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.