke is smoke, and tobacco smoke does not differ essentially from other smoke except by the addition of nicotine, and other poisons much worse than those of ordinary smoke.

The well known irritating effects of smoke upon the respiratory membranes easily explain the injurious effects from tobacco smoke observed in the throats of smokers.

Smoker's sore throat is a condition very familiar to throat specialists. The highly irritating and injurious effects of tobacco smoke in cases of chronic disease of the throat and lungs from other causes is also well known. So long as the patient continues to smoke his throat maladies are incurable; but from the moment he lays aside his pipe or cigar, recovery begins.

It is largely through the injury inflicted upon the naso-pharyngeal mucous membriane that smoking impairs the hearing and the sense of smell.

Sir Morell Mackenzie, the famous London throat specialist, is quoted by a London author as saying that:

"In considering the evils produced by smoking, it should be borne in mind that there are two bad qualities contained in the fumes of tobacco. The one is the poisonous nicotine, and the other is the high temperature of the burning tobacco. The cigarette, which is so much in vogue nowadays, is most certainly the worst form of indulgence, people being tempted to smoke all day long. and easily ac-

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customing themselves to inhale the fumes into their lungs, and thus saturating their blood with the poison."

And again, "Unfortunately it is not necessary to smoke to be a victim of tobacco. Many persons find their neighbors' pipes or cigars very trying, and, for a person with a delicate throat, exposure to an atmosphere laden with the fumes of tobacco is even worse than smoking."

Smoking Leads to Consumption.

The unusual liability of cigar workers to tuberculosis or lung consumption has long been noted. Attention has even been called to the danger of contracting the disease through the use of cigars by reason of the liability of infection through handling by persons suffering from the disease.

In a paper read by the author by request before the National Association of Life Underwriters, at its meeting in New York City (1918), attention was called to certain statistical facts which seem to show that tobacco is a potent factor in causing pulmonary tuberculosis in men. It was shown that for every 100 females who die of tuberculosis, there are 137 male decedents, an excess of 37 per cent, although the excess of males in the population is only 2 per cent.

It was further shown that,

"Up to the period of 25 years, however, the female decedents are greatly in excess of the males, show-

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ing 122 female deaths to 100 males. Beginning with the twenty-fifth year, however, the figures are reversed, the disparity steadily increasing to a maximum of 243 male decadents to 100 female decedents at the age period of 50-54 years.

"The average for the entire period from 25-70 years is 166 male deaths from lung tuberculosis to each 100 female deaths.

"There certainly must be some definite reason for this very great preponderance of male decedents from an infectious disease. That the male constitution is not more susceptible than the female is shown by the preponderance of female decedents during the first twenty-five years of life, the period of greatest susceptibility to infectious disease. In 1915, between the years of 35-70, male deaths exceeded female deaths to the enormous number of 14,791, or one-fourth of the total number of decedents. During this period, one-fourth of the total number of deaths were due to lung tuberculosis.

"Another point which should be mentioned in this connection is the fact that in certain parts of the country, Michigan, for example, while tuberculosis on the whole is decreasing, the decrease is due wholly to the lessened mortality of females from this disease, since the mortality of males is actually increasing.

"The fact that lung tuberculosis is increasing in males is very significant when associated with another fact; namely, the enormous increase in the

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consumption of tobacco, especially in the form of cigarettes, within the last few years. The increase of tuberculosis in man runs parallel with the increase of the consumption of tobacco."

The Fourth and Fifth Reports of the Phipps Institute of Philadelphia for the study and treatment of tuberculosis present strong evidence of the damaging influence of tobacco in the battle against this most dangerous enemy of human life. The "Fourth Report" (1907) says,—

"We have merely evidence as to the influence of tobacco on the development and mortality of tuberculosis and not upon implantation. The preposterous claim that has been made that tobacco is a preventive of tuberculosis implantation can not be maintained in the presence of the statistics of a large number of tobacco users who have developed tuberculosis. More than two-thirds of the males who applied for treatment used tobacco in one form or another. The statistics here given, if they have any meaning at all, would seem to indicate that the use of tobacco has a predisposing influence for the implantation of tuberculosis. In fact, the extensive use of tobacco by males may be one of the explanations why tuberculosis is at present so much more prevalent among males than among females.

"The damaging influence of tobacco in tuberculosis is probably exercised through the circulation. Tobacco undoubtedly depresses the heart and interferes to some extent with vigorous circulation. It is generally conceded that anything that depresses the cir-

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culation interferes with nutrition and consequently predisposes to tuberculosis both in implantation and development."

The Fifth Report (1908) gives us the following most significant facts which have never been invalidated or disputed:

"We now have statistics for two years on the use of tobacco. During the fourth year 73.01% of the males used tobacco and 26.98% did not use it. For the current year (Feb. 1, 1907, to Feb. 1, 1908) 78.95% used it and 21.04% did not use it. During the fourth year 61.80% smoked only, 8.38% chewed only, and 29.81% both smoked and chewed. During the current year 63.77% smoked only, 7.18% chewed only, and 29.01% both smoked and chewed.

"As with alcohol, so with tobacco, the mortality was much greater among those who used it than among those who did not use it. During the fourth year 18.58% of those who used tobacco died, as compared with 5.15% of those who did not use it; and during the current year 15.30% of those who used tobacco over those who did not use it is as great as the excessive mortality among those who used alcohol over those who did not use it.

"Alcohol and tobacco give no protection against tuberculosis, as has been claimed by some people. The striking preponderance of mortality among patients who used alcohol and tobacco as compared with those who did not use them, moreover, warrants abstinence on the part of all who are suffering from tuberculosis in active form."

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Dr. Wright of St. Mary's Hospital, London, found that nicotine greatly lowers the tuberculo-opsonic index, one of the most delicate means of measuring the resistance of the body to the tubercle bacillus. In one case reported by Wright, that of a cigarette smoker, the index was reduced to zero. The patient died three weeks later.

Dr. Webb, a famous lung specialist, of Colorado Springs, observed in the examination of thousands of soldiers at the various camps during the war, that cigarette smoking is an active cause of chronic bronchitis. He reported the finding of "ronchi'' in the lungs of nearly all smokers. Ronchi mean irritation, and irritation means low resistance, an open door to tuberculosis.

Destructive Changes in the Heart
and Blood-Vessels Caused by Nicotine

Adler and Hensel (1906) injected 15 deci-milligrams of 1 to 200 solution of Merck's nicotine intraenously (1/12 of a cigarette 1/40 of a grain). After 18 injections marked changes in the aorta made their appearance. These changes involved the entire aorta to the ileac bifurcation. They became most marked after 38 to 50 injections.

Gebrowsky and Papadia (1907) observed similar changes in the aorta.

Gy observed that the effects of nicotine are less marked than those of tobacco for the reason that nicotine does not represent all the poisons found either in tobacco or tobacco smoke.

Boveri observed atheroma of the aorta and hypertrophy of the suprarenal capsules (degeneration of the kidney).

Bylac obtained identical results and observed also aneurisms of the aorta and calcareous plaques (arteriosclerosis) in a rabbit weighing two kilograms, which was given in the course of 38 days, 35 c. c. of a 10 per cent infusion of tobacco by intravenous injection.

Lesieur (1907) observed lesions of the aorta as the result of subcutaneous injections of infusions of

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French and English tobaccos. The alheroma (calcereous degeneration) was most often found at the arch of the aorta.

The appearance of these lesions is always the same, whether produced by lead, tobacco, adrenalin, oxalic acid or digitalis.

The atheroma is, according to Josué, a process of defense. There is first a simple thickening of the elastic and muscular tissues of the artery. Later degeneration occurs because of disturbance of the circulation.

Claude Bernard made a microscopic study of the effects of nicotine upon the blood-vessels of a frog's foot. He found that the vessels contracted so strongly that they were completely emptied of blood.

Lauder Brunton and others have shown that nicotine is a powerful vasoconstrictor.

The violent chill sometimes observed in guinea-pigs after injections with infusion of tobacco, were thought by Claude Bernard to be the same sort of effect as that produced by the ligature of an artery in preventing blond from entering a muscle in causing trembling of the muscle.

Fleig and de Visme have shown that tobacco, no matter in what way introduced, always causes a formidable elevation of blood pressure. This is due to the direct action of nicotine upon the muscular walls of the vessels. Later, this vasoconstriction is followed by a paralytic vasodilatation.

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Gy observed changes in the arteries in two cases as the result of the use of Caporal tobacco.

Boveri produced atheroma in 10 rabbits out of 16.

Degeneration of the Large Arteries.

Baylac obtained the same results in 5 rabbits out of 8; Gebrowsky in 7 rabbits out of 9.

Hypertrophy of the heart is a natural result of the raised blood-pressure.

Examination of the heart tissue showed, in dogs (Favarger), degeneration of the heart muscle.

Gebrowsky found lesions of the ganglia of the heart.

Brooks made postmortem examinations of fifty-four tobacco users and found damaged heart muscles in nearly every case. Fatty and fibroid degeneration and brown atrophy were most common.