Downloaded from http://jramc.bmj.com/ on March 18, 2018 - Published by group.bmj.com
J R Army Med Corps, 1918;30:238–9
This letter from Lt Col George Stoney-Archer describes an anecdotal association between heavy smoking and ill health, and makes the daring suggestion that notices should be posted in consulting rooms and hospital wards forbidding people with ‘any form of heart trouble, general debility or nervousness’ to smoke. Archaeological evidence suggests that humans have smoked tobacco for more than 3000 years. The introduction of tobacco from the Americas to Europe in the early 1500s is attributed to a number of European explorers—most notably Columbus and Cabral. Although tobacco smoking by natives in what is now Cuba was observed as early as 1492 by Columbus,1 tobacco was initially brought to Europe as a medicinal herb. It rapidly became a panacea for all ills,2 and there were few conditions for which tobacco was not prescribed,3 and little control over its dosage or formulation. Nicotine—the active ingredient isolated from tobacco in 18284—is eponymously named after Jean Nicot—a French diplomat and scholar who championed the medicinal use of tobacco extensively in France in the 1560s. It is a potent parasympathomimetic alkaloid—one of a number found in the nightshade family of plants (Solanaceae). It is unsurprising, therefore, that with such widespread uncontrolled use for all manner of medical conditions, nicotine’s poisonous capabilities were recognised as early as 1577 by Gesner5 and others, and nicotine’s addictive properties were described by Sir Francis Bacon as early as 1610 who wrote ‘The use of tobacco is growing greatly and conquers men with a certain secret pleasure, so that those who have once become accustomed thereto can later hardly be restrained there from.” In time, medicinal tobacco became unpopular with physicians due to its toxicity, and usage gradually declined through the 17th and 18th centuries although it was retained in pharmacopoeias until as late as 1847.6 However, it remained a popular stimulant through the taking of snuff, chewing tobacco and pipe smoking. The modern cigarette began to be produced on an industrial scale in France in the 1840s.7 In small doses nicotine is a mild stimulant—reducing the activity of monoamine oxidase in the brain8—thereby increasing levels of a number of neurotransmitters, including dopamine and serotonin. These are the main contributors to the addictive properties of tobacco. Toxicity at higher doses is caused by excessive stimulation of nicotinic cholinergic neurons and activation of the sympathetic nervous system resulting in a variety of symptoms including feelings of anxiety and panic as well as physical symptoms of palpitations, tachycardia, ataxia, tremor and muscle fasciculation.9 Certainly a number of these symptoms are alluded to in Lt Col Stoney-Archer’s letter when he describes soldiers as ‘complaining of nerves’ or being ‘nervous and shaky’ (anxiety, panic, tremor, muscle fasciculation) and having ‘disorderly action of the heart’ (tachycardia and palpitations). Disorderly action of
the heart (DAH—also known as smoker’s heart) was the biggest cause of disability for soldiers in the early part of the century, and was believed to be caused by excessive smoking.10 One cannot help wondering how many soldiers diagnosed as ‘shell shock’ during WW1 were in fact suffering the symptoms of nicotine toxicity. This would not be an unlikely scenario given the enormous lengths the government went to during WW1 to supply front line soldiers with cigarettes. Although there are no confirmed statistics relating to smoking prevalence among soldiers in the British Army prior to 1959,11 there is some credibility attached to a figure of 96.5% based on the deliberations of the Princess Mary’s Gift Fund, a fund inaugurated by Princess Mary in October 1914 which aimed to provide a Christmas gift for every serviceman at the front or at sea. The gift consisted of a brass box that contained tobacco, cigarettes, a pipe and lighter. Non-smokers—considered to amount to 2 out of every 58 soldiers (3.5%)—were provided with a different gift of writing paper and pencil.12 There were several senior military representatives on the Fund Committee who would have had a fairly accurate idea of the smoking prevalence of their soldiers.
Cigarettes formed part of the free ration for British troops in WW1 to which POWs and wounded soldiers in hospital were also entitled which, added to cigarettes provided by other charities, welfare parcels and duty-free prices at the NAAFI, gave soldiers access to an abundance of free and cheap cigarettes. They were considered essential to the war effort. In a cable to the US minister of war in 1918, General Pershing, the commander of the American forces in Europe in WW1 wrote: ‘You ask what we need to win this war? I will tell you. We need tobacco, more tobacco—even more than food’.10 With tobacco playing such a prominent role in war politics, one can imagine that the anti-tobacco lobby’s voice was drowned out at this time in history. The first line of Lt Col Stoney-Archer’s letter reads: ‘I was glad to see recent letters in the daily papers dealing with “nerves” due to too much tobacco.’ In Bhabutta’s historical review of cigarette smoking in the British army,10 he mentions three letters to the Times13 which focus on the detrimental effects of smoking which attracted violent objections,14 and one can only speculate that it was these letters that Stoney-Archer was referring to in the first line of this letter. Viewed from a modern day perspective, the author’s suggestion of a notice in consulting rooms and hospital wards seems somewhat ineffective, but the evidence that cigarette smoking was as harmful to health as we know it to be today was still some decades away. Nowadays, such notices and posters adorn every hospital and GP notice board and have become very
Roughton S. J R Army Med Corps 2014;160(Supp 1):i57–i58. doi:10.1136/jramc-2014-000295
i57
Downloaded from http://jramc.bmj.com/ on March 18, 2018 - Published by group.bmj.com
much the ‘white noise’ of health promotion activity although there have been some very eye-catching antismoking poster campaigns in the past.15 Evidence of their effectiveness is difficult to measure, but smoking prevalence has declined from a WW1 high to about 55% of men in 1968, and its current prevalence of less than 20% today. This is likely to be due to a combination of factors including health promotion, price and legislation as well as the now ubiquitous availability of smoking cessation support. Lt Col Stoney-Archer’s letter was ahead of its time on a number of levels and represents the vanguard of the groundswell of medical opinion on the harmful effects of cigarette smoking which was to develop over the ensuing decades. However, this view was not popular in 1918 as alluded to in the author’s comment:
Susanna Roughton Correspondence to Lt Col Susanna Roughton, Surgeon General’s Department, Whittington Barracks, Lichfield, STAFFS WS14 9PY, UK; [email protected] Acknowledgements Col R Bhabutta L/RAMC, Regional Clinical Director Scotland & Northern Ireland. The original article can be found online as supplementary file. To view please visit the journal online (http://dx.doi.org/10.1136/jramc-2014-000295). Provenance and peer review Not commissioned; internally peer reviewed.
To cite Roughton S. J R Army Med Corps 2014;160(Supp 1):i57–i58. J R Army Med Corps 2014;160(Supp 1):i57–i58. doi:10.1136/jramc-2014-000295
REFERENCES It would be interesting to see if such letters might appear referring to electronic cigarettes in the future.
1 2 3 4
THE AUTHOR Lt Col George Johnstone Stoney-Archer RAMC, BA, MB BCh, BAO was born in Dublin in 1874, graduated its University in 1897 and was gazetted as a lieutenant in the RAMC in 1898, the year before he married Ethel May Beauchamp in Dublin. Promoted to captain in 1901, he served with the 5th and 7th Stationary Hospitals during the Boers War and was subsequently a surgical specialist in Ireland and Burma. At the time of writing his letter to the J R Army Med Corps, Lt Col Stoney-Archer was clearly involved in occupational health activity as he describes his work as having ‘…been for twelve months on a travelling medical board examining on an average 1,000 men per week….’ He describes ‘thousands of officers and men in hospitals, convalescent hospitals, command depots and home battalions’, so presumably he was carrying out occupational health assessments of some description. He retired from service in 1921 on the grounds of ill health and retired to Cheltenham, Gloucestershire, where he died in November 1955 leaving four children.
i58
5 6 7 8
9 10 11 12 13 14 15
Charlton A. Medical uses of tobacco in history. J R Soc Med 2004;97:292–6. Stewart GG. A history of the medicinal use of tobacco 1492–1860. Med Hist 1967;11:28–68. Decaux F. L’utilisation du tabac dans la médecine d’autrefois. Acta Phytotherapeutica 1961;8:66–71. Posselt W, Reimann L. Chemishe Untersuchungen des Tabaks und Darstellung des eigrenhumlichen wirksamen Principes dieser Pflanze. Geigers Magazin der Pharmazie 1928;24:138–61. Gesner C. Epistolarum medicinalum, 1577 Libri 111. Zurich, 1577. Wesley J. Primitive Physick: or an Easy and Natural Method of Curing most Diseases. London, 1847. Goodman JE. Tobacco in history: the cultures of dependence. New York: Routledge, 1993:97. Fowler JS, Volkow ND, Wang GJ, et al. Neuropharmacological actions of cigarette smoke: brain monoamine oxidase B (MAO B) inhibition. J Addict Dis 1998;17:23–34. Schep LJ, Slaughter RJ, Beasley DM. Nicotinic plant poisoning. Clin Toxicol 2009;47:771–81. Bhabutta RK. Cigarette smoking in the British Army: A historical perspective. 1995. MSc dissertation. Richards HJA, Crowdy JP. Smoking habits of young soldiers. B J Prev Soc Med 1961;15:84. Condell D. “A gift for Christmas”—the story of the Princess Mary’s Gift Fund, 1914. Imperial War Museum Review no. 4. 1989;69–78. The Times: 3/10/16 9e, 5/10/16 9b and 6/10/16 9c. The Times: 4/10/16 11c, 6/10/16 9c, 7/10/16 9e and 9/10/16 6d. Haynes R. The most shocking anti-smoking posters ever made. 2012. http://blog. solopress.com/design-guide/design-insight-the-most-shocking-anti-smokingposters-ever-made/ (accessed 10 Sept 2013).
Roughton S. J R Army Med Corps 2014;160(Supp 1):i57–i58. doi:10.1136/jramc-2014-000295
Downloaded from http://jramc.bmj.com/ on March 18, 2018 - Published by group.bmj.com
Susanna Roughton J R Army Med Corps2014 160: i57-i58
doi: 10.1136/jramc-2014-000295 Updated information and services can be found at: http://jramc.bmj.com/content/160/Suppl_1/i57
These include:
Supplementary Supplementary material can be found at: Material http://jramc.bmj.com/content/suppl/2014/05/20/160.Suppl_1.i57.DC1 References Email alerting service
This article cites 7 articles, 0 of which you can access for free at: http://jramc.bmj.com/content/160/Suppl_1/i57#ref-list-1 Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
J R Army Med Corps, 1918;30:238–9
This letter from Lt Col George Stoney-Archer describes an anecdotal association between heavy smoking and ill health, and makes the daring suggestion that notices should be posted in consulting rooms and hospital wards forbidding people with ‘any form of heart trouble, general debility or nervousness’ to smoke. Archaeological evidence suggests that humans have smoked tobacco for more than 3000 years. The introduction of tobacco from the Americas to Europe in the early 1500s is attributed to a number of European explorers—most notably Columbus and Cabral. Although tobacco smoking by natives in what is now Cuba was observed as early as 1492 by Columbus,1 tobacco was initially brought to Europe as a medicinal herb. It rapidly became a panacea for all ills,2 and there were few conditions for which tobacco was not prescribed,3 and little control over its dosage or formulation. Nicotine—the active ingredient isolated from tobacco in 18284—is eponymously named after Jean Nicot—a French diplomat and scholar who championed the medicinal use of tobacco extensively in France in the 1560s. It is a potent parasympathomimetic alkaloid—one of a number found in the nightshade family of plants (Solanaceae). It is unsurprising, therefore, that with such widespread uncontrolled use for all manner of medical conditions, nicotine’s poisonous capabilities were recognised as early as 1577 by Gesner5 and others, and nicotine’s addictive properties were described by Sir Francis Bacon as early as 1610 who wrote ‘The use of tobacco is growing greatly and conquers men with a certain secret pleasure, so that those who have once become accustomed thereto can later hardly be restrained there from.” In time, medicinal tobacco became unpopular with physicians due to its toxicity, and usage gradually declined through the 17th and 18th centuries although it was retained in pharmacopoeias until as late as 1847.6 However, it remained a popular stimulant through the taking of snuff, chewing tobacco and pipe smoking. The modern cigarette began to be produced on an industrial scale in France in the 1840s.7 In small doses nicotine is a mild stimulant—reducing the activity of monoamine oxidase in the brain8—thereby increasing levels of a number of neurotransmitters, including dopamine and serotonin. These are the main contributors to the addictive properties of tobacco. Toxicity at higher doses is caused by excessive stimulation of nicotinic cholinergic neurons and activation of the sympathetic nervous system resulting in a variety of symptoms including feelings of anxiety and panic as well as physical symptoms of palpitations, tachycardia, ataxia, tremor and muscle fasciculation.9 Certainly a number of these symptoms are alluded to in Lt Col Stoney-Archer’s letter when he describes soldiers as ‘complaining of nerves’ or being ‘nervous and shaky’ (anxiety, panic, tremor, muscle fasciculation) and having ‘disorderly action of the heart’ (tachycardia and palpitations). Disorderly action of
the heart (DAH—also known as smoker’s heart) was the biggest cause of disability for soldiers in the early part of the century, and was believed to be caused by excessive smoking.10 One cannot help wondering how many soldiers diagnosed as ‘shell shock’ during WW1 were in fact suffering the symptoms of nicotine toxicity. This would not be an unlikely scenario given the enormous lengths the government went to during WW1 to supply front line soldiers with cigarettes. Although there are no confirmed statistics relating to smoking prevalence among soldiers in the British Army prior to 1959,11 there is some credibility attached to a figure of 96.5% based on the deliberations of the Princess Mary’s Gift Fund, a fund inaugurated by Princess Mary in October 1914 which aimed to provide a Christmas gift for every serviceman at the front or at sea. The gift consisted of a brass box that contained tobacco, cigarettes, a pipe and lighter. Non-smokers—considered to amount to 2 out of every 58 soldiers (3.5%)—were provided with a different gift of writing paper and pencil.12 There were several senior military representatives on the Fund Committee who would have had a fairly accurate idea of the smoking prevalence of their soldiers.
Cigarettes formed part of the free ration for British troops in WW1 to which POWs and wounded soldiers in hospital were also entitled which, added to cigarettes provided by other charities, welfare parcels and duty-free prices at the NAAFI, gave soldiers access to an abundance of free and cheap cigarettes. They were considered essential to the war effort. In a cable to the US minister of war in 1918, General Pershing, the commander of the American forces in Europe in WW1 wrote: ‘You ask what we need to win this war? I will tell you. We need tobacco, more tobacco—even more than food’.10 With tobacco playing such a prominent role in war politics, one can imagine that the anti-tobacco lobby’s voice was drowned out at this time in history. The first line of Lt Col Stoney-Archer’s letter reads: ‘I was glad to see recent letters in the daily papers dealing with “nerves” due to too much tobacco.’ In Bhabutta’s historical review of cigarette smoking in the British army,10 he mentions three letters to the Times13 which focus on the detrimental effects of smoking which attracted violent objections,14 and one can only speculate that it was these letters that Stoney-Archer was referring to in the first line of this letter. Viewed from a modern day perspective, the author’s suggestion of a notice in consulting rooms and hospital wards seems somewhat ineffective, but the evidence that cigarette smoking was as harmful to health as we know it to be today was still some decades away. Nowadays, such notices and posters adorn every hospital and GP notice board and have become very
Roughton S. J R Army Med Corps 2014;160(Supp 1):i57–i58. doi:10.1136/jramc-2014-000295
i57
Downloaded from http://jramc.bmj.com/ on March 18, 2018 - Published by group.bmj.com
much the ‘white noise’ of health promotion activity although there have been some very eye-catching antismoking poster campaigns in the past.15 Evidence of their effectiveness is difficult to measure, but smoking prevalence has declined from a WW1 high to about 55% of men in 1968, and its current prevalence of less than 20% today. This is likely to be due to a combination of factors including health promotion, price and legislation as well as the now ubiquitous availability of smoking cessation support. Lt Col Stoney-Archer’s letter was ahead of its time on a number of levels and represents the vanguard of the groundswell of medical opinion on the harmful effects of cigarette smoking which was to develop over the ensuing decades. However, this view was not popular in 1918 as alluded to in the author’s comment:
Susanna Roughton Correspondence to Lt Col Susanna Roughton, Surgeon General’s Department, Whittington Barracks, Lichfield, STAFFS WS14 9PY, UK; [email protected] Acknowledgements Col R Bhabutta L/RAMC, Regional Clinical Director Scotland & Northern Ireland. The original article can be found online as supplementary file. To view please visit the journal online (http://dx.doi.org/10.1136/jramc-2014-000295). Provenance and peer review Not commissioned; internally peer reviewed.
To cite Roughton S. J R Army Med Corps 2014;160(Supp 1):i57–i58. J R Army Med Corps 2014;160(Supp 1):i57–i58. doi:10.1136/jramc-2014-000295
REFERENCES It would be interesting to see if such letters might appear referring to electronic cigarettes in the future.
1 2 3 4
THE AUTHOR Lt Col George Johnstone Stoney-Archer RAMC, BA, MB BCh, BAO was born in Dublin in 1874, graduated its University in 1897 and was gazetted as a lieutenant in the RAMC in 1898, the year before he married Ethel May Beauchamp in Dublin. Promoted to captain in 1901, he served with the 5th and 7th Stationary Hospitals during the Boers War and was subsequently a surgical specialist in Ireland and Burma. At the time of writing his letter to the J R Army Med Corps, Lt Col Stoney-Archer was clearly involved in occupational health activity as he describes his work as having ‘…been for twelve months on a travelling medical board examining on an average 1,000 men per week….’ He describes ‘thousands of officers and men in hospitals, convalescent hospitals, command depots and home battalions’, so presumably he was carrying out occupational health assessments of some description. He retired from service in 1921 on the grounds of ill health and retired to Cheltenham, Gloucestershire, where he died in November 1955 leaving four children.
i58
5 6 7 8
9 10 11 12 13 14 15
Charlton A. Medical uses of tobacco in history. J R Soc Med 2004;97:292–6. Stewart GG. A history of the medicinal use of tobacco 1492–1860. Med Hist 1967;11:28–68. Decaux F. L’utilisation du tabac dans la médecine d’autrefois. Acta Phytotherapeutica 1961;8:66–71. Posselt W, Reimann L. Chemishe Untersuchungen des Tabaks und Darstellung des eigrenhumlichen wirksamen Principes dieser Pflanze. Geigers Magazin der Pharmazie 1928;24:138–61. Gesner C. Epistolarum medicinalum, 1577 Libri 111. Zurich, 1577. Wesley J. Primitive Physick: or an Easy and Natural Method of Curing most Diseases. London, 1847. Goodman JE. Tobacco in history: the cultures of dependence. New York: Routledge, 1993:97. Fowler JS, Volkow ND, Wang GJ, et al. Neuropharmacological actions of cigarette smoke: brain monoamine oxidase B (MAO B) inhibition. J Addict Dis 1998;17:23–34. Schep LJ, Slaughter RJ, Beasley DM. Nicotinic plant poisoning. Clin Toxicol 2009;47:771–81. Bhabutta RK. Cigarette smoking in the British Army: A historical perspective. 1995. MSc dissertation. Richards HJA, Crowdy JP. Smoking habits of young soldiers. B J Prev Soc Med 1961;15:84. Condell D. “A gift for Christmas”—the story of the Princess Mary’s Gift Fund, 1914. Imperial War Museum Review no. 4. 1989;69–78. The Times: 3/10/16 9e, 5/10/16 9b and 6/10/16 9c. The Times: 4/10/16 11c, 6/10/16 9c, 7/10/16 9e and 9/10/16 6d. Haynes R. The most shocking anti-smoking posters ever made. 2012. http://blog. solopress.com/design-guide/design-insight-the-most-shocking-anti-smokingposters-ever-made/ (accessed 10 Sept 2013).
Roughton S. J R Army Med Corps 2014;160(Supp 1):i57–i58. doi:10.1136/jramc-2014-000295
Downloaded from http://jramc.bmj.com/ on March 18, 2018 - Published by group.bmj.com
Susanna Roughton J R Army Med Corps2014 160: i57-i58
doi: 10.1136/jramc-2014-000295 Updated information and services can be found at: http://jramc.bmj.com/content/160/Suppl_1/i57
These include:
Supplementary Supplementary material can be found at: Material http://jramc.bmj.com/content/suppl/2014/05/20/160.Suppl_1.i57.DC1 References Email alerting service
This article cites 7 articles, 0 of which you can access for free at: http://jramc.bmj.com/content/160/Suppl_1/i57#ref-list-1 Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
