The Use and Abuse of Tobacco by John Lizars, M.D. (Edinburgh: 1856, 1857, 1859, reprinted, Philadelphia: P. Blakiston, Son & Co, 1883) TOBACCO. Snuffing, smoking, and chewing are bad habits, and we advise any gentleman who is not hopelessly abandoned to either, to give it up.—Medical Circular. -viii- NOTICE TO THE EIGHTH EDITION IN this Eighth Edition I have made some alterations, chiefly as regards arrangement; but I find, that less or more of a desultory character must necessarily attach itself to a brochure, intended merely as a vehicle of Practical Observations. The reader will see that I have found myself called upon to make some allusion to the recent attempts [1831-1833] at that fatal operation—excision of the tongue. The object of the Author will be attained, if his Observations have any appreciable tendency in arresting the progress of excessive Smoking, by drawing the attention of the Public to so important a subject. It is difficult to estimate, either the pernicious consequences produced by habitual Smoking, or the number of its victims among all classes, old and young. The enormous consumption of Tobacco can be ascertained from -ix- yearly returns made by the Government Custom-House; but its physical, moral, and mental deteriorations, admit of no such tangible analysis. These, although certain, are slow and imperceptible in their development, and it is therefore impossible to ascertain the extent of the injury which the poisonous weed inflicts upon the public health, or the alteration it must necessarily effect upon the character of its inhabitants. The consumption of Tobacco is stated to be, in 1853, 29,737,561 pounds, thus showing an allowance of considerably more than a pound, on an average, to every man, woman, and child, in the United Kingdom of Great Britain and Ireland. The prevalence of Smoking has been of late greatly on the increase, and the use of the narcotic commences with the young from mere childhood. Such a habit cannot be more lamented than reprobated. The injury done to the constitution of the young may not immediately appear, but cannot fail ultimately to become a great national calamity. JOHN LIZARS. Edinburgh, South Charlotte Street, 1859. -x- Table of Contents Advisory viii Preface: Notice to the Eighth Edition ix Chapter I. General Characteristics of Tobacco 13 The Introduction of Tobacco into Europe 13 The question of its intention for the Use of Man discussed 15 The Botany and Chemistry of Tobacco considered 15 Physiological Effect 20 M. Fiévé [1857] 21 Chapter II. Practical Observations on the Use and Abuse of Tobacco 23 Contagion from Cigar-smoking 23 Syphilis propagated by smoking tobacco 23 Condition of Paris 24 Effect on a Fever Patient 25 Local Effects on the Mouth 26 Ulceration of the Lips, Tongue, Gums, Mucous membrane of the Mouth, Tonsils, Velum Palati, Pharynx 26 Constitutional Effects enumerated [1854] 27 Dyspepsia from use of Tobacco 30 Diarrhoea 31 Effects in Cholera 32 Disease of Liver 32 Congestion of Brain 32 Apoplexy [1830] 33 Palsy 33 Mania [1854] 34 Loss of Memory 34 Amaurosis 34 Deafness 35 Nervousness 35 Emasculation 35 Cowardice 36 General Effects 36 Quotations from various Authors, and narrations of peculiar cases of poisoning by tobacco 38 Chapter III. Communications and Extracts 53 Opinions of Dr. Prout [1840] 53 Boussiron [1844] 54 Dr. Pereira 54 Orfila [1817] 55 Sir Benjamin Brodie 55 Dr. Cleland [1840] 56 Dr. Johnston [1855] 56 King James I [1604] 59 Rev. Dr. Adam Clarke [1797] 63 Mr. Solly [1856] 65 Dr. Wm. Henderson 66 Mr. Fenn [1857] 66 Dr. Tod [1856] 71 Mr. Anton 81 Mr. O'Flaherty 81 Dr. M'Cosh 81 Camden 83 Mr. Erichsen [1857] 105 Account of Hospitals for the Insane in the United States [1843] 107 Report of the Penna. Hospital for the Insane [1849] 108 Communications from numerous Scientific men in illustration of the evil effects of Tobacco 109 the Half-Yearly Abstract of Medical Sciences 111 Dr. Laycock [1846] 112 British Anti-Tobacco Society 118 Cases reported in the Lancet [1857] 124 Dictionnaire des Sciences Médicales [1821] 132 Darwin, &c. [1794] 136 -xi- CHAPTER I. GENERAL CHARACTERISTICS OF TOBACCO. 1. IT is generally agreed that the use of tobacco in Europe, as a meang of inebriation, originated in the introduction of the leaves of the plant into Spain from America. There is every reason to suppose that the plant previously existed in Asia, if not from the earliest times, though we have no very reliable authority for its having been used, at least to any great extent, for any of the purposes to which we have devoted it. I am aware that various old authors report, that the ancients of the extreme East were acquainted with the burning of vegetable substances as a means of inhaling narcotic fumes, and, indeed, when we consider their love of incenses, both as a luxury and an element of their religious cult, we need not be surprised at this; but we have no evidence that the smoking of tobacco was known in the Old World before the introduction of the plant from the New. It was in 1492 that Columbus first be- -13- held, at Cuba, the custom of smoking cigars; but it was not until some years afterwards that a Spanish monk recognized the plant in a province of St. Domingo, called Tabaca—a much more likely foundation for the name of the herb than that adopted by some, who assert that it originated in tabac, a tube used by the natives for smoking. That there was no particular aptitude in the European taste for the use of this herb, seems to me evident from the very slow progress which ensued even of the knowledge of its qualities. So late as 1560, when Jean Nicot, the French ambassador at the court of Portugal reported of it to his sovereign, scarcely any thing was known of the foreign vegetable, and in place of the men who accompanied Columbus having taken to any imitation of the Cuban-natives when they returned to Europe, it would rather seem that the adoption of 'the pipe is attributable to an Englishman, Raphelengi, who, having accustomed himself to it in Virginia, introduced the practice into England. Sir Walter Raleigh does not seem to have used the pipe until after the return of Sir Francis Drake in 1586, so that nearly a hundred years expired before even the roots of the habit were fixed in the English people. Nor, probably, would the practice after this have spread so rapidly as it did, if it had not been for the persecution to which it was almost immediately exposed. If it is true, as has been paid, that a few opposing volumes will fix the roots of a heresy, we need scarcely wonder at the triumph of tobacco, against the use of which more than a hundred fulminating volumes issued from the press within a few years. 2. These observations suggest a reference to the question, how far tobacco was intended for the use of man? The practice of the Cuban savages is seized by one party as a proof of a final cause, insomuch as savages are supposed to follow the first dictates of nature; and then comes the other party, who point to the tardy adoption of nature's gift by a civilized people as a clear proof that the weed was not intended for the uses to which it is applied. I believe that it is utterly vain to discuss questions of this kind. We have no elements for a proper judgment. Perhaps, for aught we know, the American savages were some thousands of years in coming to the habit—at least we have no reason to suppose that it could be a very primitive adoption. Whether, indeed, man's custom, in most cases, is a proof of itself of nature's intention, must always be a puzzle; but as we know that many very bad things are greatly more natural to human beings than we would wish them to be, we have just as good a right to say for those to whom good tendencies are delightful from the beginning, that nature intended they should do their best to eradicate what is hurtful, and reclaim their fellow creatures from the indulgences of vice. The true practical question must in short always be, what is beneficial and what is hurtful, according to the results of our experience. 3. The botany of our subject presents us with seven or eight different species of the plant, all affecting, more or less, the warm latitudes. Virginia seems, of all regions, the best suited to its culture, and yields in great quaritity the common or Virginian tobacco (Nicotiana -15- tabacum). A more hardy kind (N. rustica,) may be cultivated in such latitudes as that of Scotland. This is the species which has been found in Europe, Asia, and Africa; and were it not for the restriction imposed by statute, we would produce it on rich soils in greater quantities than would be convenient for our treasury, or beneficial to our people. I need hardly say here, that the question of intention, on the part of nature, is not much helped by the habitat of the production used; otherwise we might expect to find the northern races less addicted to the use of this tropical weed than those of the warmer regions. We know that probably the contrary is the truth; but all our efforts to draw any conclusion for or against the adaptation of a race to a production of a climate, are rendered futile by the teachings, not more of our religion, than of naturalists, who insist for a central point of origin for all races, and a constitution suited to all climates. The safest position to hold, is that for which I insist, that a bad habit may be formed in any latitude, and supported by any number of arguments, where the wish still holds its mysterious power over the conclusions of what we call reason. 4. Aa regards the composition of tobacco, we have endless experiments in that nearly new science, Organic Chemistry, which seems to try the patience of industry itself. There are some nine or ten different substances which go to the formation of a tobacco leaf, and these seem to change in their proportions according to the condition of the plant. Setting aside starch, various acids and salts, we come to what may be termed the -16- essential element or principle called Nicotina, with the formula C20H14N 2. These proportions of carbon, hydrogen, and azote, really tell to the analyst nothing from which he could predicate any thing certain as to the character of the compound. In this respect, all the formulæ of organic substances are nearly under the same mystery; a small difference in the proportions producing the greatest difference in the combined results. But we can be under no mistake as to the character of the element which is called Nicotina—a colorless liquid alkaloid, with an acrid, burning taste. It is one of the most intense of all poisons, approaching in ita activity the strongest preparation of prussic acid. 5. The other important element procured from the analysis of tobacco, is an oil called nicotianin, supposed to be "the juice of cursed hebanon" referred to in Hamlet; this is the poet's formula; the chemist's is C11H11N 2; but if the latter did not know from actual experience the deadly power of the substance, he would have a small chance of arriving at it by any analogy between formulæ. As this oily substance is also a very intense poison, differing essentially from the alkaloid, and indeed it is supposed capable of acting on different vital organs, we have thus in tobacco two poisons—rather a remarkable fact in organic chemistry, where we find, generally, only one very active principle at the base of any particular production in the vegetable kingdom. It is indeed asserted by Landerer, that there is none of this deadly oil in the fresh leaves of tobacco; and Mr. Pereira remarks, that the substance must be developed in the drying of the leaves under the influ- -17- ence of air and water. The discovery; if true; may free the weed from the charge of possessing a double poison; but the consequence is all the same to the foreign consumer; who never sees the leaf in its green state. 6. It has been said that the smoke of tobacco, as analysed by Zeise and others, contains nothing of the deadly alkaloid; and tobacco smokers have pleaded for less detrimental effects from the pipe or cigar than from the quid, but I fear their conclusion is not very tenable; for the detrimental oil, as we in fact see from the pipe itself, is largely increased by the continued roasting and burning. We know; too, that the old pipe is a favorite with the epicures; the more oil by which it is blackened the better becomes the instrument; till it attains perfection as a mass of clay soaked with poison; and dried, and soaked and dried a hundred times; so that the entire matter is imbued with the absorption. See Dr. Waller Lewis's recommendation to the gentlemen of the London Post-Office; at page 137. The chewer takes less of the oil; but more of the alkaloid; the smoker less of the alkaloid; but more of the oil; the comparison is simply a balance of evils; which is odious to either set of debauchees; and some get quit of the invidious comparison by taking the drug in both forms—a refuge from scientific doubt compensating for the greater amount of destruction to health and comfort. But if we are to believe Dr. Morries, the nicotianin is not destitute of a portion of the alkaloid; and as we know that the inhaled smoke is largely infected with the oil of an old pipe; the smoker has less to say for his habit than the chewer will concede; and I fairly admit; that it does -18- not appear to me to be at all clear; that the former has any advantage over the latter in other respects; for while the smoker's account must be debited with the topical diseases; chiefly carcinomatous; from which the chewer is to a great extent free; he consumes a far greater portion of the weed than his competing debauchee—a surplus so great; in the confirmed cigar smoker, that we are often called upon for a surprise at the number of these small rolls which constitute his daily supply. 7. Turning to the main part of our subject; the physiological effects, we find that; in the carnivora; tobacco shows its power in a very striking manner; causing vomiting; purging; universal trembling; staggering; convulsions, and stupor. Physiologists are not at one in regard to the peculiar mode of action; the nerves are probably the principal medium; but the many instances we have on record, of death produced by an application of small quantities to wounds, would indicate that the process is more complex. There is an ingenious experiment reported, where the effect of tobacco was noticed in an animal whose head was cut off; and artificial respiration kept up. The tobacco did not, as in the ordinary case, paralyse the heart; and the conclusion is accordingly drawn; that it is through the medium of the brain that the death action is exercised on that organ. But the whole of this question is rendered dubious or difficult by other facts. For instance, there is a difference of action between the alkaloid and the oil; the latter of which is said not to possess the power of paralyzing the heart. Applied to the tongue of a cat; one drop of the oil caused convulsions, and in two minutes death, -19- without for some time affecting much the action of the heart; so that, in this respect it operates very much in the manner of prussic acid. 8. On man, the physiological effects have been very minutely observed. I cannot do better than give the words of Mr.Pereira: "In small doses, tobacco causes a sensation of heat in the throatm and sometimes a feeling of warmth at the stomach. These effects are, however, less obvious when the remedy is taken in a liquid form, and largely diluted. By repetition, it usually operates as a diuretic, and less frequently as a laxative. Accompanying these effects are often nausea, and a peculiar feeling, usually described as giddiness, scarcely according with the ordinary acceptation of this form. As dropsical swellings sometimes disappear under the operation of these doses, it has been inferred that the remedy promotes the operation of the absorbents. In larger doses it promotes nausea, vomiting, and purging; though it seldom gives rise to abdominal pain, it produces a most distressing sensation of sinking at the pit of the stomach. It occasionally acts as an anodyne, or more rarely promotes sleep. But its most remarkable effects are languor, feebleness, relaxation of muscles, trembling of the limbs, great anxiety, and tendency to faint. Vision is frequently enfeebled, the ideas confused, the pulse small and weak, the respiration somewhat laborious, the surface cold and clammy, or bathed in a cold sweat, and, in extreme cases, convulsive movements are observed. In excessive doses, the effects are of the same kind, but more violent in degree. The more prominent symptoms are nausea, vomiting, and in -20- some cases purging, extreme weakness, and relaxation of the muscles, depression of the vascular system (manifested by feeble pulse, pale face, cold sweats, and tendency to faint), convulsive movements, followed by paralysis, and a kind of torpor terminating in death." 9. As an accompaniment to these physiological effects, I may here give an extract from the newly published pamphlet by Monsieur Fiévée, showing the mental or moral effects of this deleterious agent. Ed. Note: Full Citation: Fulgence Fiévée de Jeumont (1794-1858), Du Tabac, de son Usage, de ses Effets Médiats ou Immédiats sur l'Économie, et de son Influence Sociale (Paris: J.H. Truchy, 1857) "We do not insist principally on the material disasters resulting from tobacco, knowing very well that any reasoning on this subject will not produce conviction. A danger of far greater interest to those concerned in the preservation of the individual, is the enfeeblement of the human mind, the loss of the powers of intelligence and of moral energy, in a word, of the vigor of the intellect, one of the elements of which is memory. "We are much deceived, if the statistics of actual mental vigor would not prove the low level of the intellect throughout Europe since the introduction of tobacco. The Spaniards have first experienced the penalty of its abuse, the example of which they have so industriously propagated, and the elements of which originated in their conquests and their ancient energy. The rich Havanna enjoys the monopoly of the poison which procures so much gold in return for so many victims; but the Spaniards have paid for it also by the loss of their political importance, of their rich appanage of art and literature, of their chivalry, which made them one of the first people of the world. Admitting that other causes operated, tobacco has been one of the most influ- -21- ential. Spain is now a vast tobacco shop, and its only consolation is, that other nations are fast approaching to its level. Ed. Note: See data on the pattern of smoking-linked national collapses dating from the Spanish conquistadores' conquest of Mexico, being cited in that era. Soon, due to tobacco use, Spain itself declined rapidly, says Dr. Hippolyte Depierris, Physiologie Sociale: Le Tabac, Le Plus Violent des Poisons (Paris: Dentu, 1876), pp 417-419. Tobacco, as the great flatterer of sensuality, is one of the most energetic promoters of individualism—that is, of a weakening of social ties. Its appearance coincides fatally with reform and the spirit of inquiry. Man inaugurates the introduction of logic in matters inaccessible, at the same time that, as Montaigne says, he gives way to a habit destructive of the faculty of ratiocination—a contradiction which shows us that necessity of defect by which he is tormented." Ed. Note: Other Books By Dr. Fiévée Mémoires de Médecine Pratique (Paris: J. B. Baillière, 1845) Étude de l'Action de la Flanelle en Contact Direct avec la Peau: et de son Influence Physiologique, Pathologique et Thérapeutique (Paris: Hamel, 1855) Mémoire sur les Accidents Morbides Produits par l'Usage des Cosmétiques a Base de Plomb (Paris: J. Hamel, 1855) Mémoire de Médecine Pratique sur l'Angine Covenneuse, Gangreneuse, Épidémique et Endémique: sur sa Forme Croupale Secondaire, Accompagnées de Considérations sur le Croup Aigu (Paris: Hamel, 1855) Mémoire sur les Moyens de Triompher des Hernies Inguinales, Crurales et Embilicales: et sur la Nécessité de les Prévenir (Paris: Hamel, 1856) Étude Médico-Philosophique sur la Coutume de Coucher Deux, ou Plusieurs Ensemble de ses Facheuses Influences, Physiques et Morales (Paris: J.H. Truchy, 1857) My own experience confirms much of this, but a more particular physiological account will be found in my Practical Observations. The reader, will find a very interesting paper by Dr. Alfred Swaine Taylor, in Guy's Hospital Reports, Vol. IV., p. 345. -22- CHAPTER II. PRACTICAL OBSERVATIONS ON THE USE AND ABUSE OF TOBACCO. 10. ALTHOUGH for a considerable time past I had collected many important facts regarding the Use and Abuse of Tobacco the publication of these Practical Observations has nevertheless, been in some measure accelerated by the perusal of a paper by Professor Sigmund of Vienna, "Upon Syphilitic Contagion from Cigar Smoking," which appeared in the Medical Times and Gazette, under "Selections from Foreign Journals." From the brief statement there given, it is difficult to decide what opinion Dr. Sigmund entertains on the subject—whether he considers that the tobacco generates the syphilitic ulceration of the lips, tonsils, and gums, or that the cigar is impregnated with the venereal virus, through the medium of the manufacturer of it. 11. Many cases of syphilitic virus, introduced into the healthy constitution, by stocking a cigar or pipe used by a diseased person, have come under my notice. The practice is by no means uncommon, in some ranks of life, for two individuals to smoke the same pipe or cigar alternately, the one taking a puff, or draw after the other, and in this way the morbid poison produces a similar effect to what is exemplified in the communica- -23- tion of yaws or sibbens, by drinking out of an infected cup or vessel. I have often been consulted by gentlemen having marked syphilitic ulcerated throat, which they could not account for, having had no primary symptoms on the genitals. On interrogating them, they have admitted lighting a pipe used by another or having accepted a puff of a friend's cigar. Some patients have presented themselves with syphilitic ulceration on the lower or upper, lip, or the commissure between them having a thickened base. Some have had syphilitic ulcers of the mucous membrane of the cheeks, tongue, and tonsils. A few have had, with the preceding ulcers, secondary eruption of the skin and loose hair, while others have been affected with secondary condylomata. I once witnessed an operation performed upon a woman with syphilitic ulcer of the lower lip, combined with a hardened base, produced by smoking a pipe of a syphilitic patient. Excision of the diseased mass was resorted to by the operator, a man of great experience and dexterity, mistaking the affection, for carcinoma. In a few weeks after the operation, the secondary syphilitic eruption manifested itself, and was cured by the hydriodate of potass. It is scarcely possible to heal a syphilitic sore, or to unite a fractured bone, in a devoted smoker—his constitution seems to be in the same vitiated state as in one affected with scurvy. 12. A writer on tobacco describes Paris, in its relation to smoking, thus: "In Paris," says he, "it is impossible to walk in the streets without being constantly exposed to receive into the mouth, and consequently to inhale, the fumes of tobacco from so many mouths, clean and -24- unclean, passing before and behind, to the great annoyance, and indeed injury to the health of every one, and most disgusting to those cognizant of its poisonous effects. In the arcades and passages it is particularly offensive and obnoxious, the atmosphere of those close places being always contaminated by the pestilential exhalations. I may add, this must be still more so the case in the smoking-rooms of our clubs. And I may here put a query—May not the fumes of tobacco, exhaled from a smoker laboring under syphilitic sore throat and mouth, be inhaled by a clean, healthy individual, with an abraded or ulcerated lip, and the former contaminate the latter? I have seen syphilitic ulceration of the lip, the chin, the mouth, and the throat, individually and collectively, where no trace whatever could be brought to bear on how the ulcers were caused. How often does syphilitic onychia occur without our being able to discover any contamination?" 13. A remarkable change occurs to the excessive smoker, when he labors under influenza or fever, as he then not only loses all relish for the cigar or pipe, but even actually loathes them. Does not this important fact satisfactorily show, that the furor tabaci depends on the morbid condition produced on the salivary secretion and organ of taste by the deletenous drug, and at the same time illustrate the pathological law, that two morbid states seldom or ever co-exist in the same individual? The sudden removal of all desire to smoke, affords the best refutation to the delusive representations which the unhappy tobacco victim urges for continuing the injurious habit, on the ground, that its abandonment would -25- be prejudicial to his health, and proves, if he had a will to relinquish the pipe or cigar, he would find a way. The best argument to use in dealing with the obstinate prejudices of such peopIe, is to tell them, that an accidental attack, of a new disease can safely and at once occasion the total withdrawal of tobacco without producing any bad consequences. It is scarcely possible to cure either syphilis or gonorrhœa, if,the patient continue to indulge in smoking tobacco. 14. When tobacco is too much indulged in, it produces, both locally and constitutionally, the most dire effects. Locally, smoking causes ulceration of the lips, tongue,* gums, mucous membrane of the mouth or cheeks, tonsils, velum, and even pharynx. Many, from smoking, produce carcinomatous ulceration of the lower or upper lip, or its commissure, requiring excision of the diseased structure. One individual, a captain of the Indian navy, fell a victim under my care (from smoking Cherouts). When I first saw him, he had ulceration of the mucous membrane of his left cheek, extending backwards to the tonsil and pharynx of the same side, having all the characteristic appearances of carcinoma. The disease resisted every variety of treatment. Internally—alteratives and mild diet; externally—fomentations, poultices, a solution of honey and water, and nitric acid. From this case, and other instances, it would appear that the cigar induces carcinoma just as readily as the cutty-pipe. It would seem that the pungent oil of the tobacco, combined with the heat, constitutes the ex- ____________ * See Chapter III., p. 132. -26- citing cause. The ulceration of the lips, especially the lower, so closely resembles syphilis, that it requires great care and examination to distinguish it. If there be no carcinomatous condition of the ulcerated surface of the lips, mouth, or throat, rinsing the mouth with a solution of honey (a teaspoonful in a tumbler of warm water) three or four times a day, prescribing an alterative powder of the bicarbonate of soda, rhubarb, columba, twice a day; a blue pill once a week; light diet, as the farinaceous, with occasionally fowl or veal; confinement to a large, well-ventilated room, and the rigid abstinence of the pernicious weed, will generally soon effect a cure. In some, it may be necessary to touch the ulcerated surface with nitric acid every fourth or fifth day. 15. Devoted smokers as pertinaciously insist, that they cannot give up such a luxury, as the drunkard affirms that he cannot relinquish his stimulus. But I have known instances in both classes of individuals manfully giving them up. There is an officer in Her Majesty's service who had upwards of ten severe attacks of delirium tremens, and is now a teetotaller, and he has been go for upwards of fifteen years. 16. The following case, from the Half-Yearly Abstract of the Medical Sciences, for January onwards to July, 1854, page 70, satisfactorily shows that tobacco can be given up. It is likewise a terrible illustration of its baneful effects on the constitution. Drs. Rankin and Radcliffe, the editors, head it, "A case of Angina Pectoris resulting from the Use of Tobacco," and thus introduce it: "The following case possesses a very high -27- degree of interest." The history of the case is thus related by Dr. Corson, of New York: "A highly intelligent man, aged sixty-five, stout, ruddy, early married, temperate, managing a large business, after premising that he commenced chewing tobacco at seventeen, swallowing the juice, as is sometimes customary, to prevent injuring his lungs from constant spitting, and that years after he suffered from a gnawing, capricious appetite, nausea, vomiting of meals, emaciation, nervousness, and palpitation of the heart, dictated to Dr. Corson, recently, the following story: "Seven years thus miserably passed, when, one day after dinner, I was suddenly seized with intense pain in the chest, gasping for breath, and a sensation as if a crowbar "were pressed tightly from the right breast to the left, till it came and twisted in a knot round the heart, which now stopped deathly still for a minute, and then leaped like a dozen frogs. After two hours of death-like suffering, the attack ceased; and I found that ever after my heart missed every fourth beat. My physician said that I had organic disease of the heart, must die suddenly, and need only take a little brandy for the painful paroxysms; and I soon found it the only thing that gave them any relief. "For the next twenty-seven years I continued to suffer milder attacks like the above, lasting from one to several minutes, sometimes as often as two or three times a day or night; and to be sickly looking, thin, and pale as a ghost. Simply from revolt ing at the idea of being a slave to one vile habit alone, and without dreaming of the suffering it had cost me, -28- after thirty-three years' use, I one day threw away tobacco forever. "Words cannot describe my suffering and desire for a time. I was reminded of the Indian, who, next to all the rum in the world, wanted all the tobacco. But my firm will conquered. In a month my paroxysms nearly ceased, and soon after left entirely. I was directly a new man, and grew stout and hale as you see. With the exception of a little asthmatic breathing, in close rooms and the like, for nearly twenty years since I have enjoyed excellent health." On examination, Dr. Corson found the heart seemingly healthy in size and structure, only irregular, intermitting still at every fourth pulsation. After such well-marked examples of manly firmness, no one need pretend to affirm that the luxury of smoking, snuffing, plugging, or chewing, or quidding, cannot be given up; or that the stimulus of wine, or spirits, or malt liquors, cannot be relinquished. I may here remark, that chewing or quidding does not seem to irritate the mucous membrane of the mouth to the extent that smoking does; it never causes ulceration. 18. Some of the constitutional effects of tobacco have been already detailed under Dr. Corson's case. But I shall commence their enumeration by generally stating, that they are numerous and varied, consisting of giddiness, sickness, vomiting, dyspepsia, vitiated taste of the mouth, loose bowels, diseased liver, congestion of the brain, apoplexy, palsy, mania, loss of memory, amaurosis, deafness, nervousness, emasculation, and cowardice. 19. When a youth commences his apprenticeship to -29- smoking tobacco, he suffers often the most inconceivably miserable sickness and vomiting—almost as bad as seasickness. It generally produces these effects so rapidly, that their production must entirely depend upon nervous influence, as giddiness is almost immediately induced. The antidote or cure for this miserable condition is drinking strong coffee, or brandy and water, and retiring to bed or sofa. If he perseveres, he has just to suffer onwards, until his nervous system becomes habituated to the noxious weed, and too often to the bottle at the same time. It is truly melancholy to witness the great number of the young who smoke now-a-days; and it is painful to contemplate how many premising youths must be stunted in their growth, and enfeebled in their minds, before they arrive at manhood. 20. "Let the young adept," says Boussiron, in his interesting Treatise on Tobacco, "whom you wish to form by your lessons, smoke the leaves of tobacco, thornapple, or deadly night-shade, and you may be certain to see take place the effects nearly identical in violence—giddiness, intoxication, disturbed vision, nausea, vomiting, and frequently diarrhœa." 21. Dyspepsia from the use of tobacco is accompanied with the same symptoms as when the disease is produced by drinking or gluttony, and want of exercise in the open air. The only cure is, by "throwing away tobacco for ever"—and this will be accelerated by a blue pill once a week, the alterative powder morning and evening, prescribed under ulceration of the mouth, the infusion of quaasia, or quaasia and gentian combined, mild nutritious diet, as coffee or tea, with lightly toasted bread, -30- beef-tea with or without rice, or toast for three or four days, a glass or two of sherry wine, and exercise in the open air, either on foot or horseback, or carriage, or still better, all combined. Exercise should be taken before meals, and the patient lounge on a sofa for two or three hours after meals. Change of air, fully fifty or one hundred miles distant, is of great benefit. After three or four days, beef-steak or mutton-chop should supersede the beef-tea, and then a few vegetables, well boiled, may be taken. A few drops of the balsam of copaiba, say eight or ten drops combined with ten of aquæ potasssæ, and a teaspoonful of sweet nitre, in half a cup of cold water sweetened, and taken at bed-time, has a most soothing effect. Franks-Specific is the most elegant and agreeable preparation of copaiba, even preferable to the capsules. There is an imitation of Franks Specific prepared by the chemists of London. 22. The vitiated taste of the mouth is generally a symptom of dyspepsia, and is to be cured in the same way. 23. The looseness of the bowels is to be treated by "throwing away tobacco for ever;" by prescribing an astringent mixture of the electuary of catechu, prepared chalk, syrup of ginger and laudanum, by farinaceous and milk diet for eight days, with rest in bed for four or five days, then for the same time on a sofa. At the end of eight or ten days, beef soup with rice, or lightly toasted bread, puddings of rice, sago, and arrow root, for four or five days. Then beef-steak or mutton-chop, with rice, lightly toasted bread, and a glass or two of port wine, -31- made into negus or mulled. Exercise in the open air should now be freely taken. 24. During the prevalence of cholera, I have had repeated opportunities of observing, that individuals addicted to the use of tobacco, especially those who snuff it, are more disposed to attacks of that disease, and generally in its most malignant and fatal form.* 25. Disease of the liver seems to be caused by the tobacco exciting the system, and by the dyspeptic symptoms produced. It is to be treated by "throwing away tobacco for ever;" by prescribing half a grain of the protoioduret of mercury, with or without opium, according to the state of the bowels, made into a pill with the extract of gentian, morning and evening; by an infusion of quassia, or quassia and gentian combined; by blistering over the region of the liver, and dressing the tender surface with mercurial ointment. In some cases it is necessary to keep a portion of the blistered surface open for some time. In the commencement, rest, and farinaceous and milk diet. Afterwards, exercise in the open air, beef-tea with rice, or lightly toasted bread, for a few days; and then beef-steak or mutton-chop, and a glass or two of sherry. If the protoioduret threatens to affect the mouth, it should be given up, and the same with the mercurial dressing of the blistered surface. Dr. Scott of India's foot-bath of nitro-muriatic acid is often beneficial. When convalescent, nothing is so beneficial as change of air. 26. Congestion of the brain occurs almost only in ____________ * See Fenn's cases, p. 66. -32- those much addicted to smoking, in whom a cigar is never out of the mouth; but I have witnessed it also to occur in the snuffer of the plant. It is denoted by headache, want of sleep, or rather restless nights, and occasionally flushing of the countenance. The worst case I have had under my care was a foreigner, who travelled for a manufacturer of cigars—he was at the same time fearfully nervous. He had a red, swollen countenance, as if he combined the bottle with his smoking, but this he assured me he never did—the tobacco was enough for him. I inserted an issue or seton in the nape of his neck, purged him with calomel and aloes, put him on as low a diet as he would permit, confined him to the house, and entreated him to smoke as few cigars as possible. In a fortnight the congestion of the brain was subdued, and then he was allowed gradually more and more nourishing diet and exercise in the open air. He returned to Edinburgh in two years after in good health but still nervous even from the moderate use of cigars. He said that he had tried to give them up altogether, but that he had found that impracticable—a difficulty connected, no doubt, with his avocation. 27. Apoplexy has been taken notice of by several authors, supervening to the smoking of tobacco; also to the immoderate use of snuff, as related by Morgagni; likewise in the Ephemerides des Curieux de la Nature, and in the Journal d'Allemagne for 1830, page 179. The treatment here is the same as that for congestion of the brain. 28. The form of palsy produced by excessive smoking is generally hemiplegia, and it is almost always incura- -33- ble. It follows as often from too much snuffing as too much smoking. The treatment consists in "throwing away tobacco for ever," inserting setons in the lumbar region, tonics, cold bathing, and good diet. 29. Mania is a fearful result of the excessive use of tobacco—two cases of which I have witnessed since the publication of this treatise. I have also to mention, that a gentleman called on me, and thanked me for the publication of my Observations on Tobacco, and related to me, with deep emotion, what had occurred in his own family from smoking tobacco. Two amiable younger brothers had gone deranged, and committed suicide. There is no hereditary predisposition to mania in the family. At a meeting of the Medical and Chirurgical Society of London, on May 2d, 1854, a paper was read, entitled, "Additional Remarks on the Statistics and Morbid Anatomy of Mental Diseases," by Dr. Webster, wherein he cites, among the causes, the great use of tobacco, which opinion he supported by reference to the statistics of insanity in Germany. 30. Loss of memory takes place in an extraordinary degree in the smoker, much more so than in the drunkard, evidently from tobacco acting more on the brain than alcohol. The cure consists in "throwing away tobacco for ever." 31. Amaurosis is a very common result of smoking tobacco to excess, but I have never seen it produced by snuffing or chewing. It occurs with or without congestion of the brain. It is commonly confined to one eye. It is generally curable, but not always, by "throwing away tobacco for ever"—by inserting a seton in the -34- back of the neck, another seton in the temple or temples, according as one or both eyes are affected. In the course of eight or ten days, the seton in the temple is to be withdrawn, a common fly blister applied, and the blistered surface sprinkled with strychnia. The bowels to be freely opened with calomel and aloes. The diet to be light, as the farinaceous. The patient should be confined in a large, well-ventilated apartment, and an obscure light. 32. Deafness is not so common a sequence to smoking tobacco as amaurosis. It is to be treated on precisely the same principles, with the difference of applying the blisters and strychnia behind the ears. 33. Nervousness is remarkably common from indulging too much in smoking, snuffing, or chewing tobacco. It is to be treated by "throwing away tobacco forever"—by having recourse to the shower-bath in winter, and sea-bathing in summer—by nourishing diet, attention to the bowels, the alterative powder, as prescribed under ulceration of the lips, the tonics, as quassia and gentian, and even quinine; exercise in the open air, and by mixing in quiet, agreeable society, as the nervous system is easily and readily over-excited; and, lastly, by change of air, and ultimately travelling about. 34. Emasculation, as an effect of tobacco, may well astonish the gay Lothario, as he might, unconscious of the cause, have boasted, that "never in my youth did I apply the means of weakness and debility." I have been consulted by fathers of from thirty to forty years of age, who, having married in early life, have had two or three children soon after marriage onwards to thirty -35- years old, but have been surprised that they had eventually lost all inclination for sexual indulgence. On interrogating them, I have invariably found that they were all excessive smokers, and on convincing them that tobacco was the cause of their temporary impotence, they have instantly "thrown away tobacco forever," and in a few months after have returned to me, saying that they had become fathers again. I have found unmarried men similarly affected with the want of the sexual vis et animus. 35. I have invariably found, that patients addicted to tobacco smoking were in spirit cowardly, and deficient in manly fortitude to undergo any surgical operation, however trifling, proposed to relieve them from the suffering of other complaints. In such cases chloroform is a great boon. 36. When we consider the effect of tobacco in tetanus, and in strangulated hernia in former days, we can readily comprehend its powerful narcotic effects: they are stronger than opium—opium differing from tobacco only in constipating the bowels. The use of tobacco for medical purposes has been long known, but its application has been carried, fundamentally, of late, to the full extent to which the human body can be subjected—a cigar having been actually inserted into the anus, by an American physician, as a medical reagent—thus introducing the poison into every vital passage. 37. The number of people who from twelve years of age are given to smoking, snuffing, plugging, and chewing, or quidding the noxious weed, appears quite incredible. By its so general consumption, we must become -36- changed in both corporeal and mental faculties—we cannot fail to be enfeebled in body and mind, and become a deteriorated race. I once travelled with a gentleman from South America, who first filled his nostrils with snuff, which he prevented falling out, by stuffing shag tobacco after it, and this he termed "plugging"—then put in each cheek a coil of pigtail tobacco, which he named "quidding," in this country called "chewing;" lastly, he lit a Havannah cigar, which he put into his mouth; and thus smoked and chewed, puffing at one time the smoke of the cigar, and at another time squirting the juice from his mouth, as so graphically described by Dickens in the boat story, on the way to the Far West. This gentleman was as thin as a razor, with an olive-colored countenance, and frightfully nervous. The preceding is neither a caricature, nor an exaggerated account of the fearful extent to which the use of tobacco is carried—not merely in Europe, as we know, but, as there is every reason to fear, in every quarter of the globe where it either grows, or is unhappily conveyed. 38. There can be no doubt, from what has occurred in the [Crimean] war [1853-1856] just ended, that had the Turks never indulged in the vicious habit of smoking tobacco, they would not have required the assistance of the French, Sardinians, and British. They would have been as powerful as in the days of the Sultans Othman [574-656], Orchan, Amurath the First [1359-1389], and Bajazet, and would have sent such a message through Menschikoff to the Czar Nicholas, as the Sultan Bajazet said to the Count de Nevers, of France, when taken prisoner after his celebrated unsuccessful cavalry charge (like that at Balaklava) near Nicropolis. Ed. Note: Now 140 years later, this cryptic reference is unknown. -37- 89. It is allowed by British and other European officers, that the Turkish soldier is equal, if not superior, to the private soldier of any other European nation.* But the officers are ignorant, lazy, and indolent, constantly stupefied with tobacco. The late expedition of Omer Pacha [a Turkish military commander] from Batoun to Kutais, is graphically described by one of the correspondents of an English journal: while the private soldiers were toiling away in dragging the artillery through forests, their officers were squatted, smoking their pipes or chibouques! 40. It is stated that Abbas the First, Shah of Persia in the beginning of the seventeenth century (he reigned from 1587 to 1629), denounced opium and tobacco; and that, when leading an army against the Cham of Tartary, he proclaimed that every soldier in whose possession tobacco was found, would have his nose and lips cut off, and afterwards be burnt alive. He re-established the Persian empire by his activity and conquests. 41. Amurath the Fourth [1623-1640], of Turkey, denounced the use of tobacco. He ended his reign in 1649 [1640]. 42. The manner of the embodiment of the Janizaries, and especially their training for soldiers by their founder Ala-ed-deen, the brother of the Sultan Orchan, is well worth the consideration of the Secretary-at-War, the Commander-in-Chief, the Horse-Guards, and, more particularly, of the Army Reform Commissioners. 43. "The Mahrattas, in working a battery, never pointed their cannon so as to mark in a particular spot, ____________ * Vide Le Continent, in 1854. Paris, 1854. Also, General Willliams's (the brave defender of Kars) Speech at the Army and Navy Club, June, 1858. -38- but aimed at random all round the wall. After loading a gun they sat down, smoked and conversed for half-an-hour, then fired, reloaded, and resumed their conversation. Two hours at mid-day, by mutual consent, were set apart for meals and recreation." "The English calculated seven years as the period in which a breach might be effected.* 44. It is stated that the Sikhs, now named the Punjabees, never smoke tobacco, it being contrary to their religion. I may ask, are there any soldiers in India equal to the Sikhs? At Chillianwallah, at Moodkee, at Ferozshah, at Aliwur, at Mooltan, at Sobraon, no soldiers behaved better. 45. Mr. Meadows, in an interesting account of the Chinese, states, that "the soldier who smokes tobacco is bambooed, and he who smokes opium is beheaded."—Vide British Quarterly Review, No. 51 for July, 1857, page 49. 46. Rumph, in his Herbarium Amboinense, says, that the Chinese and natives of India used tobacco only as a medicine or medicament. "Neutiquam," he observes, "vere ad suctionem sed tantum modo ad usum medicum unanimo enim consensu, Indi assentiunt sese Tabaci suctionem ab Europeis dedicisse." 47. The celebrated French surgeon, Percy, states, that tobacco was as regularly served out to the French soldiers as provisions, and thus comments on the practice: "It had doubtless been calculated that smoking hurt the appetite; and to save daily from four to six ____________ *[Hugh] Murray's British India [Edinburgh: Oliver & Boyd, 1832), vol. ii. p. 127. The author here alludes to the siege of Darwar, occupied by Tippoo in September, 1791. -39- ounces of bread per man, they furnished him "with three farthings' worth of bad tobacco. During the conquest of Holland, Louvois paid more attention to furnishing tobacco than provisions; and even at this day, as well as in former times, more care is taken to procure tobacco than bread to the soldier. Every soldier was obliged to have his pipe and his match." 48. Constant relates the following anecdote of the great Napoleon: "Napoleon," says he, "once took a fancy to smoke, for the purpose of trying a very fine oriental pipe presented to him by a Turkish or Persian ambassador. Preparation having been made—the fire having been applied to the recipient—nothing more was to be done than to communicate it to the tobacco, but that could never be effected in the way taken by his majesty for that purpose. He contented himself with opening and shutting his mouth alternately, without the least in the world drawing in his breath. 'How the devil,' cried he at last—'that does nothing!' "I made him observe, that he made the attempt badly, and showed him the proper mode of doing it. But the emperor always returned to his kind of yawning. Wearied by his vain attempts, he at last desired me to light the pipe. I obeyed, and returned it to him in order. "But scarcely had he drawn in a mouthful, when the smoke, which he knew not how to expel from his mouth, turned back into his palate, penetrated into his throat, and came out by the nose and blinded him. As soon as he recovered breath —'Take that away from me—what abomination! Oh, the swine!—my stomach turns!' "In fact, he felt himself so annoyed for at least an hour, that he renounced -40- for ever the pleasure of a habit which he said was only fit to amuse sluggards." 49. The students attending the American colleges are said to destroy their physical and moral powers by smoking tobacco, so as to unfit them to prosecute their studies, and afterwards to become useful members of society. But we have even the judges on the bench quidding tobacco, as well as the members of parliament, so facetiously described by Dickens in his American Notes for general circulation, wherein he terms Washington the head-quarters of tobacco-tinctured saliva. Dr. Budget in his treatise on tobacco, states, that in America, "it is no uncommon circumstance to hear of inquests on the bodies of smokers, especially youths; the ordinary verdict [for death certificate purposes] being, 'died from extreme tobacco smoking.'" [Ed. Note: See more such data.] 50. "The pupils of the Polytechnic School in Paris have recently furnished some curious statistics bearing on the tobacco controversy. Dividing the young gentlemen of that college into two groups-—the smokers and non-smokers—it is shown that the smokers have shown themselves in the various competitive examinations far inferior to the others. Not only in the examinations on entering the school are the smokers in a lower rank, but in the various ordeals that they have to pass through in a year, the average rank of the smokers had constantly fallen, and not inconsiderably, while the men who did not smoke enjoyed a cerebral atmosphere of the clearest kind."—From the Globe, also the Dublin Medical Press. 51. Excessive smoking has had no small share in the -41- degeneration of Spain. A Spaniard is never without a cigar in his mouth. It was observed during the Peninsular war, that the Spanish officers passed the whole day in smoking, in cutting and mincing tobacco to make paper, cigars, and in eating and sleeping—and never existed men sunk in such idleness, indolence, and apathy. I am sorry to add, that the Portuguese were in the same degraded condition. Germany is said to be as immersed in tobacco as Spain. And I fear we are fast drifting into the same degraded condition. Fenelon says, "Youth is the flower of a nation, it is in the flower that the fruit should be cultivated." Condorcet, on the progress of the human mind, thus, concludes: "Such is the practice of using fermented liquors, hot drinks, opium,* and tobacco, that men have sought with a kind ____________ * The author of "Confessions of an English Opium Eater," states, that the number of amateur opium-eaters in London is immense. And in Manchester, the work people of the cotton manufactories are rapidly getting into the practice of opium-eating. In the Nineteenth Report of the Inspectors of Prisons in the Northern and Eastern Districts of England, it is stated that, in the district of Wisbeach, "opium-eating is very prevalent in this district, and the use of the drug is often apparent in its effects on the morals and intellects of the prisoners." The Rev. A. S. Thelwall, in his interesting work on "The Iniquities of the Opium Trade with China," gives a deplorable account of the destructive effect on the health of the Chinese who indulge in it. He gives a translation of a memorial to the Emperor, by Choo Tsun, a member of Council, &c. "In the history of Formosa," says he, "we find the following passage: Opium was first produced in Kaoutsinne, which by some is said to be the same as Kalapa or Batavia. The natives of this place were, at the first, sprightly and active, and, being good soldiers, were always successful In battle. But the people called Hung-maou (red-haired,) came thither, and having manufactured opium, seduced some of the natives -42- of frenzy, means of procuring sensations which may be continually renewed. There are few nations among whom these practices are not observed, from which is derived a pleasure that occupies whole days, or is repeated at every interval that prevents the weight of time from being felt, satisfies the necessity of having the faculties roused, and at last blunting the edge of ____________ into the habit of smelting it. From these the mania for it spread rapidly throughout the whole nation; so that in process of time the natives became feeble and enervated, submitted to foreign rule, and ultimately were completely subjugated. Now the English," continues he, "are of the race of foreigners called Hung-maou. In introducing opium into this country, their purpose has been to weaken and enfeeble the. Central Empire. If not early aroused to a sense of our danger, we shall find ourselves ere long on the last step towards ruin." "It thus appears," concludes Choo Tsun, "it is beyond the power of any artificial means to save a people enervated by luxury." In the same memorial, Choo Tsun thus observes: "While the stream of importation of opium is not turned aside, it is impossible to attain any certainty that none within the camp do ever secretly inhale the drug. And if the camp be once contaminated by it, the baneful influence will work its way, and the habit will be contracted beyond the power of reform. When the periodical times of desire for it come round, how can the victims (their legs tottering, their hands trembling, their eyes flowing with child-like tears,) be able in any way to attend to their proper exercise? Or how can such men form strong and powerful legions? Under these circumstances, the military will become alike unfit to the fight, or in a retreat to defend their posts. "Of this there is a clear proof in the instance of the campaign against the Yaou rebels in 1832. In the army sent to Lëenchnow on that occasion, great numbers of the soldiers were opium-smokers; so that, although their numerical force was large, there was hardly any strength to be found among them." If the smoking of opium produces such direful effects, why should not tobacco? ' They are both narcotics, nay, tobacco is the more potent narcotic or poison. -43- this necessity, thus prolongs the duration of the infancy and inactivity of the human mind. These practices, which have proved an obstacle to the progress of ignorant and enslaved nations, produce also their effects in wise and more civilized countries, preventing truth from diffusing, through all degrees of men, a pure and equal light." 52. While investigating the baneful influence of tobacco, I have been led to consider the effects of brandy and other stimulants on the courage of the soldier, during the last Russian war. It appears to me, that the Russians lost their different battles in the Crimea chiefly from having served out to them too much brandy or raki, immediately before entering into action. This was especially remarked after the battle of Inkermann. That extraordinarily intelligent soldier, Philip O'Flaherty, in his Sketches of the War, thus observes, after the battle of Inkermann: "We took a good many prisoners who were half-drunk. It appears that the authorities supplied the men plentifully with liquor, in order that they might fight well. The Russians had a great many killed and wounded. The hills were strewn with them." This intoxicated condition of the Russians is also described in several letters from the camp. Even our own troops, about the conclusion of the war, were becoming excessively addicted to drinking. It may be said that the Russians, besides their prodigal allowance of raki, were often led into action after long forced marches, and in an ill-fed condition. Nevertheless, the over-dose of raki would, in my estimation, detract from their powers of endurance, instead of prolonging them. [Ed Note: Evidently Russia learned; at the beginning of World War I, it banned alcohol.] -44- 53. Our prize-fighters are not allowed stimulants or tobacco either during the time of their training, or on the day of their battle—not even during their fighting. The training of the prize-fighter with some modification, appears admirably adapted to the rearing of soldiers, especially young recruits. I understand boat-racers, like pugilists, are prohibited tobacco. See Lancet for 2d May, 1857. The huntsman who indulges in a glass of brandy (jumping powder) on the morning of the chase, does not ride to hounds like the sober rider. The Iron Duke, or any other true sportsman, never indulged on the morning of a hunt with fox-hounds. The hunter, or horse, gets only a small feed of oats, on the morning of his going out to hounds. The fox-hound gets no food on the day of his chase. The greyhound, like the fox-hound, is fed the day before. The race-horse gets only half a feed of oats on the morning of his race. 54. Thus men and animals, intended for a hard day's work, depend on the stamina acquired by previous training, and not on immediate stimulus. It is evident, that had mankind never indulged in stimulants or narcotics, they would have been earlier advanced in civilization, humanity, and morality—would have had stronger physical and higher mental powers. Let us read only the history of the great Franklin. He who smokes and drinks has his mind stupefied, like the opium-eater, or the wine-bibber, or the brandy, whisky, or ale-drinker. It is only what his mind has previously learned that he makes, or can make use of. He cannot advance a step farther. 55. The cases of diseased brain and spinal cord oc- -45- curring in tobacco-smokers, afford strong proof that tobacco, besides affecting the nervous system through the medium of the nerves of the nose and mouth, when smoked, must also enter into the circulation of the blood, by being mixed with the saliva, and swallowed, and thus taken up by the lacteals or absorbents. The latter process must take place in those who use tobacco in the form of snuff, as it must often be swallowed, especially during sleep. It must also occur in those who chew or quid the weed. The relaxation of the bowels, terminating in obstinate diarrhoea, proves that it passes down the alimentary canal with the saliva, even in the smoker. 56. When nux vomica, or its alkaloid, strychnia, is prescribed in small doses, several days elapse before its effects on the constitution are exemplified; and, in like manner, a considerable period intervenes before its effects leave the system, after it has been discontinued. The same apparent result seems to take place with tobacco. It is evidently a cumulative poison, as is shown by its ultimately producing softening of the brain, and frequently amaurosis. 57. In the above view of the action of tobacco, I am supported by Mr. Solly, in his interesting and able Lecture on Paralysis, published in the Lancet for the 13th December, 1856, and of which I have given a brief extract. There is also an interesting paper in the Lancet for 3d January, 1857, by Mr. Fenn of Nayland, Suffolk, wherein he states that "he has seen very mild cases of typhoid fever rendered fatal from the excessive use of tobacco." The extreme liability to attacks of typhus fever is now well ascertained for every febrile state, -46- from the most simple, even influenza, is liable to degenerate into various typhoid forms. A fuller extract from Mr. Fenn's paper I have already given. 58. The incurable nature of ulceration of the tongue led me to consider whether the poison might not pervade the sanguiniferous system, otherwise why should the removal of the diseased mass by ligature, or the knife, prove unsuccessful in eradicating the contaminated tissue? Dr. B—'s and Dr. Tod's case of the woman's tongue, show satisfactorily that the teeth had nothing to do in producing the ulcerated surface. Dr. B—'s case, and Dr. Tod's case of M. J— T—'s demonstrate, that neither the knife nor the ligature had any effect in arresting the disease, and Sir Astley Cooper's views of the inutility of these means in checking the disease in Dr. B—'s case, confirm these—the constitution of the unfortunate individual having been poisoned with the ensnaring weed, through his ignorance of the nature of his hallowed luxury. 59. Representations have been made of the ulceration of the tongue as it occurred in Dr. B—'s case and also Mr. J— T—'s. I have here to acknowledge the handsome liberality of Dr. B—, in permitting me to copy the interesting case of an affectionate friend, and the admirable sketches of the diseased tongue, made by that talented draughtsman, Mr. James Stewart. Dr. B— acknowledges that he was an excessive smoker himself for years, until he became go nervous, that he could not steady his hand, when he "threw away tobacco forever." Here I may remark, how many narrow escapes of having cancer of the -47- tongue must every smoker have had, when we consider that every one with a disordered stomach has had one or more pimples on his tongue, which, had they been irritated with pungent tobacco smoke, as in Dr. B—'s case, would in all probability have ended in ulceration, becoming cancerous, and ending fatally. 60. Although the subject is yet far from being exhausted, "the tobacco controversy" has nevertheless elicited much additional information, valuable because practical, as to the effect of smoking on the human body, both in a physiological, pathological, and therapeutic aspect. The liberal and enlightened policy of the editor of the Lancet by opening the columns of his journal [Ed. Note, in an 1857 series of papers on tobacco effects] as the medium for impartial investigation, deserves the warmest expression of thanks, not less from the profession than the public; and I make no apology for availing myself of the many interesting contributions which have there appeared on the subject. 61. Experience is the only test to confirm the decisions of truth, and refute the errors of mere authority. But its verdict unfortunately is in many cases injuriously delayed, in consequence of long-protracted and misleading exculpatory pleadings. "The evil that men do lives after them; the good is oft interred with their bones;" and this holds equally true with the customs, habits, etc. of a country. The evils these occasion, live after them. Their extent and magnitude are only known after they have become so apparent that they cannot longer be denied. And if the controversy evoked on the injurious effects of excessive smoking, should gradually arrest the progress of so dangerous a luxury, and sensibly diminish -48- a mischief which is unlimited, in a certain sense, almost either as to extent or duration, the author will rest satisfied that his own exertions, with the powerful co-operation which he has received from others, have not been in vain. He would earnestly indeed rejoice, if the national authorities here would adopt the same regulations which obtain in Switzerland. There, we are told, "that the Governing Council of the Canton of Berne have just enacted, that young men who are as yet unconfirmed (confirmation is administered in Switzerland between the fifteenth and sixteenth year) are prohibited from using tobacco." As the Council came to this determination in consequence of their belief in the deleterious effects of tobacco on the human frame, it seems equally to be the duty of the Council to extend their regulations, by a general prohibition, when they consider that the health of the community is injured by the use of tobacco. Ed. Note, for an example of a subsequent general prohibition, banning cigarette sales to adults, not just children, see Iowa's 1897 cigarette ban. 62. I consider it my duty to append Dr. Hassall's truly valuable and warning remarks on tobacco smoking—to whose long and truly invaluable practical labors in the field, as well as by his writings on "adulterations detected," the nation owes a debt of gratitude which never can be repaid. "Tobacco owes its chief properties to the presence of two active principles, termed nicotina and nicotianin. The first of these, nicotina, is thus characterized: It is liquid and volatile, with an acrid burning taste, and possesses the strong odor of tobacco; to test-paper, it shows an alkaline reaction; water, ether, alcohol, and the oils dissolve it. It combines with various organic and inorganic acids to form salts. 1000 grains of tobacco yield, according to the kind used, from -49- 3.86 to 11.28 grains of nicotina. The action of nicotina on the human frame is that of an acrid, narcotic poison, causing giddiness and vomiting; and, in doses of a few grainy death. "The properties of the latter, nicotianin, are as follow: It is a concrete oily substance, having the smell of tobacco, and a bitter taste. It is volatile; the dilute acids and water do not dissolve it, but it is soluble in liquor potasssæ and ether. In swallowing nicotianin, the same sensation is produced on the tongue and fauces as by tobicco. A grain administered internally; quickly caused giddiness; nausea; and retching. It also produces sneezing when applied to the nose. Six pounds of tobacco leaves furnish about eleven grains of nicotianin. It is also known as 'concrete oil of tobacco,' and 'tobacco camphor.' "Both these active principles and constituents have been shown, by Zeise and Melsens, to be present in the smoke of tobacco; they are, therefore, undoubtedly not destroyed by the combustion of the tobacco; whether used in the form of cut tobacco or cigars; but in the act of smoking they are inhaled; and thus drawn into the mouth, fauces, lungs, and even the stomach, especially when the saliva, impregnated with the tobacco smoke, is swallowed. Further, that these active constituents are actually absorbed, and make their way into the system; is proved from the sickness, giddiness, and death-like faintness experienced by those who are unaccustomed to smoking; that they are absorbed to some degree, if not to the same extent, in the case of habitual smokers, of tobacco; is unquestionable—the difference in the effects experienced -50- being due to the circumstance of the system becoming more inured to its use; and therefore less susceptible of its influence." 63. In a moral and physical point of view, the importance of the inquiry cannot be over-estimated. The strongest proof of this, is attested by the fact, that, during last year; not less than twenty-eight million lbs. (28,000,000) of tobacco were consumed in Great Britain, exclusive of the large portion smuggled, which cannot be estimated. 64. A vast load of responsibility is devolved upon the members of the medical profession, who are, if not the sole, by far the most competent section of the community to pronounce a judgment on, and solve so important an inquiry. So far as the discussion has progressed; the three following deductions have been indisputably estabblished by unquestionable medical testimony: 1st. That excessive smoking, long persisted in, is injurious to man in the highest degree—physically, mentally, and morally. 2dly. That the commencement of smoking in early life, and indulgence in the practice early in the day, cannot be too strongly condemned; as leading to most pernicious effects on the constitution. 3dly. That smoking, even in what is called a moderate degree, is, to say the very least of it, indirectly injurious, more especially to the young; because it is not denied; it acts as an inducement to drinking—thus becoming the source of intemperance, and all its accompanying evils. It is notorious that the practices are, almost without exception, inseparably associated. The remark -51- has become a maxim: "Smoking induces drinking, drinking jaundice, and jaundice death." 65. If insurance companies would act upon Mr. Solly's test—the peculiar morbid condition of the palate and fauces as proving inveterate smoking—and raise the annual premiums to smokers in whom such appearances were detected, as on hazardous insurances, the practice of smoking might receive that great and salutary check from motives of self-interest, which admonition and warning, as to the evils resulting from the noxious weed, have failed to effect: and the detection, hy Mr. Erichsen, of the mixture of so many deleterious and poisonous ingredients in the manufacture of snuff, it is to he expected, may, in like manner, operate upon the selfish feelings of the snuffer, and powerfully tend to root out his disgusting hahit. -52- CHAPTER III. COMMUNICATIONS AND EXTRACTS. 66. IN his valuable work on the "Nature and Treatment of Stomach and Urinary Diseases [London: J. Churchill, 1840], Dr. [William] Prout, at pages 24 and 25, observes: "There is an article much used in various ways, though not as an aliment, the deleterious effects of which on the assimilating organs, &c., require to be briefly noticed, viz., tobacco. Although confessedly one of the most virulent poisons in nature, yet such is the fascinating influence of this noxious weed, that mankind resort to it in every mode they can devise, to ensure its stupefying and pernicious agency. Tobacco disorders the assimilating functions in general, but particularly as I believe, the assimilation of the saccharine principle. I have never, indeed, been able to trace the development of oxalic acid to the use of tobacco; but that some analogous and equally poisonous principle (probably of an acid nature,) is generated in certain individuals by its abuse, is evident from their cachectic looks, and from the dark and often greenish-yellow tint of their blood. The severe and peculiar dyspeptic symptoms sometimes produced by inveterate snuff-taking are well known; and I have more than once seen such cases terminate fatally with malignant disease of the stomach and liver. Great smokers, also, espe- -53- cially those who employ short pipes and cigars, are said to be liable to cancerous affections of the lips. But it happens with tobacco, as with deleterious articles of diet, the strong and healthy suffer comparatively little while the weak and predisposed to disease fall victims to its poisonous operation. Surely, if the dictates of reason were allowed to prevail an article so injurious to the health, and so offensive in all its forms and modes of employment, would speedily be banished from common use." 67. Professor Petit-Radel is said to have died of cancer of the pylorus, consequent on smoking tobacco. 68. [Bertrand] Boussiron states that he has seen many smokers perish of atrophy. Ed. Note: Books by Bertrand Boussiron De l'Action du Tabac sur la Santé et de son Influence sur le Moral et l'Intelligence de l'Homme (Paris: B. Dusillion, 1844) De l'Action du Tabac sur la Santé et de son Influence sur le Moral et l'Intelligence de l'Homme (Paris: B. Dussillion, 1845 and Turin: Libraries de la Minerve Subalpine, 1845) Dell' Azione del Tabacco sulla Salute e della sua Influenza sul Morale e sull Intelligenza dell Uomo: Prima Versione Italiana sulla Quarta Edizione Francese (Livorno: Stamperia Artisit Tipografi, 1845) 69. Pereira, in his valuable work on Chemistry and Materia Medica, page 1426, states, that "Nicotina is an energetic poison, almost equalling in activity hydrocyanic acid." Ed. Note: Other Books by Dr. Pereira An Introductory Lecture on the Relations of Chemistry to the Vital force: Delivered in the Philadelphia College of Medicine (Philadelphia: John H. Gihon, 1847) Medicinal Chemistry for the Use of Students and the Profession: Being a Manual of the Science, with its Applications to Toxicology, Physiology, Therapeutics, Hygiene, Etc. (Philadelphia: Lea and Blanchard, 1848) 70. In the Dictionnaire des Sciènces Medicalés for 1821, two brothers are said to have smoked until they died of apoplexy—the one after smoking seventeen pipes, the other eighteen pipes. Fourcroy cites several instances of the destructive effects of tobacco in his translation of Ramazzani. The little daughter of a tobacco merchant died in frightful convulsions, from having slept in a chamber where a great quantity of tobacco had been rasped. An intoxicated soldier swallowed his saliva impregnated with tobacco, awoke in strong convulsions, and nearly became insane. I have strong suspicions that such a melancholy event as the latter must have occurred frequently. -54- 71. [Matthieu J. B.] Orfila [1787-1853], in his General System of Toxicology [or, A Treatise on Poisons Found in the Mineral, Vegetable and Animal Kingdoms Considered in Their Relations with Physiology, Pathology and Medical Jurisprudence (Philadelphia: M. Carey & Son)], 1817, Vol. II, page 211, quotes the following experiments to show the poisonous qualities of tobacco: "Sir Benjamin Brodie [1783-1862] injected into the rectum of several dogs, and one cat, from one to four ounces of a strong infusion of tobacco; these animals became insensible, motionless, and all died in less than ten minutes; the pulsations of the heart were no more sensible a minute before death; one of them only vomited. Their bodies were opened immediately after death; the heart was very much distended, and no longer contracted." Ed. Note: Other Books by Dr. Orfila Traité des Poisons, Tirés des Règnes Minéral Végétal et Animal; ou Toxicologie Générale, Considérée Sous les Rapports de la Physiologie, de la Pathologie et de la Médecine Légale (Paris: Crochard, 1814 and 1815) Directions for the Treatment of Persons Who Have Taken Poison, and Those in a State of Apparent Death Together with the Means of Detecting Poisons and Adulterations in Wine, also the Means of Distinguishing Real from Apparent Death: with an Appendix, on Suspended Animation and the Means of Prevention (Baltimore: Nathaniel G. Maxwell, 1819) Traité de Médecine Légale (Paris: Béchet, 1831 and 1836) 72. Sir B. Brodie states in his Physiological Researches, published in 1851, under Effects of Vegetable Poisons: "We may conclude from these experiments, that the empyreumatic oil of tobacco occasions death, by destroying the functions of the brain, without directly acting on the circulation. In other words, its effects are similar to those of alcohol, the juice of aconite, and the essential oil of almonds." 73. In volume seventh of the Biographical Dictionary, the Rev. Mr. Rose, under the life of Richard Fletcher, Bishop of London, informs us, that "he (the Bishop) was very fond of tobacco, then little known, and that Camden imputes his death to the immoderate use of it." And [William] Camden [1551-1623], in his Annals, 3d edition [London: Thomas Harper, 1635], p. 469, translation, states that "Richard Fletcher, Bishop of London, a courtly prelate, who, while by immoderate use of tobacco he smothered the cares he took by means of his unlucky marriage, and by the Queen misliked (who did not so well like of married bishops), breathed out his life." The Bishop died in 1596. -55- 74. Dr. [Henry W.] Cleland, in his treatise On the [History and] Properties Chemical and Medical of Tobacco [Glasgow: Maclure & Macdonald, 1840], states that "the circumstance which induced [Sultan] Amurath [Murad] the Fourth [1623-1640] to be so strict in punishing tobacco smokers, was the dread which he entertained of the population being thereby diminished, from the antiphrodisiac property which he [correctly] supposed [understood] tobacco to possess"—vide Cleland on the History and Properties, Chemical and Medical of Tobacco, p. G. If, as I understand, Amurath is synonymous with Mourad, the antiphrodisiac properties of tobacco must have been a subject of credence and observation so early as Ed Note: to be common knowledge and reported as such by 1555 as per citation by French analyst André Thevet, thus chronologically long before the first part of the seventeenth century, the period of the reign of the fourth Amurath or Mourad, extending from 1622 to 1640. Ed. Note: Tobacco kills babies and kills foetuses. Tobacco prevents pregnancy and causes stillbirths, an accurate Turkish belief being cited as recently as 1912 and 1931. See The Tobacco Habit, by Herbert H. Tidswell, M.D., (London: J. & A. Churchill, 1912), p 12; and The Cigarette As A Physician Sees It, by Daniel H. Kress, M.D. (Mountain View, CA: Pacific Press Pub Ass'n, 1931), page 35. However, the Turkish government (after Murad IV's good start in the 1630's, ordering execution of tobacco pushers, a correct prosecution decision as per anti-murder precedents) thereafter failed to follow-through, thereafter failed to execute tobacco pushers. This failure to continue prosecuting, executing, tobacco pushers, led to rampant tobacco-addiction in Turkey, and according to Sir Benjamin Brodie [1783-1862], led to Turkey's national deterioration. Tobacco pushers in their hatred of Murad, named a brand the "Murad"! Pushers know their murderous and genocidal history, you should too! See also related degeneration data by James Parton (1868). The [1604] Counter-blast of King James [1566-1625] had considerably preceded the prohibitory punishment against the use of tobacco by the Ottoman Sultan. 75. The injurious properties of tobacco are determined by the following analysis of its chemical constituents by Professor [James F. W.] Johnston [1796-1855], of Durham, in his Chemistry of Common Life [Edinburgh: Blackwood, 1855]: "These are three in number: a volatile oil, a volatile alkali, and an empyreumatic oil." . . . . "The volatile oil has the odor of tobacco, and possesses a bitter taste. On the mouth and throat it produces a sensation similar to that caused by tobacco smoke. When applied to the nose, it occasions sneezing, and when taken internally, it gives rise to giddiness, nausea, and an inclination to vomit." "The volatile alkali has the odor of tobacco, an acrid, burning, long-continuing tobacco taste, and possesses narcotic and very poisonous qualities. In this latter respect it is scarcely inferior to -56- prussic acid—a single drop being sufficient to kill a dog. Its vapor is so irritating, that it is difficult to breathe in a room in which a single drop has been evaporated. The reader may recollect the great sensation produced in 1851, by the trial of the Comte de Bocarmé, at Mons, and his subsequent execution, for poisoning his brother-in-law with nicotin. Ed. Note: For more on this case using tobacco as a murder weapon, see Hippolyte A. Depierris, M.D., Physiologie Sociale (Paris: Dentu, 1876, reprinted and edited, E. Flammarion, 1898), pp 79ff. For more on the tobacco - crime link, click here. A hundred pounds of the dry tobacco-leaf yield about seven pounds of nicotin. In smoking a hundred grains of tobacco, therefore, say a quarter of an ounce, there may be drawn into the mouth two grains or more of one of the most subtle of all known poisons." "The empyreumatic oil is acrid and disagreeable to the taste, narcotic, and poisonous. One drop applied to the tongue of a cat brought on convulsions, and in two minutes occasioned, death. The Hottentots are said to kill snakes by putting a drop of it on their tongues. Under its influence, the reptiles die as instantaneously as if killed by an electric shock. It appears to act nearly in the same way as prussic acid." "The crude oil is supposed to be the juice of the cursed hebenon," described by Shakspeare as a distilment. "Sleeping within mine orchard, My custom always of the afternoon, Upon my secure hour thy uncle stole, With juice of cursed hebanon in a vial, And in the porches of mine ear did pour The leperous distillment: whose effect Holds such an enmity with blood of man, That, swift as quicksilver, it courses through The natural gates and alleys of the body; And with a sudden vigour it doth posset And curd, like eager droppings into milk, -57- The thin and wholesome blood; so did it mine; And a most instant tetter bark'd about, Most lazar-like, with vile and loathsome crust, All my smooth body." HAMLET—Act i., Scene v. The cigar, especially if smoked to the end, discharges directly into the mouth of the smoker everything that is produced by the burning. Thus, the more rapidly the leaf burns and the smoke is inhaled, the greater the proportion of the poisonous substances which is drawn into the mouth And finally, when the saliva is retained, the fullest effect of all the three narcotic ingredients of the smoke will be produced upon the nervous system of the smoker. It is not surprising, therefore, that those who have been accustomed to smoke cigars, especially of strong tobacco, should find any other pipe both tame and tasteless, except the short black cutty, which has lately come into favor among inveterate smokers. Such persons live in an almost constant state of narcotism or narcotic drunkenness, which must ultimately affect the health even of the strongest. "The chewer of tobacco, it will be understood from the above description, does not experience the effects of the poisonous oil which is produced during the burning of the leaf. The natural volatile oil and the nicotin are the substances which act upon him. These, from the quantity of them which he involuntarily swallows or absorbs, impair his appetite, and gradually weaken his powers of digestion. The same remarks apply to the taker of snuff. But his drug is still milder than that of the chewer. During -58- the first fermentation which the leaf undergoes in preparing it for the manufacturer of snuff, and again during the second fermentation, after it is ground, a large proportion of the nicotin escapes, or is decomposed. The ammonia produced during these fermentations is partly the result of this decomposition. Further, the artificial drying or roasting to which tobacco is exposed in fitting it for the dry snuffs, expels a portion of the natural volatile oil, as well as an additional portion of the natural volatile alkali or nicotin. Manufactured snuff, therefore, as it is drawn up into the nose, and especially dried snuff, is much less rich in active ingredients than the natural leaf. Even the rappees, though generally made from the strongest Virginian and European tobaccoes, containing five or six per cent. of nicotin, retain only two per cent. when fully manufactured." 76. The following extracts are from King James's [1604] Counterblast to Tobacco, pp. 213-222—a work from its rarity inaccessible to the general reader, and which may be considered not uninteresting by many, considering the character of the royal author, and the early period at which his remarks were published, nearly two centuries and a half ago: In my opinion," says the royal commentator, "there cannot be a more base and yet more hurtful corruption in a country, than is the vile use (or rather abuse) of taking tobacco in this kingdom, which hath moved me shortly to discover the abuses thereof in the following little pamphlet." In the Counterblast to Tobacco, he remarks: "That the manifold abuses of this vile custom of Tobacco-taking may the better be espied [understood], it is fit, -59- that you first enter into consideration, both of the first originall thereof and likewise of the reasons of the first entry thereof into this country. For certainly, as such customs that have their first institution, either from a godly, necessary, or honourable ground, and are first brought in by the means of some worthy, vertuous, and great personage, are ever and most justly holden in great and reverend estimation and account by all wise, virtuous, and temperate spirits, so should it by the contrary, justly bring a disgrace into that sort of customs, which having their originall from base corruption and barbarity, do in like sort make their first entry into a country, by an inconsiderate and childish affectation of novelty, as is the true case of the first invention of Tobacco-taking, and of the first entry thereof among us. For Tobacco was first found out by some of the barbarous Indians." Tobacco is, as you use or rather abuse it, a branch of the sin of drunkenness, which is the root of all sins." "To take a custom in anything that cannot be left again, is most harmful to the people of any land. Mollicies and delicacy were the wreck and overthrow, first of the Persian and next of the Roman empire. And this very custom of takftfg Tobacco is even at this day accounted so effeminate among the Indians themselves, as in the market they will offer no price for a slave to be sold, whom they find to be great tobacco-taker." "Is it not a great vanity, that a man cannot heartily welcome his friend now, but straight they must be in hand with tobacco; no, it is become in place of a cure, a point of good fellowships and he that will refuse to take -60- a pipe of tobacco among his fellows (though by his own election he would rather feel the savour of a sinke, is accounted peevish and no good company, even as they do with tippling in the cold eastern countries. Yea; the mistress cannot in a more mannerly kind entertain her servant, than by giving her; out of her fair hand; a pipe of tobacco." "Moreover, which is a great iniquity and against all humanity, the husband shall not be ashamed to reduce thereby his delicate, wholesome, and clean-complexioned wife to that extremity, that either she must also corrupt her sweet breath therewith, or else resolve to live in a perpetual stinking torment." He concludes thus in reference to smoking: "Have you not reason then to be ashamed; and to forbear this filthy novelty; so basely grounded, so foolishly received, and so grossly mistaken, in the right use thereof." "A custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and in the black, stinking fume thereof; nearest resembling the horrible Stygian smoke of the pit that is bottomless." Vide "Workes of the Most High and Mightie Prince James; by the grace of God, King of Great Britain," &c., 1616. 77. The following extract is from an able article on the United States, which appeared in the London Spectator of July 5th, 1856: "We have been long familiar with the fact, that the manners and social habits of Americans are not to our taste, and that few persons who could obtain a respectable maintenance in Europe, would find the change to -61- the United States a change for the better. . . . It is in startling contrast with our ordinary train of thought about the United States, to hear it even whispered as a possibility, that the race of men which inhabit the country is undergoing a process of physical and moral degeneracy; that the symptoms we have been accustomed to consider as evidences of growth are really proofs of decay; that the people are, like medlars, rotten before they are ripe, and that a premature senility is the true characteristic of the great Anglo-Celtic Republic of the West. That such a theory should have been started, gives one a shock, which does not pass off when the facts upon which it professes, to rest are calmly considered. "It is said, for instance, that the bulk of Americans live thoroughly unwholesome lives; consuming inordinate quantities of spirituous liquors from youth upward, and at all hours of the day smoking and chewing tobacco to excess, eating greedily, and giving themselves no time to digest their food, always in a bustle and excitement, enjoying neither quiet nor rational recreation, nor domestic peace. And how few Americans has any Englishman known of whom he could say, that they were genial or happy! what an anxious, nervous, haggard expression of face, is that by which we instinctively recognize a Yankee everywhere! how completely the manner, and countenance, and figure of the typical Yankee answer to this account of the usual life of the people! . . . What if the bad habits of men and women, acting with a climate that tends to exhaust vitality, should really in a few generations have produced a palpable inferiority of physique? The positive asser- -62- tion of this degeneration would indeed be most unphilosophical, on a basis of facts such as are patent to common observation; but that these facts are patent, is sufficient to excite the alarm and sharpen the self-watchfulness of all classes of Americans, who can look forward to the tremendous consequences of a degradation of the national nerve and muscle; through intemperance and bad habits of living. . . . The fashionable classes of American society are more notorious for their luxury than for their refinement or ambition." 78. I am given to understand that there exists a rule among a large and influential religious sect; when a student presents himself as a candidate for examination for ordination; which compels him to answer, Whether he smokes tobacco; or uses it in any form? If he confesses he does so; he is remitted to his studies until he gives it up, and can aver that he has "thrown away tobacco for ever." 79. The great Wesley, I believe, first suggested the rule, which still obtains, that no minister connected with the Wesleyan body should use snuff or tobacco, unless prescribed by a physician. 80. Adam Clarke, LL.D. [1762-1832], a Methodist divine, published in 1837, among his detached pieces, a [Ed. Note: reprint of his 1797] dissertation on "the Use and Abuse of Tobacco." It is unnecessary for me to enter at present into a formal criticism of his treatise, but in referring to such authority in support of my views, I may be permitted to quote the following case. At page 29, he says: "A person of my acquaintance, who had been an immoderate snuff-taker for up- -63- wards of forty years, was frequently afflicted with a sudden suppression of breathing, occasioned by a paralytic state of the muscles which serve for respiration. These affections grew more and more alarming, and seriously threatened her life. The only relief she got in such cases, was from a cup of cold water poured down her throat. This became so necessary to her, that she could never venture to attend even a place of worship, without having a small vessel of water with her, and a friend to administer it. At last she left off snuff; the muscles re-acquired their proper tone; and, in a short time after; she was entirely cured of a disorder, occasioned solely by her attachment to the snuff-box; and to which she had nearly fallen a victim." Ed. Note: Clarke's Dissertation Was Repeatedly Re-published A Dissertation on the Use and Abuse of Tobacco Wherein the Advantages and Disadvantages Attending the Consumption of that Entertaining Weed are Particularly Considered: Humbly Addressed to all the Tobacco-Consumers in Great Britain and Ireland, But Especially to Those Among Religious People (London: G. Whitfield, 1797; London, G. Whitfield, 1798; Liverpool: J. Nuttall, 1805; Newburyport [Mass]: Thomas & Whipple, 1812; Salem: Henry Whipple, 1812; Burlington, N.J.: David Allinson & Co., 1812; London, 1814; New York: C. S. Van Winkle, 1819; New York : M'Elrath and Bangs, 1829; Baltimore: Sherwood & Co., 1845; London, W. Tegg & Co., 1857; Newburyport: Thomas & Whipple, 1900 and 1983; London: Whitfield, 1900 and 1983; New York: Van Winkle, 1900 and 1983; and Burlington, N.J.: Allinson & Co., 1900 and 1983) 81. [James] Anton, in his interesting Retrospect of a Military Life [During the Most Eventful Periods of the Last War] [(Edinburgh: W. H. Lizars, 1841)], relates the death of one of the sergeants of the 42d Regiment from smoking tobacco, which apparently had induced apoplexy. See page 154. On conversing with Mr. Anton, he states that the sergeant was an excessive smoker of the weed. 82. The Paris correspondent of the New Orleans Picayune, in recording the death of the poet Berat, says: "Berat was not forty-five years old. He, too, was slain by that disease which is so fell a destroyer to our contemporaries; and especially to Frenchmen—the softening of the spinal marrow. Trousseau attributes to the excessive use of tobacco the fatal effects on the nervous system. Roger Collard; who died in the dawn of a most brilliant career; some three years ago, of this terrible disease, attributed his untimely end to his cigar. Count D'Orsay was another victim of this disease; and -64- his death made a profound impression on the Emperor, who at once sent his physician, Bretonneau, to whom the Count complained of fatigue in all his members—of enervation. Dr. Bretonneau replied, 'You surely smoke some twelve or fifteen cigars a-day. Smoke less. Abstain, if you can, altogether from smoking, and you will end these symptoms of weakness and enervation." 83. In the able Clinical Lecture of Mr. [Samuel] Solly [1805-1871], Surgeon of St. Thomas's Hospital, on Paralysis, there occurs the following statement: "There was another habit, also, in which my patient indulged, and which I cannot but regard as the curse of the present age—I mean smoking. Now, don't be frightened, my young friends, I am not going to give a sermon against smoking—that is not my business, but it is my business to point out to you all. the various and insidious causes of general paralysis, and smoking is one of them. I know of no single vice which does so much harm as smoking. It is a snare and a delusion. It soothes the excited nervous system at the time, to render it more irritable and more feeble ultimately. It is like opium in that respect, and if you want to know all the wretchedness which this drug can produce, you should read the "Confessions of an Opium-eater." I can always distinguish by his complexion a man who smokes much, and the appearance which the fauces present, is an unerring guide to the habits of such a man. I believe that cases of general paralysis are more frequent in England than they used to be, and I suspect that smoking tobacco is one of the causes of that increase."—Vide Lancet for 18th December, 1856, page 641. Books by Dr. Solly The Human Brain: Its Configuration, Structure, Development, and Physiology (London: Longman, Rees, Orme, Brown, Green and Longman, 1836) The Human Brain: Its Structure, Physiology and Diseases, With a Description of the Typical Forms of Brain in the Animal Kingdom (London: Longman, Brown, Green and Longmans, 1847) The Human Brain: Its Structure, Physiology and Diseases, With a Description of the Typical Forms of Brain in the Animal Kingdom (Philadelphia: Lea and Blanchard, 1848) The Human Brain: Its Structure, Physiology and Diseases, With a Description of the Typical Forms of Brain in the Animal Kingdom. From the 2d London ed. (Philadelphia: Lea and Blanchard, 1848) Surgical Experiences, The Substance of Clinical Lectures (London: Hardwicke, 1865) See additional Data Below by Dr. Solly, Starting on p. 85. -65- 84. I lately visited a gentleman in a Lunatic Asylum, laboring under general paralysis, and bis mind becoming idiotical. On corresponding with. his former medical attendant I understand his habits were, that he lived temperately as regarded drink, but worked hard in a mercantile house, and smoked to excess; the phrase he makes use of is—that "he blazed away at a fearful rate." 85. In Dr. William Henderson's work on "Plain Rules for Improving Health," second edition, pages 87, 88, 89, and 261, there are cases of dyspepsia, palpitation of the heart, of insanity, etc. produced by using tobacco. One gentleman, "from having been one of the most healthy and FEARLESS men, became one of the, most timid. He could not present a petition, much less say a word concerning it, though he was a practising lawyer. He was afraid to be left alone at night." In the cases of insanity mentioned by him, the patients "had used tobacco to excess, though perfectly temperate otherwise, as regarded drink." The reader is referred to pages 18 and 52, for further information on mania. 86. In the Lancet, for 8d January, 1857, Mr. Fenn thus describes the result of his investigations on the effects of tobacco: "Tobacco," says he, "has the effect of relaxing the skin and mucous membranes, causing the latter to pour out their secretions more freely, and to shed the epithelium more rapidly; at the same time, the sensibility of the nervous system is greatly depressed, and the vital force diminished. On account of its softening and re- -66- laxing effect upon the mucous membrane of the bowels, it is greatly resorted to in habitual constipation. But it will be seen that this weakening influence is exerted upon the organ liable to be most seriously affected in typhoid fever, and very frequently is the predisposing cause of the uncontrollable diarrhœa and hæmorrhage which occur in such cases. I have seen very mild cases of typhoid fever rendered fatal, from the excessive use of tobacco, either from diarrhœa or peritonitis, the result of perforation. Now perforation scarcely ever occurs until the patient is moribund, and the body semi-putrid; but the immoderate use of tobacco will predispose to perforation under very different circumstances. For instance, a gentleman in my practice had progressed very favorably to the fifteenth day of typhoid fever; the diarrhœa was very moderate, and the symptoms altogether so mild as to call for a purely expectant treatment, nourishment, with very little stimulant, sufficing to keep the patient in a very fair condition from day to day. On the fifteenth day his bowels were relaxed at 6 in the morning; at 5 P.M. he got out to have his bed made, and as his bowels had not moved since 6 A.M., he thought it might save getting out again if he could evacuate them at the same time; for this purpose he made a straining effort and almost instantly felt something give way; a violent pain ran rapidly across the region of the bladder, and soon diffused itself over the whole abdomen; tympany occurred within an hour, and in twenty-four hours he died from peritonitis, the result of perforation of the small intestine. A milder case than this I never saw, but the patient was accustomed to smoke ten or twelve -67- cigars daily. I could quote other cases almost parallel where the immoderate use of tobacco destroyed all the chances of recovery in otherwise favorable or merely doubtful cases of typhoid." How many of our brave soldiers must have died at Varna, Burmah, and other localities, where diarrhœa, dysentery, and cholera were epidemic, and where tobacco was consumed immoderately! I should imagine that the greater number of those who died suddenly, and in agony, must have had perforated intestine. The reader is referred to page 53, Prout's experience, which in a measure confirms this. 87. Dr. B—, an experienced physician, has krndly communicated the following interesting and satisfactory case of a near-relative, who fell a victim to tobacco smoking, which produced cancerous ulceration of the tongue; also a graphic delineation of the disease. Mr. A., a gentleman about fifty-eight years of age, of a strong wiry frame and healthy constitution, none of whose relations had ever had a cancerous affection, was observed, in 1831, to articulate with difficulty—his tongue being too large for his mouth. On being interrogated by a medical friend, a relation of his own, he acknowledged that he was a devoted victim to the weed. His tongue at this time was enlarged, firm, and coated with a white crust, somewhat resembling the confectionery named kisses. There was a sulcus in the centre of the tongue, with a bright red line at the base. The sore was washed with a solution of the chlorate of soda, before this sketch was taken. His medical attendant, to induce him to give up smoking, informed him that -68- the disease of his tongue would kill him, so that he at once "threw away tobacco forever." From this time the disease progressively got worse. In May, 1833, the patient, accompanied by his medical relation, visited London, and consulted Sir Astley Cooper, when the patient put the following question to Sir Astley: "Had I come early enough, could I have been cured?"—to which Sir Astley replied: "Sir, there never was a time early enough to have warranted an operation: every fibre, every papilla of your tongue is diseased; and it would have been merciful to have clapped a pistol to your head, the instant the disease began." Sir Astley prescribed for him, but to no purpose, as the disease increased with a rapidity inconceivable; for by the end of June, the anterior portion had mouldered away (so graphically described by his medical attendant), the tongue being previously cleansed by the chlorate of soda, in doing which the fœtor was intolerable. He now suffered acute pain, and was obliged to take morphia every night. His pulse was from 120 to 160. In July, his spirits began to be dreadfully depressed, accompanied with pains in his head, and he at this time remained chiefly in bed. By the 24th, the ulceration had extended to the fauces, and the glands at the angle of the lower jaw bone became swollen. Deglutition was now difficult and painful, and his strength began to fail—but still no hæemorrhage. By the middle of August, the tongue had mouldered away—the stump presenting an irregular, lumpy surface, covered with a flocculent, dirty, greenish-white -69- deposit, and the ulceration extending on the left side to the os hyoides, accompanied with a most offensive discharge. There was a spasmodic difficulty in swallowing, a troublesome cough, with difficult expectoration, great mental depression, and hallucination of mind. On the 25th of this month, for the first time, an oozing of arterial blood took place, but not to any extent. His pulse was 130, and very weak—some aberration of mind. Cough very incessant during the night, and he appeared in great agony. In the beginning of September he became very weak, so that he was confined to bed, passing restless nights, with profuse perspirations. His mind much affected, breathing very difficult, with constant expectoration of viscid phlegm mixed with blood. When he attempted to swallow fluids, they were returned by the nostrils. The dressing the extensively-ulcerated surface caused severe pain, and the fœtor was excessively offensive. The sub-maxillary glands were now greatly enlarged. Pulse generally above 120. By the 25th September, the whole of the uvula, velum, and tonsils were destroyed by the ulceration. The glands at the angle of the lower jaw larger and more painful. He was then unable to swallow, and hence could take no nourishment. From this to the 2d October, all his symptoms became aggravated, the salivation more profuse, the perspirations more abundant, and the difficulty of breathing insupportable; and after three hours of intense suffering he expired. "All the death-bed scenes and death-bed. sufferings I had ever witnessed," says his medical -70- friend, "were comparatively easy, [compared] to the individual agonies and gaspings for breath this kind and amiable man was destined to endure." His medical friend adds: "The disease is novel and unique to me—it has differed in its appearance and progress from any and every disease of the tongue that I have ever seen or read of." Professor Bennet, in his microscopic examination of a section of the late D. R.'s tongue, goes to corroborate the above view. Query—If the ulceration differs from carcinoma, a smoker runs the risk of two diseases, viz., carcinomatous sarcoma, and carcinomatous nicotianum? A case precisely similar to Mr. A's, I have received from my friend Dr. Tod, of Gilmore Place. 88. A middle-aged woman, an inveterate smoker, was alarmed at seeing a small warty-looking growth in the centre of her tongue, which frequently gave her a stinging pain, and which she requested a neighbor to look at. She continued to smoke her pipe, never dreaming that the tobacco was the cause of her sufferings, until the excrescence began to ulcerate, which it did rapidly, and extended to the root of her tongue, destroying the anterior portion by sloughing, and ultimately destroying life in twelve months. 89. J. T—, ætatis 46, consulted Dr. Tod, of Gilmore Place, in the middle of January, 1856, regarding a slight swelling on the right side of his tongue, which was attributed partly to decayed teeth, and partly to smoking tobacco. He consumed two ounces weekly with a pipe. His wife states, that whenever any thing agi- -71- tated him, he flew to the pipe, and smoked until he trembled nervously. He "threw away tobacco forever." As three of the contiguous teeth were decayed, with ragged edges, they were immediately extracted, but without any benefit. In a short time, a fissure took place at the swollen point, which increasing, I was consulted, and, after a careful examination, it was pronounced cancerous, and recommended to be treated by ligature. On the 14th July, 1856, ligatures were passed from under the tongue to its upper surface, so as to include all the disease; but on the fifth day, such smart hæmorrhage took place from the central ligature, that they required to be removed, and the actual cautery applied. The cautery was repeated very often in consequence of the bleeding occurring. [The manner of applying ligatures to the tongue, when affected with cancer, is delineated in Fig, 4 of Plate XXXVIII. of my Practical Surgery, 2d edition, and described at page 305 of the same work.] In September following, the glands at the angle of the jaw became swollen, and threatened suffocation. The ulceration spread rapidly, involving the right half of the tongue. At this time he was sadly tormented with profuse salivation, and fœtor of breath. His pulse from first to last has never been under 100, but often above. Towards the end of October, fearful hæmorrhage took place, requiring Dr. Tod to sit up all the night of the 27th, applying one actual cautery at a black heat after another. Next day his tongue was swollen as if he had been severely salivated with mercury, the point pro- -72- jecting an inch or two beyond the lips and teeth, and very turgid. 3d November.—Tongue still tremendously swollen and pallid, causing perpetual exudation of the saliva, and preventing him swallowing. He is now much emaciated, and the pulse never under 110. The glands at the back of the tongue and neck are much increased in size. 10th November.—His tongue now projects beyond his teeth fully two inches, and he cannot retract it. The teeth are beginning to indent themselves in the soft tongue, and threaten to cut it in two. His existence is now kept up, more by nutrient enemata, than by nourishment from the mouth, the difficulty of swallowing is so distressing. 19th.—Dr. Tod nipped, with the bone pliers, the upper teeth parallel with the gum, which gave him some relief. 3d December.—His face has a hideous appearance, from the protruded swollen tongue, which is daily becoming more detached by the ulceration extending across, and from the enormously swollen glands of the neck. He is unable to swallow any quantity, and is therefore still nourished by enemata. In the night time, his breathing is so laborious, that it can be heard in the adjoining room. Smell of tongue still very offensive. 22d.—At his solicitation we have this day put a ligature in the fossa, between the root and the projecting portion of the tongue, to facilitate the separation of the latter. While tightening the ligature, a point of the -73- surface of the projected part bled a little, but soon stopped. We punctured the tumor below his chin, as it pointed, and the skin threatened to inflame and ulcerate. Strumous-looking matter, whey-colored, with