Welcome to the tobacco chapter from the book How to Live (1915), by Prof. Irving Fisher, Ph.D., and Eugene Lyman Fisk, M.D. To go to the tobacco section "Table of Contents" immediately, click here.
In that era, medical science, emphasizing prevention, was conquering smallpox, plague, yellow fever, etc. Confidence was high that life-style diseases (e.g., those from tobacco) could soon be the next eliminated.
Politicians and the media had cooperated in those prior disease conquests. There was cooperation in that era against tobacco, and states (Iowa, Tennessee, Michigan) were banning cigarette manufacture. More progress was expected. 'Prevention' was the keynote of the period; people expected it to continue.
However, tobacco pushers had already conquered the media and politicians. People ceased to be meaningfully told tobacco effects.
In 1915, a President, Wm. H. Taft, was endorsing pro-health action. Nowadays presidents, such as Truman, Bush, Reagan, take tobacco lobby money, and obstruct tobacco-prevention. How morals have deteriorated!
The tobacco-effects concealment-process is called the "tobacco taboo." Other pertinent words are "censorship" and "disinformation."
Here is the text by Prof. Irving Fisher, Ph.D. (1867-1947), and Eugene Lyman Fisk, M.D. of an early exposé (1915) of tobacco dangers. It cites facts you rarely ever see, due to the "tobacco taboo."
The phrase "tobacco taboo" is the term for the pro-tobacco censorship policy—to not report most facts about tobacco.
This information about tobacco hazards was being circulated in 1915, 49 years before the famous 1964 Surgeon General Report.
Back then, with people's then substantially higher educational level, people understood statistics and prevention. They understood that prevention was different than making arrests! getting convictions!mass jailings! They understood instead that to prevent problems, for example, malaria, the solution was not mass jailings, but instead to take preventive measures, for example, to drain the swamps, thus eliminate mosquito breeding areas!
Re the effects and evils caused by tobacco, many people then knew to (a) not criminalize the effects, (b) not focus on individual cases, but instead to (c) act on statistical norms, and (d) ban at the cause level! See examples of bans by Iowa,   Tennessee, and Michigan.
This site reprints only the tobacco material, pp 13, 82-83, 339-365, and 412-413; and some introductory material with pertinent context, pp v-27. For the full book, contact your local libary.

How to Live
Prof. Irving Fisher, Ph.D.,
Eugene Lyman Fisk, M.D.
(New York: Funk & Wagnalls Co, 1915)

Table of Contents
Foreword to the Fifteenth Editionix
Medieval Ideals1
The Present Health Movement2
Medical Practise2
I. Housing7
Features of Ventilation7
Air and Catching Colds8
Heating Systems10
Cool Air10
Dry Air11
Tobacco Smoke13
II. Clothing14
Porous Clothes14
Tight Clothing16
Cottons, Linens, Woolens17
III. Outdoor Living18
Out-of-door Air18
Outdoor Schools19
Outdoor Recreations19
IV. Outdoor Sleeping20
Well Persons21
Vital Resistance22
Night Air22
Protection from Cold22
Outdoor Tents24
V. Deep Breathing25
Breathing Exercises26
Muscular Exercise26
Mental State27
(Pp. 28-81 Not Reprinted Here)28
(Pp. 84-338 Not Reprinted Here)84
What It Is339
Effects on Animals and Man343
Tobacco Smoking Athletes345
Insurance Experience on Smokers349
Poisonous Effects351
Tobacco and the Soldier353
(Pp. 366-410 Not Reprinted Here)366
Heart and Lung412
(Pp. 414-461 Not Reprinted Here)414


To one who has been an eye-witness of the wonderful achievements of American medical science in the conquest of acute communicable and pestilential diseases in those regions of the earth where they were supposed to be impregnably entrenched, there is the strongest possible appeal in the present rapidly growing movement for the improvement of physical efficiency and the conquest of chronic diseases of the vital organs.

Through the patient, intelligent and often heroic work of our army medical men, and the staff of the [Surgeon General's] United States Public Health Service, death-rates supposedly fixt [irreducible] have been cut in half.

While it is true that to the public mind there is a more lurid and spectacular menace in such diseases as smallpox, yellow fever and plague, medical men and public health workers are beginning to realize that, with the warfare against such maladies well organized, it is now time to give attention to the heavy loss from lowered physical


efficiency and chronic, preventable disease, a loss exceeding in magnitude that sustained from the more widely feared communicable diseases.

The insidious encroachment of the chronic diseases that sap the vitality of the individual and impair the efficiency of the race is a matter of increasing importance. The mere extension of human life is not only in itself an end to be desired, but the well digested scientific facts presented in this volume clearly show that the most direct and effective means of lengthening human life are at the same time those that make it more livable and add to its power and capacity for achievement.

Many years ago, [then Prime Minister Benjamin] Disraeli [1804-1881], keenly alive to influences affecting national prosperity, stated:

"Public health is the foundation on which reposes the happiness of the people and the power of a country. The care of the public health is the first duty of a statesman."

It may well be claimed that the care of individual and family health is the first and most patriotic duty of a citizen.

These are the considerations that have influenced me to cooperate with the life extension movement, and to commend this volume to the earnest consideration of all who


desire authoritative guidance in improving their own physical condition or in making effective the knowledge now available for bringing health and happiness to our people.

Wm. H. TAFT.
[President, 1909-1913
Chief Justice, 1921-1930]
New Haven, June 12, 1915.

Nowadays, Oct 2001, the President, George W. Bush, is pro-tobacco; the Chief Justice, Wm. Rehnquist, is a smoker! How the nation has deteriorated!



Since the foregoing words were written, the entire power of our country has been mobilized in defense of human liberties. This great peace-loving nation has proved its strength against a formidable war-making nation.

At the foundation of national strength lies human vitality. That is, underneath our power to furnish the money, munitions, food, ships, machinery and morale which won the war [11 Nov 1918, days earlier], we find the great fundamental requirement of sound bodies and minds.

The test of war, however, reveals the startling degree of physical insufficiency that characterizes civilized man all over the world. According to General Crowder's report, close to 35 per cent. of the men called in the draft were disqualified for active military service because of physical defects. These did not by any means include all who had physical impairments; for many were accepted with certain forms of serious infection which could be treated at the camps. These figures [compare] with those reported for several years [before] by


the Life Extension Institute on the basis of its examinations of large groups of supposedly healthy people. This coincidence is only one of several where the conclusions of the Institute, as exprest in the earlier editions of this book, anticipated lessons suddenly thrust uppn us by the [World] war [I] and as suddenly crystalized nto accepted knowledge.

Thus we have, as a by-product of a terrible and devastating [world] war, the revelation of a great national need and, in consequence, a new and lively interest in human vitality and efficiency. It is now, as never before, the evident and urgent duty of all citizens to make themselves in the highest degree fit.

The principles of individual hygiene which have been applied in the training and guidance of the soldier should also be imprest upon the civilian. Our full strength is demanded to "carry on" through the post-war problems of reconstruction.

I therefore commend anew this book to the earnest attention of our people at a time when, as a nation, we are turning from the destructive, life-destroying activities of war [just ended days ago, 11 Nov 1918] to the constructive, life-renewing activities of peace.

Washington, D. C., Dec. 5, 1918.



It gives the authors and the Hygiene Reference Board, who have cooperated in writing this book, great satisfaction to find that within three years it has passed through fourteen editions, reaching a total of over one hundred thousand copies, and that its usefulness is still on the increase.

It has been used as a text-book of hygiene in the University of California, Yale, Mills College, and elsewhere. Physicians and laymen alike have bought it in numbers for distribution among their friends or patients. A special edition was printed for, and circulated by, the Oregon Journal. A Japanese edition has been produced; and translations not yet published have been, or are being made in French, German, Italian, Dutch and Chinese. A Spanish translation has been made by the National Committee of Physical Education, an official organization appointed by the President of Uruguay, and published in their official organ, "Uruguay Sport."


There seem to be three chief reasons for the success of the book. One is, that unlike any previous book on the obscure and only partially developed science of individual hygiene, it represents not simply the opinion of one man but the composite judgment of more than ninety leading authorities on the subject in all its branches.

A second reason is that the readers of the book find in it something new and contrary to conventional ideas, for the authors decided at the outset to show the courage of their convictions and of those of the whole Hygiene Reference Board. Even where certain members of the Board would have preferred, because of life-long habits of extreme scientific conservatism, to refrain from changing their own personal customs and those of the people, as for instance in regard to alcohol, tobacco, tea, and coffee, the book has consistently and unhesitatingly given the conclusions of physiological science instead of taking counsel of tradition or of easy compromises with accepted indulgences.

The third reason is that those who have bought and distributed this book have had the satisfaction of knowing that its royalties went not into private pockets but into the philanthropic activities of the Life Extension Institute.


One of the most important measures of this type financed by these royalties is the circular of information for men rejected in the [military service] draft, which has been prepared by the Institute, issued by the U. S. Public Health Service, and placed in all the draft boards with the approval of the Provost Marshal General.

Also a considerable distribution has been made of the book, "Health for the Soldier and Sailor," which, contains in addition to material from the the book "How to Live," chapters on personal hygiene in the camp and in military service.

This latter book, by order of the Surgeon-General of the Navy, has been placed in all of the Naval Libraries, and has, with the cooperation of the publishers, been distributed to the medical officers and lay officers of certain rank in the Army and Navy.

The book, "How to Live," embodies the central idea of tlie Institute, which is to analyze, criticize and correct current habits of living. That these are radically wrong in many particulars and are responsible for an untold amount of harm, misery, and a vast number of premature deaths, was suspected by the authors several years ago on the basis of such fragmentary data as was


then available. That these suspicions were only too well justified was demonstrated by the enormous number of impairments found among apparently well people examined by the Institute. These findings, greeted at first with incredulity even by some public health experts and physicians, have been confirmed on a vast scale by the results of the medical examinations of registrants in the draft and volunteers.

At last the country is awake on this subject. Millions of people now realize that our national strength, in war or peace, is, in the last analysis, a matter of human vitality, and in consequence a new and livelier interest is being manifested in physical training, diet, and a well-ordered life. The striking improvement through physical training and corrective measures among men found unfit for serviced but sent to the camps for treatment and upbuilding, and the remarkable physical change among the young men in camp who have been accepted, have received wide comment.

This new attitude of the public mind is making far easier the work of the Institute in urging the vital importance, both from the personal and from the civic point of view, of periodic medical examinations, of


earlier and wider application of preventive medicine, and of a franker, fuller and more enthusiastic acceptance of modern physiological science where, as is frequently the case, it is found at variance with ancient social traditions.

Already as by-products of the war, certainly principles which seemed radical at the time they were presented in the earlier editions of this book, are now accepted by physiological science and medical science and even by the mass of the public as well-established truths, namely, the low protein standard in diet, the excessive food indulgence of the average adult, the profound influence of focal infection, especially mouth infection, in causing chronic disease.

The authors will welcome comment and criticism, but caution all who are disposed to question its material, especially scientific men, that beneath its popular form there lies first-hand scientific information and research and a certain sifting of the material by the Hygiene Reference Board.

That so little change, except in the way of additional evidence and stronger emphasis on most of the principles set forth in earlier editions and collected in the present edition,


has been necessary, is evidence of the close contact with the movement of scientific thought attained by the association with the Hygiene Reference Board.





THE purpose of the Life Extension Institute embraces the extension of human life, not only as to length, but also, if we may so express it, as to breadth and depth. It endeavors to accomplish this purpose in many ways, but especially through the promotion of individual hygiene.

Thoroughly carried out, individual hygiene implies high ideals of health, strength, endurance, symmetry, and beauty; it enormously increases our capacity to work, to be happy, and to be useful; it develops, not only the body, but the mind and the heart; it ennobles the man [person] as a whole.

Medieval Ideals

We in America inherit, through centuries of European tradition, the medieval indifference to the human body, often amounting to contempt. This attitude was a natural outgrowth of the theological doctrine that the "flesh is in league with the devil" and hence is the enemy of the soul. In the


Middle Ages saintliness was often associated with sickliness. Artists, in portraying saints, often chose as their models pale and emaciated consumptives.

We are beginning to leave this false tradition behind and are working toward the establishment of more wholesome ideals. It is probably true, for instance, that the man or the woman who is unhealthy is now handicapped in opportunities for marriage, the public attitude toward which may be considered an index to the ideals of society.

The Present Health Movement

A great health movement is sweeping over the entire world. Hygiene has repudiated the outworn doctrine that mortality is fatality and must exact year after year a fixt and inevitable sacrifice. It aims instead to set human life free by applying modern science. Science, which has revolutionized every other field of human endeavor, is at last revolutionizing the field of health conservation.

Medical Practice

The practice of medicine, which for ages has been known as the "healing art," is undergoing a gradual but radical revolution. This is due to the growing realization that an ounce of prevention is worth a pound of cure. As teachers and writers on hygiene, as trainers for college athletes, as advisers


for the welfare departments of large industrial plants, and in many other directions, physicians are finding fields for practising preventive medicine. Even the family physician is in some cases being asked by his patients to keep them well instead of curing them after they have fallen sick.

Furthermore, the preventive methods of modern medicine are being applied by the people themselves, as witness the great vogue to-day or sleeping out of doors; the popularity, not always deserved, of health foods and drinks; the demand for uncontaminated water supplies, certified milk, inspected meat and pure foods generally; the world-wide movement against alcohol; and the legislation for health insurance as well as to correct wrong conditions of labor and to safeguard the laborer.

Labor itself to-day is being held in honor, and idleness in dishonor. Ideals are being shifted from those of "leisure" to those of "service." Work was once considered simply a curse of the poor. The real gentleman was supposed to be one who was able to live without it. The king, who set the styles, was envied because he "did not have to work," but had innumerable people to do work for him. His ability to work, his efficiency, his


endurance, were the last things to which he gave consideration. To-day monarchs (the few that are left), and presidents are trying to find out how they can keep in the fittest condition and accomplish the greatest possible amount of work. Even among society women, some kind of work is now "the thing."

The exigencies of war have given a new and powerful impulse to these tendencies. The military ideal includes vigorous health of muscle and nerve; and military ideals are affecting the lives of us all. Physical and military training are coming to be required for school children and sought after by the middle-aged who are suddenly realizing, to their chagrin, how unfit they are to render military service to their country.

One of the most satisfying tasks for any man or woman to-day is to take part in this movement toward truer ideals of. perfect manhood and womanhood. Our American ideals, tho improving, are far inferior to those, for instance, of Sweden; and these, in turn, are not yet worthy to be compared with those of ancient Greece, still preserved for our admiration in imperishable marble.

With our superior scientific knowledge, our health ideals ought, as a matter of fact, to excel those of any other age. They should


not stop with the mere negation of disease, degeneracy, delinquency, and dependency. They should be positive and progressive. They should include the love of a perfect muscular development, of integrity of mental and moral fiber.

There should be a keen sense of enjoyment of all life's activities. As William James once said, simply to live, breathe and move should be a delight. The thoroughly healthy person is full of optimism; "he rejoiceth like a strong man to run a race" [Psalm 19:5]. We seldom see such overflowing vitality except among children.

When middle life is reached, or before, our vital surplus has usually been squandered. Yet it is in this vital surplus that the secret of personal magnetism lies. Vital surplus should not only be safeguarded, but accumulated. It is the balance in the savings bank of life.

Our health ideals must not stop at the avoidance of invalidism, but should aim at exuberant and exultant health. They should savor not of valetudinarianism, but of athletic development. Our aim should be to see not how much strain our strength can stand, but how great we can make that strength. With such an aim we shall, incidentally and naturally, find ourselves accom-


plishing more work than if we aimed directly at the work itself. Moreover, when such ideals are attained, work instead of turning into drudgery tends to turn into play, and the hue of life seems to turn from dull gray to the bright tints of well-remembered childhood.

In short, our health ideals should rise from the mere wish to keep out of a sick-bed to an eagerness to become a well-spring of energy. Only then can we realize the intrinsic wholesomeness and beauty of human life.




Section I — Housing

AIR is the first necessity of life. We may live without food for days and without water for hours; but we can not live without air for more than a few minutes. Our air supply is therefore of more importance than our water or food supply, and good ventilation becomes the first rule of hygiene.

Living and working rooms should be ventilated both before occupancy and while occupied.

It must be remembered that the mere construction of the proper kind of buildings does not insure ventilation. We may have model dwellings, with ideal window-space and ventilating apparatus, but unless these are actually used, we do not benefit thereby.

Features of Ventilation

The most important features of ventilation are motion, coolness, and the proper degree of humidity and freshness.


There is an unreasonable prejudice against air in motion. A gentle draft is, as a matter of fact, one of the best friends which the


seeker after health can have. Of course, a strong draft directed against some exposed part of the body, causing a local chill for a prolonged time, is not desirable; but a gentle draft, such as ordinarily occurs in good ventilation, is extremely wholesome.

Air and Catching Colds

It goes without saying that persons unaccustomed to ventilation, and consequently over-sensitive to drafts, should avoid over-exposure while they are in process of changing their habits. One must always use common sense and never grow foolhardy. It is never advisable that a person in a perspiration should sit in a strong draft. But after even a few days of enjoyment of air in motion, with cautious exposure to it, the likelihood of colds is greatly diminished: and persons who continue to make friends with moving air soon become almost immune to colds.

The popular idea that colds are derived from drafts is greatly exaggerated. A cold of any kind is usually a catarrhal disease of germ origin, to which a lowered vital resistance is a predisposing cause. The germs are almost always present in the nose and throat. It is
  • exposure to a draft

  • plus the presence of germs

  • and a lowered resistance of the body
  • which produces the usual cold.

    Army men have often noted that as long as they are on the march and sleep outdoors, they seldom or never have colds, but they develop them as soon as they get indoors again.*


    The best ventilation [when indoors] is usually to be had through the windows. We advise keeping windows open almost always in summer; and often in winter.

    One should have a cross-current of air whenever practicable; that is, an entrance for fresh air and an exit for used air at opposite sides of the room. Where there can not be such a cross-current, some circulation can be secured by having a window open at both top and bottom.


    In winter, ventilation is best secured by means of a window-board. This is a board the edge of which rests on the edge of the window-sill, the ends being attached firmly to the window-frame. It affords a vertical surface three or four inches high and situated three or four inches in front of the window, so as to deflect the cold air upward when the window is slightly open. The air will then reach the breathing-zone, instead of flowing on to the floor and chilling the feet, which is the usual consequence of open-
    * See SUPPLEMENTARY NOTES, "Avoiding Colds" [not here reprinted].


    ing a window in winter. It seems tragic to think that for lack of some such simple device, which any one can make or buy, there is now an almost complete absence of winter ventilation in most houses.

    When coal conservation is essential a partial substitute for ventilation can be secured by an electric fan which, if properly situated, will reclaim for use the warmed air constantly accumulating at the ceiling.


    Air should never be allowed to become stagnant. When there is no natural movement in the air, it should be put in motion by artificial means. Even a hand fan is of distinct hygienic value.

    Heating Systems

    A wood or grate fire is an excellent ventilator. A heating-system which introduces warmed new air is better than one acting by direct radiation, provided the furnace is well constructed and gas-proof.

    Cool Air

    The importance of coolness is almost as little appreciated as the importance of motion. Most people enervate themselves by heat, especially in winter. The temperature of living-rooms and work-rooms should not be above 70 degrees, and, for people who have not already lost largely in vigor, a temperature of 5 to 10 degrees lower is preferable. Heat is depressing. It lessens both


    mental and muscular efficiency. Among the employees of a large commercial organization in New York who were examined by the Life Extension Institute, some of the men in one particular room were suffering from an increase of body temperature and a skin rash. On investigation it was found that the room in which they worked was overheated. There was no special provision for ventilation. A window-board was installed, with the result that the men recovered and no other cases of skin rash occurred in that room.

    Dry Air

    As to dryness of air, there is little which the individual can do except to choose a dry climate in which to to live or spend his vacations. Unfortunately, there is not as yet [in 1915, pre-air conditioning] any simple and cheap way of drying house air which is too moist, as is often the case in warm weather.


    In the cold season, indoor air is often too dry and may be moistened with advantage. This may be done [in 1915, pre-furnace-installed humidifers], to some extent by heating water in large pans or open vessels. But for efficient moistening of the air, either a very large evaporating-surface or steam jets are required. The small open vessels or saucers on which some people rely, even when located in the air-passages of a hot-


    air furnaces have only an infinitesimal influence. Vertical wicks of felt with their lower ends in water kept hot by the heating apparatus yield a rapid supply of moisture. Evaporation is greatly facilitated if the water or wicks are placed in the current of heated air entering the room. By a suitable construction the water may be replenished automatically. In very cold dry weather, the air-supply of an ordinary medium-sized house requires the addition of not less than 10 gallons of moisture every 24 hours, and sometimes much more.

    Some authorities doubt any ill effects from extreme dryness. The healthfulness of certain dry climates is pointed out, but in no climate is the air as dry as that of over-heated dwelling rooms. Medical observation of the ill-effects of such rooms should be accepted in default of exact experimental evidence which is still lacking [1915].


    It is obvious that fresh, pure air is preferable to impure air. Air may be vitiated by poisonous gases, by dust and smoke, or by germs. Dust and smoke often go together.

    Lighting by electricity is preferable to lighting by gas, as some of the gas is liable to escape and vitiate the air.


    Tobacco Smoke

    A very common and at the same time injurious form of air-vitiation is that from tobacco smoke. Smoking, especially in a closed space such as a smoking-room or smoking-car, vitiates the air very seriously, for smoker ansd non-smoker alike.


    As to dust, the morbidity and mortality rates in certain occupations, particularly those known as the dusty trades, are appreciably and even materially greater than in dustless trades.

    An accumulation of house-dust should be avoided. The dust should be removed—not by the old-fashioned feather duster which scatters the dust into the air, but by a damp or oiled cloth. Dust-catching furniture and hangings of plush, lace, etc., are not hygienic. A carpet-sweeper is more hygienic than a broom, and a vacuum cleaner is better than a carpet-sweeper. The removable rug is an improvement hygienically over the fixt [installed] carpet.


    Bacteria in the air ride on the dust-particles. In a clean hospital ward, when air was agitated by ordinary dry broom-sweeping, the number of colonies of bacteria collected on a given exposure rose twentyfold, showing the effect of ordinary broom-sweeping.



    The air we breathe should be sunlit when possible. Many of our germ enemies do not long survive in sunlight.

    Section II—Clothing

    Air may be shut out not only by tight houses but also by tight clothes. It follows that the question of clothing is closely related to the question of ventilation. In fact, it is a reasonable inference from modern investigations that air-hygiene concerns the skin quite as much as the lungs. Therefore the hygiene of clothing assumes a new and hitherto unsuspected importance. A truly healthy skin is not the waxy white which is so common, but one which glows with color, just as do healthy cheeks exposed to the open air.

    Porous Clothing

    The hygiene of clothing includes ventilation, freedom from pressure, moderate warmth, and cleanliness. Loose, porous underclothes are already [1915] coming into vogue. But effective ventilation, namely such as will allow free access of air to the skin, requires that our outer clothes—including women's gowns and mens' shirts, vests, vest-linings, and coat-linings—should also be loose and porous. Here is one of the most important but almost wholly neglected clothing reforms.


    Most linings and many fabrics used in outer clothes are so tightly woven as to be impervious to air. Yet porous fabrics are always available, including porous alpacas for linings. To test a fabric it is only necessary it place it over the mouth and observe whether it is possible or easy to blow the breath through it. All bedding should be porous. Beds should be well aired after being used.


    An air-bath promotes a healthy skin and aids it in the performance of its normal functions. Not every one can visit air-bath establishments or outdoor gymnasia or take the modem nude cure by which juvenile consumptives are sometimes treated; but any one can spend at least a little time in a state of nature on rising in the morning and upon retiring at night, when there are many things which are usually done while one's clothes are on which can be done just as well while they are off.

    Brushing the teeth, washing the hands, shaving, etc., necessarily consume some time during which the luxury of an air-bath can be enjoyed. Exercising in cold air, if not too cold, with clothing removed, is an excellent means of hardening the skin and promoting good digestion.


    Tight Clothing

    The constriction from rigid or tight corsets, belts (the latter in men as well as in women), tight neckwear, garters, etc., interferes with the normal functions of the organs which they cover. All such constriction should be carefully avoided. The tight hats generally worn by men check the circulation in the scalp.


    Tight shoes with extremely high heels deform the feet and interfere with their health. The barefoot cure is not always practicable, but any one can wear broad-toed shoes with a straight inner edge and do his part to help drive pointed toes out of fashion.* Such a reform should not be so difficult as to rid the women of [1915] China of their particular form of foot-binding. (See illustrations following this page [not here reprinted].)

    Several anatomical types of shoes, that is, shoes made to fit the normal foot instead of to force the foot to fit them, are now available. In all except cold weather, low shoes are preferable to high shoes. High-heeled shoes are, of course, an abomination. When possible, sandals, now fortunately coming into fashion, are preferable to shoes, especially in early childhood (but the adult, whose leg-muscles and foot-structure are not often adapted to such footgear, must
    * See SUPPLEMENTARY NOTES on "Posture" [not here reprinted].


    1. Feet Never Worn Shoes 2. Feet Worn Shoes Several Months 3. Deformed Feet From Foot-binding

    be cautious in their use lest flat foot result).

    The light weight of women's clothing as compared to men's is exhibited in suppleentary notes, pages 258-259 [note here reprinted]. Except for their absurd high-heeled and pointed shoes and slippers, women are much more sensibly drest in these days -1915] than men. It is regrettable that the soldier, otherwise so well cared for with regard to hygiene, must be encased in tight-fitting clothes and puttees which do not permit a proper circulation of air. The skin needs the stimulus of moving air properly to train it to change of temperature. A poorly trained skin is unduly sensitive to exposure or draft. A reform military clothing may be the next great step in military hygiene.

    Cottons, Linens, Woolens

    Only the minimum amount of clothing that will secure warmth should be worn. Woolens protect most, but for that very reason they require the least exercise of the temperature-regulating apparatus of the body. While wool is also highly absorbent of moisture, it does not give off that moisture quickly enough. Hence, if worn next to the skin, it becomes saturated with perspiration, which it long retains to the disadvantage of the skin. Consequently, woolen clothing is best confined to outer garments, designed especially for cold weather. The under-


    clothes should be made of some better conducting and more quickly drying material, such as cotton or linen. In winter, light linen-mesh and medium wool over that, can be worn by those who object to either linen or wool alone.


    As to color, the more nearly white the clothes the better. This is especially true in summer, but there is [in 1915] believed to be some advantage in white at all seasons.

    Those who have learned to clothe themselves properly find that they have grown far more independent of changing weather conditions. They do not suffer greatly from extreme summer heat nor extreme winter cold. Especially do they note that "raw" or damp cold days no longer tax their strength.

    Section III—Outdoor Living

    Out-of-door Air

    But we must not depend altogether on ventilatng our houses and our clothes. We must turn our thoughts toward an outdoor life. The air of the best ventilated house is not as good as outdoor air. Those who spend much of their lives in the open enjoy the best health and the greatest longevity. It is a great advantage to go into camp in summer and to live in the country as much as possible.


    Climate, of itself, is a secondary consideration. Not every one can choose the best climate in the world, and, after all, the main advantages of fresh air can be enjoyed in almost any locality. Even in a city, outdoor air is, under ordinary circumstances, wonderfully invigorating.


    The common prejudice against damp air greatly exaggerates its evils. While moderate dryness of air is advantageous, it seems nevertheless true that to live in damp, even foggy, air out-of-doors is, in general, more healthful than to live shut up indoors.

    Outdoor Schools

    Observations have shown that the pupils in outdoor and open-window schools are not only kept more healthy but learn more quickly than those in the ordinary schools. It is even claimed that tuberculous children in an outdoor school may make more rapid progress in their studies than the more normal children in a badly ventilated school. Parents should insist on fresh air for their children when at school. They should also insist on outdoor playgrounds.

    Outdoor Recreations

    For themselves, also, they should not neglect outings, picnics, and visits to parks. Whenever practicable, outdoor recreation should be chosen in preference to indoor recreation.



    Above all, outdoor occupations should, when possible, be chosen in preference to interior occupations, such as working on a farm rather than in a factory. It would help solve some of the greatest problems of civilization, if, in consequence of an increased liking for outdoor life, larger numbers of our population should join the "back-to-the-farm" movement. The close of the war [11 Nov 1918] is doubtless going to help this movement.

    Leaving the country for the city is often disastrous even for the purpose in view, namely, to gain wealth; for wealth gained at the expense of health always proves in the end a bitter joke. The victim proceeds through the rest of his life to spend wealth in pursuit of health.

    Section IV—Outdoor Sleeping

    Unfortunately most people can not live out-of-doors all of the time, and many are so situated that they can not even secure, ventilation, granted that they want it. But there is one important part of the twenty-four hours when most people can completely control their own air supply. This is at night. We spend a third of our time in bed. Most of us live such confined lives during the day that we should all the more avail


    ourselves of our opportunities to practise air hygiene at night.

    It is the universal testimony of those who have slept out-of-doors that the best ventilated sleeping-room is far inferior in healthfulness to an outdoor sleeping-porch, open tent, or window tent (large enough to include the whole bed). For generations, outdoor aleepmg has ocasionally been used as a health measure in certain favorable climates and seasons. But only in the last two decades [1895-1915] has it been used in ordinary climates and all the year round.


    Dr. Millet, a Brockton physician, begun some years ago to prescribe outdoor sleeping for some shoe-factory workmen who were suffering from tuberculosis. As a consequence, in spite of their insanitary working-places (where they still continued to work while being treated for tuberculosis), they often conquered the disease in a few months.

    It was largely this experience which led to the general adoption, irrespective of climate, of outdoor sleeping for the treatment of tuberculosis. The practise has since been introduced for nervous troubles and for other diseases, including pneumonia.

    Well Persons

    Latterly the value of outdoor sleeping for well persons of all


    classes, infants and children as well as adults, has come to be widely recognized.

    Vital Resistance

    Outdoor sleeping increases the power to resist disease, and greatly promotes physical vigor, endurance, and working power.

    Night Air

    Many people are still deterred from sleeping out by a mistaken fear of night air and of the malaria which they imagine this dreaded night air may bring. To-day [1915] we know that malaria is communicated by the bite of the anopheles mosquito and never by the air. The moral of this is not to shut out the night air, but, when necessary, to shut out the mosquito by screens. The experiment has been made of sleeping out-of-doors in screened cages in the most malarial of places and no malarial infection resulted, tho those who were unprotected ariol were consequently bitten by mosquitoes contracted malaria as usual.

    The truth is that night air, especially in cities, is distinctly purer than day air, on account of the fact that there is much less traffic at night to stir up dust.

    Prectection from Cold

    It is very important that any sleeping balcony, tent or shack should be protected from the wind on two or—in very windy places—three sides. But of course sleeping out-of- doors does not reach its maximum efficiency


    if there is too much protection, that is, if the sleeping-out place is so shut in that very free currents of air are not secured. An outdoor porch really ceases to be an outdoor porch and becomes really an indoor room when enclosed on four sides.

    A roll curtain (preferably rolling from the bottom) can be arranged on the open side or sides, to be used in case of storms only.

    In cold weather a thick mattress, or two mattresses, should be used. It is not only what is over the sleeper, but also what is under him, that keeps him warm. The body should be warmly clad, and the head and neck protected by a warm cap or helmet or hood. To prevent the entrance of cold air under the bed-clothes, one or more blankets should be extended at least two feet beyond the head, with a central slit for the head.

    Early awakening by the light may, if necessary, be prevented by touching the eyelids with burnt cork, or by bandaging the eyes with a black cloth or stocking.

    Sheets should be well warmed in the winter-time before being used. They can easily be warmed with a hot-water bag, flatiron, or soapstone. Blankets next to the skin are not hygienic.


    Sleeping out is really much easier than most people imagine. In fact, few, if any, of


    the other cardinal rules of hygiene are so easy to obey. Where a sleeping-porch is not available, an inward window tent can always be had which puts the sleeper practically out-of-doors and at the same time cuts off his tent from the test of the room.

    Outdoor Tents

    An outdoor tent must be kept well opened. Otherwise it fails of its purpose. The common opinion that a tent is ventilated through the "meshes" of the canvas, is erroneous. Canvas is a tightly woven fabric and impervious to air. That is why it makes good sails.

    One of the most modern boys' camps has given up the use of tents altogether, employing instead open wooden "shacks," because of the difficulty of keeping the tents sufficiently open, especially in rainy weather.*

    During the mobilization of our national army in the winter of 1917, the epidemics of measles and pneumonia were in great part ascribed to the over-crowding of tents. The recommendations of the Surgeon-General on this matter were for a time not followed until sad experience demonstrated the wisdom of his advice.

    It was also found that there was a high sickness rate from these maladies among the men from the rural districts,
    * Complete directions for convenient out-of-door sleeping will be furnished upon application, by the Life Extension Institute [no longer exists].


    which was ascribed to the fact that among such troops there were many who were not immune to measles and crowd-diseases. The greater prevalence of measles among the children in crowded cities weeds out the non-resistant by death and renders the survivors immune.

    Section V—Deep Breathing

    Ordinarily, breathing should be unconscious, but, every day, deep-breathing exercises should be employed. "A hundred deep breaths a day" is one physician's recipe for avoiding tuberculosis. A Russian author, who. suffered a nervous breakdown, found—after trying many other aids to health without success—that a retired life for several months in the mountains in which simple deep-breathing exercises practised systematically every day formed the central theme, effected a permanent cure.

    Deep breathing is a great resource for people vho are shut in most of the day. If they will seize the chance, whenever it offers, to step out-of- doors and take a dozen deep breaths, they can partly compensate for the evils of indoor living.

    In ordinary breathing only about 10 per cent. of the lung contents is changed at each


    breath. In deep breathing a much larger percentage is changed, the whole lung is forced into action, and the circulation of the blood in the abdomen is more efficiently maintained, thus equalizing the circulation throughout the body. The blood-pressure is also favorably influenced, especially where increased pressure is due to nervous or emotional causes.

    Breathing Exercises

    Breathing exercises should be deep, slow, rhythmic, and through the nose, not through the mouth. A certain Oriental deep-breathing exercise is particularly valuable to insure slowness and evenness of the breath. It consists of pressing a finger on the side of the nose, so as to close one nostril, breathing in through the other nostril, breathing out of the first nostril in the same manner and then reversing the process. Attention to the slight sound of t air, as it passes through one open nostril enables the breather to know whether the breathing is regular or is slightly irregular. Such breathing exercises can be taken at the rate of three breaths per minute, and the rate gradually reduced until it is only two or even less per minute.

    Muscular Exercise

    Muscular exercises stimulate deep breathing, and, in general, the two should go to-


    gether. But deep breathing by itself is also beneficial, if very slow. Forced rapid breathing, on the other hand, is comparatively valueless, and indeed may be positively harmful. Oxygen is absorbed only according to the demand for it in the body and not according to the supply.


    Singing requires deep breathing, and is for that and other reasons an excellent hygienic practise.

    Mental State

    The mode of our breathing is closely related to our mental condition; either influences the other. Agitation makes us catch our breath, and sadness makes us sigh. Conversely, slow even breathing calms mental agitation. It is not without reason that, in the East, breathing exercises are used as a means of cultivating mental poise and as an aid to religious life.


    (For pp 28-81, not being reprinted
    here at this tobacco-information
    site, contact your local libary.)

    use of alcohol by parents tends to damage their offspring,


    The evils of tobacco have not been [by 1915] so much studied and are not so well understood as those of alcohol.

    Ed. Note: However, much was already known.

    But every athletic trainer observes that the use of tobacco lessens physical fitness.

    The ordinary smoker is unconscious of this and often denies it. He sometimes says,

    "I'll stop smoking when I find it hurting me; it doesn't hurt me now."

    This delusive impression that one is well may continue long after something has been lost from the fitness of the body, just as the teeth do not ache until the decay has gone far enough to reach the nerve.

    At Yale and at Amherst it has been found, by actual measurement, that students not using tobacco during the college course had gained over the users of tobacco in weight, height, growth of chest, and lung capacity.

    Professor [Fred J.] Pack, of the University of Utah, finds that tobacco-using athletes are distinctly inferior to those who abstain. Professor Lombard, of the University of Michigan, finds that tobacco lessens the power of the voluntary muscles, presumably because of the depressing effect on the central nervous system. There is also much experi-


    mental evidence to show that tobacco in animals induces arterial changes. The present well-marked upward trend of mortality [premature deaths] from diseases of the arteries offers a good reason for heeding such evidence and taking the safe side in every controversy regarding it.*

    In view of the tremendous increase in the consumption of tobacco due to its use by the soldiers, this subject is of widespread importance and requires close scientific study. The tobacco problem bids fair after the war to become one of the major problems of public and private health.


    The poisons so far mentioned are limited to the amounts taken [ingested]. Infections with germs, however, bring in poisons, the quantities of which tend to increase with the multiplication of the germs. It is, therefore, especially important to avoid infections. We should not depend altogether on the protection of our health officers. We must guard our own individual bodies.

    Colds and La Grippe Germs

    Infections enter the body through the skin or mucous lining. The common cold is believed to enter by the nose. We may avoid exposure to infection from grippe and common colds by keeping away from congested public places when there is an epidemic of
    * See "Tobacco" in SUPPLEMENTARY NOTES.


    (For pp 84-338, not being reprinted
    here at this tobacco-information
    site, contact your local libary.)


    IT is the purpose of this section to present as fairly as possible the evidence relating to the effects of tobacco on the human body, so that those who smoke may correctly measure the probable physical cost of the indulgence. The extremes of opinion on this subject are well exprest in the following verses:

    Hail! Social Pipe—Thou foe to care,
    Companion of my elbow chair;
    As forth thy curling fumes arise,
    They seem an evening sacrifice—
    An offering to my Maker's praise
    For all His benefits and grace."
    —Dr. Garth.

    "A custom loathsome to the eye,
    hateful to the nose, harmful to the
    brain, dangerous to the lungs, and the
    black stinking fume thereof nearest
    resembling the horrible Stygian smoke
    of the pit that is bottomless."

    —James I.

    What It Is

    Tobacco is a plant, Nicotiana Tabacum of the order Solanaceæ which includes Atropa Belladonna, or "Deadly Nightshade," Hyoscyamus, or "Henbane," Solanum Dulcamara, or "Bitter Sweet," all powerful poisons, and likewise the common potato and tomato,


    which are wholesome foods. The cured leaves are used for smoking and chewing, or when pondered, as snuff.


    Prior to the middle of the sixteenth century, the use of tobacco was confined to the American Indians. In 1560 the Spaniards began to cultivate tobacco as an ornamental plant, and Jean Nicot, the French Ambassador at Lisbon, introduced it at the court of [French Queen] Catherine de Medici [1519-1589] in the form of snuff. Smoking subsequently became a custom which spread rapidly throughout the world, altho often vigorously opposed by governments. In the seventeenth century, in Russia, smokers' noses were cut off.


    Tobacco contains a powerful narcotic poison, nicotin, which resembles prussic acid in the rapidity of its action, wben a fatal dose is taken.

    The percentage of nicotin present varies according to the brand and the conditions under which it is cultivated.

    The following figures have been given by the various authorities:

    London Lancet1.64 to 5.3 per cent.
    French Dept. of Agriculture2.22 to 10.5 per cent.
    Connecticut Agricultural Experiment Station3
    (Home grown—after fermentation.)
    2.89 per cent.
    U. S. Dept. of Agriculture3
    .94 to 5. per cent.


    Aside from nicotin it also contains small quantities of related substances—nicotellin, nicotein, a camphoraceous substance termed nicotianin, said to give tobacco its characteristic flavor, and likewise a volatile oil developed during the process of preparation.

    On heating, pyridin (a substance often used to denature alcohol), picolin, collidin, and other bases are formed, as well as carbolic acid, ammonia, marsh gas, cyanogen and hydrocyanic acid, carbon monoxide (coal gas) and furfural. Furfural is a constituent of fusel oil, which is so much dreaded in poor whisky. The smoke of a single cigaret may contain as much furfural as two ounces of whisky.

    The complex constitution of tobacco and the smoke from its combustion has caused much debate as to the substances that are responsible for its charm and its ill-effects, which are to be described. No one can doubt the serious injurious effects from such a powerful poison as nicotin if taken in any but the most minute quantities (one to three milligrams have produced profound poisoning in man).

    It has been maintained by some that nicotin is practically destroyed in the process of smoking, and that the effects of tobacco


    are limited to the decomposition products resulting from the burning tobacco, especially pyridin. But pyridin is also formed in the burning of cabbage leaves, yet cabbage leaves do not possess any attractions [addictiveness traits] for smokers, neither do they produce the well-known effects that smoking and chewing tobacco produce.

    No doubt pyridin and furfural are factors in the drug effects of tobacco, but recent painstaking experiments by high authorities have shown the presence of nicotin in tobacco smoke, and when we reflect that there is sometimes sufficient nicotin in an ordinary cigar to kill two men, it is not strange that enough of it may be absorbed from the smoke passing over the mucous membranes of the nose, throat and lungs to produce a distinct physiological effect.

    Investigators who [pre-1915] claim to show by experiments the absence of nicotin from tobacco smoke must explain why the palpable effects of smoking, in those who have not established a "tolerance," are those of nicotin poisoning, and why the symptoms produced by chewing tobacco are identical with those following the smoking of tobacco, which are:
  • mild collapse,

  • pallor of the skin,

  • nausea,

  • sweating,

  • and perhaps vomiting,
  • -342-

  • diarrhea,
  • muscular weakness,

  • faintness,

  • dizziness, and

  • rise in blood pressure followed by lowered blood pressure.
  • Nicotin is undoubtedly decomposed by burning, but it may become volatilized by heat and a certain amount absorbed before decomposition takes place.

    Lehman,4 in 1908, found in tobacco smoke the following percentages of the nicotin contained in the tobacco:

    Cigaret smoke82 per cent.
    Cigar smoke85 to 97 per cent.

    The London Lancet,5 (1912) gives the following figures:

    Cigaret smoke 3.75 to 84 per cent.
    Pipe mixture smoke,
    smoked as cigarets
    79 per cent.
    Pipe smoke77 to 92 per cent.
    Cigar smoke31 to 63 per cent.

    The United States Department of Agriculture,3 found in tobacco smoke about 30 per cent. of the nicotin originally present in the tobacco.

    Contrary to general opinion, Havana cigars contain less nicotin than the cheaper brands. Many of the cheaper grades do, however, show a low percentage of nicotin.

    Effects on Animals and Man

    By means of an ingenious apparatus, Zhebrovski,6 a [1908] Russian investigator, compelled


    rabbits to smoke cigaret tobacco for a period of 6 to 8 hours daily. Some died within a month, and showed changes in the nerve-ganglia of the heart. Others established a tolerance similar to that exhibited by habitual smokers, but upon being killed at the end of five months, degenerative changes similar to those produced by the injection of nicotin were found, viz., hardening of the blood vessels.

    There is, indeed, no difficulty in producing the characteristic effects of nicotin by administering tobacco smoke, either in man or in animals.7

    Nicotin causes brief stimulation of brain and spinal cord, followed by depression. There is an increased flow of saliva, followed by a decrease (large doses diminish it at once) and often nausea, vomiting and diarrhea. The heart action is at first slowed and the blood pressure increased. Subsequently there is a depression of the circululation, with rapid heart action and lowered blood pressure. In habitual smokers this preliminary stimulation may not occur.

    The stimulating effect on the brain is so brief that tobacco can not properly be termed a stimulant. Its effect is narcotic or deadening.

    Those who fancy that their thoughts flow more readily under the use of tobacco


    the same case with any other habitué whose thoughts can not flow serenely except under his accustomed indulgence. That a sound, healthy man, who has never been accustomed to the use of tobacco, can do better mental or physical work with tobacco than without it has never been shown. Indeed, experiments as have been made on students and others show to the contrary.9

    Tobacco Smoking Athletes

    The statistics presented by Prof. Fred J. Pack8, of the University of Utah, are of interest in this connection.

    In six educational institutions the students competing for places on the football team grouped as follows:

    Institution.Number Competing for Places.Number Successful.Per Cent. Successful.
    Institution A.
    Institution B.
    Institution C.
    Institution D.
    Institution E.
    Institution F.

    The following tables show the relative


    scholastic standing of smokers and non-smokers:

    Scholastic Standing
    (Twelve Institutions)

    Number of MenAverage Mark

    Twelve institutions reporting:

    Number of Men.Highest Marks.Lowest Marks.

    Number of
    Highest Marks.Lowest Marks.
    101 Non-smokers116
    101 Smokers515

    Number of Men.Total Conditions and Failures.Average.


    Prof. Pack's conclusions [in 1912] were as follows:

    1. Only half as many smokers as non-smokers are sucessful in the "try-outs" for football squads.

    2. In the case of able-bodied men, smoking is associated with loss of lung capacity amounting to practically 10 per cent.

    3. Smoking is invariably associated with low scholarship.

    There have, of course, been many notable instances of high scholarship and prodigious mental achievement by heavy smokers. Such exceptions, however, do not affect conclusions derived from the study of average groups.

    Hitherto [pre-1912] figures on smoking and athletics have been open to question because comparisons were made between groups that are not of necessity of the same physical and mental type, having no important difference except in the use of tobacco. But Professor Pack has sought to avoid this objection. As he points out, the football squad is probably as nearly a homogeneous group as it is possible to find. It seems reasonable to account for the inferior physical and mental work of these particular groups of smokers on the theory that in the main the well-known toxic effects of tobacco are sufficient to create this difference.


    Dr. George J. Fisher and Elmer Berry,9 in a series of careful tests found:

    1. Cigaret smoking caused an increase in the heart-rate.

    2. Cigaret smoking maintained a blood pressure which, under the circumstances of the experiment, would otherwise have dropt.

    3. Cigar smoking caused a considerable increase in heart-rate and blood pressure.

    4. In a number of instances, in the cigar test, the heart was unable to maintain, with a vertical position, the increased blood pressure found in the horizontal position, showing a disturbance of the control of the blood-vessels. This latter effect was more pronounced in tests taken on non-smokers.

    5. It was also note that smoking was not conducive to concentration upon the reading, which the men attempted during the tests.

    Bush,10 in a series of tests on each of 15 men in several different psychic fields found the following conditions among smoking students immediately after the period of smoking was completed:

    1. A 10½ per cent. decrease in mental efficiency.

    2. The greatest actual loss was in the field of imagery, 22 per cent.

    3. The three greatest losses were in the fields of imagery, perception, and association.

    4. The greatest loss, in these experiments, occurred with cigarets.

    Bush ascribed these effects to pyridin, claiming that his experiments failed to reveal nicotin in the tobacco smoke, except in a very small proportion in that of cigarets.


    Tests for nicotin in smoke are beset with many difficulties and possible fallacies which have in the past [pre-1915] misled [pro-tobacco] investigators into apparently determining that tobacco smoke contained no nicotin, but simply decomposition products.

    Pyridin is unquestionably present in tobacco smoke, and is a poisonous substance, altho less so than nicotin. It is not found, however, in chewing tobacco, and as the clinical effects of chewing tobacco are apparently identical with those of smoking tobacco, very strong and universally accepted chemical proof of the absence of nicotin from tobacco smoke must be awaited before accepting such a conclusion.*

    Cigaret smoking is a time waster; that is, it breaks up the power of attention, as few smokers are satisfied with one cigaret and the mere physical act of lighting a fresh cigaret disturbs the continuity of thought and work.

    Dr. W. J. Mayo11 calls attention to the fact that according to his observations, research scholars who smoke cigarets have not done well.

    Insurance Experience on Smokers

    Only one insurance company, the New England Mutual,12 has published any experience on tobacco users. This covered a
    * See (4), (5), (6) in bibliography.


    period of 60 years and a body of 180,000 policyholders, as follows:

    Tobacco, 59 % 71%84%93%
    Alcohol, 57 %72%84%125%
    *The standard here used is the American Experience Table, which is largely an artificial table upon which insurance premiums are based, but which provides for a much higher mortality than the average companies sustain. For example, the actual mortality of the New England Mutual in 1913 was 57 per cent. of the expected.

    Fifty-nine per cent. of the expected mortality means that where, according to the premium tables, 100 were expected to die, only 59 actually died.

    The general class of risks in this company were of excellent quality, as the figures show. Nevertheless, the abstainers exhibited a far lower mortality than that experienced by the general class.

    Dr. Edwin Wells Dwight, who presented the figures, urged caution in their interpretation, suggesting that the low mortality among abstainers, both from alcohol and tobacco, might well be due to a more conservative habit of living. Furthermore, as the abstainers from alcohol were not separated from the abstainers from tobacco in this


    analysis a perfect comparison can not be made; but our knowledge of the toxic effects of both these narcotics and the preceding statistics of Doctor Pack justify us in assigning to tobacco a positively unfavorable effect.

    Poisonous Effects

    In experiments on animals nicotin extracts from tobacco and inhalation of tobacco smoke have produced hardening of the large arteries. Clinical observation by some of the world's best authorities indicates that the same conditions are brought about in man by heavy smoking.13

    Disturbance of the blood pressure, rapid heart action, shortness of breath, palpitation of the heart, pain in the region of the heart, are important effects. Tobacco heart is often lightly spoken of because the abandonment of the habit will often restore the heart to its normal condition, but tobacco heart sometimes causes death, especially under severe physical strain or in the course of acute disease, such as typhoid or pneumonia.

    Surgeons14 have noted failure to rally after operation in tobacco users, who are, of course, deprived of their accustomed indulgence immediately before and after operation. It is probable that many such cases pass unrecognized, altho the alcoholic is


    usually supplied the narcotic which his system demands.

    Cannon, Aub, and Binder15 have also shown that nicotin stimulates the adrenal glands, small organs adjacent to the kidneys, which secrete a substance that in excess powerfully affects the blood vessels, constricting them and temporarily increasing the blood pressure. This influence may be partly responsible for the change in the blood vessels noted in heavy smokers.

    Excessive smoking is often an important factor in causing insomnia.

    Blindness or tobacco amblyopia, a form of neuritis, is not an uncommon affection among smokers. There is also often an irritant effect on the mucous membranes of eyes from the direct effect of the smoke.

    Catarrhal conditions of the nose, throat and ear have also been noted.

    Acid dyspepsia is a common affection among smokers.

    Few people realize that so many ingredients in tobacco and tobacco smoke are deadly poisons.
  • Few people know that one drop of nicotin on the unbroken skin of a rabbit will produce death.16

  • Two drops on the tongue of a dog or cat will prove fatal; moreover, fatal poisonings have occurred in man from
  • -352-

    swallowing tobacco and even from external application of strong solutions.
  • A case was recently reported from New Haven of fatal poisoning in a baby,17 who had been fed from a milk bottle and milk-mixture in which some tobacco had been accidentally spilled.

  • Tobacco and the Soldier

    One hesitates [1915, during World War I] to say anything against tobacco as an indulgence for the soldier because of its popularity with soldiers and the widespread campaigning for the tobacco fund. No one would wish to deprive the soldier of a comfort or solace that will help him to keep his poise or to stand the long, hard strain of war.

    Ed. Note: By damaging the brain, impairing reasoning, judgment, ethical controls, TTS has these effects.

    But we believe that the soldier is entitled to know the danger of tobacco and that he should be warned of the price he may have to pay for his indulgence.

    Also there is a heavy responsibility [on the government] involved in urging this habit upon men [oft youths] who are now free from it, and adding another unfortunate aftermath to the war. Those who are not already smokers have no need of contracting the habit now.

    Let us see what hard-headed veterans of the present war—active [World War I] army surgeons who have handled men at the front—have to say.


    Major Lelean of the Royal Army Medical Corps, who has published the lectures delivered by him at the Royal Army Medical College recently, has this to say:

    "To take now the next item that comes in the ration list—tobacco. The effects of smoking on the heart and on the quality of the pulse are well shown by pulse-tracings. Without going into the question of such various objectionable ingredients in tobacco as nicotine and the more harmful furfural, one may say that excess of smoking, particularly of cheap cigarets, produces rapid heart (tachycardia), muscular relaxation, and diminution of visual acuity. These conditions result in 'shortness of wind,' which is bad for marching, and produce muscular tremor and loss of effective sight, which it need scarcely be said are worse for shooting.

    "Tobacco, like alcohol, has certain compensating advantages. The mild narcotic effect of tobacco in moderation is not apparently attended by deleterious action on habitual smokers. Seeing that the allowance provides only two pipefuls a day, it can do a man no harm to smoke one pipeful when he reaches camp and the other just before he turns in at night; the soothing effect is then most beneficial."


    But again he says regarding soldiers on the march:

    "Smoking should be forbidden; it causes thirst, tremor, and rapid heart."

    In the London Lancet for August 18, 1917, are presented the results of experiments (by Capt. John Parkinson, of the Royal Army Medical Corps, and Dr. Hilmar Koefod, of Harvard, U. S. A.) on "The Immediate Effect of Cigaret Smoking on Healthy Men and on Cases of 'Soldier's Heart'."

    They say that in the present war heart disturbances characterized by breathlessness after exertion, pain in the chest, rapid, irregular heat action, giddiness and exhaustion are quite common."

    In some cases valvular disease of the heart (V. D. H.) is found and the soldier is discharged, but in others no organic defect can be discovered, and these are classified in the Army Medical Service as D. A. H. (disordered action of the heart) and are termed ''soldier's heart." The experimenters summarize their findings as follows:

    "These observations show that, in health, the smoking of a single cigaret by an habitual smoker usually raises the pulse-rate and blood pressure perceptibly; and these effects are a little more pronounced


    in cases of 'soldier's heart.' Moreover, the smoking of a few cigarets can render healthy men more breathless on exertion, and manifestly does so in a large proportion of these patients.

    "Excessive cigaret smoking is not the essential cause in most cases of 'soldier's heart'; but, in our opinion, it is, in many cases, an important contributory factor in breathlessness and pain in the region of the heart."

    The results of these experiments are in line with those reported by Dr. George J. Fisher (Secretary, International Committee, Young Men's Christian Association) in his interesting book, "The Physical Effects of Smoking."

    The experiments were made on fifteen young subjects, physical directors, in normal condition of health and engaged in vigorous exercise daily. Seven were non-smokers and eight were classed as "moderate smokers." The experiments covered investigation of the heart-rate after exercise, and physical precision and accuracy in base-ball pitching.

    The various phases of the experiments established the following conclusions:

    I. Smoking affects the heart-rate.


    (a) The normal heart-rate of smokers is higher than that of non-smokers.

    (b) Smoking causes a delay in the return of heart-rate to normal after exercise.

    (c) The heart-rate was increased in 63 per cent. of the smoking tests. The average heart-rate at the end of fifteen minutes after smoking was 11.2 beats greater than the average normal heart-rate. In 97 per cent. of all the tests taken without smoking, the normal heart-rate returned, on an average, within five minutes.

    II. Smoking caused loss in physical precision, and loss in accuracy of pitching a baseball.

    (a) All smokers and non-smokers showed a loss in physical precision immediately after smoking.

    (b) Smoking reduces accuracy in pitching a baseball—and it would, of course, have the same effect in pitching a bomb.

    (c) In tests where there was no smoking, all the men improved in accuracy of pitching.

    In the accuracy tests of pitching, official league baseballs were used; the target was a block five feet square, with a bull's-eye one foot in diameter, surrounded by concentric circles six inches apart.


    After each man had smoked one cigar, the smokers lost 11 per cent. in accuracy when pitching, and the non-smokers lost 13 per cent.—the average loss for the two groups being 12 per cent.

    After each man had smoked two cigars, the smokers lost 11 per cent. in accuracy and the non-smokers 18 per cent.—the average loss for the two groups being 14½ per cent.

    When no cigar was smoked during tests, the smokers gained 9 per cent. in accuracy in pitching and the non-smokers gained 10 per cent.—the average gain for the two groups being 9½ per cent.

    The average difference in score made by smoking one cigar was 21½ per cent., and by smoking two cigars the average difference was 24 per cent.

    Recent experiments likewise have shown that the same harmful effects of smoking on accuracy of aim applies to rifle shooting.

    These findings should be of especial interest to those in the armed service of the country, upon whose accuracy of throwing and shooting, and upon whose steadiness, their effectiveness as fighters so largely depends.

    Naturally if the [brain-damage] solace of tobacco will


    keep a soldier from going insane [in non-medical sense] or losing his control in short periods of strain, it might, in instances, prove a veritable medicine for some, but the average soldier should not have tobacco showered upon him without a word of warning as to its possible harmful effects on his heart and nerves.

    When tobacco is used at all, it should be with extreme caution and moderation.


    From the mass of evidence and opinion with which medical literature is loaded, a few salient facts stand out:

    First: Tobacco and its smoke contain powerful narcotic poisons.

    Second: It has never been shown to exert any beneficial influence on the human body in health, and it is not even included in the United States Pharmacopœia [medication list] as a remedy for disease, notwithstanding the claims that are made for its sedative effects and its value as a solace to mankind. If these benefits are real and dependable, they should be made available in exact dosage and applied therapeutically. If they are not real and dependable in a medical sense, they are not real and safe as a mere drug indulgence.

    Third: The symptoms following tobacco-


    smoking are identical with the effects of tobacco-chewing among those not accustomed to its use; hence, any collateral psychic effect, such as the sight of smoke, the surrounding, etc., are of minor importance in establishing the habit. The main charm to the smoker is the [addictive] drug effect, as in any other similar indulgence. Nicotinless tobacco is not popular, notwithstanding the efforts of the French and Austrian Governments to make it so.

    Fourth: Fortunately, the sedative drug effect is so slight, as compared to that of other narcotics—opium, alcohol, cocaine, etc.—that the tobacco habit is less seductive and may be broken with comparative ease and is therefore less harmful morally.

    Ed. Note: This allegations is, unfortunately, error; tobacco is addictive, and the hardest drug to stop, as per its withdrawal symptoms.

    Men who have smoked or chewed steadily for 40 years have been known to give up the habit without experiencing much physical discomfort. Like any other habit, however, it may lead to increasing indulgence, and to an enfeeblement of will-power [abulia]; this is a risk that the smoker takes just as does the alcohol user or the opium habitué who begins with so-called moderate indulgence.

    Fifth: The well-known effects of tobacco on the heart and circulation should lead one


    to pause and consider the possible cost of this indulgence, especially as—

    Sixth: It is difficult to determine, years in advance, whether or not one is endowed with sufficient resistance to render so-called moderate smoking comparatively harmless.

    Again, this is error; pertinent data is cited by Dr. John Lizars as already existing in 1857.

    Seventh: The vital statistics show that disease of the heart and circulation are rapidly increasing in this country in which—

    Eighth: The per capita consumption has rapidly increased in recent years, while—

    Ninth: In the United Kingdom, where these diseases are decreasing, there has been no material increase in the use of tobacco, and the per capita consumption is less than one-third that of the United States.

    In 1880 the annual per capita consumption of tobacco in the Uniteel States was about 5 lbs., while in 1914 it had risen to more than 7 Ibs. In the United Kingdom the per capita consumption is about 2 lbs., and there has been no material increase in recent years.

    The consumption of cigarets, in partictular, has grown enormously, having more than doubled in the past five years, while there has been a slight increase in the consumption of cigars, smoking tobacco, chew-


    ing tobacco and snuff, as shown in the following table:18


    Withdrawals tax paid for consumption of manufactured
    tobacco products during the past five years
    Fiscal year.Cigars.Cigarettes.Tobacco, chewing and smoking.Snuff.

    The quantity of leaf tobacco used in the production of tobacco, snuff, cigars, and cigarets for the past ten years has been as follows:

    Year.Cigars (Large)Cigars (Small).Cigarettes (Large)Cigarettes (Small).Tobacco and Snuff.Total.


    Tenth: The poetic effusions of the lovers of the weed are no safer guide than the exaggerated and intemperate pronouncements of people who have idiosyncrasies against tobacco and simply hate it.

    Eleventh: Those who now smoke should have a thorough physical examination to determine the condition of the heart and blood vessels. This examination should be repeated at least annually, in order to detect any adverse influence on the circulation.


    1. "The Toxic Factor in Tobacco," The Lancet (London), 1912, I, p. 944.

    2. French Department of Agriculture, Compt. Rend. Acad. de Science, CLI, p. 23.

    3. Garner, W. W.: The Relation of Nicotin to the Burning Quality of Tobacco, U. S. Department of Agriculture, Bureau of Plant Industry, Bulletin No. 141, Sept. 30, 1909, p. 15; A New Method for the Determination of Nicotin in Tobacco, U. S. Department of Agriculture, Bureau of Plant Industry, Bulletin No. 102, July 6, 1907, p. 12.

    4. Lehmann, K. B.: "Untersuchungen uber das Tabak-rauchen," Müinchen, med. Wehnschr. 1908, LV, pp. 723-25; "The Physiological Action of Tobacco Smoke," Med. Rec., 1908, LXXIII, pp. 738, 739.

    5. "The Toxic Factor in Tobacco," The Lancet (London), pp. 738, 739, 1912; II, pp. 944-947.

    6. Zhebrovsky, E. A.: "The Effect of Tobacco Smoke Upon the Blood Vessels of Animals," Russky Vratch, 1907, VI, p. 189; 1908, VII, pp. 429-431; Med. Rec., 1908, LXXXIV, pp. 408, 409.


    7. John, H.: Editorial, Jour. American Medical Association, 1914, LXII, pp 461-2; "Ueber die Beeïnflussung des systolischen und diastolischen Blutdrucks durch Tabak-rauchen," Ztschr. f. exper. Path. u. Therap., 1913, XIV, pp. 352-365; Pawinski, J.: "Ueber den Einfluss unmässigen Rauchens (des Nicotins) auf die Gefässe und das Herz," Ztsch. f. klin. Med. Berl., 1914, LXXX, pp. 284-305.

    8. Pack, Frederick J.: "Smoking and Football Men," Popular Science Monthly, 1912, LXXI, p. 336.

    9. Fisher, Dr. Geo. J. and Berry, Elmer: "The Physical Effects of Tobacco," Assoc. Press, International Com. of Y. M. C. A.

    10. Bush, Arthur D.: "Tobacco Smoking and Mental Efficiency," N. Y. Med. Jour., 1914, XCIX, pp. 519, 529.

    11. Mayo, Wm. J.: Personal communication.

    12. Dwight, Edwin Wells: Proc. Assoc. Life Ins. Med. Dir., Oct., 1911, II, p. 474.

    13. Favarger, Heinrich: "Experimentele und klinische Beiträge zur chronischen Tabakvergiftung," Wien. klin. Wehnschr., 1914, XXVII, pp. 497-501; "Experimental and Clinical Study of Chronic Tobacco Poisoning," Jour. American Medical Association, 1914, LXII, p. 1764; Pekanovits, "Effects of Tobacco Smoking," Jour. American Medical Association, 1914, LXXII, p. 1907.

    14. Bangs, L. Bolton: "Some Observations on the Effects of Tobacco in Surgical Practise," Medical Record, LXXIII, March 4, 1908, pp. 421-23-51.

    15. Cannon, Aub. Binger: "Effect of Nicotin Infection on Adrenal Secretion," Jour. Pharm. and Exper. Therap., 1912, p. 381; Editorial, "Nicotin and Adrenals," Jour. American Medical Association, 1912, LXIII, p. 1287.

    16. Hare, Hobart Amory: Fiske Prize Dissertation, No. 34, p. 1884. Dixon, A. S.: Proceedings of the Academy of Natural Sciences, Philadelphia, Nov. 11, 1884.

    17. Reynolds, H. S.: Jour. American Medical Association, May 30, 1914, LXII, p. 1723.

    18. Annual Report of the Commissioner of Internal Revenue, 1917, Government Printing Office, Washington, D.C.


    Farnam, Henry W., Professor of Economics, Yale University: Notes on the Nicotine Question, May; 1914.

    Bamberger, J.: "Hygiene of Cigar Smoking, Abstr. Jour. American Medical Association, 1904, XLIII, p. 706; Zur Hygienie des Rauchens," München. med. Wehnschr., 1904, LI, pp. 1344-1345.

    "Current Comment: Some New Evidence on the Tobacco Question," Jour. American Medical Association, 1912, LIX, p. 1798.

    Editorial: "The Pharmacology of Tobacco Smoke," Jour. American Medical Association, 1909, LII, p. 386.

    Editorial: "The Use of Tobacco," Jour. American Medical Association, 1910, LX, p. 32.

    Editorial: "Tobacco-Smoking and Circulation," Jour. American Medical Association, 1914, XLII, p. 461.

    Hochwart, L. Von Frankl: "Die Nervösen Erkrankungen der Tabak-raucher," Deutsch. med. Wehnschr., 1911, XXXVII, pp. 2273, 2321.

    Index Catalog of the Library of the Surgeon-General's Office, second series, XVIII, pp. 297-306.

    Larrabee, R. C.: "Tobacco and the Heart," Abstr. Jour. American Medical Association, 1903, XLI, p. 50. Read before the Massachusetts Medical Society, June, 1903.

    Pel [Pieter Klaases (1852-1919)]: "Un cas de psychose tabagique," Ann. med. Chir., 1911, XIX, p. 171.

    Brooks, Harlow. "The Tobacco Heart." Reprint from N. Y. Medical Journal, April 24, 1915.


    (For pp 366-411, not being reprinted
    here at this tobacco-information
    site, contact your local libary.)

    all that is necessary, but your condition should be watched from time to time. Albumin in the urine may be temporary but should always be followed up and examinations made at intervals. Give the benefit of the doubt to your kidneys, and live a temperate and healthful life, avoiding stimulants, excess of meat and overeating generally. Be examined periodically. Sugar in the urine calls for careful medical supervision and regulation of diet and periodic examination by a physician.

    Discharge from Ear: Ear Trouble.—See an ear specialist or go to an ear clinic. Do not neglect such a condition, which may infect other parts of your body.

    Heart Murmurs: Heart Affections.—A man with an imperfect heart may not be fit for military service, but with proper regulation of diet, exercise, work and rest, his heart may carry him to old age. Avoid stimulants and tobacco, be very temperate in the use of tea and coffee, avoid excesses of all kinds; eat moderately; avoid heavy meals at night; get plenty of fresh air; exercise daily in the open but be careful not to overfatigue your heart or circulation—walking and gentle hill-climbing are good, but never when they cause pain in the chest or shortness of breath. Avoid dissipation and undue excitement. If there is breathlessness, dropsy, or dizziness, careful medical supervision is necessary. All damaged hearts should be examined at least once a year by a physician and the condition noted. Irregular action of heart in some cases is of little importance; in others it is serious and medical observation is important to settle this.

    High Blood Pressure.—This may be temporary but should be watched and life regulated as above, especially avoiding physical and mental over-strain and dissipation. Eat little meat; avoid stimulants, tobacco, and overeating.

    Lung Troubles.—Where there is suspected tuberculosis, consult a competent physician and follow orders strictly. The basis of treatment is abundant fresh air and nourishing diet, such as bread and butter, cereals and fats, but do not neglect green vegetables and fruits. Avoid alcohol and tobacco. Do not take patent medicines or advertised remedies, or patronize advertising quacks. Avoid fatigue, or physical and mental strain. Do not take any chances. Re-


    port to the health officer or Health Department of your district. They will be glad to counsel you.

    Rheumatism.—This may be caused by infection in tonsils, teeth, nasal cavities, or elsewhere. Liniment will not cure it. Be examined by a physician and dentist and have infection removed.

    Syphilis — Gonorrhea.—Thoroughgoing, persistent treatment is necessary for your protection and for the protection of the members of your family as well aa that of your community. In large cities, clinics for the treatment of these diseases are available for those without funds.

    Alcohol.—Alcohol as ordinarily taken is not a stimulant but a depressing drug. Your brain and nervous system govern your body. Alcohol not only reduces the efficiency of a nation, but life insurance experience has shown that the death-rate among steady drinkers supposed to be temperate—even within the bounds of so-called moderation—ia nearly double that among average people.

    Drink may lead you into trouble, possibly to a miserable death.

    Why deliberately expose yourself to this sort of machine-gun fire?

    Nervous and Mental Diseases.—Such conditions should be closely observed by your physician or at some clinic for nervous diseases. Some nervous diseases are due to bad mental habits, to fear, failure to take a courageous grip on life and forget one's troubles. Many nervous diseases are caused by physical conditions which should be sought for and cured by a thorough medical examination and treatment.

    Miscellaneous Conditions.—Nose and Throat Trouble; Gall Bladder Trouble; Chronic Appendicitis, Skin Affections.—All such conditions should have immediate medical investigation. If you have no family physician, or if your means are limited, seek hospital or dispensary treatment.

    Do not go through life with handicaps that may be easily removed. Do not shorten your life, reduce your earning capacity and capacity for enjoying life, by neglecting your bodily condition.

    While other men are cheerfully facing death for the cause


    (For pp 414-461, not being reprinted
    here at this tobacco-information
    site, contact your local libary.)

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