THE INJURIOUSNESS OF TOBACCO
When tobacco was first introduced into Europe the use of it was everywhere
regarded as an injurious habit, and on this account for a while it made
slow progress. It is no less injurious now than it ever was,--we have
simply grown used to it,--and it was only when people became used to its
injuriousness that the habit began to make great strides. We find nowadays
that smokers as well as non-smokers are suspicious of any form of
tobacco-taking to which they have not become used. Smokers who for the
first time meet chewers or snuffers or those who "dip" tobacco, as in the
South, are affected unpleasantly. Smokers keep on finding chewers
disgusting, and smokers of pipes and cigars frequently object to the odor
of cigarettes.
Nothing more strikingly illustrates how addicted people may become to a
habit than the smoking and chewing of the traditional Southern gentleman
of the old school, whom any other personal uncleanliness would have
horrified. Young men most fastidious about their apparel seem quite
unaware that it is saturated with the smell of tobacco. The odor of a
cigarette is probably as offensive to some of those who do not smoke as
any other smell under heaven. Yet such is the power of habit that we
tolerate all these things.
If we could begin all over again, we should find the same general
objection to smoking that existed in Europe when the habit first began.
Our chief need, then, is a new mind on the subject. How can we get it?
The circumstance of my giving up smoking eighteen years ago may have some
slight significance in this connection. I was smoking hard, and began to
have a vague feeling that it was hurting me. I had been playing whist at a
late hour in my room at a hotel, and when I finally went to bed I could
not sleep for a long while. I awoke with a bad taste and a parched mouth
in a room heavy with stale smoke and unsightly with cigar-butts lying
everywhere. Suddenly a disgust for the whole habit seized me, and I broke
off at once and completely. After a week or so, when the first feeling of
seediness and uneasiness and depression had worn away, I found my
appetite and concentration and initiative increasing. You will observe
that it was not until I began to regard smoking as harmful that I saw it
was also filthy. I had a new mind on the subject.
I am trying to give my readers a new mind on the subject, and if they have
not come to suspect the evil of smoking, they will naturally ask me to
prove that it is harmful.
Let us begin at the bottom.
Does it do any one any physical good? Arguments in favor of tobacco for
any physical reason are baseless. It does not aid digestion, preserve the
teeth, or disinfect, and it is not a remedy for anything. The good it
does--and no habit can become general, of course, unless it does apparent
good--can only be mental. Let me admit at once that smoking confers mental
satisfaction. It seems to give one companionship when one has none,
something to do when one is bored, keeps one from feeling hungry when one
is hungry, and blunts the edge of hardship and worry. This sums up the
agreeable results of tobacco. There are one or two more specialized
agreeable results which I exclude at this moment because they are only
temporary. The results I mention--let me admit at once--are real, and
both immediate and apparent. On the other hand, the injurious results,
after one has become inured to tobacco poison, are both unapparent and
delayed.
THE PHYSIOLOGICAL ACTION OF TOBACCO
As to the physiological and toxic effects of tobacco there is much
difference of opinion. Everybody knows that the first chew or the first
smoke is apt to create nausea; and that no matter how long a man has been
smoking, a little lump of the tar which has collected in his pipe will
sicken him. Nicotine is in itself highly toxic, but is very volatile and
is absorbed only from the portion of the cigar or cigarette held in the
mouth. The products of combustion of tobacco are chemical substances which
are also toxic, and nausea naturally stops the smoker before symptoms of
acute poisoning result. One must look, then, for symptoms of _slow_
poisoning. The popular belief that tobacco stunts growth is supported by
the fact that non-smokers observed for four years at Yale and Amherst
increased more in weight, height, chest-girth, and lung capacity than
smokers did in the same period.
Every athlete knows that it hurts the wind; that is, injures the ability
of the heart to respond quickly to extra work. It also affects the
precision of eye and hand. A great billiard-player who does not smoke once
assured me that he felt sure of winning when his opponent was a smoker. A
tennis-player began to smoke at the age of twenty-one, and found that men
whom he had before beaten with ease could now beat him. Sharp-shooters and
riflemen know that their shooting is more accurate when they do not smoke.
But you may say: "The athletes and billiard-players and the rest are
experts. I am an average man, making average use of my faculties. Besides,
I am not contending that excessive smoking isn't injurious, and I will
even concede that the limit of excess varies with the man. But is it not
true that harmful results of average smoking for the average man are
rare?"
In answer, let me on my side admit that they are--the _apparent_ harmful
results.
We are, however, very ignorant of the effect of small, continued doses of
the various tobacco poisons. All drugs comparatively harmless, such as
lead, mercury, and arsenic, produce a highly injurious effect when taken
in repeated small doses. Just what effect the use of tobacco engenders we
cannot absolutely know, but no physician doubts that smoking may be a
factor in almost any disease from which his patient is suffering.
There can be, for instance, no question that smoke simply as smoke
irritates the mucous membrane of the bronchial tubes and renders them more
susceptible to infections; by irritating the mucous membrane of the nose
and throat it tends to produce catarrh and therefore catarrhal deafness.
It would therefore seem fair to state that the man who does not use
tobacco is less susceptible to disease and contagion, and recovers more
quickly from a serious illness or operation. From this we should expect to
find that tobacco shows most in later life, when vitality is ebbing and
the machinery of the body is beginning to wear. It is in his middle age
that a man begins to feel the harm. In short, though we know only the
precise or immediate effect of nicotine and only _some_ of the _morbid
processes_ which excessive smoking may produce, it is likely that the
worst aspect of tobacco is something that we do not know very much
about--its tendency to reduce a man's general vigor.
The dominant characteristic of tobacco is the fact that it heightens
blood-pressure. The irritant action by which it does this sometimes leads
to still more harmful results. Its second action is narcotic: it lessens
the connection between nerve-centers and the outside world. These two
actions account for all the good and all the bad effects of tobacco. As a
narcotic, it temporarily abolishes anxiety and discomfort by making the
smoker care less about what is happening to him. But it is a well-known
law of medicine that all the drugs which in the beginning lessen
nerve-action increase it in the end. Thus smoking finally causes
apprehension, hyper-excitability, and muscular unrest. Here this
inevitable law seems to give contradictory results. Every physician knows
that an enormous amount of insomnia is relieved by smoking, even if it is
at the expense of laziness the next day; at the same time every physician
knows that most excessive smokers are troubled with insomnia.
CIGARETTES
In using tobacco we take the poison into the tissues. The chewer and the
snuffer get the effect through the tissue with which the tobacco comes in
contact. The cigarette-smoker almost invariably inhales, and he gets the
most harm merely because the bronchial mucous membrane absorbs the poison
most rapidly. The tobacco itself is no more harmful than it is in a pipe
or a cigar. Indeed, it is often less so in the cheaper grades, for, being
less pure, it contains less nicotine. Furthermore, the tobacco is
generally drier in a cigarette, and for that reason the combustion is
better, for the products of the combustion of dry and damp tobacco are not
the same. But since it is a little difficult to inhale a pipe or a cigar
without choking, the smoke products of a pipe or cigar are usually
absorbed only by the mouth, nose, and throat, whereas the inhaled smoke of
the cigarette is absorbed by the entire area of windpipe and bronchial
tubes. If you wish to see how much poison you inhale, try the old
experiment of puffing cigarette smoke through a handkerchief, and then,
having inhaled the same amount of smoke, blow it out again through another
portion of the same handkerchief. The difference in the discoloration will
be found to be very marked. You will _note_ that in the second case there
is hardly any stain on the handkerchief: the stain is on your windpipe and
bronchial tubes.
If a man inhales a pipe or a cigar, he gets more injury simply because he
gets stronger tobacco; but a man never inhales a pipe or a cigar unless he
is a smoker of long standing or unless he has begun with cigarettes.
Besides allowing one to inhale, a cigarette engenders more muscular unrest
than any other kind of smoke. Because of its shortness, cheapness, and
convenience, one lights a cigarette, throws it away, and then lights
another. This spasmodic process, constantly repeated, increases the
smoker's restlessness while at the same time satisfying it with a feeling
that he is _doing something_. Yet despite the fact that cigarette-smoking
is the worst form of tobacco addiction, virtually all boys who smoke start
with cigarettes.
It is generally believed that in the immature the moderate use of tobacco
stunts the normal growth of the body and mind, and causes various nervous
disturbances, especially of the heart--disturbances which it causes in
later life only when smoking has become excessive. That is to say, though
a boy's stomach grows tolerant of nicotine to the extent of taking it
without protest, the rest of the body keeps on protesting. Furthermore,
many business men will tell you that tobacco damages a boy's usefulness in
his work. This is necessarily so, since anything which lowers vitality
creates some kind of incompetence. For the same reason the boy who smokes
excessively not only is unable to work vigorously, but he does not wish to
work at all. This result, apparent during growth, is only less apparent
after growth, when other causes may step in to neutralize it. Tobacco, in
bringing about a depreciation of the nerve-cells, brings, together with
physical results like insomnia, lowered vitality, and restlessness, their
moral counterparts, like irritability, lack of concentration, desire to
avoid responsibility and to travel the road of least resistance. If there
were some instrument to determine it, in my opinion there would be seen a
difference of fifteen per cent. in the general efficiency of smokers and
non-smokers. The time is already at hand when smokers will be barred out
of positions which demand quick thought and action. Already tobacco is
forbidden during working hours in the United States Steel Corporation.
Many men were prejudiced against smoking until they went to college. There
they found themselves "out of it" because they did not smoke. More than
that, they found that the smoke of social gatherings irritated their eyes
and throat, and they thought that smoking might keep them from finding
other people's smoke annoying. A man who had left off smoking told me that
at the first "smoker" he attended afterward he found the air offensive and
his eyes smarting intolerably, although when he had been helping to create
the clouds in which they were sitting he had not noticed it at all. These
two experiences are common. For this reason, the social inducements to
smoking are considerably greater than those to drinking. The man who
refuses to drink may feel as much "out of it" as the man who refuses to
smoke, but he has ordinarily, and in the presence of gentlemen, no other
penalty to pay. He undergoes no discomfort in spending the evening in a
roomful of drinkers, and he can manage to find things to drink that will
have for them the semblance of good-fellowship. It is the social features
that attend the acquiring and the leaving-off the habit which make smoking
difficult to attack. In its present state, even if a boy were thoroughly
familiarized in school with the harm tobacco would do him, he would still
be seduced by the social side of it.[1]
When a habit fosters or traditionally accompanies social intercourse, it
is all the harder to uproot.
What grounded opium so strongly in China was its social side. The Chinese
lacked social occupation, and it was not the custom of the country for a
man to find it with his friends and family, though no people are more
socially inclined. Smoking opium became their chief social activity; they
gathered together in the one heated room of the house to gossip over their
pipes. We smoke tobacco as the Chinese smoke opium, "for company" and in
company. Thus one must provide strong reasons to make a man give it up. He
will not do so because it costs him something; he expects to pay for his
pleasures. When a man has actually gone to pieces, it is comparatively
easy to convince him that he ought to give up what is hurting him; but the
average man has not been excessive enough for that, and has never brought
himself to the point of serious conscious injury. Even a physician cannot
with any certainty tell the average moderate smoker whether tobacco is
hurting him. Consequently, if one would make this man stop smoking,
especially when he sees that leaving off has caused some people more
apparent discomfort than all their smoking did, one's only chance is to
make him change his mental attitude. I hope to assist in doing this by
calling attention to the fact that tobacco not only prepares the way for
physical diseases of all kinds, as any physician will tell you, but also,
as long investigation has shown me, for alcoholism and for drug-taking.
TOBACCO, ALCOHOL, AND OPIUM
The relation of tobacco, especially in the form of cigarettes, and alcohol
and opium is a very close one. For years I have been dealing with
alcoholism and morphinism, have gone into their every phase and aspect,
have kept careful and minute details of between six and seven thousand
cases, and I have never seen a case, except occasionally with women, which
did not have a history of excessive tobacco. It is true that my
observations are restricted to cases which need medical help,--the
neurotic temperaments,--but I am prepared to say that for the phlegmatic
man, for the man temperamentally moderate, for the outdoor laborer, whose
physical exercise tends to counteract the effect of the tobacco and the
alcohol he uses--in short, for all men, tobacco is an unfavorable factor
which predisposes to worse habits. A boy always starts smoking before he
starts drinking. If he is disposed to drink, that disposition will be
increased by smoking, because the action of tobacco makes it normal for
him to feel the need of stimulation. He is likely to go to alcohol to
soothe the muscular unrest, to blunt the irritation, he has received from
tobacco. From alcohol he goes to morphine for the same reason. The nervous
condition due to excessive drinking is allayed by morphine, just as the
nervous condition due to excessive smoking is allayed by alcohol. Morphine
is the legitimate consequence of alcohol, and alcohol is the legitimate
consequence of tobacco. Cigarettes, drink, opium, is the logical and
regular series.
The man predisposed to alcohol by the inheritance of a nervous temperament
will, if he uses tobacco at all, almost invariably use it to excess; and
this excess creates a restlessness for which alcohol is the natural
antidote. The experience of any type of man is that if he takes a drink
when he feels he has smoked too much, he finds he can at once begin
smoking all over again. For that reason, the two go together, and the
neurotic type of man too often combines the two. Tobacco thus develops the
necessity for alcohol.
It is very significant that in dealing with alcoholism no real reform can
be expected if the patient does not give up tobacco. Again, most men who
have ever used alcohol to excess, if restricted voluntarily or
involuntarily, will use tobacco to excess. This excess in tobacco produces
a narcotic effect which temporarily blunts the craving for alcohol.
Another way of saying the same thing is that when smokers are drunk they
no longer care to smoke, a fact that is a matter of common observation.
This means that there is a nervous condition produced alike by alcohol and
tobacco. When a man gets it from drinking, he does not keep on trying to
get it from smoking. As well as reacting upon each other, the two habits
keep each other going. It is not altogether by haphazard association that
saloons also sell cigars; they sell them for the same reason that they
give away pretzels--to make a man buy more drinks.
This relationship between tobacco and alcoholism is not understood by the
public. It has been absolutely demonstrated that the continued use of
tobacco is a tremendous handicap upon the man who is endeavoring to free
himself from the habit of alcoholic indulgence. Only a man of the
strongest character will persist in abstaining from alcohol unless he also
abstains from tobacco, even after he has undergone the most intelligent
medical treatment. In the system of a man already disposed toward
alcoholic stimulation, no one thing will prove so positive a factor toward
creating the sense of need as the use of tobacco. Physiological action of
tobacco is to create muscular (motor) unrest. Most habitual smokers
consume every day more than enough tobacco to carry them far beyond the
point where its stimulating effect ends and its narcotic effect begins.
Where this habitually occurs, the definitely toxic effect is notable, and
this results in a demand for that stimulation which the tobacco itself
once furnished, but now does not. Here is an evil effect of tobacco that
is rarely understood and almost never admitted.
OPIUM AND CIGARETTES IN CHINA
Current history affords us a striking proof of the closeness of the
relation between tobacco and opium.
I have spent a good deal of time in the Orient in the interest of those
who were trying to subdue the opium evil, and I may add that there is in
China to-day a flourishing American tobacco concern which has grown rich
out of the sale of cigarettes. With the extremely cheap Chinese labor, the
concern was able to sell twenty cigarettes for a cent of our money. Up to
the beginning of this enterprise (about 1900), the Chinese had never used
tobacco except in pipes, and in very minute quantities in rolling their
own crude cigarettes. The concern was sending salesmen and demonstrators
throughout the country to show the people how to smoke cigarettes. Now it
is estimated that one half of the cigarette consumption of the world is in
China. In trying to lessen the opium evil, in which they have to a
considerable extent succeeded, the Chinese are merely substituting the
cigarette evil. It is well known to the confirmed opium-smoker that he
needs less opium if he smokes cigarettes. _The Chinese to-day are spending
twice as much money for tobacco as for opium._
I once said to a Chinese public man: "I can help you to get rid of the
opium habit because you have found that you _must_ get rid of it, but I
cannot help you to get rid of the evil you are substituting for it, for
not even America has yet found out that she _must_ get rid of it. Your
cure, I fear, is worse than your disease; and _our_ disease has no
cure--until we change our mental attitude."
If any one thinks that China is the gainer by substituting the one drug
habit for the other, I beg leave to differ with him. The opium-smoker
smokes in private with other smokers, and is thus not offensive to other
people. He is not injuring non-smokers, or arousing the curiosity of boys,
or polluting the atmosphere, or creating a craving in others. In the West
the opium habit is generally condemned because the West is able to look
with a new and unbiased mind on a drug habit that is not its own.
I consider that cigarette-smoking is the greatest vice devastating
humanity to-day, because it is doing more than any other vice to
deteriorate the race.
LIKE ACTION OF THE THREE HABITS
The more you compare smoking and drinking and drugging, the more
resemblances you see. Opium, like tobacco and alcohol, ceases to stimulate
the moment the effect of it is felt: it then becomes a narcotic. The
history of the three as a resort in an emergency is precisely the same.
At the time when the average man feels that he needs his faculties most,
he will, if addicted to any of the three, deliberately seek stimulation
from it. He does not intend to go on long enough to get the narcotic
effect, since that would be clearly defeating his own aims; he means to
stop with the stimulant and sedative effect, but that he is unable to do.
The inhaler of tobacco gets his effect in precisely the same way that the
opium-smoker gets his--the rapid absorption by the tissues of the
bronchial tubes. It may be news to the average man to hear that the man
who smokes opium moderately suffers no more physical deterioration than
the man who inhales tobacco moderately. The excessive smoker of cigarettes
experiences the same mental and physical disturbance when deprived of them
that the opium-smoker experiences when deprived of opium. The medical
treatment necessary to bring about a physiological change in order to
destroy the craving is the same. The effect of giving up the habit is the
same--cessation of similar physical and nervous and mental disturbances,
gain in bodily weight and energy, and a desire for physical exercise. A
like comparison, item for item, may be made with alcohol, but it is the
similarity with opium which I wish particularly to emphasize here.
TOBACCO AND MORAL SENSITIVENESS
Morphine, as is very well known, will distort the moral sense of the best
person on earth; it is part of the action of the drug. Since the way
morphine gets its narcotic effect is very similar to the way tobacco gets
its effect, one would naturally suppose that tobacco would produce in a
milder degree something of the same moral distortion. This may seem a
startling conclusion, but change your mental attitude and observe. Have
not smokers undergone a noticeable moral deterioration in at least one
particular? They have a callous indifference to the rights of others. This
happens with all habitual indulgence, of course, but is it not carried
more generally to an extreme with tobacco than with anything else? Few men
quarrel with a hostess who does not offer them drinks, but all habitual
smokers expect that, regardless of her own desires, she will let them
smoke after dinner.
"We gave up the fight against tobacco in our drawing-rooms long ago," said
a famous London hostess. "We found it was a case of no smoke, no men."
Respectable men in New York City who would not dream of deliberately
breaking any other law carry cigars and cigarettes into the subway despite
the fact that it is forbidden and that it is vitally necessary to keep the
air there as pure as possible. A gentleman is more annoyed at being forced
to consult another's preference about not smoking than about anything else
that could arise in social intercourse, and is often at small pains to
conceal his impatience with old-fashioned people who believe they have
rights which should be respected.
On all sides the attitude seems to be, "What right has any one to object
to my smoking?" The matter is really on just the _opposite_ basis, "What
right has any one to smoke when other people object to it?"
If a man _must_ get drunk, we say he shall get drunk where he is a
nuisance only to himself and to others of the same mind. If a man feels
the need of interlarding his conversation with obscenity and grossness, we
say he may not compel us to listen to him. But a smoker may with impunity
pollute the air, offend the nostrils, and generally make himself a
nuisance to everybody in his neighborhood who does not practise his
particular vice. Is this not a kind of moral obtuseness? Change your
mental attitude and consider.
The action of a narcotic produces a peculiar cunning and resource in
concealment; it develops, when occasion arises, the desire to deceive and,
whether occasion arises or not, the desire to shift obligation and evade
direct responsibility. Tobacco does this more mildly than opium, and it
does so more appreciably with boys than with men; but, as with opium, it
is part of the narcotic effect in all cases.
Let it always be remembered that if a man smokes and inhales tobacco
excessively he is narcotizing himself more than when he smokes opium
moderately.