The Clinical Aspect of Tobacco Smoking
By EDWIN J GRACE, MD, FACS
Grace Clinic, Brooklyn
ANOTHER very disconcerting feature of many forms of investigation is the lamentable tendency to minimize the degree of the injurious effects which smoking might have on some local area of man's anatomy, thereby blissfully ignoring the tragic consequences it might have on the entire human organism.
If this philosophy is used as the standard for evaluating the problem of smoking in specific relation to man, one becomes immediately impressed by the scarcity of established facts which are presented to the laity, for the only knowledge the latter is able to acquire on the subject is derived from conspicuous advertisements intended for practical and gainful purposes.
Probably the two most serious elements in tobacco smoking are nicotine and tar. The latter generally stains the fingers, lips and teeth, tongue and trachea, and is frequently, but erroneously, called nicotine. Nicotine is an alkaloid present in tobacco, while tar is one of many compounds formed after the tobacco is ignited to form smoke. It is obvious that the products of combustion in smoking cause local irritation of the mucous membranes of the respiratory tract. Cancer of the mouth, lips, tongue, larynx and pharynx is more prevelent in smokers than in nonsmokers, but it has not noticeably increased among women since they have taken up the habit. Personally, I feel that it is too early to draw conclusions regarding this matter, due to the insidiousness and lag in the time element of the factors concerned....
In replying to a correspondent who asked if there was authentic evidence that smoking retarded or stopped improvement in the treatment of peptic ulcer, the Journal of the American Medical Association has this to say: "Smoking may delay healing or favor recurrence of chronic peptic ulcer, particularly when smoking is excessive.... The clinical evidence, however, is equivocal."
Paul White of the Harvard Medical School, when making electrocardiographic studies, demonstrated that the electric impulse generated by each heart beat was radically altered after a very limited amount of tobacco had been smoked....
It is of more than topical interest that the U S Army medical officers are concerned about the overindulgence in the socalled fragrant weed; Major C W Crompton stresses that the health and fitness of these millions of men under arms are of the utmost importance. "It makes a vast difference to you and me whether the men defending our country and us are victims of slow poisoning by nicotine or other drugs, or are on their toes, second to none as physical and mental specimens of the human race." Major Crampton continues to say that "If the nicotine of cigaret smoke is harmful, and it is -- if soldiers smoke more than civilians, and they do -- the physician's duty in the situation is clear."
A summary of Major Crampton's conclusion is that the use of cigarets has increased enormously and is still increasing. The potential toxity of smoking is a matter of the greatest importance to both military and civilian physicians. He asserts that general prohibitions are not yet indicated, but that every reasonable effort should be made to reduce nicotine consumption....
318 patients with cancer of the lower lip were studied by Lamb and Eastkake to determine, among other things, the kind of smoking (pipe, cigar, or cigarets) with regard to treatment and results. They found that the use of tobacco predisposes to leukoplakia, which leads to leukokeratosis and finally to carcinoma [cancer]. Sixty-three patients were cigaret smokers, 52 used a pipe, and 17 smoked cigars.
Shoeneck, in a survey of cigaret smoking in pregnancy, states that the only conclusion that can be drawn from a series of experiments on pregnant rabbits is that exposure to the smoke of one cigaret per day results in apparently deleterious effects upon the offspring. He feels that until it is proved that excessive cigaret smoking is not harmful in pregnancy, it should be cautioned against.
Of a different opinion is Reichel, who has investigated the influence of smoking on young women and children. He points out that chronic nicotine poisoning results in sterility which disappears after cessation of smoking. It is of particular importance to note that in pregnant women the nicotine is immediately transmitted to the child, and an accelerated heart-beat of the fetus has been recorded. Nicotine also is found in the mother's milk, and its secretion is diminished.
In general discussions concerning the preventive aspects of disease one must be appalled by the unbelievable indifference with which the profession as a whole approaches the problem of heavy smoking and its dangers. In spite of increasing literature on the subject in which the possible connection of various disease entities with the absorption of toxic products from smoking is mentioned, there exists an apathy on the part of the profession which gives no great credit to our clinical acumen. This lamentable indifference is probably accentuated by the fact that about 80 per cent of the profession smoke, and ipso facto the habit must be justifiable and commendable. Such evidence, occasionally quoted by so-called authorities, and frequently backed up by commercial associations, is absolute rubbish and represents either abysmal ignorance of the magnitude of the problem, or purposely compromises a philosophy of good medicine. Clinical indifference is further encouraged by the frequency with which critics of this habit are so often considered puritanical and fanatical....
There are two main groups of smokers: one which smokes as a matter of habit, and is able, though with some effort, to stop; the other, which smokes enormous quantities; and is, in many ways, a psychological problem, and its addiction to that habit, like that of a drug or alcohol habitue, is an aid to partial psychic escape.
As may be noted in pipe smokers, the heat generated from the burning tobacco may become a thermic irritant, but by far the most serious toxic factors formed are nicotine and tar. The vasospastic action of the former is well known, but the latter (tar) is a more dangerous element, probably of infinitely greater significance because in this clinical compound we have all the potential elements which, in their specific chemical alignment, are capable of producing malignant tissue changes.
On the basis of this assumption it is interesting to speculate on two clinical entities that are too frequently viewed with indifference: 1. cancer of the lip and oral cavity, and 2. cancer of the lung. The former is most frequently seen in pipe and cigar smokers who rarely inhale, and in whom the irritating substance (tar) is locally deposited (lip and mouth); in cancer of the lung, often occurring in cigaret smokers, this tar irritant is deposited in the bronchi during the process of inhaling. Therefore it becomes immediately apparent that in the heavy smoker tar with its chemical compounds might be an etiological factor in the development of neoplasms.
Toxicologists have already accepted this possible relationship of carcinogenesis from tar, but though volumes have been written on this subject, the preventive phase of the problem is too commonly ignored.
This paper was compiled as a result of impressions gained in observing the last 1000 cases admitted to the Grace Clinic in Brooklyn, N Y, for routine study. The patients were specifically questioned regarding the habit of smoking, and our experience with smokers has brought to our attention innumerable cases which in every detail are identical with many of the above described cases. It is our opinion that in all of them the damaging influence of tobacco has been the most devastating factor, and therefore our plea that the profession become more alert in its attitude toward this most urgent problem which, at present, is so flagrantly ignored.
SMOKE IN YOUR EYES, by Dr Hal Bieler
March 29, 1943 P.4
WHAT HAPPENS when concentrated tobacco smoke is blown into your eyes? After three puffs the inclination to get the eyes away from the smoke becomes imperative. But if the smoke continues the eyes grow red, inflamed and very painful. The conjunctiva becomes swollen and there is a watery exudation. The final result is a pair of painful, red, wet and swollen eyes.
Now, compare the eye to the air-cell of the lung. The eye is a delicate organ, but the air-cell of the lung is exceedingly more delicate and more sensitive, and it also has a much richer blood and lymph supply. The membrane lining the aircell controls the chemistry of respiration. It is thin enough for gases to permeate, while the blood supply is so rich that these gases can be diffused quickly to the cells of the whole body. Oxygen gas is absorbed and carbon dioxide gas is eliminated. The absorption or oxygen allows for tissue oxidation and oxidation is life. This process of oxidation in the body tissues is controlled by the internal secretion of the adrenal glands. The lungs necessarily receive a rich supply of adrenalin through the blood stream. Likewise it is important to note that the lungs have a thick network of lymph vessels which help to carry away irritable wastes.
Now, the difference between the response to irritation in the eye and the air-cell is dependent upon the sensation of pain. The conjunctiva of the eye is extremely sensitive to irritants and registers irritation as pain, which pain impels the owner of the eye to move his eye away from the source of the irritation. But the air-cell Of the lung contains no sensory nerve. Consequently, great damage can be done to the air-cells without the owner of them feeling pain. On the other hand, the aircells of the lung have a rich sympathetic nerve supply which is under the control of the solar-plexus or "abdominal brain." The protective function of this "abdominal brain" is to send more adrenalin to the injured aircells and thus allow for deeper and quicker oxidation and the consequent removal of the irritating poisons. Now, it is well known that when the adrenalin content of the blood stream is raised there is a feeling of well-being and a surcease from nervous tension, and to get this reaction is the average smoker's reason for smoking. Since the air-cells, lacking sensory nerves, can register no pain to their smokerowner they just lie still and "take it" while the chemical response made to this smoke misleads the smoker as to the real effect. The eyes, on the other hand, being "sensitive" and "irritable" cause a motor response which protects their own chemistry and preserves their healthy state.
What is it that these air-cells "take"? Literally they are smoked. The action of smoke on the delicate air-cells of the lung is quite similar to the action of smoke on a fresh ham hung in the smoke house to be "cured." The irritants which the smoke contains shrivel and dry and preserve and harden the exterior of the ham. The surface of the ham is so thoroughly embalmed and mummified that it becomes impervious to the action of bacteria. even at fairly warm temperatures. When smoke is inhaled into the lung the same irritating process takes place. The lung becomes red, wet and inflamed and there is cough and exudation of serum. When the stethoscope is applied "smokers rales" are heard over the entire respiratory tree. The body's defense mechanisms are called into activity and the battle starts between the embalming effect of the smoke and the ability of the adrenal glands to neutralize the irritation and destruction. The absence of actual pain makes the culprit oblivious to the damage and the gentle bath of extra adrenalin enshrouds him in a fool's paradise. Ile is unaware that his lung lymphatics are getting black with tar-like irritants: that the actual breathing capacity of his air-cells has been diminished more than one-half of the normal, and that his resistance to lung cancer, respiratory diseases or to severe infections has been decreased to more than one-half of the normal.
Manpower for Tobacco, Not Food
May 24, 1943, P.4
Both cotton and tobacco, of which the US has a 2-year Supply, are heavy users of manpower. In speaking against the Bankhead-Johnson bill, Senator Kilgore said: "On the basis of our 1943 production goals, we will devote 1,024,000,000 man-hours on the farm to short-staple cotton and 308,000,000 to tobacco. By comparison we will give 228,000,000 manhours to wheat ......
Cotton requires 91 man-hours per acre, as compared with 9 man-hours per acre of wheat and 27 man-hours per acre of corn. Tobacco is a much smaller crop than cotton, but it is an even more intensive user of manpower, taking 617 manhours per acre.
Instead of curtailing cotton production, the "farm bloc" is demanding that further increases be allowed and that all restrictions be removed. (See statements made by Rep Tarver of Ga and Wene of NJ in Hearings on the Agriculture Dep't Approp Bill before the Subcommittee of the Committee on Appropriations, House of Rep, 78 Cong, 1st Session, pages 1356 ff. and 1492 ff.)
Farm bloc-er Herbert Hoover proposed (Feb 9) that a million trained men be taken out of the army for use on farms, in mines and oil wells. Hoover insists that the shortage of foodstuffs makes it impossible for the US to "attempt too much on the military side." Instead of a second front now Hoover tells us to "envisage at least three more years of war ... possibly ... five years."
Despite his alarm over food shortages, Hoover as head of the "Feed Europe" movement urges that we send vast quantities of food to Nazi-occupied Europe. It is apparent that some of the farm bloc-ers are bent on creating food shortage
in order to prevent the US and England from invading Europe and defeating fascism.
Editor's Note: The Farm Lobby is the enemy of the plain farmer. See conclusion of this article, next week. "Facts for Farmers" is one of the few honest publications dedicated to the homestead farmer. The big agricultural press is generally corrupt, published to foot the farmer. "Facts for Farmers," 39 Cortlandt St, New York, 4-page monthly, 25c a year, is highly recommended by IN FACT.
December 13, 1943, Page 4
For Camel Smokers
Deember 13, 1943 p. 4
YEARS ago IN FACT pointed out the two biggest industries which advertise are autos and cigarets, and that about 99 per cent of the American press fakes and suppresses the news when it unfavorable to these two. (60,000 prints of our tobacco issue have sold out, but the exposé by Dr Pearl is reprinted in Facts & Fascism.)
Right now the Tobacco Workers Organizing Committee UCAPAWA-CIO of Winston-Salem, N C, is finding out how powerful a grip Camels have on the press. It is organizing R J Reynolds, maker of Camels and Prince Albert; it also has to fight the press.
Cissie Patterson's Washington Times- Herald in its southern edition, ran a screaming headline: "CIO Creating Race, Hatred. . . ."
Reynolds is run by S Clay Williams, listed in the Senate investigation as vice- president and director of the NAM.