The Danger of Smoking: More Than Cancer

At the American Medical Association's annual meeting in Chicago last week, when the doctors got around to discussing medicine instead of medicare, topic A was the danger of smoking. Physicians already familiar with tobacco's implication in the growing incidence of lung cancer were startled to hear that they had been worrying about one of the least of tobacco-caused troubles. Lung cancer brought on by cigarette smoking, reported the American Cancer Society's chief research statistician. Dr. Edward Cuyler Hammond, is "relatively unimportant'' compared with the damage tobacco does in a variety of other ways.

Focusing popular attention on the 30,000 deaths from lung cancer each year, said Dr. Hammond, has obscured the more deadly fact that four times as many "excess'' fatalities among cigarette addicts are due to a long and tangled chain of events. Between puffs on his pipe, he reported that deeply inhaled cigarette smoke sends a threat of pre mature death spreading through the lungs, arteries and the heart itself.

Speaking for a group of distinguished pathologists and statisticians,* Dr. Hammond outlined the preliminary results of a painstaking study begun seven years ago. At the East Orange, N.J.. Veterans Administration Hospital, lung tissue was obtained from 227 postmortems, put on microscope slides, and carefully examined by pathologists. The hundreds of slides were identified only with coded numbers, and pathologists did not know their origin. Later statisticians were able to match the pathological findings with the histories of the dead patients. The results of the study added up to an elaborate description of progressive smoke damage.

Subjected to Stress. Deeply inhaled smoke, the researchers found, irritates the cells that line the tiniest chambers of the lung (alveoli). The walls of the alveoli thicken, lose their elasticity and much of their ability to do their vital job of exchanging carbon dioxide for oxygen. Subjected to sudden stress--such as a cough or sneeze--the alveolar walls rupture; part of the lung becomes useless.

Even while it is attacking the alveoli, dense smoke also damages the small arteries that carry blood to the lung surface for oxygenation. The artery walls become fibrous and thickened. Soon, internal deposits on the thickened walls make the arteries so narrow that little blood can get through. Eventually many tiny arteries are blocked completely.

Damaging Chain. These two sets of events alone would be enough to explain why thousands of Americans are "lung cripples," suffering from what most U.S. doctors call pulmonary fibrosis and chronic emphysema. But the damaging chain of events runs on.

The destruction of smaller blood vessels in the lung and the thickening of slightly larger ones increases the blood pressure in the pulmonary arteries and puts a strain on the right side of the heart.

It also prompts the left side of the heart to work harder to pump blood against increased resistance. A healthy heart could probably stand the extra work; a heart already weakened by other difficulties might fail.

Even while the heart is being asked to overexert, carbon monoxide from cigarette smoke combines with red blood cells and decreases their capacity to carry oxygen. As a result, the hard-working heart muscle is given less fuel to do its job. At the same time, tobacco's nicotine causes a constriction of small arteries in the extremities and speeds up the heart, increasing its need for oxygen and complicating the coronary problem.

Snuffing Out Smokers. Hammond & Co. were careful not to suggest that smoking is a basic cause of either high blood pressure or coronary artery disease. But along with other A.M.A. panelists, they agreed that smoking almost certainly makes such conditions worse, and they agreed that the danger of serious illness or death from such infectious lung diseases as influenza, pneumonia and tuberculosis is increased if the lungs have been damaged by smoke.

By week's end the A.M.A. and the American Cancer Society seemed more concerned than ever over the medical problems involved with tobacco. The A.M.A.'s new president. Dr. George M. Fister, of Ogden, Utah, announced in his inaugural address that, to guide physicians, the A.M.A. would start a year-long study of smoking and disease. The American Cancer Society, eager to snuff out smoking among college students, began a campaign to persuade university presidents to ban tobacco company sponsorship of radio and TV broadcasts of intercollegiate athletic events.

*The others: VA Pathologist Oscar Auerbach, Columbia University Surgical Pathologist Arthur Purely Stout, and American Cancer Society Statistician Lawrence Garfinkel.

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