As a matter of fact, the cigarette fiend does not consume any more tobacco than the cigar or pipe fiend, for 10 average cigars represent the tobacco of 50 or 60 cigarettes, and, as we have seen, the cigarette is the least harmful form of tobacco. Yet there are real objections to the cigarette, viz., that it makes smoking easy for the young, that it has a strong tendency to induce the habit of inhalation, and that, being small, it can be smoked at odd moments, so that the excessive cigarette smoker tends to keep himself under some influence of the drug all day long. The 28 charge that the rice-paper of the cigarette produces harmful fumes has been repeatedly shown to be without foundation. Indeed, if the paper is impregnated with potassium nitrate to make it burn evenly and without bursting into a flame, as is frequently the case, it has a tendency to overcome the primary rise in blood-pressure which is brought on by the nicotine.

Those who lead an open-air life can smoke much more than those who remain indoors. Especially bad is constant smoking in an ill-ventilated room, for more or less of the smoke is reinhaled.

Moderate smoking is a psychic depressant, favoring ease and comfort and "laissez-faire," rather than effort and work and energy. It is truly narcotic. In so far as it is a habit the smoker may feel ill at ease if he fails to get his usual smoke; yet excessive smoking may be given up at once and absolutely without any rebellion on the part of the body. It is easier for the patient if he keeps away from smokers and has cheerful company, and if he chews something bitter or strongly flavored, such as gentian-root, lovage, chewing-gum, or chocolate.

Blood-Pressure

Many investigators have noted a decided rise in arterial pressure during smoking, even in persons habituated to its use. But this is not a constant effect. In 17 men from sixteen to thirty-one years of age, Aikman got a rise in 5 and a fall in 12, from smoking one cigarette. Thompson and Sheldon (1917), experimenting on 58 patients in middle or advanced life with high arterial pressure and arteriosclerosis, found that smoking a cigar produced a rise in systolic pressure in 35 per cent., a fall in 45 per cent., and no change in 20 per cent., the results being variable in the same patient.

Efficiency

Seaver while physical director at Yale estimated that smoking an ordinary cigar resulted in one hour in a marked drop in muscular power. Of 500 boys at school, Taylor found the grades of the smokers invariably lower than those of the non-smokers. Of 201 students at Clark University, of whom 46.3 per cent. were smokers, Clark noted that 68.5 per cent of the non-smokers and only 18.3 per cent. of the smokers won academic honors. Meylan, in a study of the tobacco habit at Columbia University, concludes that "the use of tobacco by college students is closely associated with idleness, lack of ambition, lack of application, and low scholarship." Of course one must concede that the men of poor calibre and lack of application are more prone than ambitious workers to carry the tobacco habit to excess.

Bush, in a series of 120 tests in each of fifteen men in several different psychic fields, shows that tobacco smoking was followed by a 10.5 per cent. decrease in mental efficiency, most marked in the fields of imagery, perception, and association. Habituation lessened the degree of mental inhibition resulting from the smoking, and the men of the higher intellectual rank seemed to have the greater susceptibility. Fisher and Berry found that even a single cigar lessened the accuracy of baseball players in throwing a baseball at a target. From a study of the irritable heart of soldiers, Parkinson and Koefod (1917) conclude that excessive cigarette smoking is not the essential cause in most cases, but is an important contributory factor in the breathlessness and precordial pain. Chronic Tobacco Poisoning. - Much smoking for a length of time may cause various disturbances, viz.:

1. Derangements of digestion, as lack of appetite, nausea, heartburn, constipation.

2. Headaches, depressed states of the mind, lack of energy, irritability of temper (auto-intoxication), restlessness, nervousness, and impaired memory.

3. Tobacco heart - rapid or slow, irregular, very susceptible to nervous influence. There may be palpitation, precordial distress, and dyspnea on exertion. Syncope may cause death in high altitudes, and a number of persons with tobacco heart have died in the train while crossing mountains. Tobacco-smoking has been the cause of bradycardia, tachycardia, extrasystoles, auricular fibrillation, auricular flutter, sino-auricular block, and auriculoventricular block.

4. Arteriosclerosis - atheroma of the aorta has been reported as produced in rabbits by nicotine, by infusion of tobacco, and by inhalation of tobacco smoke. It is to be remembered that atheroma of the aorta is common in rabbits without tobacco.

5. Tobacco amblyopia. This results from a chronic retrobulbar neuritis in which it may not be possible to detect anything wrong with the optic disc, but vision is dulled and is not improved by glasses. Vision is often better in a dull light than in a bright one (de Schweinitz). In some cases the optic disc may be pale and somewhat atrophied.

6. Deafness - either from the production of catarrhal conditions in the nasopharynx and Eustachian tube, or from an effect on the nerve.

Most of the bad effects are removed by the stoppage of the drug and proper hygiene, i. e., exercise, fresh air, baths, etc.

The local irritation of the smoke upon the tongue has been charged with the production of epithelioma; that on the throat with the production of catarrhal conditions or hoarseness; that of the swallowed saliva with gastric hyperesthesia and gastritis.

Cigarmakers show a high proportion of cases of anemia, tuberculosis, brachial neuritis, sciatica, hysteria, and cardiovascular affections.

The Peripheral Nervous Stimulants

We have already spoken of the peripheral sympathetic stimulation of cocaine and epinephrine, and the primary stimulation from nicotine.