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Typos — p. 50: centimeter [= centimetre]; p. 56: Artic [= Arctic]; p. 56: unimparied [= unimpaired]; p. 61: subtsances [= substances]; p. 63: objecttions [= objections]; p. 69: Labourchere [= Labouchere]; p. 77: tabacco-smoking [= tobacco-smoking]; p. 78, n. 2: Havard [= Harvard]
Chapter II (b) Good Habits Of Life And Hygiene One of the essential conditions of a healthy life is the adequate oxygenation of the blood. The renewal of the body's life means the constant replenishment of energy and substance by nutriment and the reconstruction of moribund cells all over the organism. It also means the removal of the waste products of this process, and this cannot be efficiently carried on unless the body receives adequate supplies of oxygen. Thus, there should be in all of us a suitable mechanism in the thoracic viscera and the vascular system for meeting this need; and the proper use of this mechanism and systems depending on it are, therefore, essential to health. It will readily be appreciated that there are two possible conditions under which even an adequate breathing equipment may in the long run fail to supply the body with a sufficient amount of oxygen:— (a) The air breathed may be foul or used up; i.e., it may hold in suspension a larger proportion of poisonous elements than is consistent with healthy breathing, or: (b) The air may be good, but the respiratory function may be faulty, so that, breathing is neither as deep nor as frequent as it should be, in spite of good and suitable thoracic equipment. It often happens nowadays, however, that there is a third condition under which the respiratory function may fail adequately to oxygenate the body, and that is as follows:— in addition to bad or foul air, and in addition to a bad bodily use which impairs breathing, there is actually inadequate thoracic equipment, i.e., a chest development and expansion which, given the size and weight of the individual concerned, has not the capacity if should have. This condition is often found among our urban populations, and certain orthopædic surgeons have even claimed that babies are Again to draw a simile from engineering, as every engineer knows, a steam engine designed to generate a given average degree of pressure must have a boiler proportionate to this average task. It may be able to rise to a temporary maximum higher than the average, but the requisite minimum capacity is determinable from the start, provided that the average demands are known. And, in the sense that the human body is a machine in which the equipment for generating energy must be proportionate to body weight and to the daily demands made on the supporting and motor mechanisms, it should be possible to calculate the optimal need of fresh air, etc., down to the last cubic centimeter. 1 If, therefore, through the defectiveness of the equipment there is an appreciable deficit in the intake of air at each breath, the result, which must be cumulative, necessarily leads to trouble of some kind. When it is remembered that from 350 to 400 cubic feet of air are passed through the lungs of the average adult male, taking little or no exercise, in the course of 24 hours, and are charged with carbon dioxide and deprived of oxygen to the extent of about five per cent, it is clear that only a slight deficit at each respiration may make a considerable difference in the course of a day. Ordinarily, eighteen cubic feet of oxygen will have been absorbed, and eighteen cubic feet of carbon dioxide will have been given off — this latter amount, stated in terms of charcoal, representing a lump eight ounces, or half a pound, in weight. Thus, to lower the respiratory function by no matter how little, means not only that the essential intake of 1 This has actually been done by such research workers as Professor G. Dryer and G. F. Hanson in The Assessment of Physical Fitness (London, 1920). See also Professor Achille de Giovanni: Clinical Commentaries Deduced from the Morphology of the Human Body (London, 1909). The accumulated poisons resulting from any such. protracted subnormal breathing may be imagined. The variety of the forms the evil may take, however, often tends to blind people to the uniformity of the cause. But, to some extent, every man tends to differ constitutionally from his neighbour, and this makes a poisoned condition manifest itself in a specific or individual manner in each of us, without necessarily implying any difference in the original cause. For instance, there may not be so much difference as at first appears between the basic nature of the disease in a case of dementia and in a case of rheumatoid arthritis, or between the origin of a sore throat and that of a festering finger. Defective oxygenation of the body is in itself a state of potential disease, and the site of the ultimate trouble and its nature are, as a rule, secondary and determined by factors which are additional to and less important than the original cause. It would seem unnecessary further to stress the importance of the adequate breathing of good air for the maintenance of health. But perhaps a few further remarks on certain modern developments may not be out of place. First of all, the reader may be interested to know that to anyone who has cultivated an adequate respiratory function in these days of widespread subnormal breathing, an unusual sensitiveness respecting the quality of the air available in any confined or even open space becomes a commonplace. And such a person is soon struck by the marked lack of "pulmonary taste" — to coin a new phrase for a newly recognized power — prevailing everywhere and, incidentally, merely confirming the belief that most modern men are bad breathers. It is not a question of a sense of oppressive heat. The temperature has, as a matter of fact, little do do with it. It is a question of the quality of the air, and it is here submitted that the taste controlling this state of affairs in England is deplorable. Indeed, cold extremities and a sense of chilliness are in themselves very often but symptoms of inadequate respiration or else of an inadequate oxygen intake, i.e., therefore, of an imperfectly oxygenated body; so that although it seems to the inadequate breather that a recently opened window will but add to his discomfort, the change is much more likely to relieve it. 1 But this bad "pulmonary taste" cannot be cured by an act of will, but only by cultivating adequate breathing. Secondly, there is the modern cult of taking so-called "deep" breaths as a means of cultivating adequate breathing. It should be thoroughly understood that there can be no such thing to-day as cultivating adequate breathing without re-conditioning all the acquired faulty reflexes which lead to inadequate breathing as a life-routine, and that it is just as hopeless for a man who has not been thus reconditioned to try to 1 The whole trouble is complicated by the superstition that "a draught" may cause a cold or a "chill". No draught of air ever caused a cold or a chill in a sound body, and those who fear draughts either do so through superstition, or else because experience has taught them that in their unsound condition they cannot survive even slight local modifications in temperature. Thirdly, the adequate breathing of good air, as a function designed to cleanse and vivify the body, is best done in the waking hours and in the open, between rising and bed-time, when the breathing and other functions of the body are not reduced in tempo and when the system is not demanding rest above all. The common practice adopted by townspeople of living in badly ventilated rooms all day long, and then trying to compensate themselves for this regrettable practice by sleeping in a draught all night, does not seem to be indicated by Nature's own scheme. Nature clearly intended both men and animals to get on with very much less air at night than in the daytime. Most wild animals sleep in a fug that would strike even the average badly-breathing urbanite with wonder, and in quarters that would certainly be condemned by the Borough Medical Officer. But it should be remembered that by sleep Nature intended primarily to secure complete rest, and that everything is subordinated to that end. All the functions are slowed down, and the respiratory need itself is reduced to a minimum. Thus, there is no point in sleeping in a draughty room, This will be appreciated more fully when it is remembered that in sleep metabolism and breathing are so much reduced that the production of heat declines to a third (in a man of ten stone, from 112 to 40 calories an hour) and that temperature, owing to the diminished intake of oxygen, falls about .6 degrees Fahrenheit (hence the need of adequate bed-clothing). Thus, it seems clear that if we get enough air during the day, we need not fret too much about it at night and that, speaking generally, sleep is likely to be sounder if Nature's lead in slowing down the vital processes is obediently followed. Fourthly, nose-breathing should in any event be cultivated, because it is obviously the breathing that was intended by Nature. The nose imparts a certain warmth to the air before it reaches the lungs; it contains protective mechanisms preventing the inhalation of gross foreign bodies, it immediately conveys to the breather — far better than the mouth can — a rough chemical report on the quality of the air; and it is, in any case, a necessary first step in the routine of reconditioning bad breathing. Also, by being more natural, it seems, even in the bad breather, to correct to some extent the tendency to short quick breaths. Fifthly and finally, let everyone remember that from our remote animal existences we all derive a tendency to hold our breath when forced to deep thought or deep feeling. This is obviously a case where a very hoary instinct acts deleteriously in modern man. The animal is suddenly pulled up by something unaccustomed, unfamiliar. It stops breathing, because where all is silence, even the sound of breathing may betray its presence to the unfamiliar object, and only when a course of action has been deliberated and the unfamiliar object understood and proved to be harmless, is normal breathing resumed. It might be said that But in modern urban life most sedentary jobs are jobs in which thought has constantly to be concentrated — whether in adding figures (a particularly good test for observing the arrest of normal breathing), solving a legal point, or writing, as I am writing now, or what not. And it is precisely in such jobs that not once, but almost continuously throughout the day, breathing is arrested or reduced to the minimum of slumber. It is, therefore, of the utmost importance for the modern urbanite, whether he be an architect, a bank clerk, or a musical composer, to exercise vigilance regarding his breathing; for the chances are 999 to one that if he does not check himself, he will find his old and now useless instinct to cease breathing, when feeling or thinking deeply, reducing his daily intake of oxygen to a fraction of his normal requirements. (2) The second rule of hygiene to be considered relates to the part that sunlight plays in a healthy life. Sunlight is essential, because, apart from other considerations, it constitutes in conjunction with certain processes in the skin, a natural source of Vitamin D — that extremely important vitamin which is at once necessary for proper calcium metabolism and for the proper protection of the system against infection. It is, therefore, a primary rule of health that people should have a certain amount of sunlight on their 1 See Byron, Childe Harold, Canto III. St. lxxxix: "Breathless as we grow when feeling most; and silent, as we stand in thoughts too deep." We find, for instance, that where sunlight is not to be had for protracted periods, as in certain parts of the Artic zone, the inhabitants habitually take, as part of their diet, large quantities of certain animal or fish fats or glands which are rich in Vitamin D. An unimparied dietary instinct or else accident evidently led them at some time or other to discover this substitute for sunlight, and among their remote ancestors enough evidence must have come to hand concerning the disasters attending those who did not include these elements in their diet to establish the eating of them as a rigid local custom. Human beings, except for the odd people who are still to be seen in summer with parasols and large hats, warding off every ray of sunshine from their skins, are, as a rule, natural lovers of sunshine, just as most animals are, and the cult of sun-bathing is now so universal that little requires to be said regarding this important aspect of hygiene. Nevertheless, the modern man's less sound instincts and his tendency to lack of balance in all things, make it necessary to call attention to the danger of excess even in so desirable a pastime as sun-bathing, if only for the reason that the majority of urban dwellers to-day have no idea that there can be such a thing as excess of sunshine. A few facts should be remembered. First, that in western and particularly north-western Europe, we are a white-skinned people with hardly any natural skin pigmentation to protect us from the destructive factors in the sun's rays. The speed with which Nature in us makes an effort to pigment our bodies under the sun's rays shows the urgency of the need when the exposure is persisted in. Moreover, we know that wherever in the tropics human nakedness is exposed to sunshine habitually, the skin of the inhabitants is per- Thus, a priori, we might be tempted to conclude that there is a destructive element in sunlight from which the human body itself does its best, when exposed, to protect its deeper tissues. Experience and experiment have, however, shown this a priori conclusion to be justified. For we know that the incidence of skin cancer, for instance, is highest in gardeners and rural labourers in our temperate climes, and that it is notorious that the white populations of Australia and New Zealand who, in these countries, experience more exposure to sunlight than they could normally have had in the land of their origin, are great sufferers from skin cancer — so much so, indeed, that considerable anxiety has recently been expressed in the medical press about the progress of this disease in Australia. These facts, however, only weigh against immoderate and protracted sun-bathing, and seeing that there are few people in a country like England who have either the leisure or the opportunity for excessive exposure (for sunshine is a relative luxury in this country), the English, as a whole, like the Scots, the Welsh and the Irish, are far more likely to suffer from ignorance concerning sunlight substitutes than from excessive sun radiation. It is important to remember, therefore, that when, owing to any protracted lack of sunshine, stores of D Vitamin in the body are likely to become depleted — as during an English autumn, winter and spring — substitutes in the form of some Vitamin D containing substitute should be taken. Such substances are:— milk from cows grazing in sunbathed pasture, butter made from this same milk, or cod-liver oil, or some other fish-liver oil, approved for its D Vitamin content. (3) The third rule of hygiene consists in the necessity for adequate bodily exercise. Indeed, among those members of this section of the community who, owing to their recent elevation from a lower economic stratum, are inordinately conscious about their rank as owner-drivers, walking out of doors has, I notice, actually become the supposed mark of the non-owner-driver, therefore of inferiority. They apologize, or hasten to offer elaborate explanations if they are met without their car, and are almost ashamed, as if they lacked a garment or the insignia essential to self-respect. This attitude, of course, is difficult to reconcile with much healthy exercise in the open air, and unless golf is pursued — for golf happens to be a pastime at which the owner-driver may self respectingly be seen walking — the result is that very little exercise is taken. When we consider that, in addition to this, car-driving is apt to provoke a factitious appetite and that, in any case, sitomania is one of the prevalent abuses of the Age, it can hardly be a matter for surprise that disorders of the alimentary tract and of the arteries, Proper exercise in the open air is essential to the body and should be taken in all weathers, because it keeps the muscles, viscera and vascular system normally braced and active; it stimulates the metabolic processes (the constant building up of living cells out of nutritive material and the elimination of waste and dead products), while it also maintains the body in strength. The author has recently adduced much evidence to show that even childbed difficulties are likely to be appreciably reduced if enough exercise is taken during pregnancy. 1 The exercise should be taken with the mouth closed, so that nose-breathing may not be interfered with. The great German philosopher, Emmanuel Kant, knew this, and never took a companion with him on his walks. "He wished to breathe exclusively through his nostrils, which he could not do if he were continually obliged to open his mouth in conversation." Exercise which causes moderate perspiration is also more beneficial than exercise that does not do so. Because sweating is a potent stimulus to healthy metabolism. It is, however, desirable, after such exercise, to remove soiled under-garments. Finally, it cannot be too much emphasized that exercise is good or bad, according to the strains it imposes on the body. If these are unnatural, i.e., incompatible with normal functioning, then, on the analogy of a defective machine which gets more and more defective the more actively it is forced to function, the results of exercise are likely to be disappointing. The benefit derived from exercise is, therefore, contingent on the degree of correct bodily co-ordination enjoyed by the individual who engages in it, and that is why even set exercises designed for health, may be and often are more harmful than no exercises at all. 1 See The Truth about Childbirth (London, 1938). (4) Before leaving hygiene, a word must be said about ablutions, internal and external. An enormous amount of fuss is made about the daily bath in England and in those countries which out of pure snobbery have slavishly emulated her. The result is that, in certain classes, where a daily bath is the stamp of a certain income, much too much external ablution is practised for normal health. It is not unusual, indeed, where purse-consciousness is very aggressive in England, for people to take two baths a day. It should, however, be remembered that when it is taken warm, with soap and often salts as well, a bath is a very devitalizing exercise. It is particularly so to men, whose artificial devitalization through the wearing of trousers has in any case been carried sufficiently far. 1 But even in the case of women it is not entirely innocuous, and those who, like hospital nurses and medical men, have much knowledge of the relative healthiness of the skins of the poor and the well-to-do (i.e. over-washed people) are unanimous in declaring that the healing power of the former is very much higher than that of the latter. There must, in any case, be a considerable loss of energy to both sexes through very hot baths. Until, however, there is less purse consciousness about the daily bath, it is hardly likely that this state of affairs will be remedied. On the other hand, it is not every modern urbanite who can endure a cold bath every morning, or even a cold douche. People, whose livers are difficult, find their troubles increase if, in spite of a rooted distaste 1 Those to whom this is not obvious will find the scientific explanation of it in the author's Choice of a Mate, Part II. Chap. III. But with all this fuss about external cleanliness in England, there is, unfortunately, a corresponding neglect of internal cleanliness, though it is well to remember that, whereas the former must be a matter of active personal interference, the latter need not be so, if the automatic cleansing processes of the body are given a fair chance to do their work. As it is, however, everything is done to complicate and impede their work, with the result that millions of people, including even children, are to be met with to-day, who are quite as much "whited sepulchres" in the material, as the Scribes and Pharisees were in the spiritual, sense. Never forgetting their bath, and preferring to take two a day rather than none, they walk the stage of their lives with insides as disgusting as cesspools, and with breaths as foul as sewers. I have known excessively bathed children whose breath was so offensive that it was impossible to approach them with comfort. Emphasis on external bodily cleanliness in such circumstances is a little ridiculous for when the consequences of dirty exteriors and dirty interiors are compared the former are seen to be but trifling. Mere cold, imposed for a long time, as it is in many English and Scottish middle-class homes, on the inmates thereof, by retarding and impeding metabolism, may be a cause of internal filth. Over-eating, by heaping up subtsances that cannot be utilized and which, as in the case of the proteins, for instance, become active poisons when they are in excess, may also be a cause of internal filth. Whilst anything in the nature of retarded function as, for instance, when the kidneys are given too heavy a task of elimination after an excessive Probably, of all the sources of internal filth, constipation and over-working the kidneys are the most common, and since much error prevails regarding the correct method of dealing with these conditions, it may be well to say a few words about them. Constipation, it should be remembered, may easily become a habit. It is, therefore, important to check it in its early stages. But the most mistaken way of checking it is usually the first to be adopted, and that is by way of some aperient. Aperients should above all be avoided, because they tend to promote the conscious and unconscious belief that natural functioning has become impossible. They aggravate the dysfunction already incipient. They tend to set up chronic sub-acute inflammation in the epithelium of the alimentary canal, and interfere with that adequate renewal of life in the epithelium which, as we have seen, is essential to health. They tend to give rise to secondary trouble such as piles, fissures, diverticula, etc., and, above all, they appear to correct the disorder without going to the root of it. And, since tolerance soon supervenes, their dosage has to be increased almost day by day. Even the constant use of a lubricant oil should be avoided; for apart from acting as an artificial aid to a function that should be potent enough of itself, by preventing a certain amount of assimilation, it also fosters habits of sitomania. The oily particles of a laxative lubricant that surround the elements in the swallowed bolus of food certainly do not help assimilation, and since, in time, the oil thus artificially ingested — i.e., for purposes of lubrication and not nourishment — ultimately forms a constant stream through the intestine, issuing at the anus in the form of perpetual Nor do any of these objections constitute the most alarming charge that has been brought against internal lubricant oils, which is that the latter are usually derivatives of paraffin, and that in this form they are alleged to contain a carcinogenic factor. This has occasionally been denied, but even the suspicion that it may be so, and has been found to be so by reputable workers, should suffice, together with the other objecttions, to make the use of this artificial aid undesirable. Seeing that the causes of constipation may be:— (a) Faulty diet. (b) Lack of exercise. (c) Bad or irregular habits. (d) Consistent vicious bodily co-ordination, in action or inaction. (e) Insufficient drink. (f) Excessive sweating, particularly at night under too heavy bed-clothes, with consequent deprivation of moisture to the intestines (this is a frequent cause in babies and children), it behoves us to attack the trouble at its source, and not to attempt to correct it by the use of artificial aids which leave the cause unaffected. But even when we intend to attack the trouble at its source, we still have to perform the necessary preliminary step of convincing ourselves that the function, if given a fair chance, will be able to correct itself and resume its normal efficiency. Psychologically, this is about the only step that requires to be taken, for the only possible psychological cause of continued constipation, when once all other causes have been removed, is the conviction in the mind of the sufferer that normal functioning is an impossibility. Psychologically, then, the only step to take, is to abandon the idea that the normal function has become an impossibility, and on the positive side to be convinced that, on the contrary, where Nature is given a chance, not only will she resume normal functioning, even when it has been long arrested (provided no grave organic abnormality has arisen meanwhile), but will tend to resume it, because the well-constituted body is constantly striving towards normality. But it is hopeless to try to correct constipation if one of the six causes of it mentioned above is allowed to persist:— (a) Faulty diet: The diet rules to remember if constipation is to be corrected (and these are in addition to what will be said in the chapter on Diet) are:— Take adequate meals. An adequate, satisfying meal promotes intestinal peristalsis (the muscular action of the bowels propelling the food on its course) and stimulates the whole of the alimentary canal — hence the error of light and frequent meals. Hence, too, the error of a meal like afternoon tea. Eat when hungry and eat well. Chew all food with care, particularly cereals and raw vegetables. Remember, however, that if an adequate meal, 1 See The Choice of a Mate, Part II. Chapter II. Owing to the putrefying elements it produces when being digested, meat also tends to cause acidity and consequently constipation. Raw fruits are the most natural aperient, and the best form of food with which to make up bulk and give the desired sense of repletion. Finally, it is wise to make up some of the requisite bulk of a meal by taking fresh salads, roots (largely raw), potatoes, and foods of low nutritive value which, however, contain the necessary food salts — calcium, phosphorus, iron, etc., not too plentiful in the ordinary diet. Foodstuffs containing these mineral elements have a twofold advantage. They not only give the body essential ingredients, but also tend to neutralize the acid by-products of the food of high protein content, while they also compel one to partake less copiously of the latter. (b) Lack of exercise: Exercise should be regular and not spasmodic. Spasmodic exercise tends to be taken in excess and to cause undue fatigue. The best exercise, of course, is that which is taken, not as end in itself, but as the necessary part of a man's daily work. Since, however, exercise of this kind is sometimes though not necessarily denied to the average urban dweller, and even to those women folk in towns who are "above" doing their own work, it is as well to link the deliberate taking of exercise, as far as possible, with the daily duty — walking to the office and back, walking to the shops and back and so on. (c) Bad or irregular habits: It is important to train the body to function regularly. Bad habits creep (d) Consistent vicious bodily co-ordination, in action and inaction: This will be dealt with in a separate section. (e) Insufficient drink. A good deal is said, even by medical men, about the advisability of drinking large quantities of water during the day, whether thirst is or is not felt. It is doubtful whether the practice can really be recommended to all and sundry without qualification, and I, for my part, am convinced that the advice is unsound except in cases of established disease. Tell a man with jaundice to indulge in bland drinks often and plentifully, and the advice obviously has some value. But are we really to suppose that it can do a sound man any good to drink copiously when he does not feel thirsty? The dangers of the advice are manifold. For instance, given a subject with slight muscular development and visceroptosis (sagging belly), and the chances are that, recommending to him or her a rigorous discipline of water drinking when no thirst is felt, would result merely in dilatation of the stomach, with all the discomforts of that condition, including heartburn, flatulent dyspepsia and probably insomnia. Or by recommending long drinks of water to be taken without feeling the need of them to persons with incipient gastric or duodenal ulcer, a condition may result in which perforation is imminent. On the other hand, as in most people feeling begins But this rule should not be adopted by everybody. And people who find their functions healthy without it, should not drink when they are not thirsty simply because they have heard that it is the thing to do. (f) Excessive sweating: This is merely a question of ordinary vigilance. The tendency to sleep under eiderdowns and to retain the same amount of bed-clothes throughout a season in which wide variations may occur from day to day in the temperature out of doors, often make it impossible to guard against this evil. It is, therefore, a good plan to bear the matter of bed-clothes in mind, especially during an English winter, when sudden changes from vernal mildness to arctic cold may occur in the space of twenty-four hours. To sit in an over-heated room and perspire is obviously wrong. But here again, it is a matter of individual build and condition. For a thin man to perspire grossly indoors would argue a far greater degree of excess heat in the house or room than if a very fat man were to do so; but as it is the thin man who generally speaking can least afford to sweat unduly when taking no ex- Before concluding this section on Hygiene, a word or two must be said on the vexed question of Tobacco-Smoking.
Whether we should or should not smoke tobacco — cigarettes, cigars, or the pipe — is a question that has to be faced, although it is far from easy to answer. There is much evidence to show that smoking is bad. There is also much evidence to show that, in moderation, it is quite harmless. On purely historical grounds — its close association with the Puritans, under whom it rose to popularity, and the known achievements, contentment and health in England before the introduction of the weed into this country at the end of the 16th century — tobacco-smoking ought to be rigorously eschewed by all people of taste. On the other hand, in the two hundred and fifty years of its existence as a part of English life, it has become such a familiar feature of the house and of ceremony in and out of the home, it has become associated with so much that is congenial in the "smoking room" of clubs, hotels, private houses and institutions of all kinds, and the very fragrance of the cigarette, cigar or pipe has come to mean so much in the form of leisure, conversation, relaxation, friendliness and even hospitality, that the ritual of smoking alone, apart from the actual pleasure it gives to the individual, has become almost as much a confirmed habit as the ritual which governs our manners and our modes of address and greeting. And yet, in spite of the apparently strong hold it has taken upon the life of the nation, there are thousands of men, young and old, who do not indulge in it, who It would, therefore, be ridiculous to make the claim that it was a necessary habit. The question really is, can it be regarded as a desirable habit, and should it be continued? It would be platitudinous to say merely that, if excess is avoided, there can be no harm in continuing it; for this is true of every practice under the sun, from playing marbles in the gutter to reading elevating poetry. Nor is it very helpful to point to individuals who, although perpetually smoking, even cigarettes (Henry Labourchere, for instance), lived to a ripe old age and managed to remain in fairly good health until the end. For, in these individual cases, there are always special features which often remain quite unknown and may have secured a state of health above the average in spite of tobacco-smoking. In Labouchere's case, for instance, we know that he was a consistently abstemious eater — an exceptional man, therefore, as modern men go. The only fruitful way of approaching the problem, therefore, is to try to discover whether any general differences have been scientifically ascertained between large groups of those who smoke and those who do not smoke; for, since the advent of women into our smoking-rooms and smoking compartments, the question has become one almost of genetics or eugenics. When we learn that about 40,000,000,000 cigarettes are smoked every year in the United Kingdom, which is roughly a thousand cigarettes a year per head, or nearly three a day, and that when we exclude all babies, infants, and children up to about fifteen years of age, the number per head is very much higher, it will be seen that the problem may be urgent if there is the The expenditure on tobacco alone — something in the neighbourhood of £200,000,000 per annum — is serious enough, especially when it is remembered that it is all spent on a product imported from abroad. But the expenditure would be negligible if tobacco-smoking were harmless, for, seeing the amount of solace and pleasure it gives, and the amount of sociability it encourages, the price would be nothing if we could be sure that the habit was not injurious. It may perhaps be best to start off by saying in what respect, if any, tobacco is actually beneficial to health. According to Sir Robert Armstrong-Jones, tobacco relieves psychic tension, tranquillizes emotion, and promotes repose, and he commends the spending of £12,000 a year on tobacco in the London asylums. 1 According to Dr. F. W. Alexander, owing to its pyridine content, it is powerfully germicidal. It was much used, for instance, during the Great Plague in London (1665) by those visiting and conveying the bodies of the victims, and it was found that those who used it plentifully "wonderfully escaped the dire contagion." Thus it gained renown as a disinfectant and was even used in English churches as incense. It rapidly destroys the cholera vibrio, and during the cholera epidemic in Hamburg not a single cigar-factory-hand was attacked by the disease. It also destroys the bacilli of pneumonia. 2 Professor W. E. Dixon denies that it is an active germicide. He says that although Dr. Pantoni has shown that tobacco has a strong disinfectant action in vitro, when the smoke is drawn into the mouth, the action is attenuated by the saliva and mucosa, and its antiseptic effect is negligible. 3 Drs. F. C. Turley and T. R. Harrison, who set out 1 The Practitioner. January, 1927. 2 Medical Press and Circular. 30.7.30. 3 British Medical Journal. 22.10.27. Finally, Dr. Wingate M. Johnson, whose paper "Tobacco Smoking" in The Journal of the American Medical Association might be suspected of having been inspired by the smokers and tobacconists of the world, examines five common medical objections to the habit of tobacco-smoking, and comes to the following conclusions:— "1. Tobacco-smoking apparently has no permanent effect on the blood pressure. "2. There is no foundation for the popular belief that smoking decreases the weight of an individual. "3. It is doubtful whether tobacco plays a major part in the etiology of angina pectoris. "4. The act of smoking, if it affects blood pressure at all, reduces it temporarily. "5. The effect of tobacco-smoking is chiefly local, exerted principally on the pharynx." 2 Many observers, such as Drs. Moynihan, H. Tyrell-Gray, Izod Bennett, F. W. Price and others, have claimed that tobacco-smoking is a potent cause of l Medical Press and Circular. 29.6.32. 2 Journal American Medical Association. 31.8.29. Professor W. E. Dixon asserts that, like caffeine, nicotine stimulates all the nerve-cells, leaving an after depression, and the confirmed cigar smoker thus finds himself compelled to continue the artificial control of his nerve centres with nicotine. 2 Comparing the relative effects of different kinds of tobacco smoking, Dr. F. W. Alexander says that, although pipe-smoking allows much more nicotine to reach the mouth of the consumer, cigarette-smoke contains furfural, a harmful substance, which he hints may be one of the causes of cancer. It is especially present in the smoke of the cigar or pipe. Cigars, pipes, Egyptian and Turkish cigarettes, however, all yield ammonia, which is an antidote to furfural and aldehydes generally, but the cheap Virginian cigarettes contain very little ammonia, and as Dr. Alexander points out, it is the cigarette-smoker who chiefly suffers from the affects of tobacco. 3 Dr. Alexander's hint that the substance "furfural" may be a factor in the generation of cancer, whether of of the tongue or lungs, in habitual smokers, is not without significance in view of the following recently ascertained facts:— the increase in cancer of the lung in modern times and the greater incidence of cancer of the tongue and lung among men (who, until com- 1 Lancet. 14.4.34. Dr. Seale Harris (Journal American Medical Association. 10.11.28) forbids tobacco-smoking in cases of healed gastro-duodenal ulcer. 2 The Practitioner. January, 1927. See also British Medical Journal. 22.10.27. 3 Medical Press and Circular. 30.7.30. The matter is discussed in an editorial of The British Medical Journal, 2 and the question is put whether tobacco-smoke with its tobacco-tar content has a carcinogenic activity similar to that of coal-tar. Experiments on animals have not upheld the supposed similarity. But as the Editor of The British Medical Journal says: "This does not prove that the smoking habit has no effect on the incidence of cancer, because there are other chemical constituents of tobacco smoke which might have a carcinogenic action. . . . It is possible that the heat of the smoke may induce epithelial proliferations." In a review by Lickint of the experiments and clinical work that has been done on this problem, reported in The Journal of the American Medical Association, 3 we are told that of 4,059 cases of cancer of the bronchi and lungs, 3,370 were found in men and only 689 in women (i.e. a ratio of five to one), and the author points out that the frequency of cancer of these organs is increasing. He believes it to be due in part to the great increase in cigarette smoking with its attendant inhalation and reminds us that in smoke-filled rooms "not only smokers but non-smokers are exposed to this danger." He mentions eight other medical authorities who supported his view, and concludes that, owing to the long time that nicotine and other products of the burning of tobacco remain in the liver and urinary bladder, primary cancer of these organs also is sometimes caused by tobacco. As to the possible relation of the increase in cancer of the respiratory tract, and the recent extension of the smoking habit. The British Medical Journal editorial l Lancet. 4.6.32. 2 Issue of 25.2.33. 3 Issue of 29.3.30. The original article by Dr. F. Lickint appeared in the Zeitschrift Fur Krebsforschung. Berlin. 16.12.29. A special investigation carried out in New York City is of interest in this respect. The object was to determine the monoxide content of the blood of smokers, and it was found that "normal individuals, who do not use tobacco and who are not habitually exposed to automobile gases, showed an average saturation of the blood with carbon monoxide of 1.5%. On the other hand, in individuals who are smokers, the saturation was from three per cent to four per cent." 1 The latter were subjects smoking from ten to fifteen cigarettes a day. Drs. H. W. Haggard and L. A. Greenborg have, however, pointed out that the non-smoker, who takes a walk on Fifth Avenue, New York, during the hours of heavy automobile traffic, accumulates more carbon monoxide than the heavy smoker. 2 The question is further complicated by the extraordinary number of men of ripe old age who, as has been pointed out earlier in this discussion, have been smokers all their lives. Dr. Lickint who, to shed light on the question, examined 100 men over ninety, found that among ten of these, who were over 100, three had never smoked, four were still smokers, and three had been smokers but were so no longer. Of the remaining ninety, aged between ninety and 100, nineteen had never smoked, thirty-two were life-long smokers, and thirty-nine had given up the habit. But all the smokers favoured either the pipe or cigars, and Lickint suggests that it is the growing popularity of cigarette smoking, with its associated habit of tobacco-inhaling ("whereby 1 Journal American Medical Association. 13.5.33. 2 Ibid. 10.3.34. As to the effect of tobacco-smoking on mental efficiency, Dr. Rosslyn Earp made a study of smokers and non-smokers at Antioch College, Ohio, in 1925 and again in 1927, and reported both results to The Lancet. There were 231 non-smokers and 215 smokers in the second study, and he found that it abundantly confirmed the results of his 1925 investigation. "The superiority of the non-smokers in scholarship is as clear as it was in the previous sample. There is no significant difference between the scholarship of smokers who inhale and those who do not, nor between those who smoke much and those who smoke little. It is true that during the year we have dismissed because of low scholarship 10.5% of our heavy smokers, 6.7% of lighter smokers, and only 2.5% of our non-smokers, and since the grades of students who have been dismissed are necessarily excluded from our study, the remaining heavy smokers gain from these dismissals. . . . May I repeat, to avoid misunderstanding, that there is no possible doubt of the association between low scholarship and the smoking habit, whatever the explanation may be?" 2 Commenting on these findings, which are not sufficiently extensive to base a case upon, an editorial in The Medical Press and Circular says: "It is hard to believe that tobacco is to any great degree destructive of intellectual efficiency, but at the same time it is possible that some of the most brilliant writers, had they been non-smokers, would have developed a still further degree of excellence." 3 Professor W. E. Dixon, dealing with the effect of smoking on mental efficiency, quotes Dr. Clarke who, in 1900, found that smoking impaired scholarship, Dr. 1 British Medical Journal. 12.4.30. 2 Lancet 3.8.27. 3 Issue of 21.9.27. Dr. Wingate M. Johnson does not enter deeply into the question of tobacco-smoking and mental efficiency. But he makes one remark which is probably very true, and which should put us on our guard against inferring too hastily that tobacco is always the cause where mental peculiarities are observed in conjunction with heavy smoking. He says: "I am inclined to think that the average highly nervous individual smokes to excess because he is nervous, rather than that he is nervous because he smokes to excess." 2 There seem to be some grounds for supposing that tobacco smoking causes an increase in the concentration of blood sugar as the result of the nicotine in the fumes stimulating the suprarenal glands. This, according to an editorial in the Journal of the American Medical Association, 3 would account for the pleasure of smoking, and also for the proverbial power of tobacco smoking to allay, if only temporarily, the pangs of hunger after a fast, and feelings of distress due to fatigue and irritability. It even suggests why people in a state of acute tension, after an accident or any ordeal, so frequently ask for a cigarette. At all events, the general consensus of expert opinion appears to show that even if the constant artificial stimulation of the whole body by nicotine (for the 1 British Medical Journal. 22.10.27. 2 Journal American Medical Association. 31.8.29. 3 Issue of 10.3.34. Professor W. E. Dixon declared that the physiological evidence clearly points to the fact "that the insidious action of nicotine spread over many years of continuous absorption is responsible for at least some of the cardio vascular diseases so common in middle and later life," 2 and many will be found to agree with him. Dr. Emil Bogen, for instance, at the end of a long paper on cigarette-smoking, says: "Under ordinary conditions, many competent observers have failed to note any deleterious effects whatsoever from the use of cigarettes. Certain conditions, however, have been so frequently associated with the practice of smoking that the causal connection seems indisputable. Cardiac arythmias, shortness of breath, thrombo-angitis, nicotine amblyopia and chronic inflammations of the upper respiratory passages are familiar examples. A 1 The Practitioner. January, 1927, and British Medical Journal, 22.10.27. 2 British Medical Journal. 24.10.29. The same conclusion is reached by Professor W. L. Mendenhall, 2 and it is probably all that can be wisely said. Over-indulgence is to be condemned out of hand, as it is in regard to everything else in life. As to moderation — this must be left to the individual. A moderate use of tobacco means different things to different people. The evidence, however, seems to point conclusively to the fact that, whereas even a slight excess would appear to be easily tolerated when the smoker is using a pipe or cigars, it is less easily tolerated when the source of the smoker's pleasure is the cigarette and particularly the Virginian cigarette so common to day. But there is a pitfall about pipe-smoking, too, which is all too commonly overlooked by those medical writers who condemn the cigarette, and that is that there is nothing to warn the average pipe-smoker about the danger of continuing to smoke a pipe that has become foul. His friends and associates may be offended by it; but as it reaches the state of foulness by slow and, to him, hardly perceptible stages, the average pipe-smoker is inclined to smoke a pipe long after it has ceased to be sanitary, and this constitutes a real danger. Generally speaking, therefore, it seems fair and reasonable to influence all adolescents, male and female, if possible not to acquire the smoking habit, or at least to make it clear to them that there is considerable doubt regarding its supposed innocuousness and that, if they do acquire it, they should try to establish rigid rules in connexion with it. For instance, it is a very 1 Journal American Medical Association. 12.10.29. 2 Tobacco. Havard University Press. (1930). The French have a very wise proverb, borrowed from the old Persian sage, Zoroaster, and it reads: "Dans le doute abstiens toi." In regard to no practice more than to tobacco-smoking is this advice so apt to-day, and it might well be taken to heart, particularly by all those who have not yet started to smoke. It now only remains to say a word about tobacco-smoking by women. I did more than hint, in my Defence of Aristocracy, that smoking tobacco might adversely affect sexual potency, 1 but the evidence that tobacco, whether smoked or not, does affect the sexual mechanisms of the female body, if the latter is in any way subjected to its chemical action, is certainly impressive. Dr. Unbehann, for instance, found about fifteen years ago that the female tobacco-workers who came to the female clinic at Giessen University were specially liable to disturbances and irregularities of menstruation, with severe pain, and while their fertility was almost average, abortion was more than twice as 1 p. 225 of the book in question. Dr. Max Hirsch comes to conclusions very similar to these. He found abortions extraordinarily high in female workers at tobacco factories, as high as 36.9% of births as compared with the average of 27% among other workers. He also declares that inflammatory conditions of the vulva, vagina, and the endometrium are common among female tobacco workers, and comments on the high rate of mortality among their babies (22.7% as compared with an average 15.7% for the district). He does not believe that this evil is due to nicotine finding its way into the mother's milk through the body's absorption of it, but that it is due to the deleterious effect of the tobacco on the constitution of the mothers and on the germ-plasm from which their children grow. 2 Drs. Sontag and Wallace, on the other hand, would appear to argue that, at least among expectant mothers who smoke cigarettes, the effect on the foetal circulation and heart-beat is "due to the passage of the toxic products of tobacco smoke into the foetal circulation," and they recommend a further study of the whole question of tobacco-smoking among pregnant women. They also refer to the toxic effect of tobacco on nurslings through the nicotine contained in the mother's milk of cigarette-smoking mothers, and thus appear to suggest, against Hirsch, that the tobacco (at least when its influence is exerted through cigarette-smoking) does actually reach the secretion of the breast. 3 Here again, however. Dr. Wingate M. Johnson comes to the rescue of resolute women smokers with the fol- 1 Lancet. 19.1.29. 2 Biologie und Pathologie Des Weibes. Vol. I. p. 950. 3 Journal of American Medical Association. 6.4.35. Perhaps it would be well not to be too deeply impressed by this very limited experience of a learned advocate of tobacco-smoking for all; because, when we remember what the female organism has to do, both in pregnancy and during lactation, and also recollect what has been said about the importance of pure air for the healthy condition of the body, it seems very doubtful whether tobacco-smoking can possibly be harmless in the case of expectant and nursing mothers, and this appears to be once again a case in which the benefit of the doubt should be given to the body by means of total abstention. The spectacle of an expectant or nursing mother smoking cigarettes certainly looks offensive, and it can hardly be possible that the vital processes going on within her, on which so much depends, can remain unimpaired by the practice. As to the general question, whether or not women should smoke — this is very difficult to answer. It seems to me that here again it is for the individual man and woman to decide — the former whether he wishes to marry a girl who smokes, and the latter whether, if she hopes to marry, she can rely on being sufficiently strong-minded to abandon a habit once acquired if she is to do the best by her children. 1 J.A.M.A. 31.8.29. See also a remarkable letter by the same medical man (Ibid. 14.12.29) in which he describes how many female members of his family, after having smoked all their lives, lived to a great age and reared large healthy families. Unfortunately it is always possible and permissible to reply to such claims: "How much healthier they might have been and how much longer they might have lived, had they not smoked at all!" It should also have been necessary to say a word about clothes for each sex in relation to health. But this too I have already done in my Choice of a Mate, to which the reader is again referred. |
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