Compliments of the Author.] 
TOBACCO-POISONING, 
AND 
ITS EFFECTS UPON THE EYE-SIGHT. 
By A. W. CALHOUN, M.D., Atlanta, (La. 
Profeetor of Eye ind Ear and Throat Di*m*e* in the Atlanta Medical College. 
[From Transactions Medical Association of Georgia.] 
Jab. P. Haiikison & Co., State PrinterB, 
Atlanta. Georgia. TOBACCO POISONING ANI) ITS EFFECTS UPON 
THE EYE-SIGIIT. 
By A. W. CALHOUN, M.D., Atlanta, Ga. 
Professor of Eye and Ear and Throat Disease# in the Atlanta Medical College 
[From Transactions Medical Association of Georgia.] 
Jas. P. Harrison & Co., State Printers, 
Atlanta, Georgia. TOBACCO-POISONING AND ITS EFFECTS UPON 
TIIE EYE-SIGHT. 
By A. W. CALHOUN, M.D., Atlanta. 
Professor of Eye and Ear and Throat Diseases, in the Atlanta Medical College. 
Jiead before the Medical Association of Georgia. 
That so palpable a fact as “tobacco blindness” should have 
so long remained unknown to the world, is indeed astonish- 
ing. Many physicians, and the people at large, are still 
skeptical, but among oculists, it has long been known that 
the excessive, and in many instances the very moderate, 
use of tobacco, will produce a train of symptoms, which, if 
let alone and the same cause be continued, will ultimately 
end in a partial or complete loss of sight, known as “tobacco 
amaurosis.” That it does more or less damage in almost every 
instance, can be readily demonstrated by examining the throat 
of any smoker,in whom there will be found unmistakable evi- 
dences of slight or severe pharyngitis. It is not necessary to go 
far out of your way to find more than one person who justly 
attribute their unsteady gait, their tremulous hand and gen- 
eral “ nervousness” directly to the habit of chewing or 
smoking, or both. I doubt not but that each one of you 
here can call to mind some friend or acquaintance, whose 
mental as well as physical strength has been seriously un- 
dermined, if not wrecked, by tobacco-poisoning. While 4 
Tobacco Poisoning. 
damage may be expected from tobacco if used in any man- 
ner, it is mainly through smoking that the system is so filled 
with the poison that the optic nerve undergoes partial or 
complete atrophy, with corresponding blindness. There is, 
perhaps, nothing surprising in the fact that a large ma- 
jority of one’s acquaintances smoke, but there is some- 
thing amazingly fearful in the quantity of tobacco used 
each day by an old smoker. The active principle, nicotine, 
is very abundant in tobacco, and is readily developed by 
burning. The smoker takes this poisonous principle into 
the mouth, the system becomes saturated, the delicate and 
sensitive nerves of vision become diseased, and their death, 
or atrophy, is the termination. That men may, in many 
instances, harmlessly use tobacco for a long series of years, 
is no more an argument in opposition to its evil effects than 
that alcoholic stimulants can be taken, in exceptional cases, 
for a long life-time without serious detriment to the indi- 
vidual. That it injures the nervous system will scarcely 
be doubted by any one acquainted with its physiological 
effects, and that it takes the life of the nerve of sight, is now 
a fact beyond question. 
The history of the following few cases, taken from the 
records of a large number in my possession, will give a fair 
insight into the nature of the disease under consideration. 
Case 1. Mr. B, aged 50, is a large, vigorous man, in every 
way apparently in good general health, but for more than 
eighteen months has been gradually losing his sight. lie 
is a farmer, and in the open air almost the entire day, and has 
been smoking for twenty years, but not till one and a half 
years ago did he notice any unpleasant effect from it. The 
quantity of tobacco daily consumed is difficult to estimate, but Tobacco Poisoning. 
5 
lie is smoking his pipe from rising in the morning till he 
retires at night, with the exception of the time devoted to 
his meals. The quality is what he calls “first-class plug” 
tobacco, cut and rubbed into very small pieces, before being 
put into the pipe. The vision began failing, by his seeming 
to look through a thin cloud, which dimness has gradually 
increased, till finally, all objects appear covered by dense 
smoke. Accurately estimated, his vision fell to and it 
was only with very strongly magnifying glasses that he 
could, even for a few moments, read very large newspaper 
type. There had never been the slightest pain, merely a 
gradual diminution of sight. At night he found the vision 
grew invariably more indistinct. The little floating bodies 
in the vitreous (“mouches volantes”) were a great source of 
annoyance to him. With the aid of the ophthalmoscope, 
I found both optic discs decidedly anaemic, the right show- 
ing the white atrophic appearance much more than the left. 
The retina on each side was also more or less anaemic. 
The treatment of this man was the immediate and com- 
plete cessation of the use of tobacco, and the administration 
of jV gr. sulphate of strychnia three times daily. 
It is now two years since the beginning of the treatment 
and his vision has been raised from to ff (almost 
normal) and, with proper glasses, he reads ordinary print 
with ease and comfort. 
Case 2. Mr. W., aged forty-two years, a banker, has 
smoked fifteen to twenty cigars a day for the last several 
years, but remains in perfect general health. For the past 
six months he has continually seen floating bodies (mouches 
volantes) before him, and sees everything through a mist. 
Towards night this mist increases in thickness, and very 6 
Tobacco Poisoning. 
much obscures all objects. He has had no pain, but seeks 
advice because of increasing loss of sight. The ophthalmo- 
scope shows an almost perfectly white papilla (atrophy of 
the optic nerve) in the left eye, and an anaemic condition of 
the nerve and retina in the right eye. 
At once he stopped the use of tobacco, and took sulph 
strychnia three times daily, and so regulated his business 
that he could remain a good portion of the day in the open 
air. The left eye remains about in the condition as in the 
beginning of treatment, but the right has been fully restored 
to its normal condition, and he is now constantly and 
actively engaged in his business. 
Case 3. Mr. D. a machinist, aged about forty years, 
smokes his pipe ten or twelve times daily, and one cigar 
after each meal. When not smoking, he is chewing tobacco, 
lie is a very early riser, and begins either smoking or chew- 
ing, sometimes both, before breakfast. Says he has noticed 
gnats or something like strings of beads (mouches volantes) 
floating before his eyes for one or two years, but only for 
the last ten or twelve months has everything appeared cov 
ered with a thin veil, which has by degrees grown thicker, 
till it now incapacitates him for work. No sort of glass 
has the slightest beneficial effect. lie has had no pain, but, as 
in the majority of the other cases, says his vision is absolutely 
useless at night. The ophthalmoscope reveals a white 
atrophic nerve with anaemic retina in each eye. The vision 
is down to Iff. The pupils contract and dilate slowly under 
the influence of light and shade. 
He himself suspected the cause of his trouble, and, in part, 
proposed the treatment. He had in his pocket a few cigars, 
which he threw upon my table and has never touched to- Tobacco Poisoning. 
7 
bacco in any shape or form from that day to this. For a 
time I gave him hypodermically, 2V gr. strychnine once 
daily, gradually increasing the dose up to } gr. For 
some time past he has been taldng it internally three times 
daily, in gr. doses, and using electricity once daily or 
every other day. The vision has been restored to almost 
its normal condition, the increased blindness at night has 
been relieved, and the cloud before his eyes has disappeared. 
Case 4, is that of a woman, Mrs. F., aged thirty, who not 
only smokes her pipe freely, but is an immoderate “dipper” 
of snuff. This has been a habit with her for six or seven 
years. The cloudy vision, increasing towards night, the 
floating bodies, the white atrophic appearance of the optic 
disc and anaemic retina are all present to a very marked 
degree, otherwise she is apparently very healthy. 
She was, with difficulty, persuaded to quit the use of the 
pipe and brush, and put upon strychnia and electricity. 
The recovery in the course of a few months was perfect in 
one eye and partial in the other. 
These suffice as a specimen of the most favorable class of 
cases of tobacco poisoning. Some had already complete 
atrophy of the optic nerve (amauorsis), and others, various 
other stages of the disease, in which treatment was of very 
little or no service. Perfect and incurable blindness from 
tobacco is of much more frequent occurrence than any one 
would dream of, except he be brought constantly in contact 
with eye diseases. Indeed, one writer says that not only 
does the optic nerve suffer such injury from smoking, but 
the brain itself has been affected by it to so great an extent 
in several instances that actual delirium tremens has result- 
ed. Atrophy of the auditory nerve (nervous deafness) has 
also been traced to tobacco smoking. 8 
Tobacco Poisoning. 
From the cases here reported, the following will be noted 
as prominent and more or less invariable symptoms : misty 
vision, the clond gradually thickening, absence of pain, 
small bodies floating before the eyes, the vision becoming 
more blurred at night, the peripheral being much clearer 
than central vision. Some or all of these symptoms will 
be found in almost every well defined case. It has been 
said that the blindness begins in the right eye, but my ex- 
perience does not boar me out in this observation. 
Successful treatment depends upon total abstinence from 
tobacco. This is the first and most important step towards 
a cure. It is no easy matter to give up this habit, but I 
have been struck with the willingness with which patients 
abstain from its use, when once they are convinced that 
their vision is endangered. One or two cigars daily, or a 
few cigarettes, suffice to keep up the poisoning, whereas, 
discarding it at once and entirely, will often, without further 
treatment, effect a perfect cure. Electricity aids materially 
in stimulating and strengthening the nerves, but sulphate 
of strychnia is the main reliance, in so far as medicines are 
concerned. I occasionally give it hypodermically in grad- 
ually increasing doses, but most frequently administer it in 
fluid or pill form, beginning with doses of or 3*0 gr., 
slowly increasing to £ or i gr., given immediately before 
or after meals, that it may be digested with the food. 
If by these notes of warning I may be the means of pre- 
venting in any one this seductive but dangerous indulgence, 
or of restoring sight to some dimmed eye, I shall feel fully 
repaid for my self-imposed task.