In summary, the majority of studies so far reported indicate that cigarette smokers run a higher risk of developing postopera- tive pulmonary complications than do nonsmokers, corroborating a long-held clinical impression. The risk of developing such com- plications appears to increase with increasing dosage of cigarette smoke. SUNNARY AND CONCLUSIONS 1. Cigarette smoking is the most important cause of chronic ob- structive bronchopulmonary disease in the United States. Ciga- rette smoking increases the risk of dying from pulmonary emphy- sema and chronic bronchitis. Cigarette smokers show an increased prevalence of respiratory symptoms, including cough, sputum pro- duction, and breathlessness, when compared with nonsmokers. Ventilatory function is decreased in smokers when compared with nonsmokers. 2. Cigarette smoking does not appear to be related to death from bronchial asthma although it may increase the frequency and se- verity of asthmatic attacks in patients already suffering from this disease. 2. The risk of developing or dying from COPD among pipe and/ or cigar smokers is probably higher than that among nonsmokers while clearly less than that among cigarette smokers. 4. Ex-cigarette smokers have lower death rates from COPD than do continuing smokers. The cessation of cigarette smoking is associated with improvement in ventilatory function and with a decrease in pulmonary symptom prevalence. 5. Young, relatively asymptomatic, cigarette smokers show measurably altered ventilatory function when compared with non- smokers of the same age. 6. For the bulk of the population of the United States, the im- portance of cigarette smoking as a cause of COPD is much greater than that of atmospheric pollution or occupational exposure. HOW- ever, exposure to excessive atmospheric pollution or dusty occupa- tional materials, and cigarette smoking may act jointly to produce greater COPD morbidity and mortality. `7. The results of experiments in both animals and humans have demonstrated that the inhalation of cigarette smoke is associated with acute and chronic changes in ventilator-y function and pul- monary histology. Cigarette smoking has been shown to alter the mechanism of pulmonary clearance and adversely affect ciliary function. 8. Pathological studies have shown that cigarette smokers who die of diseases other than COPD have histologic changes charac- teristic of COPD in the bronchial tree and pulmonary parenchyma more frequently than do nonsmokers. 9. Respiratory infections are more prevalent and severe among cigarette smokers, particularly heavy smokers, than among nonsmokers. 10. Cigarette smokers appear to develop postoperative pulmo- nary complications more frequently than nonsmokers. CHRONIC OBSTRUCTIVE BRONCHOPULXONARY DISEASE REFERENCES (I) ABBOTT, 0. A., HOPKINS, W. A., VAN FLEIT, W. E., ROEINSON, J. S. A new approach to pulmonary emphysema. Thorax 8: 116-132, 1953. (2) ALBEKT, R. E., LwPhfANN, M., BRISCOE, W. The characteristics of bron- chial clearance in humans and the effects of cigarette smoking. Archives of Environmental Health 18(5) : 738-755, May 1969. (S) ALBERT, R. E., SPIEGELMAN, J. R., SHATSKY, S., LIPPMANN, M. The effect of acute exposure to cigarette smoke on bronchial clearance in the miniature donkey. Archives of Environmental Health 18 (1) : 30-41, January 1969. (4) ANDERSON, A. E., JR., FIJRLANFXO, J. A.. FORAKER, A. G. Bronchopul- monary derangements in nonsmokers. American Review of Respira- tory Diseases lOl(4) : 518-527, April 1970. (5) ANDERSON, A. E., JR., HERNANDEZ, J. A., ECKERT, P., FOFMKER, A. G. Emphysema in lung macrosections correlated with smoking habits. Science 144 (3621) : 1025-1026, May 22, 1964. (6) ANDERSON, -4. E., JR., HERNANDEZ, J. A., HOLMES, W. L., FORAKER, A. G. Pulmonary emphysema. Prevalence, severity, and anatomical patterns in macrosections, with respect to smoking habits. Archives of Environ- mental Health 12(5) : 569-57'7, May 1966. (7) ANDERSON, D. 0. Observations on the classification and distribution of pulmonary emphysema in Canada. Canadian Medical Association Journal 89: 709-716, October 5, 1963. (8) ANDERSON, D. O., FERRIS, B. G., JR., ZIcKhfANTEL, R. The Chilliwack Respiratory Survey, 1963. Part IV. The effect of tobacco smoking on the prevalence of respiratory disease. Canadian Medical Association Journal 92(20) : 1066-1076, May 15, 1965. (9) ANDERSON, W. H., WrLLrArxs, J. B. Effects of cigarette smoke on dis- tribution of pulmonary perfusion. In: Current Research in Chronic Respiratory Diseases. Proceedings of the 11th Aspen Emphysema Conference, Aspen, Colo. U.S. Department of Health, Education, and Welfare, Public Health Service Publication No. 1879, 1969. pp. 75-79. (10) ANTHONISEN, N. R., BASS, H., ORIOL, A., PLACE, R. E. G., BATES, D. V. Regional lung function in patients with chronic bronchitis. Clinical Science 35: 495-511, December 1968. (11) ASHFORD, J. R., BROWN, S., DUFFIELD, D. P., SMITH, C. S., FAY, J. W. J. The relation between smoking habits and physique, respiratory symp- toms, ventiIatory function, and radioIogical pneumoconiosis amongst coal workers at three Scottish collieries. British Journal of Preventive and Social Medicine 15 : 106-11'7, 1961. 202 (12) ASscLEY, D. J. B. Environmental factors in the aetiology of lung cancer and bronchitis. British Journal of Preventive and Social ,\Iedicine 23 (4) : 258-262, November 1969. (13) ATTINCER, E. O., GOLDSTEIN, ,\I. >I., SEG,U, \I. S. Effects of smoking upon the mechanics of breathing. I. In normal subjects. American Review of Tuberculosis and Pulmonary Diseases 77(l) : l-16, January 1958. (14) AUERBACH.' O., HaAlMOXD, E. C., GARFINXEL. L., Thickening of walls of arterioles and small arteries in relation to age and smoking habits. New England Journal of Xedicine 278( 18) : 980-984, Xay 2, 1968. (15) AUERUACH, 0.. ~IAhlMOND, E. C., KIRBIAN, D., GARFINKEL, L. Emphysema produced in dogs by cigarette smoking. Journal of the American RIedical Association 199(4) : 241-246, January 23, 1967. (16) AUERBACH,~., IIAM~~OND,E.C.,KIR~~AN,D.,GAPSXNKEL,L. Emphysema produced in dogs by cigarette smoking. In: Hanna, hf. G., Jr., Nettesheim, P., Gilbert, J. R. (Editors). Inhalation Carcinogenesis. Proceedings of a Biology Division, Oak Ridge National Laboratory Conference, Gatlinburg. Tennessee, October 8-11, 1969. U.S. Atomic Energy Commission Symposium Series 18, April 1970. pp. 375-387. (17) i%UERBACH, O., STOUT, A. P., HAsrhlOr;D, E. C., GARFINKEL, L. Smoking habits and age in relation to pulmonary changes. Rupture of alveolar septums, fibrosis and thickening of walls of small arteries and arterioles. New England Journal of Medicine 269 (20) : 1045-1054, November 14, 1963. (13) AVIADO, D. >I., CARRILLO, L. R. Hormones and pulmonary effects of tobacco. I. Corticosteroids and their antiasthmatic action. Archives of Environmental Health 18(6) : 925-933, June 1969. (19) A\'rAoo, D. >I., PALECEK, F. Pulmonary effects of tobacco and related substances. I. Pulmonary compliance and resistance in the anesthetized dog. Archives of Environmental Health 15(2) : 187-193, August 1967. (XI) AVIADO, D. >I., SADAVONGVIVAD, C.,~ARRILLO, L. R. Cigarette smoke and pulmonary emphysema. Influence of bronchodilators and biogenic amines in experimental induction in rats. Archives of Environmental Health 20 (4) : 483-487, April 1970. (21) AYIADO, D. >I., SAMANEK, M. Bronchopulmonary effects of tobacco and related substances. I. Bronchoconstriction and bronchodilatation: In- fluence of lung denervation. Archives of Environmental Health 11(Z) : 141-151, August 1965. (22) A~IALIO, D. >I., SAMANEK, M., FOLLE, L. E. Cardiopulmonary effects of tobacco and related substances. I. The release of histamine during inhalation of cigarette smoke and anoxemia in the heart-lung and intact dog preparation. Archives of Environmental Health 12(6) : 70>724, June 1966. (23) BAIK, W. J., DILLEX, J. V. Pulmonary clearance of "9FEz.0, and "`CR,O, in rats and dogs exposed to cigarette smoke. In: Davres, C. N. (Edi- tor). Inhaled Particles and Vapors. II. Proceedings of an International Symposium. Cambridge, September 28 to October 1, 1965, Oxford, Pergamon Press, 1967. pp. 251-271. (24) ?&XHUhl, 0. J., FELTON, J. S., JAhfISON, .I. N., GAINES, R. % CLARKE, D.R.,OwAx,D., TEE INDUSTRIAL HEALTH COIlhfITTEE,TlIE 'X'UBEXKU- LOSIS AND HEALTH ASSOCIATION OF Los ANGELES COUNTY. A SurveY for chronic respiratory disease in an industrial city. PreIiminary re- sults. American P&view of Respiratory Diseases 86(5) 1675-685, November 1962. 203 C-05) RALLEXCER, J. J. Experimental effect of cigarette smoke on human respilztory cilia. Sew England Journal of Medicine 263 (17) : 832-835, October 27, 1960. (26) BALLESGER, J. J., DAWON, F. W., DERUYTEK, 31. G., H,ARDING, H. 13. Eifects of nicotine on ciliary activity itz Titro. ;1nnals of Otologg, Rhinology and Lary-r;gology 74(2) : 303-311, June 1965. (27) BANS, D. V.. GORDON, C. A., PAUL, G. I., PLACE, R. E. G., SNIDAL, D. P., WOOLF, C. R. Chronic bronchitis. Report on the third and fourth stages of the coordinated study of chronic bronchitis in the Department of Veterans Affairs, Canada. sledical Services Journal, Canada 22(l): l-59, January 1966. (28) BAT~IST~, S. P.. KEKSLER, C. J. Use of the nonimmersed in vitro chicken tracheal preparation for the study of ciliary transport activity. Cigarette smoke and related components. Archives of Environmental Health 20 (3) : 318-325, March 1970. (29) BATTISW, S. P., KENSL~, C. J. Mucus production and ciliary transport activity. In ~ivo studies using the chicken. Archives of Environmental Health 20 (3) : 32&338, hlarch 1970. (20) BEST, E. W. R. A Canadian Study of Smoking and Health. Ottawa, Department of National Health and Welfare, 1966. 137 pp. (31) BICKERXAX, H. A., BARACII, A. L. The effect of cigarette smoking on ventilatory function in patients with bronchial asthma and obstructive pulmonary emphysema. Journal of Laboratory and Clinical Medicine 43 (3) : 455-462, March 1954. (32) BLAIR, IV. H., HENRY, 31. C., EHRLICII, R. Chronic toxicity of nitrogen dioxide. II. Effect on histopathology of lung tissue. Archives of En- vironmentzl Health 18(2) : 186-192, February 1969. (33) BOAKE, \v. C. A Study of illness in a group of Cleveland families. XVIII. Tobacco smoking and respiratory infections. New England Journal of hfedicine 259(26) : 1245-1249, December 25, 1958. (34) BONNELL, J. A. Emphysema and proteinuria in men casting copper- cadmium alloys. British Journal of Industrial hIedicine 12: 181-195, July 1955. (35) BOXNELL, J. A., KAZASTZIS. G.,KING, E. A follow-up study of men ex- posed to cadmium oxide fume. Bsitish Journal of Industrial Medicine 16: 135-147, 1959. (36) BOWCOT, K. R., COOPER, D. A., WEISS, W. Smoking and the health of older men. 1. Smoking and chronic cotigh. Archives of Environmental Health 4(l) : 69-72, January 1962. (87) BOUHUYS, A. PETERS, J. hf. Control of environmental lung disease. New England Journal of Medicine 283(11) : 5'73-582, September 10, 1970. (38) BOUHKJ~S, A., SCHILLINC, R. S. F., VAN DE WOESTIJSE. K. P. Cigarette smoking, occupational dust exposure, and ventilatory capacity. Ar- chives of Environmental Health 19(6) : 793-797, December 1969. (89) BOUHUYS, A., WOLFSON, R. L., HORNEX, D. W., BRMN, J. D., ZUSKIN, E. Byssinosis in cotton textile workers. Respiratory survey of a mill with rapid labor turnover. Annals of Internal Medicine 71(Z) : 257-269, August 1969. (40) BOUS~Y, S. F., HELGASON, A. IT., BILLIC, D. M., GYORKY, F. G. Clinical physiologic, and morphologic examination of the lung in patients with bronchogenic carcinoma and the relation of the findings to postopera- tive deaths. American Review of Respiratory Diseases lOl(5) : 685- 695, May 1970. 204 (41) BOWER, G. Respiratory symptoms and wntllatory function in 172 adults employed in 3 bank. American Review of Respiratorp Discuses 83: 6&l-689, 1961. ($2) BR[h'lih~~?.i, G. L., COATS, E. 0.. JR. The prevalence of chronic bronchitis in an industrial population. American Review of Respiratory Diseases 86: 47-54, 1962. (4s) BROWN, K. E., CahxFBELL, A. II. Tobacco, alcohol and tuberculosis. British Journal of Diseases of the Chest 55 (3) : 150-158. 1961. (44) CARSON, s., GDLDHAhlER, R., CARPENTm, R. ReSponSeS of ciliated epithelium to irritants. Mucus transport in the respiratory tract. American Review of Respiratory Diseases 93 (3, Part 2) : 8692, March 1966. (45) CEDERLOF, R. FRIBEXG, L., ITRUB%, 2. Cardiovascular and respiratory symptoms in relation to tobacco smoking. Archives of Environmental Health 18 (6) : 931940, June 1969. (46) CEDERLOF, R., FRIRERC, L., JONSSON, E., KAIJ, I,. Respiratory symptoms and "angina pectoris" in twins with reference to smoking habits. AA epidemiological study with mailed questionnaire. Archives of Environ- mental Health 13 (6) : `726-737, December 1966. (47) CHAXG, S. C. Microscopic properties of whole mounts and sections of human bronchial epithelium of smokers and nonsmokers. Cancer 10 (6) : 12461262, November-December 1957. (48) CHMhIAN, T. T. The acute effect of cigarette smoking on pulmonary function. Journal of the Irish Medical Association 56(333) : 72-74, alarch 1965. (49) CHESTER, E. H., GILLESPIE, D. G., KIZAUSE, F. D. The prevalence of chronic obstructive pulmonary disease in chlorine gas workers. Amer- ican Review of Respiratory Diseases 99 (3) : 365-3'73, March 1969. (50) CHEVALIER, R. B., K~UJMHOLZ, R. A., Ross, J. C. Reaction of nonsmokers to carbon monoxide inhalation. Cardiopulmonary responses at rest and during exercise. Journal of the -4merican Medical Association 198(10) : 1061-1064, December 5, 1966. (51) CHIANG, S. T., WANG., B. C. Acute effects of cigarette smoking on pul- monary function. American Review of Respiratory Diseases lOl(6) : 860-868, June 1970. (52) C~IIVERS, C. P. Respiratory function and disease among workers in alka- line dusts. British Journal of Industrial Medicine 16: 51-60, 1959. (53) CoATES, E. O., JP, BOWER, G. C., REINSTEIN, N. Chronic respiratory disease in postal employees. Epidemiologic survey of a group em- ployed in one building. Journaf of the American Medical Association 191(3) : 161-166, January 18, 1965. (54) COHCU, J. Chronic bronchitis and emphysema. Observations on trends and distribution according to death certificate data, Israel 1960 to 1964. Israel Journal of Medical Sciences 3(6) : 885-889, November- December 1967. (55) COLLEGE OF GENERAL PRACTITIONERS. Chronic bronchitis in Great Brit- ain. A national survey carried out by the respiratory diseases study group of the College of General Practitioners. British Medical. Journal 2: 973-979, October 14, 1961. (56) COMME, J. H., JR., FORSTEX. R. E., II, DIJBOIS, A. B., BRISCOE, W. A., CAmSEN, E. The Lung. Clinical Physiology and Pulmonary Function Tests. Chicago, Year Book Medical Publishers, Inc., 1963. 390 pp. (57) COOK, W. A.,. WEBB, W. R. Surfactant in chronic smokers. Annals of Thoracic Surgery 2 (3) : 327333, h1ay 1966. 205 (58) COOLEY, J. R. T., REP, D. D. Urban and social origins of childhood bron- chitis in England and iTales. British Medical Journal 2(5303) : L'13- 217 April 25. 1970. (jg) Dtinxar~, T. The effect of cigarette smoke on cilinry activity in the upper respiratory tract. .\..\I..~. Archives of Otolar)-ngology 70: 16G 168, 1959. (~0) DuHAhrN, T. Effect of cigarette smoke on diary activity. American Review of Respiratory Diseases 93 (3) : 108-114, Ilarch 1966. (61) DALHAMN, T., RYLANDER, R. Ciliastatic action of smoke from filter- tipped and non-tipped cigarettes. Nature 201(4317) : 401--101, Janu- ary 25, 1964. (6:) DALHAMN, T., RYLANDER. R. Ciliastatic action of cigarette smoke. Vary- ing exposure times. Archives of Otolaryngology 81(4) : 379-382, April 1965. (63) D,%H,xhm', T., RYLAXDER, R. Tar content and ciliotoxicity of cigarette smoke. Acta Pharmacolog~cs et Toxicologica 25(3) : 369-3'72, 19G7. (64) DALHXMN, T., RYI.AxDER, R. Ciliotoxicity of cigarette smoke and its volatile components. American Review of Respiratory Diseases 98(3) : 509-511, September 1968. (GA) DALHAMX, T., RYLXNDLR, R. Ciliotosicity of cigar and cigarette smoke. Archives of Environmental Health 20(2) : 252-253, February 1970. (66) DAMS, T. R. A., BXTTISTA, S. P., KI?%SLER, C. J. AIechanism of respirn- tory effects during exposure of guinea pigs to irritants. Archives of Environmental Health 15(4) : 412-419, October 1967. (67) DEANE, M., GOLDSNIT~, J. R., TUJU, D. Respiratory conditions in out- side workers. Report on outside plant telepflone workers in San Fran- cisco and Los Angeles. Archives of Environmental Health lO(2) : 323-331, February 1965. (68) DENSEN, P. M., JOKES, E. W., Bass, H. E., BREUER, 3. A survey of respi- ratory disease among Xew York City postal and transit workers. 1. Prevalence of symptoms. Environmental Research 1: 262-286, 196'7. (69) DENSEN, P. M., JOSES, E. W.. Bass, H. E., BREW%, J., REED, E. A survey of respiratory disease among New York City postal and transit work- ers. 2. Ventilatory function test results. Environmental Research Z(4) : 277-296, July 1969. (70) DOLL, R., HILL, A. 13. Mortality in relation to smoking: Ten years' observations of British doctors. (Part I) British Medical Journal l(5395) : 1399-1410, May 30, 1964. (72) DOLL, R., HILL, A. B. hlortality in relation to smoking: Ten years' observations of British doctors. (Concluded) British Medical Journal 115396) : 1460-1467, June 6, 1964. - . (7-O) DOWING, H. F., JACKSON, G. G., INOWE T. Transmission of the expeti- mental common cold in volunteers. II. The effect of certain host factors upon susceptibility. Journal of Laboratory and Clinical Medicine 50 (4) : 516525, October 1957. (73) EDELSfAN, N. H.. MITThfm, C., NoRrzrs, A: H., COHEN, B. II., SHOCK, N. W. The effects of cigarette smoking upon spirometric performance of community dwelling men. American Review of Respiratory Diseases 94 (3) : 421-429, September 1966. (7-1) EDWARDS, F., MCKEO~N, T., WHITFXLD, A. G. W. Association between smoking and disease in men over sixty. Lancet 1: 196-200, January 24, 1959. (75) EAmICH, R.. HENRY, M. C., FENTERS, J. Influence of nitrogen dioxide on resistance to respiratory infections. In: Hanna, &I. G., Jr., Nette- 206 sheim, P.. Gilbert, J. R. (Editors). Inhalation Carcinogenesis. Pro- ceedings of a Biology Division, Oak Ridge Sational Laboratory Con- ference, Gatlinburg, Tennessee, October 8-11, 1969. U.S. Atomic Energy Commission S>mposium Series 18, April 1970. pp. 243-257. (76) EICH, R. H., GIL~E~~T, R., AUCHINCLCSS, J. II.. JR. The acute effects of smoking on the mechanics of respiration in chronic obstructive pul- monary emphysema. American Review of Tuberculosis 76: 22-32, 1957. (77) ELWOOD, P. C., PEh%%ro~, J., MERRITT, J. D., CARLY, G. c. R., bfcAULAY, I. R. Byssinosis and other respiratory symptoms in flax workers in Northern Ireland. British Journal of Industrial aiedicine 22 :2'7-37, 1965. (78) ERIKSSON, S. Studies in Alpha,-antitrypsin Deficiency. Acta hledica Scandinavica 1'77 (Supplementum 432) : 1965. 85 pp- (79) FALK, G. A., BR~SCOE, W. A. Chronic obstructive pulmonary disease and heterozygous alpha,-antitrypsin deficiency. Annals of Internal Medi- cine 72(4) : 595-596, April 19'70. (80) FALK, H. L., TRE~IER, H. M., KOTIN, P. Effect of cigarette smoke and its constituents on ciliated mucus-secreting epithelium. Journal of the National Cancer Institute 23 (5) : 999-1012, November 1959. (81) FERRIS, B. G., JR., ANDERSON, D. 0. The prevalence of chronic respiratory disease in a New Hampshire town. American Review of Respiratory Diseases 86(Z) : 165-177, August 1962. ($2) F~lsrus. B. G., JR, ANDERSON, D. O., BURGESS, W. A. Prevalence of respiratory disease in a flax mill in the United States. British Journal of Industrial Medicine 19: 180-185, 1962. (83) FINKL~, J. F., SANDIIXX, S. H., SWTH, D. D. Cigarette smoking and epidemic influenza. American Journal of Epidemiology 90(5) : 390- 399, November 1969. (84) FLETCHER, C. &I., HORN, D. Smoking and health. WHO Chronicle 24(B) : 34&3'iO, August 1970. (~5) FLEXCHER, C. Bf., TINKER, C. M. Chronic bronchitis. A further study of simple diagnostic methods in a working population. British Medical Journal 1: 1491-1498. May 27, 1961. (86) FLICK, A. I,., PATON, R. R. Obstructive emphysema in cigarette smokers. A.M.A. Archives of Internal Medicine 104: 518-526, 1959. (87) FRANKLIN, W., LOWELL, F. C. Unrecognized airway obstruction associ- ated with smoking. A probable forerunner of obstructive pulmonary emphysema. Annals of Internal Medicine 54 (3) :379-386, March 1961. (88) FRASCA, J. M., AUERBACB, 0.. PARKS, V. R., JAMIESON, J. D. Electron microscopic observations of the bronchial epithelium of dogs. 11. Smok- - ing dogs. Experimental and filoleculat Pathology 9(3) : 380-399. December 1968. (gg) F-MAN, G., CRASE, S. C. STEPHENS, R. J., FIJRIOSI, N. J. Pathogenesis of the nitrogen dioxide-induced lesion in the rat lung: A review and presentation of new observations. American Review of Respiratory Diseases 98(3) : 429-443, September 196% (go) FREE;~~AN, G., HAYDON, G. B. Emphysema after low-level exposure to NO,. Archives of Environmental Health S(1) : 125-128, January 1964. (91) F~E>~AN, G., STEPHENS, R. J., CRANE, S. C., FUnIOSI, N. J. Lesion of the lung in rats continuously exposed to two parts per million of nitrogen dioxide, Archives of Environmental Health 17(Z) : 181-192, August 1968. 207 (92) FREOUR, P., COI:DRAY. P.. Rousst-L, A., SERISE. -\. Les bronchites.chi,oni- ques et l'insuffissnce I-espiratorie dans l'agglomeration de Bordeaux. (Chronic bronchitis and respiratory insufficiency in Bordeaux). Journal de LIedecine de Bordenus 113 (2) : 1865-1873, December 1~66. (99) GAKDESU, B. A productive cough upon request as an index of chronic bronchitis: The effec!s of age, sex, smoking habit, and environment upon prevalence in Australian general practice. Y!Iedical Journal of Australia l(1) : 16-20, January 4, 1969. (9.6) GLAhlhIONA, S. T. Effects of cigarette smoke and plant smoke on pulmo- nary surfactant. American Review of Respiratory Diseases 96(3) : 539-541, September 1967. (95) GOrDshUTrr, 3. R., HECHTEX, H. H., PERKIKS, N. M. RORHANI, N. 0. Pulmonary function and respiratory findings among longshoremen. American Review of Respiratory Diseases 86(6) ;867-874, December 1962. (96) GREEN, G. M., CAROLIN, D. The depressant effect of cigarette smoke on the in ~?ifro antibacterial activity of alveolar macrophages. New Eng- land Journal of Medicine 276(8) : 421-427, February 23, 1967'. (97) GREENBERG, X., MILNE, J. F., WATT, A. Survey of workers exposed to dusts containing derivatives of Bacillus subtilis. British Xedical Journal 2: 629-633, June 13.1970. (98) GUENTER, C. A., WELCH, 31. H., RUSSELL, T. R., HYDE, R. M., Hnarxr~n- STEN, J. F. The pattern of lung disease associated with alpha-l anti- trypsin deficiency. Archives of Internal nfedicine 122 (3) : 254-257, September 1968. (99) GUILLERM, R., SAIXDELLE, A., FALOT, P., HEE, J. Action de la fumee de cigarette et de qutlquesuns de ses constituants sur les resistances ventilatoires chez le cobage. (Action of cigarette smoke and some of its constituents on ventilatory resistance in the guinea pig.) Archives Internationales de Pharmacodynamie et de Therapie 167 (1) : 101- 114, May 1967. (100) GUYATT, A. R., BERRY, G., ALPEKS, J. EL, BRAMLEY, -4. C., FLETCHER, C. M. Relationship of airway conductance and its immediate change on smoking to smoking habits and symptoms of chronic bronchitis. Amer- ican Review of Respiratory Diseases 101(l) : 44-54, January 1970. (ror) HAMMARSTEN, J. F., WELCH, M. H., RICHARDSON, R. H., PATTERSON, C. D., GUENTER, C. A. Familial alahai-antitrypsin deficiency and pul- monary emphysema. Transactions of the American Clinical and Clima- tological Association SO(l) : 7-14, 1968. (102) HAMMOND, E. C. Evidence on the effects of giving up cigarette smoking. American Journal of Public Health and the Nation's Health 55-p): 682491, May 1965. (10.7) HAnfhfoND, E. C. Smoking in relation to the death rates of 1 million men and women. In : Haenszel, W. (Editor). Epidemiological Approaches to the Study of Cancer and Other Chronic Diseases. Bethesda, U.S. Public Health Service, National Cancer Institute Monograph No. 19, January 1966. pp. 127-204. (104) HAMhfoPr'D, E. C., AUERBACH, o., KIRMAN, D., GAZLF'NKEL, L. Effects of cigarette smoking on dogs. I. Design of experiment, mortality, and findings jn lung parenchyma. Archives of Environmental Health 21(6) : 740-753, December 1970. (105) HAMMOND, E. C., HORN, D. Smoking and death rates-report on forty- four months of follow-up of 187,783 men. II. Death rates by cause. 208 Journal of the American Xedical Association 166(1I): 1294-1368, March 15, 1958. (IUG) HAYWN, G. B.. DA~IDSOX;, J. T., LILLINCTON, G. A.. WASSERMAS, K. Nitrogen dioxide-induced emphysema in rabbits. American Review of Respiratory Diseases 95 (5) : 7977805, hlay 1367. (JOT) HAYM)N, G. B., FREEMAN, G., FKJKIOSI, N. J. Covert pathogenesis of NOZ induced emphysema in the rat. Archives of Environmental Health 11(6) : 776-783. December 1965. (108) HAYXES, W. F., JR., KRS~ULO~IC. V. J.. BELL, A. L. L.. JK. Smoking hI. C., FIXDLAY, J., SPANCLER, J., EHRLICII, R. Chronic toxicity of NO, in squirrel monkeys. III. EtIect on resistance to bacterial and viral infection. Archives of Environmental Health 20(5) : 566570, I\Iay 1970. (110) HEPPER, X. G., HYATT, R. E., FOULER, W. S. Detection of chronic obstructive lung disease. An evaluation of the medical history and physical examination. Archives of Environmental Health 19 (6) : 806 S13, December 1969. (III) HERXANDEZ, J. A., ANDERSON, A. E.. JR., HOLMES, W. L., FORAKER, A. G. Pulmonary psrrnchymal defects in dogs following prolonged cigarette smoke exposure. American Review of Respiratory Diseases 93( 1) : 78- 83, January 1966. (11-0) HIGGIXS, I. T. T. Respiratory symptoms, bronchitis and ventilatory capacity in random sample of an agricultural population. British 1Iedical Journal 2: 1198-1203, November 23, 1957. (113) HICCI~;S, I. T. T. Tobacco smoking, respiratory symptoms, and ventiIa- tory capacity. Studies in random samples of the population. British Medical Journal 1: 325-329, February 7,1959. (114) HIGGISS, I. T. T., COCURAN, J. B. Respiratory symptoms, bronchitis and disability in a random sample of an agricultural community in Dumfriesshire. Tubercle 39: 296301, 1958. (115) HIGGIXS, I. T. T., COCHRANE, A. I,. Chronic respiratory disease in a random sampie of men and women in the Rhondda Fach in 1958. British Journal of Industrial Medicine 18: 93-102, 1961. (116) HIGGIXS, I. T. T.. COCHR~NE, A. L., GILSON, J. C., WOOD, C. H. Popula- tion studies of chronic respiratory disease. A comparison of miners, foundry\vorkers, and others in Staveley, Derbyshire. British Journal of Industrial Medicine 16: 255-268, 1959, (117) HIGGIXS, 1. T. T., GILSON, J. C.. FERRIS, B. G., JR., WATZRS, >I. E., CAhlPBELL, H., HIGGINS, M. W. Chronic respiratory disease in an industrial totvn: A nine-year follow-up study. Preliminary report. American Journal of Public Health and the Nation's Health 58(9) : 1667-1676, September 1968. (118) HIGGI~s.I.T.T.,HI~~I~s, M.W.,LOCKSEIIN, M. D.,CAXALE, N.Chronic respiratory disease in mining communities in Marion County, West Virginia. British Journal of Industrial hledicine 25 (3) : 165-175, July 1968. (119) HIGGINS. I. T. T., OLDHAM, P. D., COCHRANE, A. L., GILSON, J. C. Res- piratory symptoms and pulmonary disability in an industrial town. Survey of a random sample of the population. British JIedicaI Journal 2: 904-909, October 20, 1956. 209 (fix,?) HILDIXG, A. C. On cigarette smoking, bronchial cai-cinema and ciIiary action. II. Experimental study on the filtering action of cow's lungs. the deposition oi tar in the bronchial tree and removal by cilinry action. lu'ew England Journal of Medicine 254(25) : 1135-1160. June 22, 1956. (121) HOLLAND, W. W., Errram-, A. Cigarette smoking, respiratory symptoms and anti-smoking propaganda. An experiment. Lancet l(7532) I 41-43, January 6, 1968. (I%?) HOLLAND. W. W., HUIL, T.. BENNETT, A. E., ELLIOTT, A. Indications for measures to be taken in childhood to prevent chronic respiratory disease. Milhank, Memorial Fund Quarterly 47 (3, part 2) : 215-227, July 1969. (12s) HOLLAND, R. II., KOZLOWSKI, E. J., BOOKER, L. The effect of cigarette smoke on the respiratory system of the rabbit. A final report. Cancer 16(S): 612-615, Xay 1963. (I%$) HOLLAND, Vi. W., REID, D. D. The urban factor in chronic bronchitis. Lancet l(7383) : 4451148, February 27, 1965. (12.5) IIOLMA, B. The acute effect of cigarette smoke on the initial course of lung clearance in rabbits. Archives of Environmental Health 18(2) : 1'71-173, February 1969. (126) HUHTI, E. Prevalence of Respiratory Symptoms, Chronic Bronchitis and Pulmonary Emphysema in a Finnish Rural Population. Field survey of age group 40-64 in the Harjavalta area. Acta Tubercuiosea et Pneumologica Scandinavica (Supplementurn 61) : 1965. 111 pp. (107) HURST, A. Familial emphysema. American Review of Respiratory Dis- eases 80: 179-180, 1959. (1%) HYATT, R. E., KISTIN, A. D., MAIL~N, T. K. Respiratory disease in Southern West Virginia coal miners. American Review of Respiratory Diseases 89 (3) : 387-401, March 1964. (129) IDE, G., SUNTZEF-F, V., COW'DRY, E. V. A comparison of the histopathology of tracheal and bronchial epithelium of smokers and nonsmokers. Cancer 12(3) : 473-484, May-June, 1959. (130) ITO, H., AVJILDO, D. XI. Pulmonary emphysema and cigarette smoke. Experimental induction and use of bronchodilators in rats. Archives of Environmenta Health 16(6) : 865-870, June 1968. (131) JAMES, R. H. Prior smoking as a determinant of the distribution of pulmonary ventilation. American Review of Respiratory Diseases 101(l) : 105-107, January 1970. (132) KAHN, H. A. The Dorn study of smoking and mortality among U.S veterans: Report on 8'h years of observation. In : Haenzel, W. (Edi- tor). Epidemiological Approaches to the Study of Cancer and Other Chronic Diseases. Bethesda, U.S. Public Health Service, National Cancer Institute Monograph No. 19, January 1966, pp. 1-125. (133) KAMINSKI, E. J., FANC~IER, 0. E., CALANDRA, J. C. In viva studies of the ciliastatic effects of tobacco smoke. Absorption of ciliastatic compo- nents by wet surfaces. Archives of Environmental Health 16(Z) : 18% 193, February 1968. (134) tJENNEDY, J. R., ELLIOTT, A. h1. Cigarette smoke: The effect of residue on mitochondrial structure. Science 168(3935) : 1097-1098, May 29, 1970. (135) KENSLER, C. J., BATTISTA, S. P. Chemical and physical factors affecting mammalian ciliaty activity. American Review of Respiratory Diseases 93(3, Part 2) : 93-102, March 1966. 210 (136) ~LEISET.!.:S. J. E;iects of X02 in hamret-5: AutoradiographIc ano. e!ec:rsr. microscopic aspects. In: Hanna, !,I. G., Jr., Settesheim, P., Gi:%r:. J. I?. (Editors). Inhalation Csrcinogenesls. Proceedings of a B!l!oz- Di:-ision, 0ak Ridge Sationai Laboratory Conference, Gntlin- burg. `iiwessee, October 8-11, 1963. U.S. .ktomic Energy Comniss!on S:.x!xsium Series 15, r\pril 1970, pp. 271-281. (137) IiORDIE. P., BULERJSG. E., BURY, J. H. Ciliary movement and acetyl- choline. British Journal of Pharmacology and Chemotherapy 7: 67- 79. 1953. (123) KRAIZL. 1.. E., BL-LXGH, .\I. H. Studies on Ii\-ing ciliated epithelium. Xxericln Review of Pespiratory Diseases 99(5) : 711-718, Nay 1969. (129) KRCGER, -1. P., s?dlTIi, R. F. Eifects of gaseous ions on tracheal ciliary rate. Proceedings of the Society for Experimental Biology and hfedi- tine 5s: 41"-114, 1958. (140) &!U\lHOLZ, R. .A., CHEVALIEq R. B., ROSS, J. C. Cardiopulmonary func- tier. in young smokers. A comparison of pulmonary function measure- menrs and some cardiopulmonary responses to exercise between a &~oup of young smokers and a comparable group of nonsmokers. .Xnnals of Internal Medicine 60 (4) : 603-610, April 1964. (222) KTUYEOLZ. R. A., CHEVALIER, R. B., ROSS. J. C. Changes in cnrdiopul- mor.ar&- functions related to abstinence from smoking. Studies in xocrg ci;aretre smokers at rest and exercise at 3 and 6 weeks of ab- srirxence. =\nnals of Internal Medicine 61(Z) :197-207, February 1965. (14-1) Ii~.vxaorr. R. .A., CHEVALIEX, R. B., ROS, J. C. A comparison of pul- mortar>- co.mpiimce in )-oung smokers and nonsmokers. American Rex-:ew oi Respirsrory Diseases 9?(l) : 102-107, July 1965. (1:s) KLIIPTEE~. r'. fdentificsrion of the heterozl-gous state for the afpha,-anti- trx~zsin C?ticienc>- gene in man. Biochemical Genetics 3(3) :X3-288, - ISFCI- (I;;) ~CIEPPTPX F.. FALLAT, R., LARSOS, R. K. Obstructive lung disease and aluta.-aztitmpsln deficiency gene heterozvgosity. Science 165(38963 : S9%9il. August 29, 1969. (145) ~BELLE, C. ii-`., BEWLACQUA, 3. M., RRIEGER, H. The influence of ciga- rette -make on lung clearance. An experimental approach. Archives oE Enxir.xxmental Health l`Z(5) : 58%596, Nay 1966. (1:6) L~NRZFZT, P. U., REID, D. D. Smoking, air pollution, and bronchitis in Bri-ain. Lancet l(7652) : 853-857, April 25.1970. (fL7) I-xKios. R. I;.. Ba~~rax. al. L. The familial occurrence of chronic ob- structive pulmonary disease. Annals of Internal Medicine 63(6) : lOOl-lops, December 1965. (148) LARSOS, I?. 6., BARXAN, hf. L., KIJEPPERS, F., FUDENBERC, H. H. Genetic and en\-konmental determinants of chronic obstructive pulmonary dise,e. .\nnals of Internal Medicine 72(5) : 627-632, May 1970. (149) L~~`PAI-zI, G. -4.. G~;,~xEKI, J. J., E~RIGA, R. B., CAREY, J. P. Clear- ance of hacreria by the lower respiratory tract. Science 142: X72- 1573. Den'oer 20 1963. (150) LEEX. W. L. B. z& investigation into bronchitis. Lancet 2: 762-765, Octo.ber 13, 1956. (151) LEXOE. S. \I., WONSACOTT, T. H. The prevalence of chronic respiratory disease in rhe male physicians of London, Ontario. Canadian Medical ;\ssociation Journal 102(g) : 381-385. February 28. 19'70. (152) LEUCEXE~CERGER.C., LELXHTENBEXGER, R.. ZEDRUN. W.,%AFFER, P. A correlzred histological, cl-tological, and cytochemical study of the tracheobronchial tree and lungs of mice exposed to cigarette smoke. 211 11. Varying reslwnses of major bronchi to cigaiettr smoke, absence of bronchogenic carcinoma after prolonged ezpojore, and disappearance of bronchial lesions after cessation of exposure. Cancer 13(-t) : 721- 732, July-August 1960. (153) LEIvjS, G. P.. LYLE. H., ~lILI.ER, S. Association hrtwcen elevated hepatic Xvater-soluble protein-bound cadmium levels and chronic bronchitis and/or emphysema. Lancet Z(`i631) : 1330-1333, December 29, 1969. (154) LIEBERMAN, J. Heterozygous and homozygous alpha,-antitrypsjn den- CienCy in patients with pulmonary emphysema. Sew England Journal of Medicine 281(F) : 279-284, August 7, 1969. (15.5) LIEBERMAN, J., nhTThIAN, C.. SCHNEIDER, A. S. Screening for home- zygous and heterozygous alpha,-antitrypsin deficiency. Protein eiec- trophoresis on cellulose acetate membranes. Journal of the Imerjcan Medical Association ZlO(11) : 20X-2060, December 15, 1969. (156) LIEBESCHUETZ, H. J. Respiratory signs and symptoms in young soldiers and their relationship to smoking. Journal of the Royal Xrmy Medical Corps 105: 76-81, 1959. (157) LOWE, C. R. An association between smoking and respiratory tubercu- losis. British Xiedical Journal 2: 1081-lOS6, November 10, 1956. (158) LOGE, C. R. Chronic bronchitis and occupation, Joint meeting f;o. 1. Section of Occupational Medicine with Section of Epidemiology and Preventive Medicine. Proceedings of the Royal Society of Medicine 61(l) : 98-102, January 19F8. (159) LUK~MAN, T. Smoking in Relation to Coronary Heart Disease and Lung Function in Tlvins. A Co-twin Study. Acta Medica Scandinavica 180 (Supplement 455) : 1966.75 pp. (160) M~DERXOTT, M., COLLIXS, M. hl. Acute effects of smoking on lung air- ways resistance in normal and bronchitic subjects. Thorax 20: 562- 569, 1965. (161) XARTT, J. >I. Pulmonary diffusing capacity in cigarette smokers. An- nals of Internal Medicine 56(l) : 39-45, January 1962. (162) bfaslN, F., i%~ASIN, hI. Frequencies of alveolar cells in concentrated sputum specimens related to cytologic classes. Acta Cytologica lO(5) : 362-367, September-October 1966. (~6s) MEGAHED.G.E.,SENNA,G. &EISSA, M. H., SALEH, S.Z., EISSA,H. A. Smoking versus infection as the aetiology of bronchial mucous gland hyperttophy in chronic bronchitis. Thorax 22 (3) : 2'71-278, May 1967. (16.4) NENDENHALL, W. L., SIIREEVX, K. E. The effect of cigarette smoke on the tracheal cilia. (Abstract) 28th Annual Meeting, April 21-24, 1937, hiemphis, Tennessee. The Scientific Proceedjngs of the American%- ciety for Pharmacology and Experimental Therapeutics, Inc. Journal of Pharmacology and Experimental Therapeutics 60: 111-112, 1937. (165) XILLER, D., BOXDURANT, S. Effects of cigarette smoke on the surface characteristics of lung extracts. American Review of Respiratory Diseases 85(5) : 692-696, May 1962. (166) &fILLm, .7. AI., SPROULE, B. J. Acute effects of inhalation of cigarette smoke on mechanical properties of the lungs. American Review Of Respiratory Diseases 94 (5) : 721-726, November 1966. (167) ~IELS, C. A. Tobacco smoking: Some hints of its biologic hazards. Ohio State Medjcal Journal 46(12) : 1165-1170, December 1359. (168) MITCHELL, R. S., WEBB. N. C., FILLEY, G. F. Chronic obstructive bron- chopulmonary disease. III. Factors influencing prognosis. American Revjew of Respiratory Diseases 89(6) : 87%896, June 1964. 212 (169) (170) (171) (172) (173) (174) (175) (176) (177) (178) (179) fl80) (I8I) (182) (18J) (184) (185) I\IITCHELL, R. S., SILX-ERS, C. W., DART. G. .I.. I'ETTY, 'JZ. I,.. \'ISCENT, T. N., RYAN, S. F., FILLEY, C. F. Clinical 2nd morphologic m-r&- tions in chronic ainvay obstruct:on. .\merican Review Of Respiratory Diseases 97(l) : 54-61, January 1368. h~ORIYA&,, I. >I., D~wsm, T. R., K.as~ifL, IV. B. Evaluation of diag- nostic information supporting medical certification of deaths from cardiovascular disease. In: Haenszel, W. (Editor). Epidemioiogicai Approaches to the Study of Cancer and Other Chronic Diseases. Bethesda, U.S. Public Health Service, h'ational Cancer Institute >IOn- ograph No. 19, January 1966. pp. 405-419. ~IOP.K, T. A Comparative Study of Respiratory Disease in England and Wales and Norway. Acta Medica Scsndinavica 172 (Supphmentum 384), 1962. 100 pp. ~IoKros, X. Postoperative hyporaemia. Medical Journal of Australia Z(7) : 341-342, August 16, 1969. MORTON, H. J. V. Tobacco smoking and pulmonary complications after operation. Lancet 1: 368-3'70, &larch 18.1944. MOTL~, H. L., KUZMAN, 1%`. J. Cigarette smoke. Its effect on pulmonary function measurements. California Medicine 88 (3) : 211-220, March 1958. MYRVIK, Q. N., Ev~ss, D. G. lrretabolic and immunologic activities of alveolar macrophages. Archives of Environmental Health l-1 (1) : 92- 96, January 1967. NALIEL, J. A., COXROE, J. H., JR. Acute erTects of inhalation of cigarette smoke on airway conductance. Journal of Applied Physiology 16: `i13- 716, 1961. XANDI, hf., JICK. H., SLOXE, D., SHAPIRO, S., LEWIS, G. P. Cadmium con- tent of cigarettes. Lancet Z(7634) : 1329-1330, December 20, 1369. OSWALD, N. C., NEDIEL, V. C. Chronic bronchitis; the effect of cigarette- smoking. Lancet 2: 843-844. October 22, 1955. PALECEK, F., AVIADO, D. XI. Pulmonary effects of tobacco and related sub- stances. II. Comparative eliects of cigarette smoke, nicotine, and his- tamine on the anesthetized cat. Archives of Environmental Health 15 (2) : 194-203, August 1967. PaEcKK, F., OSKOUI, RI., AVIADO, D. 11. Pulmonary effects of tobacco and related substances. III. Inhibition of synthesis of histamine in various species. Archives of Environmental Health 15(2) : 2044213, August 1967. PARNELL, J. L., ANDERSON, D. 0.. KINNIS. C. Cigarette smoking and respiratory infections in a class of student nurses. New England Journal of Medicine 274 (8) : 979-984, May 5, 1966. Pmms, J. XI.. FERRIS, B. G., JR. Smoking, pulmonary functions and respiratory symptoms in a college-age group. American Review of Respiratory Diseases 95 (5) : 774-782, May 1967. mm, J. .\I., FERRIS, B. G., JR. Smoking and morbidity in a college-age group. American Review of Respiratory Diseases 95(5) : `783-789, Ilay 1967. mK-WN,`D. I., LONERCAN, L. H., HAKDIKCE, M. G. Smoking and pul- monary function. Archives of Environmental Health 16(2) : 215-218, February 1968. PHILLIPS, A. &I., PHILLIPS, R. \I'., TKOMPSON, J. L. Chronic cough. Analysis of etiologic factors in a survey of 1.274 men. Annals of in- ternal hledicine 45(2) : 216231, August 1956. 213 (1~6) PIPER, D. W. Respiratory complications in the postoperative period. Scottish 3Ie;lical Journal 3(5) : 193-198, Jlay 1938. (187) PRAIT, S. ;\., FISI.EY, T. h'., SMITK, >I. If., LADXAN. -4. J. X comparison of alveolar macrophngcs and pulmonary surfactant (?) obtained from the lungs of human ~mokcrs and nonsmokers by endobronchial lava@- Anatomical Record 163(4) : 497-508, April 1969. (18s) RAKIEXEN, N., RXKIETEN, ,?I. L., FELDMAN, D., BOYKIN, &I. J., JR. Mam- malian ciliated respiratory epithelium. Studies with particular refer- ence to effects of menthol, nicotine, and smoke of mentholated and nonmentholated cigarettes. A.hI.A. Archives of Otolarpngology 56: 494-503, 1942. (189) RANKIN, J., GEE., J. B., CHOSY, L. W. The influence of age and smoking on pulmonary diffusing capacity in healthy subjects. &Iedicina Thora- cnlis 22(3) : 366374, 1965. (190) RANKIN, J. G., HALE, G. S., WILKINSON, P., O'Dxy, D. 31.. SANTAMARIA, J. N., BAI~ARCZY, G. Relationship between smoking and pulmonary dis- ease in alcoholism. Medical Journal Jf Australia l(14) : 730-733, April 5, 1969. (191) READ, J., SELEY. T. Tobacco smoking and ventilatory function of the lungs. British $IedicaI Journal 2: 1104-1108, October 28, 1961. (192) RE~OTSKIE, N.. CANNEL, W., GOLDSMITH, J. R., DATER. T. R. Pul- monary function in a community sample. American Review of Respi- ratory Diseases 86(G) : 907-911. December 1962. (193) RIXIKCTON, J. Chronic bronchitis, smoking and social class. A study among working people in the towns of Mid and East Cheshire. British Journal of Diseases of the Chest 63 (4) : 193-205, 1969. (134) ROBERTSON, D. G., WARRELL, D. A., NEWTON-HOwEs, J. S., FLETCHER, C. M. Bronchial reactivity to cigarette and cigar smoke. British &red- ical Journal 3(X&5) : 269-271, August 2,1969. (195) ROQ~E, A. L., PICKREN, J. W. Enzymatic changes in fluorescent alveolar macrophages of the lungs of cigarette smokers. Acta Cytologica 12 (6) : 420-429. November-December 1968. (196) ROSENKRANTZ, H., ESSEX, H. J., SPRAGUE, R. Lung hydroxyproline lev- els in mice exposed to cigarette smoke. Life Sciences 8(11, Part 1) : 571-576, June 1, 1969. (197) ROSENKRANTZ, H., SPRAGUE, R. Biochemical screen to investigate whole smoke and vapor phase effects in mice. Archives of Environmental Health lS(6) : 917-924, June 1969. (198) ROSS, J. C., LEY, G. D., KRUMHOLZ, R. A., RAHBARI, H. A technique for evaluation of gas mixing in the lung: Studies in cigarette smokers and nonsmokers. American Review of Respiratory Diseases 95@): 447-453, March 196'7. (199) SAMIASEK, hl., AVIADO, D. M. Bronehopulmonary effects of tobacco and related substances. II. Bronchial art&al injections of nicotine and histamine. Archives of Environmental Health ll(2) : 152-159, Au- gust 1965. (200) SAMANEK, M., A~IADO, D. M. Bronchopulmonary effects of tobacco and related substances. IV. Bronchial vascular and bronchomotor re- sponses; their suggested defense function. Archives of Environmental Health 11(Z) : 167-176, August 1965. (201) SAMAXEK, M., AVIADO, D. RI. Cardiopulmonary effects of tobacco and related substances. III. Pulmonary vascular effects of cigarette smoke and nicotine. Archives of Environmental Health 12(6) : 71'7-724, June 1966. 214 (20) SA~IANEK, M., X~IAD~, D. >I., PESKIS. G. W. B~OIK~O~U~IIIOII~~~ cff~ts of tobacco and related substances. III. Axon reflexes elicited from the visceral pleura. Archives of En\-ironmental Health 11(2) : 160-166, August 1965. (203) SCARPELLI, E. JI. The Surfactant System of the Lung. Philadelphia, Lea & Febiger, 196% 269 pp. (004) SCIIOETTLIX, C. E. The health effect of air pollution on elderly males. American Review of Respiratory Diseases 86(6) : S78-897, December 1962. (205) .%a~, J. R., ~YI\IIAWADEKM, 51. S., DEsHh~uKH, P. A., PIILJTAXE, P. N. Institutional survey of pulmonary tuberculosis with special reference to smoking habits. Indian Journal of Medical Sciences 13(5) : 381- 392, nxay 1959. (PO6) SHORT, J. J., JOHNSON, H. J., LEY, H. A., JR. The effects of tobacco smoking on health. A study of 2,031 medical records. Journal of Laboratory and Clinical Xedicine 24: 586-589, 1939. (207) SIMONSSON, B. Effect of cigarette smoking on the forced expiratory flow rate. American Review of Respiratory Diseases 85: 534-539, 1962, (208) SLUIS-CREMER, G. K., SICHEL, H. S. Ventilatory functions in males in n Wit-watersrand town. Comparison between smokers and nonsmokers. American Review of Respiratory Diseases 98(2) : 229-239, August 1968. (209) SLUIS-CREMER. G. K., ~VALTEHS, L. G., SICHEL, H. S. Chronic bronchitis in miners and nonminers: An epidemiological survey of a community in the gold-mining area in the Transvaal. British Journal of Indus- rial Medicine 24(l) : l-12, January 1967. (~10) SLIITII, J. P., SXIITH, J. C., ~ICCAIL, A. J. Chronic poisoning from cad- mium fume. Journal of Pathology and Bacteriology SO: 287-296, 1960. (211) SPURCASA, A., EHRLICH, R., PETZOLD, R. Effect of cigarette smoke on resistance to respiratory infection. Archives of Environmental Health 16(3) : 385-391, March 1968. (212) S~,X?;EXU. D. C.. TECULESCU, D. B., PACU~URU, R., GAVKILESCU, N. Chronic effect of smoking upon pulmonary distribution of ventilation in healthy males. Respiration 25 (6) : 497-504, 1968. (219) STERLIXC, G. 11. >Iechanism of bronchoconstriction caused by cigarette smoking. British Medical Journal 3: 275-277, July 29, 1967. (~14) STRIEDER, D. J., MIJRPIIY, R., KAZEMI, H. Mechanism of postural hy- poxemia in asymptomatic smokers. American Review of Respiratory Diseases 99(5) : 760-766, BIsy 1969. (215) TALAMO, R. C., ALLEN, J. I)., KAHAN, >I. G., AUSTEN, K. F. Hereditary alpha,.antitrypsin deficiency. New England Journal of Medicine 278 (7) : 345-351, February 15, 1968. (216) TARKOFF, hl. P., KUEFPEXS, F., hIILLER, W. F. Pulmonary emphysema and alpha,.antitrypsin deficiency. American Journal of Medicine 45 (2) : 220-228, August 1968. (217) TIIURLBECK, W. XI.. HENDERSON. J. A., FRASER, R. G., BATES, D. V Chronic obstructive lung disease. A comparison between clinical roent- genotogic, functional and morphologic criteria in chronic bronchitis, emphysema, asthma and bronchiectasis. Medicine 49(Z) : 81-145. March 1970. (zfe) TOKIJHATA, G. K., DESSAUER. P.. PENDERGRASS, E. P., HART&TAN, T., DIGON, E., ;~IILLER, W. Pneumoconiosis among anthracite coal miners jr, Pennsylvania. American Journal of Public Health and the Nation's Health 60(3) : 441-451, March 1970. 215 (219) U.S. PUnLtc HEALTS~ SERVICE. The Health Consequences of Smoking. 1968 Supplement to the 1367 Public Health Re\-iew. \Vashington. U.S. Department of Health, Edl;cntion. and Welfare. Public Health Service Publication So. 1696. 1968. lli pp. (220) U.S. PUBLIC HEALTH SEI~~ICE.~'~TIO-;,~LCESTER FOR HEXLT~I STATISTICS. Cigarette smoking and health characteristics, United States, July 1964June 1965. Washington, U.S. Department of Health, Education, and Welfare, Vital and Health Statistics Series 10, No. 34, Public Health Service Publication No. 1000, >Iay 1967. 61 pp. (221) U.S.PUBLIC HEALTH SERVICE.NAT:ONALCESTEKFOR HEALTH STATISTICS. Vital Statistics of the United States-1967. 1'01. II-Xortality-, Part A. Washington, U.S. Department of Health, Education, and Welfare, Public Health Service Publication, 1969. (22) U.S. PC`BLIC HEALTH SERVICE.NATIONALCESTERF~RHEALTH STATISTICS. Vital Statistics Rates in the United States 1940-1960. Washington, U.S. Department of Health, Education and IVelfare, Public Health Service Publication No. 16'77, 1368. 881 pp. (223) U.S. PUBLIC HEALTH SERVICE. Smoking and Health. Report of the Ad- visory Committee to the Surgeon General of the Public Health Serv- ice. Washington, U.S. Department of Health, Education, and Welfare, Public Health Service Publication No. 1103, 196-l. 387 pp. (2,O:) WEBB, W. R., COOK, W. A., LANIUS, J. W., SHAIT, R. R. Cigarette smoke and surfactant. American Review of Respiratory Diseases 95(Z) : 244-247, February 196'7. (225) WEIR, J. BI., DUNN, J. E., JR. Smoking and mortality: A prospective study. Cancer 25(l) : 105-112, January 1970. (226) WELCH, 31. H., REINECKE, M. E., HAhfAlAxsTEN, J. F., GUENTER, C. A. Antitrq-psin deficiency in pulmonary disease: The significance of in- termediate levels. Annals of Internal Medicine 71(3) : 533-542, Sep- tember 1969. (397) WICKEN, A. J. Environmental and personal factors in lung cancer and bronchitis mortality in Northern Ireland, 1960-62. Tobacco Research Coucil, Research Paper No. 9, 1966. 84 pp. (128) WIGIITMAN, J. A, K. A prospective survey of the incidence of postopera- tive pulmonary complications. British Journal of Surgery 55 (2) : 85- 91, February 1968. (229) WIKLANDER, O., NORLIN, U. Effect of physiotherapy on post-operative pulmonary complications: A clinical and roentgenographic study of 200 cases. Acta Chirurgica Scandinavica 112: 246-254, 1957. (290) WILHELMSEN, L. Effects on bronchopulmonary symptoms, ventilation, lung mechanics of abstinence from tobacco smoking. Scandinavian Journal of Respiratory Diseases 48(3/4) : 407414, 1967. (231) WILHELM~EN, L., OH&%, I., TIBBLIN, G. Decrease in ventilatiry capacity between ages of 59 and 54 in representative sample of Swedish men. British Medical Journal 3 (5670) : 553-556, September 6, 1969. (232) WILSON, R. H., MEADOR. R. S., JAY, B. E., HIGGINS. E. The pulmonary pathologic physiology of persons who smoke cigarettes. New England Journal of Medicine 262(19) : 956961, hIaY 12. 1960. (2s~) WINKELSTEIN, W., KANTOR, S. Respiratory symptoms and air PolIution in an urban population of Northeastern United States. Archives of Environmental Health 18(5) : 76&777, bfay 1969. (234) WOOLCOCK, A.J.. VINCENT, N. J., MACKLEM, P. T. Frequency depend- ence of compliance as a test for obstruction in the small airways. Journal of Clinical Investigation 48: 1097-1105, 1969. 216 2.75) WYNDER, E. L., GOODVAS, I). A., HOFFMAN.S, D. Cllintoxic components in cigarette smoke. Ii. Carboxy!;c acids znd nldehydes. Cancer 18(4) : 505-509, April 1965. :L'36) WYNDER, E. L., KAISER. II. E., GOODMAN, II. A., HOFFIIXNP;, D. A method for determining cili,st,tic components in cigarette smoke. Cancer 16 (9) : 122-1225. September 1963. (257) WYNDER, E. L., KAUFMAN, P. L., LESSER, R. L. A short-term follow-up study on ex-cigarette smokers. With special emphasis on persistent cough and weight gain. American Review of Resp~ratury Diseases `S(4) : 645-655, October 1967. (5s) WYNDER, E. I,., LEMON. F. R., MAKTEL, N. Epidemiology of persistent cough. American Review of Respiratory Diseases 91(5) : 679-700, hlay 1365. (~39) YEAGEK, H.. JR. Alveolar ~~11s: Depressant effect of cigarette smoke on protein synthesis. Proceedings of the Society for Experimental Bi- ology and Medicine 131(l) : 247-250, May 1969. (-040) &MEL, N., YOUSSEF, H. H., hIhE, F. J. Airway resistance and peak expiratory flow-rate in smokers and nonsmokers. Lancet 1: 1237-1238. June 8, 1963. (z$z) Zwr, S., GOLDMAX, H. I., LEVIN, A. Cigarette smoking 2nd pulmonary function in healthy young adults. American Review of Respiratory Dis- eases 89(l) : 73-81, January 1964. 217 RRONCHOPTJLMONARY APPENDIX TABLES 219 TABLE AZ.-,Smoliing and c/Lronic obslrrrctiua pttlwonar~ discase su'ttptonls'-percolt prevalence (Numbcn in garcnthcwe rcprcscnt tolnl number of individusl in yatiiculnr smoking group) Shl = Smokera. NS = Nanamokcra. EX ; Ex-amokere. Author, ycllr, countl-Y, Nutt$rO;nd Drcnlhl~~snns Cowh Sputum production or dyspnea Chest illncssses Other Commenle rcfcrcnce DoPUhtiOn ____ Short 2,031 male and NS I... 1.6 (496) NS ,, .ID.O C.hril illnrssra Oswnld 3,602 male nnd Chronic Bronchilir Chronic and 2.2*12 femnle nfh brrducLllln. PhilliDe 1.274 mnle NS `2.0 (461) et al., fnctor~ workcn sm . ..Gl.O (823) 1966. wiLhout overt U.S.A. pulmonary (185). dircnsc or hcnrt failure. Higgins 301 male nnd Ccmoh and spufum Chronic Bronchilia 1957, 280 ffmnle hfolcs Malea `41&l Malts Enslnnd i-oral dwellers NS . ,, 7.1 (28) NS..........7.1 NS . . . ..I... a.6 NS I,,.... 3.6 (II?). 26-74 yeDrS of SM . ,. ,. 63.9 (222) 531 ..I. . . . ...19.8 Shl . . . . . . . . . 17.1 Sbf , ., I.. 9.9 we. FtWU21.24 Ft??7l~fGJ FO7I&# FL-?Mlt-, NS ., ,, 4.6 (176) NS .,I. . . . ...21.6 NS . 9.7 NS . ,, . ., 3.4 sm ,... 17.2 (93) sm . , . 9.1 Shf .a . . ..16.1 Shl . . . . 8.6 k r T,\nr.~ A2.-Smokhg and chronic obstructive pulmonary, disease sl/jliptotlis +m+xnt pcvalence (coral.) (Numbers in pnrcnthcvrs rcyrescnt tatnl number of individunl~ in vnrticular smoking nroUV) Sbl = Smokers. NS = Nunsmokers. EX = Ex.amokrra. and 92 frmnlcs Cochran. randomly chosen 1958. (members of an England agricullurel (114). commur*itu.) Edwards 1,131 male out- et al.. ImticntY on 1959. lists of Ennlnod lmlcral prnc- (74). titionera >60 YCPci of DBF. Cammrnta Couoh and sputum NS .,... . . . . ...33.3 NS I..,. 0.0 hlalca NS (6) S!d . . . . . . . . . ...29.3 SH 16.0 NS . . . . . . . 0.0 Sbf ., ..24.0 (151 FtWIalW Femdcs SM . . . 6.7 NS ., ,, 3.1 (G4) NS . . . . . ...46.3 NS . 10.9 FCrntllC# Shl .I ,I 3.0 (20) SH ..,.., .20.0 Shf ..I 10.0 NS . ,,,, .` 0.0 S.M ,,....I 6.0 Chronic bronchilir NS .,, ,, 1C.6 (151) Cigarette8 29.1 (778) l-9 . ...23.4 (236) lo-19 . ...31.2 (361) >20 . . . . . 33.7 (176) Pipe . . . 18.6 (340) - Flick 222 mnle NS . . . . . . . 10.0 (61) NS ..,,,.... 26.0 (49) NS . . 30.0 (47) and pntitnts not sm ,. ,. ..66.0 (167) Sbl ,, ..66.0 (1.66) SM . . . 60.0(138) Pnton, auffvrina from 1359. avert rnnlio- U.S.A. D\lllilOnF.~y (86). dincnac. ZO..OO r*rnofopc. Hiuuina 716 maln In Couoh and c~ulutn Chronic bronchitis et al., VR?/OUI SM ,. ., ., ,. 7.1 (86) NS . ,. . . . . .a.., 0.4 NS s I. . . 7.1 SM , ,,.., 14.3 106D. OCCUD~UO~~ NS ,. ., ,. 36.0 (1176) SM ,, ,, ,, ,. ,, .24.9 SM .a .a 20.2 NS . . . . . . 3.b England 26-64 yc(~rc, (IIS). of age. -- Liebnchuetr,l47 male NS ,. ,, ,. 0.0 (621 lC59, soldiers Shi ,. ., ,. 13.0 (83) Elsland 20-30 years tl.76). of ogc. - -- Ashford 4.014 male Et al., Rcnpiraloru ayrn~,lomr Rwpirntov coal workers. NS . . . . . . 103 (677) symplumn- lQC\. EX . ,. ,. 19.6 ,England (123) "bronchitis and/or (11). Cignrcttes 21 1 (1,604) Pipe only 36.1 (202) uthmn". Nu Cizarcttn duua 1.<,1>,- 3 and DIDC 37.1 (90) tionslaip AIlShI 21.7 (3,210 f"Ul-ld. t4 TAllI E A2.- .Ytt~okin~~ 117rtf chrouic obstricclilrc prtlt~lcr?rcrrl~ tliucccw .ul/~Jr/J~o~~lY'-- td ],c:rcclll /murlfcm: (CWll.) IP (N\,,,,~,Q~ ,n ,,nrcnthws rrprcucnt t,,tuI n,,n\l~cr of l,~dlvldunl~ in ~nrtlcufnr amokinv k!:ro'JD) SM z= Slnok~rr. NS ~1 Nunanwkvra. 1,:~ := Ex.smokurs. Author, YPUi-. NumLcrnnd Urcnthlc~sncas country. type uf Cough Sputum prduction 01 dyapnea Chest illnesses Other Comment.9 rrfcrrncc nnpulntion -______- -- Dnwcr. 06 malt nnd NS . . . . . . . . 4.1 (49) NS .,. . . ...20.4 NS . . . .31.7 Cheat lllnws- 1861. 11 lcmulc Shl .#. .27.0 (76) Shl . . . . . ...34.2 Sht ,,.,.I 88.2 clllY!t COllll U S.A. bnuk om~~loycoa l'lvc, clunr 1. (19) l'inc. clgor lG.4 I'il~c.cluar duringcach 01). 40.10ycnrs 63.0 01 Ilint z of I,YV. Wlr~tPIR. - Flrtchvr nnd 3G3 mnlc I.w~don -- NS . , 8 , (80) NS ..,..,.a., 8.7 NS . . . . . . . . . .I NS . . .a. 4.S Tlukcr, trQnalwrt t-14 g./dny 16.6 (1GC) I-14 a./dny ..ZI.U 1..14 n./dny *. 8.2 1-14 n./doy lOGI, Cm[ll"Yl'L* >lS . . . ...27.0 (110) >lG . . . . . . . ..aO.D >lG . . ...*.. 8.0 8.2 Ynulnnd 40 GoYchrI >lS . ...10.7 185). 01 DPB. Read 170 malcand M&a and 132 Iernnlc NS ..,..s.. 4.4 SCIIJY. indlvldunla SM . . . . . ...23.1 1961. lntervicwed EX . . . . . ...21.2 Auatdlr inanoub FHlt.llC~ (191). Datient NS , 4.9 clinic (not SM . . . . . ...18.6 all paticntsl, BIlebum 1.461rnale NS . . . . ...10.2 (263) NS..........ll.O NS.......... 9.8 et al.. llaht SM . . . . . . ..23.3(1.108) SM ., . . . . ...30.4 SM . . . . . . . ...14.6 IDVZ. Industry 60 .,. . . ,, .29.0 PO . . . ..GO.O (24) X0 *..II... 62.0 ?`,\uLE AZ.-Slnoking and chronic obstwclil~e pulmomr~ discasc' .S~III~~O~II.S `-.-pcrcoil prcunleuce (co?it.) (Numbers In ~nrentbrsw re~resrnt tutnl number ol individunls in ~nrticular smoking aroun) SM = Smokcra. NS = Nonsrnoken. EX = Ex-smokers. Author, YCPT, Number snd nrenthlcssnns countrY, type of Cough Sputum Drduction or dyspnea Chest illness- Other Commcnte refrrencc population - Boucot 6,137 mslcs NS . . 13.0 (806) et Ill.. 1862. cnroliina SM .31,6(6.331) U.S.A. in pulmonary (36). neoplasm project. Ftrria 90 male and Chraic Nonrpccific CL &I,. 71 female Reepiralory Dbcosc llC2. Rnx mill- n1a1ca Frtlld20 .63.1(32) GO.0 (4) Fenis 642 male and Chronic Irorkchilir hgc-,prcifir and 6?5 frmnle ?lrnlCI r*tm. AlldCrWn. wnidcnts of NS . . . . . . 13.8 (126) 1962. New Iinmpshire EX . ,, ,, ..lI.O (77) U S.A. town chosen Cianrcttcs 40.3 (340) IElI. by randurn l-10 . ...218 rumpling of 11-20 . .34.2 CC"S"S. 21-30 . 4?.3 31-40 G1.1 >:I ., .SG.3 F'cnlol~, NS . 0.4 (97Lo El . 10.8 (37) Cignrcttn 19.8 (208) I-10 .13.1 II-20 ..I. 22.2 21-30 31-40 .27.3 F=: >41 .` u --