Chapter III.

The Medical Aspect.

17.—The extremely careful, and, on the whole, impartial researches of Dr. Richardson have thrown much light on the effects of tobacco. In his work on "The Diseases of Modern Life" he devotes three chapters to tobacco, and the picture he draws of its evil effects is a dark one. It is true that he doubts if tobacco produces organic disease; thus differing from many other distinguished writers. His only ground for maintaining this position is that he has not recognised such diseases in his practice. There is, however, no encouragement for smokers in this, even if it be the true position, for, as Dr. Richardson abundantly shows, tobacco aggravates every existing form of disease, and effectually prevents its cure, keeping up in the system, so long as its use is continued, complicated functional disturbance, which, in multitudes of cases, after embittering the later years of life, terminates fatally.

19.—It will be observed that in this summary there is not a redeeming feature in the action of tobacco, except where it is stated to soothe the brain when exhausted. But this is only the semblance of a redeeming quality. It is the soothing effect of a poison, and can only be enjoyed by those who are lowering their vitality and keeping up an unhealthy state of every function by its habitual use. It could have no soothing effect on the healthy subject unused to its influence. It is a temporary relief of the same delusive character as all habitual narcotism, and is especially mischievous in diverting the attention from the true remedy, viz., careful regulation of the balance between the powers of the individual and the efforts he puts forth, and a studious regard of all the known conditions of health.

20.—The effect of smoking on digestion is thus described by Dr. Richardson:—"The bitter extract of which I have already spoken, and which so readily excites vomiting in the young smoker, appears to act at all times, with more or less violence, on the mucous lining. At first it produces great irritation, redness and injection; after a time the changes are subdued, but not entirely removed. The membrane secretes irregularly, and as a general rule does not produce the due amount of gastric fluid; hence digestion is impeded. After digestion an acrid fluid is left in the stomach, which irritates and gives rise to heartburn, eructations, frequent nausea; with an almost constant sense of debility in the stomach, and sometimes to cravings for particular foods, especially for those which have an acid reaction, such as pickles and fresh fruits. The muscular portion of the stomach is first acted on by the nicotine. In small quantities the nicotine excites a slight movement in the muscular fibres, not only in the stomach, but of the other parts of the alimentary canal, and in the moderate smoker's it acts as an aperient. Carried to excess it produces a palsied condition of the muscular fibres, leading to a great increase of debility in the digestive organs, to a serious impairment of their functions, and to constipation."^*

21.—Let not the smoker take any consolation from the reference to the aperient effect here mentioned by Dr. Richardson. Our bodies do not require daily doses of poison to secure the discharge of the natural functions. Whoever depends on such aid will surely suffer in the long run. The peristaltic action produced by tobacco is the effect of a poison! Partial paralysis of the nerves accompanies it and the consequence is disease. Hence, either constipation or uncontrollable diarrhoea is a common affection of habitual smokers.

22—Of its action on the functions of the heart, Dr. Richardson says:—"There cannot be a doubt that inveterate smoking interferes very seriously with the contractile force of the central organ of circulation. No one can observe the influence of nicotine after its direct administration without feeling assured that it cannot be imbibed without inducing a paralysing effect on the heart, with irregularity of action and faintness. The conditions brought on by tobacco in this way are often developed suddenly, and last for many minutes, or even for hours at a time. The symptoms induced are characterised by palpitation, a sensation as though the heart were rising into the throat, a feeling of breathlessness and an insupportable pain in the region of the heart. Pains of a spasmodic kind extend also to the muscles of the chest, and occasionally to those of the arms, especially the left arm."

23.—Of course the doctor takes care to tell us that this extreme affection is the result of immoderate smoking, and he thinks it possible that a single pipe a day may, in the case of a man who is over-working himself, "curb extra excitement, prevent over-action, and arrest the development of the heart." This is dangerous advice for a man like Dr. Richardson to give. The benefit is to be obtained at a certain cost of evil. And how few will stop at the single pipe. Assuredly the multitudes who are suffering from heart-disease, induced by this very cause, need no encouragement in the dangerous practice. Besides, is it probable that an agent which produces the violent disturbance Dr. Richardson describes, can be beneficial as an antidote to an "unatural degree of muscular exercise," making "extreme demands on the pulsating organ that knows no rest?" The advice is as unphilosophical as it is dangerous and delusive. The proper remedy would be to abstain from "unnatural muscular exercise." But if that be impossible, let no one be deluded by the idea, by whomsoever propounded, that even small doses of a poison like tobacco can counteract the mischief, and secure exemption from the operation of the inflexible laws of nature. Probably in such cases abstinence from tobacco would soon lead to such an increase of muscular and nerve power as would prevent the given amount of labour from being felt as extreme.

24.—Dr. Richardson doubts whether smoking is a primary cause of disease of the lungs, but his testimony is none the less decisive as to the injury done by it in aggravating and developing chest diseases, and arresting the process of cure. He says:—"When it is said that smoking is not a cause of the diseases to which attention is now being called, it is not also conveyed that when these diseases are once set up smoking does not aggravate them; nor that when certain efficient causes are at work to induce these affections, the use of tobacco does not lend weight to the result. I am convinced it does both these things, and I could quote example upon example where persistence in smoking has tended to sustain and confirm the malady. This is most true in regard to consumption; for consumption is a disease which, with hereditary taint often lying at the bottom of it, is capable of being excited by the long-continued inhalation of impure airs. It is a disease that is intensified when the sufferer from it inhales, in the smoke of tobacco, carbonic acid, and the various other products of tobacco smoke, the action of which is so injurious to the blood. There is also another way in which tobacco does harm to consumptive persons. There is never any affection of the lungs, never any arrest in the process of breathing, without some derangement in the digestion. Indirectly the stomach requires oxygen; and without oxygenated blood it fails to produce its digestive fluid. Fresh air gives appetite. Smoking, as every one knows, destroys appetite and enfeebles digestion. Consumption does the same, and one of the most common presages of consumption is page 17 indigestion. Such indigestion, intensified by the act of smoking, adds, therefore, trouble upon trouble, and hastens that destruction which the disease of itself is sufficiently competent to enforce. For these reasons I have made it a rule for years past to insist that every consumptive patient should abandon the pipe and cigar, and I have found a rigid obedience to this rule worth many a formal prescription."

25.—But how infinitely better is prevention than cure! Considering the wide-spread tendency to consumption in this country, it is fearful to think of the immense amount of mischief that must be done by smoking, and of the multitudes in whom it is confirming and developing the fatal tendency. Dr. Brewer, who has written upon the effects of tobacco, mentions the case of a young man, apparently a confirmed consumptive. All the usual remedies were applied, but to no purpose. He became worse and worse. At length it was found that he was continuing to smoke the whole time. He was induced to abandon the cigar, and from that time recovery commenced, and proceeded rapidly.

26.—Dr. Richardson adds:—"In chronic bronchitis, in the ordinary run of cases, the use of tobacco is also injurious. The smoke acts as an irritant to the already irritable surface of the bronchial tubes; it keeps up cough; it increases indigestion, which in this disease as in phthisis, and for the same reasons, is a troublesome attendant; and it stands constantly in the way of successful treatment. I have seen many times a cough, following upon a cold, remain persistently in persons who smoke, and then immediately disappear when the smoking has been suspended."

27.—There is a humiliating sense of weakness in the apology that Dr. Richardson puts forward in defence of smoking that "single pipe" per day to which we have referred. Having asserted that it enables habitues to study, and soothes some of its restless votaries to sleep, he proceeds:—"It is not, however, necessary in accepting this argument, to accept tobacco as a requirement of the natural life. The excessive labours to which I have referred are altogether contrary to natural laws; for in this day we have run into the extreme of industry, and have carried our competition to the extent of folly. While, therefore, it would be implied that even to the natural man such adventitious aids as tobacco are unneccessary, it may be admitted that our social exigencies override our philosophies; and that as the individual man cannot by himself create a social revolution, he may be pardoned if he is too often led to bend lowly to custom, and seek in the unnatural conditions in which he is placed, unnatural, or perhaps, under the circumstances, I might almost say, natural remedies. For the most natural remedies are, in truth, unnatural measures, since they imply, in the necessity that calls for them, a primitive departure from nature."

28.—Never was a more specious though unconscious gilding of indulgence and folly put forward. Instead of counselling, as a wise physician, a return to nature as the only true remedy for the "folly" denounced, Dr. Richardson becomes the apologist for weakness, knowing as he does, too well, the suffering and ruin entailed on individuals, on families, and on the community, by the insane resort to tobacco and other narcotics as a relief from the self-induced evils that abound. The description of the inveterate smoker who cannot go to sleep at night without his pipe, is painful in the extreme, the more so from the veil of poetic diction in which it is sought to shroud the tremendous fact of his bondage to the narcotic. The attempt made to throw upon extra-exertion the blame that attaches to the slavery of bad habit is in equally bad logic.

29.—"They are excited," says the worthy doctor, "and too tired for rest; the mind is chaotic, and revolving rapidly over passing events, revolving nothing long, and dissatisfied with all." A truly humiliating picture, but graphically describing the state of the inveterate smoker. His will has become so childish that he cannot direct his thoughts, except to the one object of his desire, his darling pipe. He must have another or he cannot sleep. He gets out of bed, he indulges once more, and with the result—as described by the worthy doctor in the language of poetico-philosophical sensationalism—that "The pipe sometimes produces a soothing effect, causing natural rest, partial oblivion of the fast, and a tendency to that mental sleep that 'knits up the ravelled sense of care.'"

30.—Very "natural" indeed must be the sleep produced by a fresh dose of narcotic poison, and very refreshing doubtless the "mental rest" and "partial oblivion" resulting from the temporary stupefaction of the nerves produced by this seductive agent! Let men abandon all such unnatural habits, and square their lives by the rules of virtue and health, and cease to be the slaves of vicious customs, and they will have no need of tobacco to send them to "sleep o' nights."