Smoking In The Medical Casebook

 

Anti-smoking pamphlet:-

“Richardson’s polemical pamphlet.” [57]

This Week

Intriguingly my blog pages on addiction have proved surprisingly popular. The page on cocaine use has been read by over twice as many people as any other page. We’ll move on to the topic of smoking this week.

 

Smoking

Smoking + Sherlock 

There are huge numbers of other references to smoking in the stories, with the vast majority referring to characters enjoying smoking. 

Holmes is an expert on the subject – the following is from “The Sign Of Four”.

“Oh, didn’t you know?” he cried, laughing. “Yes, I have been guilty of several monographs. They are all upon technical subjects. Here, for example, is one ‘Upon the Distinction between the Ashes of the Various Tobaccos.’ In it I enumerate a hundred and forty forms of cigar, cigarette, and pipe-tobacco, with coloured plates illustrating the difference in the ash. It is a point which is continually turning up in criminal trials, and which is sometimes of supreme importance as a clue. If you can say definitely, for example, that some murder has been done by a man who was smoking an Indian lunkah, it obviously narrows your field of search. To the trained eye there is as much difference between the black ash of a Trichinopoly and the white fluff of bird’s-eye as there is between a cabbage and a potato.”

There are then a smaller number of references to smoking being a bad or problematic habit. 

We have already encountered the quote in “The Five Orange Pips”, where Watson describes Holmes as “a self-poisoner by cocaine and tobacco”. As we discussed in the cocaine use chapter, Conan Doyle describing the use of these substances in a negative way, would have been quite an enlightened view at the time [the story was written in 1891, whilst the excerpts below all date to the 20^th century].

In “The Adventure Of The Pince-Nez”, Holmes has a discussion with Mrs Marker, housekeeper for Professor Coram, regarding the pros and cons of smoking [though Holmes is fishing for information regarding the Professor].

I may have remarked before that Holmes had, when he liked, a peculiarly ingratiating way with women, and that he very readily established terms of confidence with them. In half the time which he had named he had captured the housekeeper’s goodwill, and was chatting with her as if he had known her for years.

“Yes, Mr. Holmes, it is as you say, sir. He does smoke something terrible. All day and sometimes all night, sir. I’ve seen that room of a morning—well, sir, you’d have thought it was a London fog. Poor young Mr. Smith, he was a smoker also, but not as bad as the Professor. His health—well, I don’t know that it’s better nor worse for the smoking.”

“Ah!” said Holmes, “but it kills the appetite.”

“Well, I don’t know about that, sir.”

“I suppose the Professor eats hardly anything?”

“Well, he is variable. I’ll say that for him.”

“I’ll wager he took no breakfast this morning, and won’t face his lunch after all the cigarettes I saw him consume.”

“Well, you’re out there, sir, as it happens, for he ate a remarkable big breakfast this morning.”

In “The Adventure Of The Dying Detective”, there is a reference to the addictiveness of tobacco.

“The best way of successfully acting a part is to be it,” said Holmes. “I give you my word that for three days I have tasted neither food nor drink until you were good enough to pour me out that glass of water. But it is the tobacco which I find most irksome. Ah, here are some cigarettes.” I heard the striking of a match. ”That is very much better.” 

In “The Adventure Of The Devil’s Foot,” there is some friendly banter between Holmes and Watson on the subject of Sherlock smoking.

My friend smiled and laid his hand upon my arm. “I think, Watson, that I shall resume that course of tobacco-poisoning which you have so often and so justly condemned,” said he. 

This quote is a little strange, as there are plenty of references in the canon to Watson smoking. Indeed, in our final excerpt, from “The Adventure Of The Veiled Lodger”, Holmes appears to be teasing Watson about his smoking habit.

“This is Mrs. Merrilow, of South Brixton,” said my friend with a wave of the hand. “Mrs. Merrilow does not object to tobacco, Watson, if you wish to indulge your filthy habits. Mrs. Merrilow has an interesting story to tell which may well lead to further developments in which your presence may be useful.”

 

Smoking In Victorian Times

As you might suspect, there is little recognition in the Victorian medical texts that smoking is a cause of disease. But there are a couple of references.

Excessive use of the voice as in lecturing or shouting – costermonger’s and clergyman’s sore throat, is a chronic laryngitis [dysphonia clericorum] with special swelling of the mucous follicles, hence often called follicular. Chronic alcoholism and excessive smoking also cause chronic congestion. [5]

A feeble state of the nervous system leads to atonic dyspepsia by lessening the activity of the secretion or movements of the stomach; consequently it is produced by cares in business, anxiety, and mental distress. Or it may originate from excessive tobacco-smoking or debauchery. In each case you must first ascertain the source of the disease, and, if possible, remove it. [6]

Smoking also crops up in our Griesinger psychiatric text as a means of calming the insane.

Tobacco is much used by the insane, but only in snuffing and smoking. The great predilection of many, especially chronic patients, for the irritation of snuff is well known; and often a snuff good-humoredly offered to an insane person prevents him breaking out in a storm of invectives, brings him to himself and calms him. The smoking of tobacco by those who have been accustomed to it, aids the easy flow of the ideas and equalises the temper. [4]

As in my chapter on cocaine use, I’m going to head away from my medical texts to find an interesting Victorian perspective on smoking. The following extracts are all taken from a polemical pamphlet written by a chemist called FW Richardson – it has the very fine title of: “Is tobacco-smoking injurious? Yes. A reply with notes on a counter-reply to a pamphlet entitled: Is smoking tobacco injurious? No!” [57]

Such pamphlets, often self-published, were a common means, in Victorian times, of getting your views across to a wider audience [sort of the Victorian equivalent of Twitter]. In the quotes “X” is the unnamed writer of the pamphlet extolling the virtues of smoking that our Richardson is responding to.

X’s pamphlet is so full of the weeds of falsity that time and space fail me to pull them all up. [57]

Tobacco contains bitter extractive, malic acid, albumen, gum, resin, moisture, about fifteen or twenty per cent of ash, and according to Schlösing, from two to eight per cent of a colourless, powerful-smelling liquid called nicotine – one-thirteenth part of a grain of which will kill a middle-sized dog in minutes [57]

If “X’s” highest idea of heavenly bliss is smoking the fumes of nicotine, stale urine, and nitro-benzole, we fear that he must have descended to the lowest depths of the sense-plane from which any efforts of ours must fail to raise him. [57]

Tobacco-smoke contains the following gases: carbon dioxide, carbon monoxide, sulpheretted hydrogen and cyanogen. Cyanogen is the most poisonous gas known. I once wished to kill some kittens by a more merciful death than drowning, so I simply conducted some cyanogen to their nostrils: in three seconds they were dead [57]

X quotes a little from Dr BW Richardson; I will do likewise. The Doctor, in his work on the “Diseases of Modern Life” says that “Smoking produces disturbances: [a] in the blood, causing undue fluidity, and changes in the red corpuscles; [b] in the stomach, giving rise to debility, nausea, and in extreme cases, vomiting; [c] in the mucous membrane of the mouth, causing enlargement and soreness of the tonsils – smoker’s sore throat – redness, dryness, and occasional peeling off of the membrane, and either unnatural firmness and contraction, or sponginess of the gums; [d] in the heart, producing debility of that organ, and irregular action; [e] in the bronchial surface of the lungs when that is already irritable, sustaining irritation and increasing cough; [f] in the organs of sense, causing in the extreme degree dilatation of the pupils of the eye, confusion of vision, bright lines, luminous or cobweb specks, and long retention of images on the retina; with other and analogous symptoms affecting the ear, viz, inability to define sounds clearly, and the occurrence of a sharp ringing sound like a whistle or bell; [g] in the brain impairing the activity of that organ, oppressing it if it be duly nourished, but soothing if it be exhausted; [h] in the volitional and in the sympathetic or organic nerves, leading to paralysis in them, and to over secretion from the glandular structures over which the organic nerves exert a controlling force.” [57] 

Which must be the longest sentence in the book! The book referred to here is an American text from 1882 [58]. It is a very entertaining read, containing such chapters as “On disease from the influence of the passions”, “Disease from sloth and idleness” and “Disease from errors of dress”.

Finally, I would remark that all that which appertains to the realm of King Smoke is – as Ruskin and others have shown – at war with Aesthetics – or the Science of Beauty. Cigar-ends and pipe-stems not only disfigure the mouth, but make the one who clings to them a ridiculous picture to an artistic eye, not to speak of the breath, clothes, curtains, etc, etc, made to smell like an old Tobacco-pipe. [57]

Tobacco is injurious to body, mind, morals, the sense of beauty, and all that which we mean by the word “Christian”, and it behoves all those who labour for a nobler day to war against the lies of creed, custom and sense, until all such vile habits as the one of which I have spoken are banished from the earth. [57]

 

Next Week

Given how popular addictions are proving, we’ll conclude our look at areas of self-harm with my chapter on opium use.

 

Buying The Book

The Medical Casebook of Sherlock Holmes and Dr John Watson is available from all good bookstores including Amazon USA, Barnes and Noble, Amazon UK and additional formats like Kindle.

 

Sherlock Holmes And The Adventure Of Masongill Hall

A story to accompany publication of The Medical Casebook Of Sherlock Holmes And Dr John Watson.

Sherlock Holmes has retired to his farm on the Sussex Downs, whilst Dr John Watson has become a GP in the Yorkshire Dales. Watson is struggling to deal with the first weeks of the COVID outbreak, yet Holmes discovers that an old enemy is about to carry out a terrible crime right under Watson’s nose. It is down to the heroic Watson to save the day.

Available from the Amazon Kindle Store.