A FEW PARAGRAPHS ABOUT TOBACCO AMBLYOPIA.A FEW PARAGRAPHS ABOUT TOBACCO AMBLYOPIA.

BY WILLIAM B. MEANY, M.D.

It is hard to say why tobacco has been selected as the general agent for inciting what is called toxic amblyopia. Is it not a fact that various toxic agents are said to be attended by varying degrees of amblyopia, and that some writers, apparently eager to ignore the effects of alcohol, have taken up the consideration of central and peripheral lesions of the optic nerve, clearly due to prolonged local disturbances of the vasomotor system, from various kinds of excesses and mechanical obstruction to nutrition, even including tuberculosis, to set forth an exaggerated view of the by no means well-established toxic effect of tobacco?

In Turkey where tobacco is inordinately used by both sexes and among all classes, the so-called tobacco amblyopia, according to competent observers, is almost unknown, and yet the daily consumption of tobacco by this portion of the Mussulmanic race is enormous. Carefully made assays show that the smoke from Turkish cigarettes (which the Turk draws directly into the lungs) contains about double the percentage of nicotine as is found in cigars made from Havana tobacco. Does not the Moslemic law religiously interdict, among other things, the use of alcohol in any form, and exacts from the faithful strict observance of bodily cleanliness by morning and evening ablutions?

In a series of clinical observations the writer reported to the Kentucky State Medical Society, in June, 1895, there will be found some cases in which it was clearly apparent that amblyopia was not caused by tobacco, but was due directly to retrobulbar neuritis. Similar cases clearly establish the fact that symmetrical scotomata is neither diagnostic of tobacco amblyopia nor constantly present in otherwise apparently "well-established cases." . . .

Is it unreasonable for one to be more inclined, taking into consideration environments and the "eccentric" character of patients, who are said to especially suffer from this form of amblyopia, to favor some mechanical obstruction to nutrition, inflammation excited by tuberculosis or even circulatory or vasomotor disturbances, the reflex phenomena in cases of megrim, keeping well to the front the neurologic elements, as some of these factors appear to be in a degree present in most all the forms of amblyopia, and not make tobacco alone chargeable for certain undeveloped or over-exaggerated type of amaurosis? A shock to the nervous system from a railroad accident has been said to be followed by the so-called tobacco amblyopic indications. . . .

When we take into consideration the study of the brain function—employing that term in its widest sense—and of the aberration occurring in it, that we call disease, we can see that the subject is still in its very infancy. Can we so readily differentiate the varying forms of amblyopia, and not be "startled" when we hear it stated or see it set forth in writing describing certain trophic neuroses that are unmistakably distinctive types of disease—as "characteristic effects" of the use of tobacco?

What physician in the school of ophthalmology, no matter how enlarged his experience or favorable the surroundings to the proper study of the aberrations found in eye troubles, may say he is safe in the recognition and differentiation of the anesthetic retinitis, coincident with locomotor ataxy, the retinitis of anemia and the multifarious forms of toxemia along with tobacco amblyopia—for is it not a fact that in the majority of instances we are unable with assurance to assign a cause? In lead poisoning, for instance, is the central visual disturbance due to saturnine cachexia or to albuminuria, anesthetic paralysis and encephalopathy which is so often present? . . .

The very fact that a number of cases of so-called tobacco amblyopia get well, although the smoking is kept up, casts doubt upon the diagnosis. . . .

The habit of smoking is now probably at its apogee, certainly it would be difficult to give it a wider scope of action. It may be taken as a rule that every man smokes, who by idiosyncrasy is not disabled from indulgence. They who scorn the "filthy habit" and are disposed to attribute many ills to its use, belong to two or possibly three categories, whose classification need not be detailed here.

It may be prudential to mildly infer that some reasoning from their anti-tobacco standpoint, in assuming that the "weed" is responsible for a certain form of amblyopia, and, in their haste to satisfy themselves with a cursory examination, even to the ignoring of the physiologic aspect and, to further their reasoning in contra-distinction to anatomic facts, are sacrificing themselves on the altar of duty rather than promulgating their purposes.

JAMA. 1898;30:721-723