• S. Humayun Shah


Tobacco in various forms has been used for centuries. American Indians were apparently thefirst to use tobacco in various forms: they smoked, chewed and sniffed.Tobacco plant is a native of tropical America. The original ancestor is not known becausetobacco is a very old plant and has been under cultivation for centuries. The plant spread all overNorth America before the arrival of Whiteman. When Columbus first landed in 1492, some of thenatives brought him a gift of dried leaves.' Throughout the West Indies, Columbus found that thetobacco trade between Indian tribes had been prevalent for hundreds of years. It was found that theIndians either inhale the smoke of the leaves when set alight in pipes, cigarettes, cigars or chewedthe leaf itself. Smoking and other forms of tobacco use had become a part of everyday life, andtobacco had real economic significance. In addition, it was used in the form of poultices and pastesfor treating burns, sores, cancers, sciatica, diseases of the liver, spleen and womb, chills,convulsions, worms, colic, warts, corns and bites by rabid dogs. This habit was adopted by whitesailors and through them reached Europe from where it spread to Africa, Australia and Asia.The practice of smoking was not very common in Europe until 1586 but from there on-wardits popularity increased inspite of opposition by Clergymen and rulers.Linnaeus in 1753, named the genus of Tobacco Plant as “Nicotiana tobaccum” after theFrench statesman Nicot. In 1828, the most important known ingredient of tobacco was isolated andcalled Nicotine.2 The eighteenth century was the century of smokeless tobacco (snuff and chewingtobacco). Its decline started about in 1850, when the sale of cigars and pipes began to take the leadand during the late 1800s the chewing tobacco decreased greatly, when chewing and spitting wereexcoriated by leaders in medicine and science such as Koch, Pasteur and Lister who associated thehabit with germs and transmission of communicable diseases.3Since the early 1970s, there has been a great resurgence in the use of all forms of smokelesstobacco in the United States. The sales of smokeless tobacco have increased about 11% each yearsince 1974 with an estimated 22 million users in the United States.4In Pakistan, the annual production of tobacco amounts to 70-80 million kg of which 85% isconsumed within the country in various forms (smoking, chewing, nasswar and hooka). Over 80%of the country’s smokers are males aged 15 and above whereas smoking among females in relativelyuncommon


Rashid, E.A. Varietal development and evolution of alkaloids in Tobacco. Botanist,

Tobacco Research Station Pakistan Tobacco Board, 1983: 13-16.

Council Report, Health effects of smokeless tobacco. Council on Scientific affairs, A.M.A.

Chicago, JAMA, 1988: 255: 1038-1044.

Greer, R.O., Jr. Poulson, T.C., Oral tissue alternations associated with the use of smokeless

tobacco by teenagers. Clinical findings, Oral Surgery, 1983: 56: 275 -84.

Schuman, L.M. Pattern of smoking behaviour, Nat. Inst. Drug Abuse Res. Monogr Ser,

; 17: 36-66.

Choudry, A.A. W.H.O. workshop on smoking and health issue in developing coun tries,

Colombo, 1 984; 1981: 18-20.

Winn, D M., Biot, W.J., Shy, C.M., et al. Snuff dipping and oral cancer among women in

the southern United States. The New Engl. Med. J. 1981 ;304: 745-748.

Jayant, K., Balakrishnan, V., Sanghvi, L.D. and Jussawalla, D.J. Quantification of the role

of smoking and chewing tobacco in oral pharygneal, and oesophageal cancer, Br. J. Cancer,

; 35: 232-235.

Shah, S.H., Nagi, A.H. Effects of nassawar and tobacco extract on oral mucosa gastrointestinal tract. A morphological study in rabbits (M.Phil. Thesis, Punjab Univer sity)

Linden Meyer, R.G., Baum, R.H., Hsu, S.C. and Going, R E. In vitro effect of tobacco on

the growth of oral carcinogenic streptococci. Am. J., Dent. Assoc. 1981; 103: 719 -722.

Hirsch, J.M., Heyden, G. and Thilander, H.A Clinical histomorphological and histo -

chemical study on snuff induced lesions of varying severity. J. Oral Pathology, 1973; 11:


McMichael, A.J. Oral Cancer in the third world. Time for intervention. Int. J. Epidemiol,

, 13 (4), 403-405.

Wynder, E.L. and Graham, E.A. Tobacco smoking as a possible etiologic factor in

bronchogenic carcinoma. A study of 684 proved cases, JAMA, 1950; 25 3: 20, 2986-2993.

Reed, P.I. Oesophageal reflux. The Practitioner, 1980; 224: 352 -363.

Adler, I. Primary malignant growth of the lungs and Bronchi, New York, Long mans, Green

and Co. 1 91 2.

Tylecote, F.E. Cancer of the lung. Lancet, 1927; 2: 256-257.

Hoffman, F.C. Cancer of the lung. An Rev. Tuberc, 1929; 19: 393-406.

Arkin, A. And Wagner, D.H. Primary Carcinoma of the lung, JAMA, 1937; 106: 587 -591.

Ochsner, A. and Debakey, M. Carcinoma of the lung. Arch. Surg., 1941; 4 2: 209 -258.

Hirayama, T. Non-smoking wives of heavy smokers have a higher risk of lung cancer a

study from Japan. Br. Med. J., 1981; 282: 183-1 85.

Trichopoulos, D., Kalandida, A., Sparros, L. and Macmahon, B. Lung cancer and passive

smoking. Int. J. Cancer, 1981; 27: 1-4.

Mahboubi, E. The epidemiology of oral cavity, pharyngeal and oesphageal cancer outside

the North America and Western Europe. Cancer, 1977; 40: 1879-86.

Pean, G.I., Lee, P.N., Todel, G.F. and Wicker, A.J. Report on a second retrospective

mortalities study in North-East England. Part-I: Factors relating to mortalities from lung

cancer, bronchitis, heart disease and strokes in Cleveland country. London: Tobacco

Research Council, 1977 (Research Paper).

Terry, L.L. The Surgeon General’s first report on smoking and health, a cha llenge to the

medical profession, N.Y. State, J. Med. 1983; 1983: 1254-55.

Takeya, Y., Popper, J.S. and Shimizu, Y. Epidemiologic studies of CHD and strokes in

Japanese men living in Japan, Hawai and California. Incidence of strokes in Japan and

Hawai strokes, 1984; 15: 15-23.

Rosenberg, L., Kaufman, D.W. Myocardial infarction and cigarette smoking in

women younger than 50 years of age. JAMA 1985; 253: 2969.

Health application of smokeless tobacco use. JAMA, 1986; 255: 1045 -48.

Hammond, E.C., Horn, D., Smoking and Heart rate, report in 44 months of follow-up of

,783 men. Total mortality JAMA 1958; 166: 1159-72.

Jedrychowski, W. Popiela, T. Association between the occurrence of peptic ulcers

and tobacco smoking public health, 1 974; 88: 195-200.

Miller, G.H., Gerstein, DR. The life expectancy of non-smoking men and women.

Pub. Health 1983; 98: 343-349.

Wormseley, K.G. Smoking and duodenal ulcer; Gastroenterology, 1978; 75: 139 -52.

Debas, H.T., Cohen, M.M., Holubitsky, I.B. and Harrison, R.C. Effect of cigarette

smoking on human gastric secretory responses. Gut, 1971; 12: 93-96.

Most read articles by the same author(s)