Art and Photography of Cigarette Smoking

An Advert in Toronto Newspaper 1977
Cigars are not as carcinogenic as cigarettes probably due to the fact that cigar smoke is not usually inhaled.  In the early 1900’s cigar smoking  was associated with elegance and currently portrays a sense of  bravado as demonstrated in this image.
Courtesy Ashley Davidoff MD 13021g
Smoking in Two Puff Harmony
From the series “People of Israel”
Ashley Davidoff MD
Generation Gap Enjoying a Cigarette Together
From the series “People of Israel”
Ashley Davidoff MD
Empty Promises
Collage of cigarette advertisements of the early 20th century revealing a portrayal of elegance, feminism, and manhood. The advertising campaigns worked well for the cigarette companies but had a dismal result on health.  The third image from the left in the top row shows a physician who states that “Luckies are less irritating”
The world war brought free cigarettes to the soldiers from the tobacco companies. The effect on the soldiers and the culture was a devastating rise in carcinoma 20 years after the event, with peaks in the incidence of carcinoma in the 1940’s and then in the 1960’s.
54458 code historical
Ashley Davidoff MD
By products of Nicotine
Polycyclic Aromatic Hydrocarbons (PAH’s) are by products of nicotine and are flat compounds that are similar to benzene in structure. Liver enzymes oxidize the PAH’s making their incorporation into DNA possible. The change in DNA structure leads to interference in function and a predisposition to carcinogenesis.
Image modified by Ashley Davidoff MD. 54460 The
Smog Filled Alveolus
An alveolus subjected day and night for 20 years to black smog from a human chimney. It had no choice but to react.
Courtesy Ashley Davidoff MD. 32166f
The acinus with its arborizations is shaped more like a bunch of grapes.
Courtesy of: Ashley Davidoff, M.D 42650
Normal Acinus and Emphysema
Image on the left shows normal size and appearance of terminal bronchioles and alveoli. On the right the image shows the effects on the respiratory bronchioles and when severe, on the alveoli as well
Ashley Davidoff MD
The Cause and the Effect in one Image
The CT scan through the chest of an 80 year old male shows a large lung mass in the posterior aspect of the right upper lobe (overlaid in green) and3 small nodules in the left upper lobe (overlaid in green). The patient is obviously a smoker and the incriminating pack of cigarettes is identified in his right shirt pocket containing 9 cigarettes. The lung cancer was shown to be an adenocarcinoma The pathology of the nodules may either represent metastatic disease or multicentric foci of bronchioloalveolar cell carcinoma. Associated finding of a thinned anterior junction line suggests hyperinflation and emphysema, and the thickened bronchial walls noted in the right lung suggest chronic bronchitis. Saber shaped trachea is also reminiscent of emphysema. The patient is emaciated, a finding that relates both to his chronic lung disease and his cancer.
Ashley Davidoff MD  87831c01b.8s
Langerhans Dendritic Macrophage
Ashley Davidoff MD
Langerhans Cell Histiocytosis
Langerhans Cell is a dendritic white cell with a wavy nucleus that creates granulomas and infiltrates the interstitium. It thus causes spiculated nodules that appear as spiculated nodules on CT
Ashley Davidoff
Anatomy of the Distal Airways in Color and in the Black and White of Radiology
The subsegmental medium sized airways give rise to the terminal bronchiole (tb) which gives rise to the membranous airways. These include in order, the respiratory bronchiole (rb), alveolar duct (ad) and alveolar sac (as)
Ashley Davidoff

Smokers Macrophage
Light brown granules in the macrophage is characteristic of the smokers macrophage
Ashley Davidoff
The Alveolus –
The Buck Ends Here
The alveolus is lined by a simple epithelium – one cell layer thick. There are two types of lining cells; Type 1 pneumocytes are squamous cells that cover 90% of the surface of the inner lining of the lung , and type II cuboidal pneumocytes that are in fact much more numerous than Type I. They are involved in the production of surfactant . In the lumen there are resident macrophages which play a crucial role in the immune system. The mucosa is grounded by a basement membrane and a lamina propria, and connected to the lamina propria and basement membrane of the surrounding capillary. The alveolus is lined by a thin layer of surfactant. (teal blue)
Ashley Davidoff
Pathophysiology of Cigarette Smoking on Medium Sized Airways, Small Airways and Alveoli
Ashley Davidoff
Pathophysiology of Cigarette Smoking on Medium Sized Airways
Inhaled smoke contains between 2000-4000 toxic substances. The cancer producing properties are well known. The smoke causes inflammation of the medium sized airways resulting in activation of the resident macrophage in the lumen of the airway, hyperemia of the mucosa, activation of the neutrophils, monocytes, nonresident macrophages, and fibroblasts. Cytokines are released which also induce the secretion of proteases and elastases among many others. Structurally there is destruction of the cilia, hypersecretion of mucus, hypertrophy of the muscularis and mild fibrosis. These findings are the hallmark of chronic bronchitis
Ashley Davidoff
Membranous airways (respiratory bronchiole, alveolar ducts, alveolar sacs)
At the level of the membranous airways the effect is predominantly related to the loss of elasticity, and aberrant accumulation of smoking related macrophages.
The weakening and destruction results in emphysema and the abnormal accumulation of smoking related macrophages relates to DIP
Ashley Davidoff
Smoking and the Alveolus –
The effect of the proteases and and elastases cause destruction of the alveoli and loss of elasticity, and therefore overall function. The destruction leads to bullous disease
The accumulation of smokers macrophage, and in the case of Langerhans cell histiocytosis leads to space occupation of the alveoli also reducing function
Ashley Davidoff
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