THE TRUE DANGER OF TOBACCO.
THE long struggle between the votaries and the opponents of Tobacco, which has ragel at intervals for the last three hun- dred years, is, we suspect, very nearly at an end. The world smokes just as the world eats, and sees as little necessity for defending the one practice as the other. It recognizes evils arising from oversmoking just as it recognizes evils arising from overeating ; but is no more alarmed by stories of paralysis produced by cigars
than by reports of apoplexy from roast goose. It sets down the victims in either case as slightly silly persons, and goes on its way with a remark about the uses of moderation. But that the Governments of Europe have seized with natural eagerness on a new and tempting opportunity of taxation, and that there is but one mode of smoking, the narghile, which looks graceful, the women of the West would, we believe, ere this, have adopted the prac- tice, as their sisters in the East have done, and the victory of the weed would be complete. Mankind have discovered, in fact, a new pleasure so great that it tempts them to overcome an instinc- tive disgust so genuine that the first cigar makes everybody sick, do not see any counter-balancing evil, and will not be lectured into giving the pleasure up. Moralists indeed have pretty nearly abandoned their efforts in despair. A man like Dean Close now and then says a harsh word against an enjoyment which he regards as purely sensual, and an economist occasionally makes a fuss about the waste of money it involves—a waste very curiously great, if we assume that tobacco has no effect either for good or evil ; but as a rule these austere thinkers have concentrated most of their attention upon alcohol, a much less dubious subject for the eloquence of asceticism. The only serious attacks now come from the fastidious, who in some countries have contrived to make it bad taste to smoke in a woman's presence ; and from physicians, who every now and then are startled by isolated facts into reviewing the popular decision. Some such facts seem recently to have come before a well-known physiologist, who, in St. Paul's Magazine for this month, does a little thinking aloud upon the matter, arriving of course, with some hesitation upon one point to be noticed directly, at the popular conclusion. It is, he says, a fallacy to argue that because nicotine in the concen- trated form, or an overdose of ordinary tobacco, is poisonous, therefore a smaller dose must in its degree be poisonous too.
Quantity alters quality sometimes, as we see in the cases of alcohol, opium, and even flesh meat, all of which can be made to yield a strong poison, but in reasonable doses are innoxious or beneficial. The effect of the doses is not cumu- lative when the smoker is in an ordinary state of health, any more than the effect of daily glasses of wine or cups of tea, either of which may be taken for seventy years with as little consequence at the close of life as at first. There are, no doubt, states of health in which a small dose may be highly injurious or even poisonous, and the essayist in St. Pauls gives, with characteristic clearness, an explanation of this circumstance, the cause, as he thinks, of much of the prejudice against tobacco :—
"The stomach is quite capable of absorbing the poison, but it absorbs it slowly compared with the rapidity of the process by which the poison is excreted ; and in consequence of this greater rapidity of excretion, although all the poison may be absorbed, yet at no one moment is there sufficient quantity in the blood to produce injury. 'Spread out the thunder into its minutest tones,' says Schiller, 'and it becomes a lullaby for children.' Spread out the deadliest poison in minute doses, and it
becomes a medicine,—as we know from the daily use of strychnine, prussic acid, and other energetic poisons, in medical practice. Now when a poison is rapidly excreted by the skin, lunge, and kidneys, so that an accumulation in the blood is prevented, all injury is avoided, a succession of minute doses not being the same as one concentrated dose. But if from any cause the rapidity of excretion be arrested, an accumula- tion takes place, and thus a small dose comes to have the effect of a largo dose. This is not hypothesis ; it has been proved by Hermann of Berlin, who found that the dose of curare which was quite innocuous when injected into the stomach of a rabbit became almost immediately fate/ If the vessels of the kidneys wore tied, thus preventing the excretion from taking place through the kidneys. Hermann also found,—what, indeed, Brown Stignard had long ago proved,—that the dose of alcohol which was fatal to an animal when left exposed to the cold, passed away without serious effects when the animal was kept very warm,—the heat accelerating and the cold retarding the excretion from the skin."
But in the great majority of cases small doses of tobacco are as entirely innocuous as small doses of the very dangerous poison contained in tea.
The experience of mankind, which after all is the best guide, is, we need not say, in exact accord with this view, and tobacco might be pronounced a harmless luxury but for one exceptional fact, which is noticed by the writer in St. Paull Magazine, but which is dismissed far too summarily. Ile admits, with a free- dom which will please the few resolute opponents of tobacco, that its use in excess is very injurious, producing nervous complaints, hysteria, mental weakness, and sometimes paralysis, and very justly sets that aside as an evil incident to almost every habit of mankind. Alcohol, coffee, and even ordinary food may all be made dangerous by taking too much, and "the argument from excess is an excess of argument "—the only important point as to that matter being the limit of moderation, which differs with every individual, and with the state of the digestion on each sepa- rate day, or even hour, tobacco before breakfast being injurious to many men who can smoke after it with impunity. But those who use tobacco want an answer, either from the lay physiologist of the St. Pauls or from the medical profession, to a much more subtle question. Has not tobacco is property belonging to very few substances which makes its use exceptionally dangerous, much more dangerous, say, than that of alcohol,— the property, that is, when administered in an overdose, of effecting some permanent change, probably in the spinal cord, which renders the victim for ever after liable to injury from the minutest dose ? This writer does not pretend to answer that question as it could be answered in the Lancet, but he has had special reason to study the action of tobacco, and believes that the following three cases quoted in the magazine, from Dr. Druhen's work on tobacco, point to the one real danger arising from its use :— "Case 1. M. T., an advocate, aged thirty, of athletic frame, began in 1840 to manifest symptoms of a spinal affection, which continued till the summer of 1843. Those symptoms fluctuated considerably, but they resisted all treatment. At last, Dr. Druhen, suspecting that the disturbing cause was excessive smoking, persuaded his patient to give up this bad habit. All the symptoms disappeared as if by enchant- ment, and at the end of one month the cure was complete. M. T. enjoyed excellent health for some time, but one day dining with the Doctor he entreated to be allowed to indulge in a cigar. The permis- sion was refused, but he persisted and smoked. 'No sooner had ho finished his second cigar than I saw him hastily quit the table. I rose also in some anxiety, and ho confessed that all his old sensations had returned. This indication was decisive. M. T. henceforth entirely gave up his cigar, took steel tonics for a month, and has over since enjoyed robust health.'—Case IL M. observed that for some years his energies had been declining ; he was excessively thin, ate little, and only found comfort in smoking very strong cigars. Ho complained of acute abdominal pains every afternoon, which only ceased at night ; tremblings of the limbs, palpitations, and sometimes sickness. Ho was advised to relinquish tobacco during one mouth; did so, and all the symptoms disappeared ; but he afterwards declared that he would rather endure the sufferings than be deprived of tobacco. He resumed his old habit, and the old pains returned.—Caso III. A man aged forty- five, of lymphatic temperament, extremely sober, and very regular in all his habits, was troubled by the premonitory symptoms of melan- choly mania. Ho was perfectly aware of his hallucinations, but could not escape them. After two or three weeks' medical treatment they passed away, and ho resumed his labours at the bank, whore he held the post of cashier. M. Druhen accidentally learned that his patient was a smoker,—a moderato smoker,—and that during his treatment the desire for tobacco had not mado itself felt, but on his recovery he again resumed his cigar, and once more the old symptoms appeared. Warned thus by experience, he renounced tobacco entirely, and from that day has had no recurrence of the symptoms."
There are physicians in London who could add greatly to this list. One we know watched a case in which a violent nervous and mental affection, cured by the disuse of tobacco, returned after an interval of years when the patient had thoughtlessly smoked a few cigars, and disappeared again on the cessation of the habit ; and numbers of smokers will testify to occasional " fits " of severe malaise from a smaller allowance of tobacco than usual. Is it not, then, at least possible, if the facts are true and every physician in large practice knows them to be correct,—that almost any devotee of tobacco may accidentally get an overdose, and may thencefor- ward be liable to suffer more or less severely whenever the ordinary dose happens not to be carried off as rapidly as usual? The poison is then absorbed, as the writer in the St. Pettis describes, and a permanent, though it may be minute, injury is inflicted on the nervous system. In what way the overdose alters the victim's liability to attack is a question for physiologists ; but it may be held to be certain that it does, and though we have called the action special, it is not unique. The vaccine virus permanently alters the liability of every child in the empire to be poisoned by smallpox, there are drugs—are there not ?—which produce a liability to epilepsy, and an overdose of mercury will intensify the action of calomel swallowed years afterwards. The old supersti- tion about antidotes probably had its origin in facts of the same kind, observed, perhaps, in times when men had a greater capacity for believing what they saw than they have in this century of ours. If this suggestion is correct, and no other explains the facts, tobacco is a permanent danger to mankind, important whenever the conditions of men's lives or the specialties of their constitutions make overdoses probable.
It would be very useful to ascertain, if it were possible, what those conditions and constitutions are, an inquiry towards which the writer in the St. Peels gives us very little help. It has been proved by experiment that inaction of the kidneys makes nicotine additionally dangerous, and the essayist lays it down as a proposition that anything which diminishes excretory action, a severe fall in the temperature, for example, creates danger. So probably does any severe reduction in the pulse, if coincident with the overdose ; or hunger, or deep depression of mind. Con- stitutions vary so infinitely that is scarcely possible to lay down many rules, but most physicians would, we imagine, endorse one or two ; as, for example, that a severe cold is always a hint to diminish tobacco, that it should never be taken fasting, and that to most men it is specially, and as it were oddly, injurious during the intervals of sleep. That last is a caution smokers do not need,—iu Europe at least—but snufftakers do, and it is one which this writer, without pretending to understand the reason, offers seriously. One pinch of snuff taken between sleeping and waking at night will do more to produce the symptoms of nico- tine poisoning than a boxful taken in the thy-time, will produce in many cases actual vomiting hours after. And finally, it may be laid down as an axiom that men of highly-strung, sensitive, nervous organizations, and men who habitually eat little, are better without tobacco. They need it least, it is on them that it exerts its worst effects, and they, of all men, are most liable to become slaves to the indulgence, which they fancy relieves the dyspepsia it produces. To all sufferers from tobacco, we would add that if the theory we have tried to maintain is correct,—and we speak as those who know by dreary experience the hold tobacco gets over the affections,—there is no remedy whatever except total abstinence. If the mischief has once been done, one cigar or one pinch of snuff is as bad as a hundred. Some of them can act on the advice without an effort, nothing in the history of tobacco being so curious as the readiness with which many confirmed victims give up the habit,—a readiness in part due, it may be, to the fact that no consequences follow its disuse such as follow the disuse of opium or alcohol. Others could as soon be broken of opium-smoking, or hemp-eating, or dram-drinking as of tobacco, and for them there is only one useful line of advice. Fight the habit with your whole will and attention, as if it were a stutter or a twitch. Bear the torture of disuse as you would bear a disease ; go to bed, or to sea, and remember that one cigar or one pinch of snuff will in bad cases re-arouse, after an interval of months, the insatiable crave.
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