Chapter 8-What about Cigarettes – Should You Stop Smoking?

The Use and Abuse of Tobacco | The Agreeable Effects of Smoking | The Indifferent Effects of Smoking | The Effect of Smoking on Health | The Effect of Smoking on the Heart | How Smoking Affects the Blood Vessels | What Smoking Does to the Digestive Tract | The Relationship of Tobacco Smoking and Cancer of the Lung | Smoking Is Not Necessarily the Sole Cause of Lung Cancer | How Can You Stop Smoking? | If You Must Smoke, at Least Cut Down on the Number of Cigarettes | Switch from Cigarettes to Pipe Smoking | Find a Substitute – Chewing Gum, Peppermints | An Effective Approach to the Tobacco Habit

Smoking is the burning question of the day. Everyone wants to know, for certain, the answer to this question: "What is the effect of smoking on my health?"

"To smoke or not to smoke" is a frequent topic of conversa­tion of the more than 100 million American smokers. Until recently, the public has been as confused as the medical pro­fession was in the past. Now overwhelming evidence on the harmful effects of excessive use of tobacco can no longer be disregarded.

In spite of all this evidence, however, the public is either un­certain or resistant. This is perfectly exemplified by my patient, Mr. R. He was suffering from "tobacco angina," an old term used to describe chest pains in coronary artery disease induced in his case by excessive cigarette smoking. "Dr. Morrison," he said, "I guess I should stop smoking, what with all the news­paper stories on the relationship of excessive cigarette smoking and cancer of the lungs. But I play golf with my family doctor, Dr. X, who is a chain smoker, and I notice my dividends from investments in tobacco stocks keep going up! Now, if cigarettes are harmful to health, why do so many doctors continue to smoke and why does the American public smoke more and more?"

Smoking has been with us for a long time. The smok­ing habit is known to be deeply ingrained from the very dawn of man's history. Archeologists tell us of their finding evidence of smoking pipes among the South American Indians in Venezuela, 6,000 years before Christ.

The legendary origin of the birth of tobacco and the "tobacco habit" is even told charmingly in Greek mythology. Zeus was banqueting with his gods and goddesses on Mount Olympus. During the dancing after the banquet, Vulcan, the god of fire, forging and smelting, was urged to dance. He was ashamed to dance, however, because of his hunchback, and his fear of ridicule. In his nervousness and embarrassment he sought comfort by lighting his pipe with a burning coal and filled Olympus with a dense cloud of foul tobacco smoke.

Zeus was enraged at Vulcan's extremely bad behaviour. He cast a thunderbolt at the pipe, which smashed it and spread bits of the pipe and the tobacco all over the world. Rain then fer­tilized the seed and the tobacco plant grew luxuriantly forever after!

One of my patients, Mrs. A, tells me she is completely at a loss as to which doctors and statisticians to believe. So many seem to be in complete disagreement on the harm from smoking. I tell her that differences in opinion make medical meetings and horse races possible, and that virtually the same controversy raged over 350 years ago.

In 1604, King James I was anxious to improve the health and well-being of his loyal subjects. After careful medical advice from his court physicians he issued the following frightening but delightful proclamation on tobacco: "A Custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs (italics—mine), and in the black stinking fumes thereof, nearest resembling the horrible Stygian smoke of the hell pit that is bottomless" The king's apparent first-hand knowledge of hell-fire is a triumph of the imagination.

A little later, in 1689, the Medical School of Paris studied and reported the effects of tobacco smoking upon health and its influence on the span of life. They concluded and maintained for long after that tobacco definitely shortens life, and that it causes colic, diarrhea, "ulcerations of the lungs," asthma, coughs, "pains in the heart," undernourishment and impotence. Enough to frighten even the stoutest of Frenchmen! Yet despite the death penalty for tobacco smoking, imposed by many kings and rulers in the 16th and 17th centuries, smoking flourished. The reason, apparently, was and is that it is an ingrained part of man's very social life. It is something that must be con­quered by intelligence and will-power. Otherwise it becomes a bio-chemical as well as social "addiction."

What is the truth about smoking? Let us now examine the tobacco habit in the light of modern scientific knowledge, and group the advantages and disadvantages of smoking as, "good, bad, and indifferent."

THE USE AND ABUSE OF TOBACCO

The Agreeable Effects of Smoking

Smoking tobacco is known from time immemorial to produce the following agree­able and enjoyable reactions:

1.  Smoking is part of the social life from the days of primi­tive man. It introduces a note of friendliness, relaxation, and sociability. It often creates a subtle bond between strangers, or may help "cut the ice" in a hostile atmosphere. It has its origins in ancient rites and religious ceremonies and so is most welcome to both primitive and civilized man on social occasions. To extract every possible enjoyment and benefit from tobacco, man has smoked it, swallowed it, chewed it, drunk concoctions of it, gargled it, sniffed it up his nose, licked it during ceremonies, smoked it through the nose instead of the mouth, used enemas of it, applied poultices of it, and healed wounds with it. Man has even used tobacco to commit suicide and murder. Now hundreds of thousands, probably millions, of people the world over earn their "daily bread" thanks to tobacco.

2.  Smoking "soothes" the nerves for many people, and will often help tide them over anxious periods of emotional crises.

3.  Smoking often is used to relieve pain and shock, as seen after an accident, in war, or in disasters. It may act for many as a sedative and even permit the smoker to go to sleep after a smoke, which might have been impossible without one. Some of my patients who were addicted to smoking could not sleep through the night without getting up at least once during the night for a smoke. (More about this later.)

4.  Smoking is known to cause a "cooler" sensation in the skin due to the temporary constriction or tightening up of the blood vessels in the skin of the body. This temporary "cooling" sensation is momentarily welcome in times of hot weather or when people are nervous, excited or generally "hot under the collar."

5. Smoking may, temporarily, give enjoyment by the action of nicotine, coal-tars, or other ingredients contained in tobacco, by the resultant rise in blood pressure, increase in heart action, release of adrenalin, and consequent increase in blood sugar. These latter physiological and pharmacological effects often cause a temporary feeling of lightness or light-headedness, mental clarity, and what appears to feel like increased physical and mental efficiency.

6.  Smoking after meals has been considered one of the most enjoyable aspects of dining. For centuries, it has been regarded as an aid to digestion, and a fitting end to each meal. Even in 1599, Henry Buttes, in his "Dyets Dry Dinner Consisting of eight severall Corses" placed tobacco as the last course of the meal, because of its value in overcoming "sorrow, pain, and constipation."

7.  Smoking often establishes a habit, which, like other habits, gives a certain sense of security and expectancy to many people who look forward to their "smoke." It may give a rhythm-like pattern to daily living, just like the rhythm involved in smoking a cigarette, cigar, or pipe; a kind of "ebb and flow" in the breathing process itself.

The Indifferent Effects of Smoking

Millions of people smoke tobacco merely as an incidental habit, which they adopt solely to be sociable in the business world. Like some of my patients who may be businessmen, salesmen, or in other walks of public life, they smoke to put their business associates, col­leagues, clients or customers at ease. Some of my patients, fol­lowing my caution, will merely light the cigarette necessary for social or business amenities, keep it burning, and simply hold it without smoking.

Similarly, the woman who smokes at a bridge game, or who smokes after meals to keep their husbands or friends "com­pany," can "take" smoking or "leave it." These smokers usually do not smoke to excess and frequently avoid the toxic effects of tobacco smoking. It is very easy for them to stop smoking and when they have done so, they rarely miss it. As a rule, these individuals have strong will-power and are not "compulsive," as habitual smokers are apt to be.

The Effects of Smoking on Health

Tobacco is a poison. If you were to consume 2 or 3 cigarettes, the effect might easily prove fatal! This is because nicotine, one of the main ingredients of tobacco, is an old established toxin, or poison, affecting the brain, the heart, and other vital organs. The tobacco plant is directly related to the deadly nightshade family of plants.

The average cigarette weighs one gram and contains only from 1 to 2 per cent of nicotine—100 to 200 milligrams (thousandth of a gram). The lethal dose of nicotine required to kill a man usually is only from 60 to 120 mg! In smoking a cigarette the average amount of nicotine inhaled is generally about 2 milli­grams. There are thousands of cases of suicides, accidental deaths, and murder recorded in the United States by the U.S. Department of Commerce, Bureau of Census, as a result of consuming nicotine preparations.

Some investigators have found that only a few drops of nico­tine base kills wild animals, such as the lion or wolf, within a few seconds. Some animals, like sheep, can tolerate large doses of tobacco. Fortunately, the body excretes or gets rid of nicotine rapidly, not allowing the average amount inhaled to ac­cumulate, unless heavy or excessive smoking is indulged in. If the latter is permitted, then the clinical symptoms of nicotine poisoning often occur, even in the habitual, heavy smoker, who may have developed some tolerance to nicotine.

Even when the cigarette is not continually inhaled, there is still at least about 1/2to 2/3of the nicotine absorbed into the system through the lining of the mouth, the tongue, and the saliva.

Aside from the chief poison, nicotine, there are other well-known poisons present in tobacco: carbon monoxide (when tobacco is burned), arsenic, and coal tar substances are some. The latter contribute to the formation of cancer of the mouth, the esophagus (the gullet) and the respiratory tract, including the larynx, bronchial tubes, and the lungs.

Let us consider some of the actions of these poisons that may occur in man from excessive tobacco smoking.

The Effect of Smoking on the Heart

Like many other physicians, in my 25 years of practice I must have treated literally thousands of patients who at one time or other suffered from symptoms of some degree of tobacco poisoning. Some were dramatic, some resistant, some funny and some tragic.

Usually the toxic effects on the heart will be noticed by the patient from "skipped" heart beats or palpitations of the heart, nervousness, or a rapid heart rate often producing dizziness, shortness of breath, especially on exertion, headaches from rises in blood pressure, or pains and distress over the front portion of the chest.

As described in Chapter 3, I had the opportunity of study­ing the effects on the heart of various stimuli in a series of volunteers. I examined the effects of stomach distention on the heart through an apparatus I devised at the time, as published m the Journal of the A.M.A. One male patient of mine, in particular, was an instructor in our own medical school, and had a mild case of coronary artery disease. This showed itself by chest pain after exertion or excitement. A habitual smoker, he had improved so greatly under treatment, which included his abstaining from tobacco, that he was now itching to get back to the "weed". In order to demonstrate to him the effects of smok­ing on his own heart, I asked him to resume smoking for one test period, a habit which I had asked him to stop, because of his angina. After smoking and delightedly inhaling two and one-half cigarettes he developed severe anginal pain over the chest, which reflected itself in striking abnormalities in his electrocardiogram, which I was running continuously during the smoking experiment. Fortunately, I abolished the anginal pain immediately by placing a tablet of nitroglycerine under his tongue. This relaxes and dilates the coronary arteries promptly, thereby stopping the pain.

This experience has been reduplicated in countless patients, since it is well known that tobacco will produce pain and em-harassment of the heart when it is already damaged or weakened by some condition, particularly coronary atherosclerosis. Here additional constriction of the coronary arteries by tobacco smok­ing, in the already narrowed passageways of the coronary arteries, can lead to further damage to the heart. The term "tobacco angina" or "tobacco heart" was originally employed to describe these chest pains due to the toxic effects of tobacco on the heart.

Like many physicians, I advise my patients with heart condi­tions to refrain from smoking, even in moderation, because of the injurious effects of tobacco on their hearts.

The blood pressure is known to rise on an average of 38 points (the systolic, or higher one) in patients with normal but unstable, sensitive blood pressure. And in patients with high blood pres­sure, tobacco smoking in moderate to heavy amounts has a strong tendency to send the blood pressure even higher than the above mentioned 38 points.

How Smoking Affects the Blood Vessels

For many years scientists and physicians have studied the effects of smoking on the peripheral blood vessels, i.e., those particularly in the hands and legs. These studies were carried out by all kinds of ingenious instruments that measured the rate of blood flow, the temperature of the tissues around the blood vessels, the degree of narrowing and opening or constriction and dilation of the blood vessels—in all sizes and locations—as influenced by smok­ing.

As a result of these studies it is thoroughly established now that tobacco causes a marked interference with the circulation in the hands, the feet, and the legs. These findings, of course, though very important, are not new to the practising physician, who has seen numerous instances of disease of the blood vessels caused by excessive smoking, mainly through prolonged spasm and constriction of these peripheral blood vessels.

Nicotine is the most noxious substance that can effect the blood vessels in man. This is aptly demonstrated in certain diseases such as Buerger's disease (a condition of obliteration of the blood vessels, usually in the legs) which not infrequently require amputation due to gangrene. Still another disease as­sociated with the excessive use of tobacco is Raynaud's Syn­drome, a condition characterized by spasm of the small blood vessels in the hands, feet, nose, cheek, and ears. Patients with this disease suffer from blanching of the skin and local pain after exposure to cold, anxiety, fatigue, physical pressure, or shock. This condition may lead to other diseases of the blood vessels.

In the conditions of peripheral arteriosclerosis and athero­sclerosis, especially of the legs, nicotine has been shown to aggravate and increase the constriction already present in the peripheral blood vessels of human subjects. Patients with this condition are far better off without tobacco.

What Smoking Does to the Digestive Tract

Many people enjoy a good smoke after a meal. They get the impression there­fore that smoking aids the digestion. A host of scientific studies carried on over a generation, however, are unanimous in demon­strating that tobacco is an irritant to all parts of the digestive tract, and often influences pathological or diseased states in it.

In the mouth, one of the most dangerous reactions to smoking has been "smokers" or geographic tongue. In this condition, the tongue is marked up like a geography map and is very prone to cancer, which may spread from the tongue into the mouth.

Tobacco smoking to excess is well known to precipitate and reduce the amount of necessary salts and enzymes in the saliva and the mouth, discoloring and affecting the enamel of the teeth. Much work is thus given to dentists and their assistants who must spend countless "man-hours" in chopping and hack­ing, drilling, and polishing away the injurious effects of tobacco on the teeth.

Tobacco is often used to "kill hunger" or stay the appetite. By cutting the appetite down it can reduce weight. In those who have not developed a tolerance to tobacco, it will produce nausea and even vomiting (as witness many a boy's first attempt at smoking).

Some 20 years ago I studied the effect of tobacco and alcohol on the stomachs of two series of patients who were heavy smokers and alcoholics. These investigations were carried out through a gastroecope, which is a long, flexible tube that is passed through the mouth into the stomach. Through a series of 29 lights and prisms in the tube the interior of the stomach can be inspected. As published subsequently, my associates and 1 found that a "gastritis," or local inflammation of the stomach, is often produced by smoking, due to the absorption of nicotine into the saliva and secretions of the mouth. These drain into the stomach and act as local irritants, producing inflammation, catarrh, and interference with normal functions of the digestive juices and stomach movements.

Stomach ulcers, in particular, are aggravated by smoking, and it has always been my practice to forbid it in all patients suffering from active ulcers of the stomach.

The Relationship of Tobacco Smoking and Cancer of the Lung

The increase of cancer of the lung in recent years is phenomenal. Many scientists, physicians, and statisticians have presented evidence showing that tobacco smoking is closely asso­ciated with cancer of the lung (as well as in the larynx). This has touched off a controversy that has raged in medical meetings, medical, journals, and the public press.

Briefly stated, medical scientists and statisticians, such as those represented by the American Cancer Society, have shown the following striking figures on the death rate from cancer of the lung:

(a) Moderate cigarette smokers, from 10 to 15 cigarettes daily, have 5 times as many lung cancers as non-smokers.

(b) Heavy cigarette smokers, from 16 to 25 cigarettes daily, have 15 times as many lung cancers as non-smokers.

(c) Excessively heavy cigarette smokers, from 25 to 50 cigarettes daily, have 25 times as many lung cancers as non-smokers.

Smoking Is Not Necessarily the Sole Cause of Lung Cancer

The fact that a goodly number of deaths from cancer of the lung occur in non-smokers indicates that tobacco smoking is not neces­sarily the sole cause of lung cancer. Additional factors as­sociated with cancer of the lung are: air pollution, engine ex­haust fumes, road dust, and industrial toxins. These are also heavily suspect as contributing factors.

Prominent among factors involved in cancer of the lung are so-called "carcinogenic" substances (cancer-producing). These are linked to the coal tars released in the burning of the cigarette. Apparently about 50 per cent of the solid particles inhaled in the tobacco smoke are deposited in the bronchial tubes, and in­clude nicotine, coal tars, and many other products. These act not only as irritants, producing the well known smoker's chronic cough, but are considered by many as the sole cause of cancer of the bronchial tubes and lungs.

Because of the alkaloids (poisons) and irritants in cigar and pipe tobaccos, the smoker does not ordinarily inhale them, in sharp contrast to the cigarette smoker. The result is a very marked reduction in the incidence of cancer from the smoking of pipes and cigars. As compared to the non-smoker, pipe and cigar smokers have, as a consequence, only a slightly increased susceptibility to cancer of the lungs. This slightly increased susceptibility among pipe and cigar smokers, however, becomes greater in the chronic, excessive, heavy smoker. Here we see an increase of occurrence of cancer of the lips, mouth, tongue, and gums. By excessive, heavy smokers is meant those who smoke from 10 to 15 or more cigars daily, or over 50 grams of pipe tobacco. (Remember that the average cigarette weighs about one gram.)

The attempt to reduce the nicotine or coal tar content of smok­ing tobaccos by means of filters, denicotinized cigarettes and the like, has not been very successful to date. The toxic effects of the smoking tobacco are still present, though reduced from 10 to 30 per cent.

The tobacco companies have launched powerful counter at­tacks and heavily subsidized campaigns of advertising to coun­teract evidence of the relationship of tobacco and cancer of the lung. The fight has largely devolved in a battle of statistics. If the reader will forgive the repetition, it has been pointed out by Mark Twain and Marilyn Monroe that "figures are often misleading."

I therefore would like to fall back on my own experiences with cancer of the lung and larynx, when I was assistant many years ago in the early days of my practice, to Dr. Chevalier Jackson and his son, at the famous Jackson Clinic in Phila­delphia. Dr. Chevalier Jackson, one of the greatest doctors of contemporary times and now in his nineties, was virtually the discoverer and creator of an entirely new science called bronchoscopy. He developed and invented many new instru­ments or bronchoscopes (hollow metal tubes) that could be passed into the lungs and enable doctors to remove foreign objects swallowed into the lungs. Thousands of swallowed coins, buttons, stones, glass, bones and what-not have been removed from the chest by the bronchoscope, thus saving the lives of countless grateful patients.

Among the other uses of the bronchoscope is its ability to inspect the interior of the bronchial tubes and lungs for cancer. After seeing hundreds of victims of cancer of the lung who passed through the clinic, I became utterly convinced, like Dr. Jackson and his son, that excessive tobacco smoking was an important cause in most cases of cancer of the lung. The clinical impression of this fact was so overwhelming that no amount of statistical calculations and mathematical figures could shake it. With very few exceptions, patient after patient who were vic­tims of the disease gave the same monotonously tragic history of chronic tobacco habit. So, in conclusion, don't let your own conclusion be made by excessive tobacco!

HOW CAN YOU STOP SMOKING?

Perhaps the best insight into "How to Stop Smoking" is Mark Twain's comment: "It's easy to stop smoking—I've done it hundreds of times"!

"Doctor," a harassed advertising executive patient of mine said desperately, "I've tried so hard for five years now to give up this awful smoking habit, which I know is so harmful to me, but I just can't seem to be able to. If I stop or even try to, I become so nervous that living with me is utterly impossible. I can't even live with myself. I can't sleep, I can't concentrate, I can't do my work properly, I tremble and go around like Shakespeare's young lover, *sighing like a furnace,' life doesn't seem worth living. I've tried everything I know or hear of— hypnosis, auto-suggestion, pipes, prayer, preparations on my tongue to make smoking taste bitter, "gimmicks" of all kinds— but I always come back to these—cigarettes. What can I do?"

Sigmund Freud, the founder of psychoanalysis, was trained originally as a pharmacologist, and was an inveterate, heavy cigar smoker. Undoubtedly, this habit contributed to his death and great suffering from cancer of the mouth and throat. He recognized his addiction to cigar smoking and its toxic effects on his heart. Yet after stopping several times, he couldn't hold out any longer and found it impossible to work or concentrate without smoking. In a letter to a friend he describes this craving as follows: "I have started smoking again since I still missed it after 14 months' absence, and because I must treat that mind of mine decently, or the fellow will not work for me." (Italics mine.) And still later he wrote, "It was impossible for me to entirely stop smoking, because of my present burden of theoret­ical and practical worries."

Clearly these victims of my "lady nicotine" have become "ad­dicts" of tobacco, and are addicted to it like so many other unfortunates who cannot live without opium, sedatives, or mari­huana. The moment they stop tobacco they develop "with­drawal" symptoms that can be truly distressful and even agoniz­ing. Luckily most smokers are not addicts enslaved by tobacco. They can break or modify the habit, so that it becomes harmless although still yielding enjoyment.

IF YOU MUST SMOKE, AT LEAST CUT DOWN ON THE NUMBER OF CIGARETTES

Many patients who find they cannot or will not give up smoking are like Mr. D. He told me, "Doctor, you want me to give up smoking for my health's sake. You know, I have very few pleasures in life. I have to work hard to support my family, have no hobbies, and I must diet to reduce my heavy over-poundage. Couldn't I just 'cut down' from one and one-half packs of cigarettes each day, to say, five or six cigarettes with filter tips and 'ration' myself this way?" As a rule this is a fairly good solution, although not ideal for many, and it makes it easier for them later to stop smoking entirely, if necessary. This "step-by-step" method is also less likely to produce severe withdrawal symptoms in many people.

SWITCH FROM CIGARETTES TO PIPE SMOKING

There are many ways to stop. One way to do it is to ease into it by the healthful and still satisfying way of switching to a pipe. This method of gratification gives distinction to some (they look elegant with pipes), occupation to others (keeping the pipe going with matches), quality to others (connoisseurs and pipe collectors), fragrance to a few (some tobaccos are refreshingly aromatic), and a feeling of male superiority to still others (few women, smoke a pipe—"it's a man's job").

One of my patients, Mr. P., who was a chain smoker of cigarettes, solved his craving for tobacco by becoming a pipe smoker. He reduced his nicotine intake substantially (one-fifth) in this way. Since he no longer inhaled, which both cigar and pipe-smokers do not do, he found life and tobacco still enjoyable, without suffering from his heart symptoms caused by cigarette addiction. Pipe smoking hag been a welcome relief to many of my cigarette or cigar smoking patients, and its injurious ef­fects have proved to be minimal as compared to those from cigarettes.

FIND A SUBSTITUTE—CHEWING GUM, PEPPERMINTS

Still another patient could stop smoking only if she kept something sweet in her mouth, like peppermints, candy or chewing gum. After the dentist protested, she changed over to non-sugar-containing candies and en joy ably substituted and triumphed over her tobacco habit.

I tell some of my patients, like Mr. R., that he must have a substitute in his mouth such as chewing gum, peppermints or Sen-Sen, so he smacks away merrily all day, feeling fresh, healthy, and with his mouth and jaws working. Mrs. J. finds she cuts down and maintains an even temper with her children and husband by a "rationing" program of one cigarette after each meal and one on retiring. She says she has something to look forward to all the time!

Another man "cured" himself of the tobacco habit by painting the tip of his tongue with a preparation containing silver nitrate. Smoking would cause such a bitter, disgusting taste that tobacco became repulsive to him and he stopped gratefully. This method is similar to that recently introduced to cure alcoholism by using a medicine called antabuse. If alcohol is drunk by the alcoholic while taking antabuse, he becomes violently sick and thus de­velops an aversion to alcoholic liquors.

AN EFFECTIVE APPROACH TO THE TOBACCO HABIT

An unusual middle-aged woman patient of mine, who was highly intelligent, educated, and raised in a very religious home (her father was a minister), combined both prayer and auto-suggestion to cure herself of the tobacco habit. It was imperative for her to do so, as she suffered from both a stomach ulcer and a heart condition. The Herculean struggle within herself to give up a fixed tobacco habit made her a nervous wreck and intolerable to live with. She refused to allow tobacco to "demonize" her life. She would set aside three daily "self-communion" periods of about 10 minutes each—on arising, on retiring, and at midday—when her chil­dren were still at school. During these periods she repeated to herself over and over again her affirmation of abstinence from smoking, her determination to abandon tobacco forever, and her prayers for guidance in overcoming the tobacco habit. The re­markable thing about her prompt tobacco cure in this way was her continuance for many years and up until now, (without thought of tobacco) of this program of self-enlightenment and self-communion. This has helped immeasurably in her health and in the philosophy and psychology of better and healthier living. Today she is a serene and healthy human being, loved and admired and a constant inspiration to her family and friends.

For most, the best cure is the application of will power. To many patients who wish to stop smoking, Shakespeare's words are pertinent, practical, and simple: "If it were done when 'tis done, then 'twere well it were done quickly." In other words, will power directed by intelligence is still the best way for many people to stop smoking the moment they have decided to stop.

Every day in my office, for the past 25 years, at least a dozen patients ask me, "Doctor, how shall I stop smoking? I've tried so many methods before." I tell them: "Mr. Z., I want you to take up a new exercise that will make it possible." Mr. Z. asks expectantly and delightedly: "Why, Doctor, what is this new system of exercise?" "Mr. Z., I want you to Exercise your Will Power!  You've never used this kind of exercise before!"

Most of my patients, however, are like President Eisenhower. He told a news conference (as quoted in the New York Times for Tuesday, July 29,1957) "The only way I knew how to stop smoking (after the heart attack) was just to stop." In other words, it all boils down to will power, the cheapest commodity in the world and the easiest to use—if you only will do so! And the will to do so must come from a motive. The motive is your own health and well-being.

Now nicotine is a well-known poison, as is demonstrated to every medical student in his second year of schooling by personal testing in the laboratory. So every heavy smoker takes a little poison daily. It gives him a momentary pick-up and nervous tension release, but the subsequent reaction is a slow­down in mental or physical efficiency. Many of my patients suffer far-reaching effects on the blood vessels of their hearts and other vital parts of the body. I shall never forget the horrible feeling I had when I first attended a large series of clinic pa­tients who suffered from Buerger's disease—a disorder of the arteries in the legs associated with heavy smoking.

Most of these unfortunate victims were amputees and had lost one or two legs from gangrene. In this chamber of horrors, one man stands out clearly in my memory. He had lost both legs and could not stop smoking; he was now about to lose his arm. But Mr. X. stoutly maintained he would rather die than give up smoking. He simply couldn't do it. And die he did! Of course, Buerger's (or smoker's) disease claims comparatively few vic­tims. However, it is still a good, although extreme, example of what heavy smoking can do to your blood vessels.

Most of us, however, are not Mr. X., willing to sacrifice health or life for a fixed habit. We now know that heavy smoking, particularly inhaling, is injurious to the heart and blood vessels and the lungs. So why not change your habit to another safe and pleasant one—say, a pipe—or cut those cigarettes or cigars down to a few daily; or best of all, "be like Ike"—just stop!

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