Smoking problems and healthcare

No HEALTH problem in our time has commanded more attention than smoking. The issuance of the official Surgeon General's Report in 1964 constituted a major scientific and medical event and began a public and medical concern that continues. Despite the concern, however, one third of the women and half the men in the United States still smoke cigarettes. 

Deaths from diseases associated with cigarette smoking continue. A large proportion of health resources and money must be devoted to trying to treat such diseases. But there are encouraging events. As many as 1.5 million people a year recently have been abandoning smoking.

Among them, fortunately, are young and middle-aged men who are at particularly high risk of premature death from lung cancer and coronary heart disease. Also hopeful is evidence from a Public 

Health Service survey indicating that while 29 percent of boys and 15 percent of girls at age 17 are regular smokers, this represents a significant reduction in the proportion of young people taking up smoking. And school systems across the country are emphasizing educational programs on smoking and health in the hope of creating a "smokeless generation."

The evidence about the dangers of cigarette smoking to health is now overwhelming. In the words of the Surgeon General of the U.S. Public Health Service, smoking "is the greatest preventable cause of illness, disability and premature death in this country."

 A conviction shared by medical and health agencies has been expressed by the New York State Commission of Health: "No other single factor kills so many Americans as cigarette smoking .... Bullets, germs and viruses are killers; but for Americans, cigarettes are more deadly than any of them. No single known lethal agent is as deadly as the cigarette." Smoking is a certain irony in the history of tobacco use. American Indians, early explorers discovered, smoked tobacco in pipes for ceremonial silicoses, and believed it had some medicinal values. 

Persistent Cough may mean Infection, Obstruction, accumulation of fluid, or in lungs

Coughing may indicate only a minor temporary throat irritation. But a persistent cough may mean infection, obstruction, or accumulation of fluid in the air passages or lungs, and so it deserves medical attention.  

 The Promise and Nature of Preventive Medicine 50 does a cough that developed during a respiratory infection but then persists long afterward. 

Urinary changes: We have already noted that blood in the urine re- quires investigation. Frequent urination may be the result of infection or, in some cases, nervous irritability of the bladder. Frequent and voluminous urination may be an indication of a relatively rare type of diabetes, diabetes insipidus. In older men, the need to get up several times a night for urination may indicate an enlarging prostate.

Difficulty in starting urination may indicate sufficient prostate enlargement to require treatment to prevent backup of urine and impairment of kidney function. Actually, any marked change in the urine-in its volume, color, or number of times it must be passed-calls for medical study. 

Nausea may stem, of course, from a gastrointestinal disturbance, but it may also arise from an infection almost anywhere in the body or from disturbance of the balance mechanism in the ear. If the nausea is mild, you can delay a little before consulting a physician, for it may disappear in a short time and not return. But severe and persistent nausea, or nausea that keeps recurring, calls for medical attention.

Jaundice, or yellowing of the skin, may be due to a viralinfection and is especially likely to be seen in younger people. It may signal gallstones, and this is especially likely to be the case for middle-aged women. In older people, it sometimes is due to cancer of the pancreas or to cancer that has spread into the liver from elsewhere. The safe rule is always to regard jaundice as a signal calling for immediate medical attention. In some people with sallow complexion, jaundice may not be readily discernible on the basis of the appearance of the skin; in such cases, look at the whites of the eyes-if they are distinctly yellow, jaundice is present.