Disturbances of the Heart / Discussion of the Treatment of the Heart in Its Various Disorders, With a Chapter on Blood Pressure

by Oliver T. Osborne

Edmunds and Smith [Footnote: Edmunds and Smith: Jour. Lab. and Clin. Med., February, 1916.] of Ann Arbor find that the livers of dogs have some power of destroying nicotin, but their studies did not show how tolerance to large doses of nicotin is acquired.

Neuhof [Footnote: Neuhof, Selian: Sino-Auricular Block Due to Tobacco Poisoning, Arch. Int. Med., May, 1916, p. 659.] describes a case of sino-auricular heart block due to tobacco poisoning. Intermittent claudication has been noted from the overuse of tobacco, as well as cramps in the muscles and of the legs.

A long series of investigations of the action of tobacco on high school boys and students of colleges seems to show that the age of graduation of smokers is older than that of nonsmokers, and that smokers require disciplinary measures more frequently than nonsmokers.

Some years ago investigation was made by Torrence, of the Illinois State Reformatory, in which there were 278 boys between the ages of 10 and 15 years. Ninety-two percent of these boys had the habit of smoking cigaretes, and 85 percent were classed as cigarete fiends.

The most important action of nicotin is on the circulation. Except during the stage when the person is becoming used to the tobacco habit, in which stage the heart is weakened and the vasomotor pressure lowered by his nausea and prostration, the blood pressure is almost always raised during the period of smoking.

The heart is frequently made more rapid and the blood pressure is certainly raised in an ordinary smoker, while even a novice may get at first an increase, but soon he may become depressed and have a lowering of the pressure. While a moderate smoker may have an increase of 10 mm. in blood pressure, an excessive smoker may show but little change. Perhaps this is because his heart muscle has become weakened. If the person's blood pressure is high, the heart may not increase in rapidity during smoking, and if he is nervous beforehand and is calmed by his tobacco, the pulse will be slowed. It has been shown that the blood pressure and pulse rate may be affected in persons sitting in a smoke-filled room, even though they themselves do not smoke. The length of time the increased pressure continues depends on the person, and it is this diminishing pressure that causes many to take another smoke. The heart is slowed by the action of nicotin on the vagi, as these nerves are stimulated both centrally and peripherally. An overdose of nicotin will paralyze the vagi. The heart action then becomes rapid and perhaps irregular. The heart muscle is first stimulated, and if too large a dose is taken, or too much in twenty-four hours, the muscle becomes depressed and perhaps debilitated. The consequence of such action on the heart muscle, sooner or later, is a dilation of the left ventricle if the overuse of the tobacco is continued.

There is, then, no possible opportunity for any discussion as to the action of tobacco on the circulation. Its action is positive, constantly occurs, and it is always to be considered. The only point at this issue is as to whether or not such an activity is of consequence to the individual. The active principle of tobacco is nicotin, besides which it contains an aromatic camphor-like substance, cellulose, resins, sugar, etc. Other products developed during combustion are carbon monoxid gas, a minute amount of prussic acid and in some varieties a considerable amount of furfurol, a poison. From any one cigar or cigaret but little nicotin is absorbed, else the user would be poisoned. It is generally considered that the best tobacco comes from Cuba, and in the United States from Virginia. While it has not been definitely shown that any stronger narcotic drug occurs in cigarets sold in this country, it still is of great interest to note that a user who becomes habituated to one particular brand will generally have no other, and the excessive cigaret-smoker will generally select the strongest brand of cigarets. The same is almost equally true of cigar smokers.

Besides the effect on the circulation, no one who uses tobacco can deny that it has a soothing, narcotic effect. If it did not have this quieting effect on the nervous system, the increased blood pressure would stimulate the cerebrum. Following a large meal, especially if alcohol has been taken, the blood vessels of the abdomen are more or less dilated by the digestion which is in process. During this period of lassitude it is possible that tobacco, through its contracting power, by raising the blood pressure in the cerebrum to the height at which the patient is accustomed, will stimulate him and cause him to be more able to do active mental work. On the other hand, if a person is nervously tired, irritable, or even muscularly weary, a cigar or several cigarets will increase his blood pressure, take away his circulatory tire, soothe his irritability, and stop temporarily his muscular pains or aches and muscle weariness. If the user of the tobacco has thorough control of his habit, is not working excessively, physically or mentally, has his normal sleep at night and therefore does not become weary from insomnia, he may use tobacco with sense and in the amount and frequency that is more or less harmless as far as he is concerned. If such a man, however, is sleepless, overworked or worried, if he has irregular meals or goes without his food, and has a series of "dinners," or drinks a good deal of alcohol, which gives him vasomotor relaxation, he finds a constantly growing need for a frequent smoke, and soon begins to use tobacco excessively. Or the young boy, stimulated by his associates, smokes cigarets more and more frequently until he uses them to excess.

Just what creates the intense desire for tobacco to the habitue has not been quite decided, but probably it is a combination of the irritation in the throat, especially in inhalers; of the desire for the rhythmic puffing which is a general cerebral and circulatory stimulant; for the increased vasomotor tension which many a patient feels the need of; for the narcotic, sedative, quieting effect on his brain or nerves; for the alluring comfort of watching the smoke curl into the air or for the quiet, contented sociability of smoking with associates. Probably all of these factors enter into the desire to continue the tobacco habit in those who smoke, so to speak, normally.

The abnormal smokers, or those who use tobacco excessively, have a more and more intense nervous desire or physical need of the narcotic or the circulatory stimulant effect of the tobacco, and, consequently, smoke more and more constantly. They are largely inhalers, and frequently cigaret fiends.