Acute nicotine or pyridine poisoning is frequently seen after the first cigar, or when an unusually large quantity of tobacco is consumed in a short time. The symptoms are those of mild collapse, viz., pallor of the skin, sweating, nausea, and perhaps vomiting, diarrhea, muscular weakness, faintness, dizziness, and lowered arterial pressure. Tedeschi reports epileptic seizures.

Treatment

Fresh air and rest lying down, with reflex stimulants, such as whisky, brandy, or aromatic spirits of ammonia. If the symptoms are severe, the treatment is that for severe collapse; but this degree of poisoning is rare from smoking, as the stomach symptoms or the mild collapse come on early and check the further use of the drug. Were the drug to manifest its symptoms more slowly, so that a larger dose might be consumed before the smoker becomes ill, many serious poisonings would result.

Tolerance is readily established up to a certain limit, which differs widely with different persons, e. g., the limit of tolerance for one person is a single cigar in an evening, while another person may smoke ten cigars in the same time without being upset. After the use of tobacco has been abandoned for a time the tolerance to it is found to have decreased.

The Tobacco Habit

As a habit drug, tobacco is peculiar in that the effects desired are not to be attributed in any great degree to its most active constituent, nicotine. Indeed, the best tobaccos are not by any means those with the highest percentages of the alkaloid.

To the beginner in smoking the pleasure is sadly lacking; and it is not until the habit is established that smoking becomes a source of comfort and pleasure. But to the habitue tobacco is narcotic, its use in moderation promoting the feelings of ease and relaxation. Strangely enough, its pleasurable effects seem quite unrelated to the extent of the physiologic action, for to most smokers there is little satisfaction from smoking in the dark or from using the tobacco in some unaccustomed way, as in a pipe instead of cigarettes, or as snuff; and a weak Havana tobacco often gives more pleasure than a two or three times as strong Virginia or Kentucky variety. It is a fact, also, that those who have the habit of inhaling, and are, therefore, accustomed to bringing the smoke in contact with a large surface of mucous membrane, get little satisfaction, no matter how strong the tobacco, unless they inhale to bring the smoke to the accustomed membranes. The same may be said of the use of tobacco in the form of snuff - smoking will not satisfy the snuff user.

Another noteworthy fact is that there is no great physiologic demand for the usual dose of tobacco, so that the habit of smoking can be stopped suddenly without any striking physiologic reaction. Also, a moderate smoker - one who is accustomed, say, to one cigar after his dinner - can get along very well without his smoke, and will have less craving for it two or three hours later than he had at the usual time for it. This is not true of morphine, cocaine, or the other habit drugs, for which the craving becomes worse and worse as the deprivation continues.

It is evident, then, that the demand for tobacco is not so much the physiologic demand of the body for its dose, as it is the psychic demand for the satisfaction of a habit. The smoker's pleasure seems to be derived largely from the presence of something in the mouth, from the studied inhalation and exhalation, and from the soft circling up of the smoke. The fact that the presence of something in the mouth with rhythmic motion of the jaw, as in gum-chewing, gives a pleasure that is similar, though weaker, places the use of tobacco in a psychic habit class with chewing gum, eating chocolate, or perhaps sucking a toothpick. In attempting to break the tobacco habit we take advantage of this fact and advocate the chewing of gum, or of some substance of strong taste, such as gentian or lovage, or the eating of candy at the usual smoking time. Many an old smoker speaks of smoking as "a fool habit."

That the effect is not all psychic, however, is suggested by the failure of any other substance to give the satisfaction that tobacco does, either for smoking or chewing. Every one prefers to smoke tobacco, for example, rather than cabbage leaves, though the smoke of cured cabbage leaves contains pyridine bases. This preference for tobacco may, however, be merely a matter of the greater delicacy of the tobacco taste and aroma.

The method of smoking makes some difference. The Lancet has shown that the pipe smoke contains the most alkaloid and the cigarette smoke the least. The pipe has the disadvantage that owing to the heat of the tobacco and the bowel of the pipe, oily nicotine and pyridine substances tend to distil into the smoke without combustion. Some of these are inhaled and some accumulate in the stem of the pipe, so that an old pipe gets "strong." The pipe-smoker tends to keep more or less under the influence of tobacco by frequent, short smokes, but he seldom inhales. The cigarette smoker is prone to inhale, i. e., draw the smoke into his lungs.

The cigar is less rapidly consumed than the cigarette, and its area of ignition is greater, so that the tobacco just in advance of the area of combustion gets hot; consequently there is some volatilization of the raw nicotine, and this is drawn in with the smoke. This is not so much as in the pipe; but the fatter the cigar, the greater will be the volatilization, and therefore the less the destruction, of the nicotine. Hence the smoke of a thin cigar, and still more so that of a cigarette, will contain less of the raw, volatile poisons than that of a thick cigar. W. E. Lee (1908) has tested the relative potencies of cigars and cigarettes as follows: A Manila cigar and a cigarette of Virginia tobacco of nearly double the strength of the Manila tobacco were burned so that the same amount of tobacco in each was consumed in the same time. The smoke of the cigar made of the weaker tobacco was about twice as toxic as that from the cigarette.