n also instance cases of grave disease from the use of
tobacco where the patients never have believed that tobacco has been
the cause of their troubles, even after a unanimous opinion to that
effect has been expressed by a number of competent medical advisers.
The habitual consumption of opium, in doses of any amount, is
generally admitted by most people to be physically injurious outside
of its strict medicinal application. Moderate indulgence in alcohol as
a beverage is beginning to acquire a very widespread evil reputation.
But how about tobacco? Tea and coffee we can confidently leave to the
consideration of a somewhat remote posterity of a considerably
advanced intelligence and elevated hygienic ideals.

The relation of tobacco to the physical welfare of man can only be
fairly estimated by viewing the subject in its broadest aspect; by
considering its effects upon the race as a whole rather than in
individual cases; by taking into consideration economical and other
social conditions that at first sight might be considered as having
little relevancy to the medical side of the subject. But there can be
no just consideration of the matter otherwise. The direct deleterious
effects of the immoderate use of tobacco are readily observable; but
the great bulk of the evil physical effects due to the moderate use of
this plant are of an intermediate nature and not directly noticeable;
nevertheless, they are real, and worthy of medical attention. The
plainly marked results following the use of tobacco in relatively
large amounts seem to be due to quick and extreme interference with
nutrition, and a diminution of function of all kinds, which may be
represented by anything from a slight decrease of appetite and
digestive ability up to a complete loss of function of almost any
important organ. Tobacco has stimulating as well narcotic properties,
but as ordinarily used its stimulating effect appears to be slight as
compared with its narcotic influence. In this respect it differs from
alcohol, the use of which, owing to the usual method of introduction
in large amounts through the stomach, produces directly, by
stimulation, readily noticeable structural changes. But with tobacco
the direct evil results are mostly of a functional character, and are
more generally diffused, owing to the usual slow manner of
introduction into the body. These two properties have an effect upon
the body in moderate use as well as in immoderate use, the