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The Influence Of Smoking On The Female Organism

( Originally Published 1923 )

THE shrunken and flaccid features and facial muscles of even relatively young women from Russia, Greece, and the Orient who came to consult me in Carlsbad in the years preceding the late war were often very striking, and when I inquired into the cause of the condition, I found that nearly all of these women were smokers, and had been addicted to the use of tobacco for years.

That their appearance was not the result of some other factor, such as climatic influences, was shown by the fact that I observed the same condition in women from western countries, who were heavy smokers. Thus, in 1914 I had occasion to see a young lady from New York, who had previously been a renowned beauty, yet at that time, in spite of being only twenty-eight years of age, looked like a woman of about forty, by reason of her yellowish complexion and flabby, withered features. She smoked cigarettes from morning till night, and was afflicted with a distressing cough, doubtless also on account of her passion for smoking, which even kept her from sleeping at night.

There have also come under my observation in the last few years young lady patients from the interior who doubtless as one of the many unpleasant manifestations consequent upon the late war were likewise tobacco devotees and showed the same premature flabbiness and "fading" of the features, together with somewhat sunken cheeks, and eyes that had lost the fire of youth.

Aside from their flabby and drooping facial musculature, all these women and young girls showed a similar condition of the other muscles of the body. They were no longer so sprightly and resilient as healthy women and young girls generally are, their fatty covering layer had disappeared as had also in part the muscle tissues themselves, the muscles were reduced and flabby, and the over-lying skin of an unhealthy pallor.

All this need not surprise us when we reflect that tobacco, according to the investigations of Hertoghe, is highly prejudicial to an organ upon which the tone of all the muscles and tissues of the body, and consequently its freshness of appearance, depend, viz., the thyroid gland. The latter is, indeed, one of the most important organs in the body.

The thyroid gland regulates all the vital processes. Body nutrition as a whole, blood formation and the circulation, the activity of the heart, the entire nervous system, and even the condition and outward appearance of the skin and its appendages, the hairs, are under the control of its powerful influence.

The thyroid plays a particularly important rôle in the life of woman, owing to the fact that, through its close relations with the reproductive glands, it takes an active part in all modifications of the latter organs.

Thus, swelling and enlargement of the thyroid gland frequently occurs during menstruation. Even among young girls this organ enlarges during the period of puberty, and in pregnancy it often attains a considerable size or may even become an actual goiter. Thyroid enlargement frequently occurs in diseases and altered conditions of the female reproductive organs, as well as during the most trying stage of woman's sexual life, in which she bids farewell to youth and becomes an elderly person, namely, the change of life or menopause.

All this accounts for the fact that goiter is a commoner condition in women than in men. In the former, because of the special circumstances of their sex life, this important gland is driven to much greater heights of activity than in men, and for this very reason rapid ageing is likely to occur oftener in relatively young women than in men.

Reflection upon the important function of the thyroid gland above referred to will lead one to understand even more plainly why morbid changes in this organ open the way to rapid ageing in women.

This is especially evident in a certain disease condition characterized by complete or partial wasting of the thyroid gland myxedema.

The highest grade of this thyroid failure to which myxedema is due is but seldom encountered, but partial forms of it, consisting of a simple weakness or debility of the organ, are much more frequent, in fact of every-day occurrence. The symptoms arising from such a condition are so numerous and frequently so inconspicuous, that it is not surprising the disorder sometimes remains unrecognized and patients live and die with it in the absence of any clinical diagnosis of the disorder.

There exists, however, a group of typical symptoms by virtue of which, when they occur together, the condition betrays itself to the specially trained medical eye. Among these may be particularly mentioned premature grayness and loss of the hair, the occurrence of obesity without an excessive in-take of food (though but seldom in smokers), the premature appearance of wrinkles and creases in the skin, irregular menstruation and frequent flooding, lassitude, impaired memory, and a yellowish, dry facial skin, with flabby features, etc.

To these symptoms are added, in the more advanced cases, puffiness below the eyes, bloated face and hands, and a marked sensitiveness to cold.

These women nearly always exhibit a more or less pronounced nervousness, though in the more advanced cases there is an actual state of apathy. According to Hertoghe, gallstone disease is of exceedingly frequent occurrence in these women.

That such premature ageing is dependent upon changes in the thyroid gland is most strikingly shown in that upon ingestion of fresh preparations of this gland nearly all of the symptoms above referred to are improved or caused to disappear, as I have often personally had occasion to observe and have noted in a previous work.

Yet it should be emphasized that this drug, which is by no means harmless in the hands of the laity, should be taken only under the close supervision of a physician in which event, according to my own experience extending over many years, such ultimate unpleasant effects as cardiac palpitation, sleeplessness, copious sweating, etc., may with certainty be avoided.

To obviate rapid ageing of women, therefore, all harmful influences reacting upon this gland, which plays so important a rôle in their lives, must be carefully avoided. Of these prejudicial factors tobacco comes next to alcohol, according to the investigations of Hertoghe1 in Antwerp. At first it stimulates the thyroid, but this is followed by excessive activity, and the latter, in turn, as is observed in all other glandular organs and with especial frequency in the reproductive glands, by exhaustion and such a state of inactivity that the gland can no longer carry on its many important functions, or do so only in an imperfect manner.

The thyroid gland is likewise harmed by tobacco in the male sex, but the injury caused in women is far more lasting, because the thyroid in the latter, by reason of the various phases of female sexual life, particularly pregnancy, lactation, and the menopause, as well as the irritations and diseases of the uterus and ovaries, is much more ex-posed to overstrain and various fatiguing influences than that of the male.

Because of the differences in bodily construction and the special circumstances of the sexual life of woman, the latter is already less capable of resisting the effects of tobacco than man, for tobacco acts very prejudicially not only on the thyroid gland but also on the sex glands. This has been shown by a series of experiments carried out on animals. Clinical experience teaches that in the male sex impotence may occur as a result of immoderate use of nicotine. Its effect on the function of the ovaries is no less harmful, so that in women disturbances of menstruation and even sterility may result.

While tobacco produces harmful effects on women who are already completely developed sexually, its injurious action is even more serious in incompletely developed, immature young girls, among whom smoking nowadays is unfortunately becoming more and more prevalent. Indeed, the pernicious influence of tobacco on the organisms of young girls is, in my opinion, a matter which the governmental authorities cannot allow to pass unnoticed.

Such a multitude of men have been lost as a result of the war, whether on the battlefield or through disease the result of privations and inadequate nutrition, that it would be a great pity if those who embody the hopes of the nation were so seriously to imperil their sublime duties as future mothers and propagators of the race, out of sheer folly and childish whims.

This condition logically calls for the passage of laws that will forbid smoking by young women and impose a severe penalty upon the purchase of tobacco by them. It would also be a highly desirable thing for the welfare of the people if the clergy would exhort parents, from the pulpit, to exert a more strict control over their children in this direction and impressively warn them against any indulgence and lack of reserve which would later wreak a terrible vengeance from the health standpoint, not to mention that of morality.

The delicate body tissues of young girls, in common with those of the female organism in general, are far more jeopardized by tobacco than those of men. Nicotine acts, like most other poisons, in a direct manner on the tissues, and in particular upon those of the blood-vessels, as was first demonstrated by the investigations of Adler and Hensel and later by a number of other workers. While they are perhaps not identically the same, these tissue changes strongly suggest those found in hardening of the arteries.

Everyday clinical experience shows that hardening of the arteries occurs especially early in heavy smokers.

As already mentioned in the first part of this book, there is, aside from syphilis, no other factor (not even alcohol) which plays so harmful a rôle in the production of arteriosclerosis as heavy smoking. The first result is an elevation of the blood pressure, which, as is well known, favors the production of arteriosclerosis in that a state of tension in the vascular channels is maintained which is later accompanied by morbid changes in the tissues of the vessel walls.

As the condition proceeds further, there next results a narrowing of the lumen of the vessels, so that the tissues are only with difficulty and inadequately supplied with blood. Owing to insufficient nutrition of, for example, the hair follicles, the teeth, etc., these appendages then fall out, and owing to scanty nutrition of the tissues of the skin, the latter undergoes shrinkage, and folds and wrinkles make their appearance. Not so unreasonably, therefore, did French investigators long ago make the statement that every one appears as old as his arteries are. ("On a Page de ses artères.")

Yet it would be a mistake to think that this condition of affairs occurs only in persons of rather advanced age. Even a considerable number of young men have hardened arteries without being aware of it, as was demonstrated in the late war, in many tissue sections from young soldiers who , had never complained of any bodily disturbance during their life time. As a rule, only heavy smoking leads to such serious results, unless it be in the children of arteriosclerotic parents or in young girls and women, on whose delicate tissues smoking acts much more detrimentally.

Particularly harmful in this connection are cigars of high nicotine content. Fortunately, women who smoke cigars are not many. To my mind a cigar in the mouth imparts to any woman, however beautiful, a rather mannish aspect, and when, some years ago, I was taken to a ladies' club in Copenhagen, in which the women smoked one cigar after another, I was led mentally to supply beards and side whiskers on their faces.

On the other hand, I cannot, in all fairness, assert that an occasional cigarette in the mouth of a lady would give her an unwomanly appearance. Furthermore, the harmful effects previously de-scribed should not occur if women already completely developed in body and mind smoked a few small cigarettes a day. Only if they are the off-spring of parents suffering from hardening of the arteries should they preferably abstain completely from smoking.

It is important, however, that smoking should never be indulged in on an empty stomach, that only a very mild variety of tobacco should be used, and further, that it should be smoked slowly and not in rapidly repeated puffs, that the smoke should not be inhaled, and that it should not, as foolish girls in their teens are so fond of demonstrating, be swallowed and then blown out again through the nose. To those ladies, however, who are so slightly vain that they are unwilling to give up the immoderate use of tobacco in spite of the risk to their beauty it entails, I would recommend that they take plenty of food.

It is a well established fact that we withstand all kinds of intoxications better if we take ample amounts of food, especially of the albuminous variety, since these very materials serve for the building up of the important substances which protect us as antidotes or antibodies.

Unfortunately the taking of ample amounts of food by heavy smokers meets with the difficulty that their appetite is often poor, and that the tobacco only too often leads to undernutrition by causing disturbance of the functions of the stomach and intestines. This, in turn, becomes a further cause of rapid ageing in women.

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