If it be argued that the law would be difficult to enforce, the answer may be given that valuable citizens are law-abiding, and that few whose lives were worth the saving to the State or nation would violate the law by neglecting its provisions.
THE EFFECTS OF TOBACCO ON THE HEART.
BY DR. EDWARD R. SNADER, Lecturer on Physical Diagnosis, in Hahnemann Medical College, Philadelphia.
MEDICAL opinions concerning the effects of tobacco on the heart are by no means definite or uniform, if the various views of writers on the subject be compared. On the one hand, the belief is staunchly held that hypertrophy of the heart is frequently and directly produced by the habitual use of the weed in its various forms. On the other hand, the assertion is made with equal positiveness that no organic heart lesion can be definitely laid to the blame of tobacco. Investigation into the possible effects of tobacco on the heart should, logically, embrace:
First.- An inquiry into the drug properties of tobacco and its active principles, i.e., the power of tobacco to produce toxic effects upon the heart.
Second.- If the plant shows toxic properties, and they are manifested upon the heart, the nature of that action, i.e., whether sympathetic, specific, or organic or inorganic.
Third.- The signs and symptoms by which we can definitely recognize and systematically classify the tobacco heart-disease or diseases.
And, as a natural corollary, from a medical standpoint:
Fourth.- The measures for the prevention, amelioration or cure of the disease or diseases.
That tobacco does affect the heart is theoretically certain if the various investigation into the nature of the plant are even approximately correct. For scientific purposes lay diatribes against the tobacco habit are absolutely valueless, inasmuch as as isolated instances are cited as a text for sermonizing, and no effort is made to prove beyond cavil that cited instances of poisoning are unquestionably due to tobacco. Dr. Benjamin Ward Richardson, while studying the effects of tobacco upon the general system, found that there existed in tobacco smoke the following constituents: Water, in a state of vapor; free carbon, diffused in very minute particles, or soot; some ammonias (in a state of vapor), giving to the smoke an alkaline reaction; carbonic acid and carbonic oxide, each in a state of gas, and a vapor easily condensible into an oily-like substance, crude nicotine. It will be seen that tobacco smoke is a complex substance. The fluid alkaloidal body, nicotine, further yielded a volatile empyreumatic substance, which contained an ammonia and a dark, resinous, bitter extract.
The products of the combustion of tobacco, however, have been separated into still more refined division. Eulenberg and Vohl passed the smoke of tobacco through a strong solution of potassa, and afterwards through a solution of dilute sulphuric acid.
The solution of potassa separated carbonic, acetic, formic, butyric, valeric and other acids, including even hydrocyanic, together with creosote and some hydrocarbons.
“The acid solution fixed ammonia, and a series of oily bases resulted belonging to those homologues of aniline which Dr. T. Anderson first discovered in coal tar. These bases run parallel with aniline, and, under the acton of iodide of ethyl, yield ammonium compounds. They are composed of the elements of carbon, hydrogen and nitrogen, and they differ in physical, and, probably, in physiological qualities, according to their atomic weights. The lightest is pyridine, composed chemically of C5H5N; the heaviest is viridine, C12H19N; and intermediate are picoline, C7H7N; lutidine, C7H9N; collodine, C8H11N; parvoline, C9H13N; eoridine, C10H15N; and rubidine, C11H17N. Pyridine was found to be most abundant in smoke from tobacco, and picoline, lutidine and collodine in smoke from the cigar.” However, in everyday smoking, all these products are not formed and inhaled, but the carbon, the ammonia, the carbonic acid and oxide and the nicotine are produced. The carbonic acid and the nicotine are the agents that most affect the heart.
These investigation prove that tobacco has toxic power. The question naturally arises, if toxic, and it affects the heart, through what physiological system are its effects produced? The intensity of the symptoms developed by a first smoke disprove the popular idea that tobacco is a narcotic, like opium. Primarily its action seems to be as an irritant to the motor nervous system, and certainly “not as a narcotic upon the sensational.” In addition to the general phenomena produced by a toxic first smoke, the condition of the heart of man, reasoning from the analogy of experiments on animals, ought to closely resemble Richardson’s description: “The heart, overburdened with blood, and having little power left for its forcing action, is scarcely contracting, but is feebly trembling, as if, like a conscious thing, it knew equally its own responsibility and its own weakness. It is not a beating, it is a fluttering heart; its mechanism is perfect, but each fibre of it, to its minutest part, is impregnated with a substance which holds it in bondage and will not let it go.”
If such are the acute toxic effects of tobacco upon the heart, what are the pathological conditions, disorders and symptoms produced by the abuse of it, and by working in it for a considerable period of time? In a progressive study of the subject. I accepted as a fact the chemical proof of tobacco’s toxic power, the probable truth of the asserted condition of the heart in animals when first under the weed’s influence, and the reasonable inference therefrom of a similar cardiac condition in man; but I regarded it as essential that investigation from a clinical standpoint also should positively demonstrate that tobacco produced cardiac effects. With the object of attempting such a demonstration, I began, among the employees of tobacco factories, a series of examinations. The table opposite shows the results obtained from the careful examinations of thirty-one hearts:
All the subjects examined were males. The oldest was 32 years of age; the youngest, 17.
The longest period of time employed working in tobacco was 24 years: the shortest, 3; one used the weed 15 years; one, 16; one, 18; one 19; one, 20; one, 21; and nineteen, over 10 years.
The use of the weed was begun in one instance at 1 year of age; one at 5; two at 7; one at 8; one at 10; and the remainder, with two exceptions, formed the habit at or about the period of puberty.
The character of the pulse was irregular in twenty; intermittent in seven; weak in eleven; strong in five (strong in only two cases of hypertrophy); both irregular and intermittent in seven; irregular, intermittent and weak in three; irregular and weak in three; simply weak in two; normal in twelve.
The highest pulse-rate, standing, was 136; sitting, 138. The lowest pulse-rate, standing, was 56; sitting, 56. Eight had a pulse-rate of over 100 when standing, two over 100 while sitting. Twenty-two had a pulse of over 72 while standing; fourteen over 72 while sitting. Three had pulse of less than 70 standing. Three had pulses of the same rate standing as sitting. Two had pulses faster while sitting than standing (one a case of aortic stenosis). The pulse-rate was below 70 both standing and sitting in four cases. In one case of enormous hypertrophy the pulse was 56 standing and 68 sitting. In three the pulse was stronger when sitting than when standing.
The impulse was diminished in twelve; increased in nine (increased in two without hypertrophy); the impulse was (nearly) normal in ten.
Five had experienced attacks of palpitation, three of whom suffered from hypertrophy. Only one had the palpitation directly following the use of tobacco.
Eight cases of hypertrophy were discovered six simple and two associated with aortic stenosis. It would be manifestly unfair to infer, simply because the subjects of hypertrophy were workers in and users of tobacco, that the enlargement of the heart was due to the plant. All the remaining causative factors of cardiac overgrowth could not be excluded, and hence the solution of the question of origin remains sub judice. That the tobacco habit can cause the so-called irritable heart I do not doubt; but that tobacco sets up a particular and specific hypertrophic enlargement seems conjectural. It seems only fair to say that the abuse of the plant may lead to an irritable heart, and that an irritable heart may become hypertrophied, but that, if such enlargement does take place as a consequence of the toxic effects of tobacco, it is not a specially peculiar muscular increase, and is probably undistinguishable from other forms. (The existence oft he traditional tobacco hypertrophy I cannot but regard as unproved.) In all the cases of hypertrophy I elicited a history of considerable muscular exertion and rough out-door sports. One was a baseball pitcher. All the hypertrophies were symptomless. In but two could I elicit histories of palpitation, and even this information was secured by means of close and persistent questioning. The men did not know they had a heart so far as symptoms were concerned. It is quite possible that the sedative effect and the cardiac muscular weakness induced by the habit kept the heart from manifesting its full strength. The effect of the tobacco had probably been to diminish the force of the heart’s action and induce vessel relaxation. This symptomless character of the hypertrophy would apparently seem entitled to be considered pathognomonic of the effects of tobacco on the heart, and to be of diagnostic value. However, this symptom is not met with alone in users of the weed. I have seen other symptomless cases of simple hypertrophy where there existed no tobacco habit or history of it.
Hale wrote Lectures On Diseases Of The Heart, Materia medica and special therapeutics of the new remedies Volume 1, Materia Medica And Special Therapeutics Of The New Remedies Volume 2, Saw Palmetto: (Sabal Serrulata. Serenoa Serrulata), The Medical, Surgical, and Hygienic Treatment of Diseases of Women, New Remedies: Their Pathogenetic Effects and Therapeutic Application, Ilex Cassine : the aboriginal North American tea, Repertory to the New Remedies with Charles Porter Hart, The Characteristics of the New Remedies, Materia Medica and Special Therapeutics of the New Remedies, The Practice of Medicine, Homoeopathic Materia Medica of the New Remedies: Their Botanical Description etc.