Medicine: Cloven Smokers

At 17, Tim Cislaw of Costa Mesa, Calif., seemed to have it all: suntanned good looks, natural athletic and artistic talent, and popularity. One night last March, while recovering from the flu, he took a few drags on a kretek, or clove cigarette, an Indonesian concoction of tobacco and cloves that has become popular with teen-agers across the nation. Soon he was gasping for breath, and by the next day he was in an intensive-care unit suffering from what appeared to be an unusually severe type of pneumonia. “He had cysts the size of golf balls in his lungs,” says Thoracic Surgeon Frederick Schechter, who treated him at Humana Hospital in West Anaheim. In May, despite massive doses of antibiotics and four operations, Tim Cislaw died.

Schechter has since seen two other teen-agers with dangerously inflamed lungs apparently related to kreteks. Like Cislaw, one of the victims had been suffering from a virus at the time that he smoked the cigarettes. Both eventually recovered.

The clove craze began on the West Coast around 1980. Now, says Beatrice Schwalbe, 19, a former two-pack-a-day kretek smoker from Costa Mesa, “anywhere you find a bunch of teen-agers, you’ll find clove cigarettes.” New York City Importer George Georgopulo reports that sales of the two leading brands–Jakarta and Djarum–have jumped 40% in the past year alone.

Though billed as an herbal, low-tobacco substitute for regular cigarettes, kreteks actually contain 60% tobacco and at least as much tar and nicotine as regular cigarettes. They also contain eugenol, a natural anesthetic found in cloves. Although eugenol has long been used by dentists to relieve pain, “no one knows what happens when it is burned,” says Dr. Tee Guidotti, professor of occupational medicine at the University of Alberta in Edmonton.

Guidotti, working with Schechter, suspects that eugenol–or some byproduct created when it is burned–immobilizes infection-fighting cells, allowing viruses and bacteria already present in the lungs to run amuck. The other possibilities, he says, are that eugenol or another ingredient has a direct toxic effect or that it triggers an acute allergic reaction. Last month the American Lung Association issued a preliminary warning about clove cigarettes, and the Centers for Disease Control in Atlanta plan to look for further evidence of kretek-induced illness.

Schechter thinks the CDC will find a rash of cases. Since the Los Angeles Times carried a story about Cislaw, Schechter’s office has been flooded with hundreds of calls from clove smokers complaining of shortness of breath, nosebleeds, nausea, lung infections and asthma. “About 30% to 35% said they were coughing up blood,” he says. “Emergency rooms haven’t seen a symptom like that since TB was in style.”