By J.M.W. Kitchen, M.D., New York.

With perhaps the exception of heredity, the question of stimulants and narcotics in their relation to the physical welfare of the race is second to none in importance. With trifling exceptions, the whole world is addicted to their use. The universality of such use has led many to consider them a necessity to man, and that they are God's gifts to him, and, if rightly used, are of physical benefit. It may not be a perversion of judgment to consider that their widespread popular use is greatly due to the efforts of the race to gain anaesthesia for, and distraction from, those pains and punishments that are the inevitable sequence of departure from hygienic and social law on the part of the individual, his ancestry, and society in general.

The taste for these things is acquired, not natural, though the acquisition may be through hereditary influence. An idea is held by a majority of even fairly intelligent individuals that there is a justifiable, harmless, and even beneficial use of these substances by the general public, though acknowledging that beyond a certain indefinite line this use becomes an abuse.

I believe that there may occasionally be cases in which the physical benefits derived from their use outweigh the injury they inflict, but I think this use is very much less than is generally supposed, and if we can judge from the preponderance of evil effected by such use, these substances ought to be considered as the materialized curses of God rather than as beneficent gifts. The prevalent idea as to the beneficent nature of these substances I consider to be a delusion that can only be explained upon the hypothesis that there is a widespread lack of appreciation of the fact that, though they may have an immediate pleasant and agreeable effect upon the body, their injurious effects are cumulative, and are usually ultimate, and so distant as to be difficult of direct connection with their cause to ordinary observation. The more moderate the use of these substances, the more remotely is the effect removed from the cause and more difficult of detection. That the ordinary habitual, so-called moderate use of stimulants and narcotics, such as tea, coffee, tobacco, and alcohol, is, in the vast majority of cases, really an abuse, is a proposition that I think should be admitted by all who have given the subject an unbiased study.

The idea that the user of tobacco and other injurious substances will be cognizant of the injury inflicted by habitual use in moderate or even excessive amounts is an undoubted fallacy. The daily, weekly, or monthly injurious effect may be entirely unobservable to even trained physicians, and yet the ultimate cumulative effect may be fatal. I can instance numerous cases of physicians directly fatally injured by the use of alcohol, who have never had the slightest cognizance of the fact; and I can also instance cases of grave disease from the use of tobacco where the patients never have believed that tobacco has been the cause of their troubles, even after a unanimous opinion to that effect has been expressed by a number of competent medical advisers. The habitual consumption of opium, in doses of any amount, is generally admitted by most people to be physically injurious outside of its strict medicinal application. Moderate indulgence in alcohol as a beverage is beginning to acquire a very widespread evil reputation.

But how about tobacco? Tea and coffee we can confidently leave to the consideration of a somewhat remote posterity of a considerably advanced intelligence and elevated hygienic ideals.

The relation of tobacco to the physical welfare of man can only be fairly estimated by viewing the subject in its broadest aspect; by considering its effects upon the race as a whole rather than in individual cases; by taking into consideration economical and other social conditions that at first sight might be considered as having little relevancy to the medical side of the subject. But there can be no just consideration of the matter otherwise. The direct deleterious effects of the immoderate use of tobacco are readily observable; but the great bulk of the evil physical effects due to the moderate use of this plant are of an intermediate nature and not directly noticeable; nevertheless, they are real, and worthy of medical attention. The plainly marked results following the use of tobacco in relatively large amounts seem to be due to quick and extreme interference with nutrition, and a diminution of function of all kinds, which may be represented by anything from a slight decrease of appetite and digestive ability up to a complete loss of function of almost any important organ. Tobacco has stimulating as well narcotic properties, but as ordinarily used its stimulating effect appears to be slight as compared with its narcotic influence.

In this respect it differs from alcohol, the use of which, owing to the usual method of introduction in large amounts through the stomach, produces directly, by stimulation, readily noticeable structural changes. But with tobacco the direct evil results are mostly of a functional character, and are more generally diffused, owing to the usual slow manner of introduction into the body. These two properties have an effect upon the body in moderate use as well as in immoderate use, the effect being simply in proportion to the quantity used, though the effects of moderate use may not be measurable by ordinary means. It is easy to see the effects of large amounts of tobacco in the stunted growth of adolescents; in functional cardiac disorders; in intellectual sluggishness, loss of memory, and color blindness; in loss of appetite, and other neuroses of motion, and marked blunting of various functions of sensation, and in degeneracy of descendants; but that lesser evils are produced must be proved mostly by inference, circumstantial collateral evidence, and analogy.

The greater evils that are the outcome of a moderate use of tobacco are probably due to prolonged slight interference with nutrition, and consequent general decrease of vitality, which renders the individual more susceptible through indirect influence to the invasion of disease, and which lessens the capacity for productive effort.