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The patient was referred to a tobacco cessation society for tailored advice and counseling

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, in its "Metropolitan News" for 11 April 1863, reported the death of a forty-eight year old Italian confectioner as a result of what his medical advisor claimed was "excessive smoking" which had "unquestionably produced disease or nervous paralysis of the heart." The Duke of Wellington was strongly opposed to smoking and as a result of the growth of cigar smoking, particularly among military officers, he asked that The Illustrated London News Such discussions were, in the main, the province of the middle and upper classes

Bragg, Geo