Cigarette smoking and the responsibility of the hospital physician.

1 t is right that this conference which has demonHELPING OUR PATENTS TOP SMOKING strated so many aspects of the care of chest and heart disease should devote one session to their commonest preventable cause-cigarette smoking. In this matter we cannot leave prevention to the Public Health authorities. They indeed can legislate for clean air in our cities-but this is of limited use if half our citizens insist on the pollution of their private air supplies. Legelation alone cannot change private habits. But we as personal physicians are in a privileged position and can have a very powerful influence on our patients if we care to use it. The hospital physician has a special responsibility since the diseases caused by cigarettes bring a considerable burden to the hospital service. In England and Wales over 4 percent of our hospital beds are needed every day to care for the cigarette-induced cases of chronic bronchitis, coronary disease and bronchial carcinoma. About 8,000 hospital beds are occupied because of cigarette smoking, or the equivalent of all the beds in the 12 London University Teaching Hospitals. Every large hospital is devoting about 30 of its beds to treat the results of cigarette smoking. This is an extravagant waste of our resources of both staff and equipment which we cannot afford. Prevention is all the more important since there is comparatively little we can do for these patients on diagnosis. Over one-third of our patients die in their first coronary attack, and only 5 percent of our lung cancer patients survive five years. By the time the patient with chronic bronchitis or emphysema comes to the hospital, he is usually severely and permanently crippled. As hospital physicians each of us has three responsibilities in this matter: 1. To help our patients to stop smoking. 2. To control smoking in our hospitals. 3. To encourage the reduction of cigarette smoking in the community.