Abstract
The etiology of thrombo-angiitis obliterans is unknown. The current theories as to the cause are specific infections, endocrine disturbances, toxic factors, such as ergotism and tobacco. Thus far there is no decisive evidence in favor of specific infection. The role of tobacco has been stressed by Buerger, Erb, Meyer, L. F. Barker, Silbert and others. Statistically Barker has shown that the excessive use of tobacco is much more common in patients with thromboangiitis than in a control group of similar ages. The disease has been reported in individuals who do not use any tobacco. In the large experience of Silbert, however, no typical instances of thrombo-angiitis obliterans have ever been observed in non-smokery. Silbert has noted clinically that cessation in the use of tobacco has often definitely arrested the progress of the disease. While it is a fact that patients suffering from thrombo-angiitis are almost universally excessive smokers, it is also true that many equally extensive users of tobacco never develop thrombo-angiitis obliterans. If, therefore, tobacco plays an etiologic role, the question arises why this agent should affect one group of individuals, and not all others.
It occurred to one of us (J. H.) to investigate this problem from the point of view of specific hypersensitiveness to tobacco. Typical cases of thrombo-angiitis observed for a number of years in the Thrombo-angiitis Clinic were selected for investigation. This report gives the results obtained in 68 cases of thrombo-angiitis varying between the ages of 24 and 56, and 122 controls. All the control cases were males addicted to the use of tobacco, 47 healthy college students between the ages of 16 and 21, and 75 adults, chiefly Russian Jews, between the ages of 26 and 68.
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