View report page

22
this trouble in this country than in the United States of America where
the average length of the cigarette stub is 30·9 millimetres compared with
18·7 in Britain.
The hypothesis that the heavy smoking of cigarettes is the direct
cause of the increase in lung cancer, while it is accepted by many as an
explanation of the position, is not accepted by all and it certainly does not
account for all the facts. Some see in the correlation not the position of
cause and effect, but one arising from the fact that something in the makeup
of the individual which predisposes him to lung cancer either itself or
with other causes makes him a heavy smoker.
Smoking seems to be directly related not only to lung cancer but to
other conditions. There is a clear relation in men of twenty-five to sixtyfour
between smoking and persistent cough and sputum. Smokers have
more chest illness, wheezing, breathlessness and chronic bronchitis.
There is too a clear relationship between smokers and disease of the
coronary arteries. The general death rate is higher within each quinquennial
group in regular cigarette smokers than in non-smokers; this
relationship is not seen in cigar or pipe smokers. Of the eight commonest
diseases in men over sixty, three—bronchitis, peptic ulcer and hypertension
were constantly associated with smoking habits. The incidence of
bronchitis and peptic ulcer was higher in men smoking cigarettes than in
pipe smokers or non-smokers; on the other hand, hypertension was
commoner in men who do not smoke. Another condition which might
be worsened by smoking is tuberculosis of the lungs; here smoking can
reactivate a quiescent disease.
While there is this quite severe indictment of smoking, it is probable
that this applies only to heavy smoking. In the relationship of smoking
and lung cancer the limiting amount seemed to be about twenty cigarettes
a day. Except in those with a special idiosyncrasy, it is very doubtful it
light smoking causes damage in any of these ways. On the other hand, the
heavy smoker in whom this smoking causes these troubles is really an
addict and needs help for the treatment of what leads to his addiction
as much as, or perhaps even more than, to wean him away from his heavy
smoking. What causes people to smoke at all is a very complicated
matter, and is perhaps quite distinct from the question of what causes a
person to become a heavy smoker.
Deaths from Infectious Diseases
These were eight from tuberculosis, eight from influenza and one
from measles.