In spite of the fact that a large number of men today do not smoke, more and more frequently every clinician has a patient who smokes too much. The accuracy with which he investigates these cases depends somewhat on his personal use of tobacco, and therefore his leniency toward a fellow user. Perhaps the percentage of young boys who smoke excessively is larger than the percentage of men. Whether or not the term "excessive" should be applied to any particular amount of tobacco consumed depends entirely on the person. What may be only a large amount for one person may be an excessive amount for another, and even one cigar a day may be too much for a person is as much for him as five or more cigars for another. If one is to judge by the internal revenue report it will appear that, in spite of the public school instruction as to the physiologic action of tobacco and its harm, and in spite of the antitobacco leagues, the consumption of tobacco is enormously on the increase. Alexander Lambert [Footnote: Lambert, Alexander: Med. Rec., New York, Feb. 13, 1915] in studying periodic drinkers and alcoholics, finds that most patients are suffering from chronic tobacco poisoning, and if they stop their smoking, their drinking sometimes ceases automatically. Howat [Footnote: Howat: Am. Jour. Physiol., February, 1916.] has shown that nicotin causes serious disturbances of the reflexes of the skin of frogs. Edmunds and Smith [Footnote: Edmunds and Smith: Jour. Lab. and Clin. Med., February, 1916.] of Ann Arbor find that the livers of dogs have some power of destroying nicotin, but their studies did not show how tolerance to large doses of nicotin is acquired. Neuhof [Footnote: Neuhof, Selian: Sino-Auricular Block Due to Tobacco Poisoning, Arch. Int. Med., May, 1916, p. 659.] describes a case of sino-auricular heart block due to tobacco poisoning. Intermittent claudication has been noted from the overuse of tobacco, as well as cramps in the muscles and of the legs. A long series of investigations of the action of tobacco on high school boys and students of colleges seems to show that the age of graduation of smokers is older than that of nonsmokers, and that smokers require disciplinary measures more frequently than nonsmokers. Some years ago investigation was made by Torrence, of the Illinois State Reformatory, in which there were 278 boys between the ages of 10 and 15 years. Ninety-two percent of these boys had the habit of smoking cigaretes, and 85 percent were classed as cigarete fiends. The most important action of nicotin is on the circulation. Except during the stage when the person is becoming used to the tobacco habit, in which stage the heart is weakened and the vasomotor pressure lowered by his nausea and prostration, the blood pressure is almost always raised during the period of smoking.