Fig. 1.4
Cigaretteadvertisementseemingtoindicatephysician’sapproval [23]
.PhilipMorris Co.advertiseswithfourarticlesfortheirproducts
Fig. 1.5
Exampleofthe tobaccoindustry’scovertyet
obviousadvertisingtargeted atyoungpeople
Fig. 1.6
Thetobacco industrydidnotevenshy
awayfromusingmacabre methodstoadvertiseits
products,asillustratedby thiscigarettepack.Insertfor
theabovecigarettebrand
asprestigiousasthatofchewingtobaccoorthecigar.Cigarswerethoughtofasmaledomain. In1904,aNewYorkwomanwasarrestedforsmokingandsimultaneouslydrivinghercar
[29] .
AftertheFirstWorldWar,cigarettesalsobecameincreasinglypopularwithwomen.The dancerLolaMontezandthewriterGeorgeSandmaybecitedasprominentexamplesof
womenwhosmoked.IntheUSA,thehabitwasobservedmainlyamongwell-to-dowomen, especiallyinNewYork.Thecigarettebrandsoftheday,suchasHerbedelaReine,were
aimedmainlyatafemaleclientele.TheLondontobaccohousePhilipMorrisdevelopedacork tipforthecigarette,andadvertisedthismodiiedcigaretteforwomen.However,sincethese
cigaretteswererolledbyhand,theyweretooexpensivetocapturebroadsegmentsofthe market. This situation changed again when it became customary for women also to take
employmentand,astheybecameincreasinglyemancipated,tosmokeinpublic.TheUSirm AmericanTobaccoproducedLuckyStrike,whichbecamethebestsellingcigarettebrand.
Usingtestimonialsfromfemalecelebrities,suchastheaviatrixAmeliaEarhart,sloganslike “Tokeepaslenderigure–reachforaLuckyinsteadofasweet”,orendorsementsfromilm
stars Constance Talmadge and Jean Harlow, who appeared from 1929 onwards smoking LuckyStrikecigarettesinpublic,advertisementsforcigarettesmokingweresystematically
targetedatwomen.Eveninthosedays,advertisingusedslogansextollingthevirtuesofmild smoking:“Easieronyourthroat”,“IpreferLuckies,andsodoesmydaughter”,“Foryour
digestion–smokeCamel”or“Camelsneverjangleyournerves” [2,30]
.Initsadvertising,the Chesterieldcompanydirectedthefollowingsloganatolderwomen:“Tohelpthecountry,I
thinkI’lltryone”. Withtheseadvertisingpractices,theUScigaretteindustrysucceededinthe1930sand
1940sinstylisingthecigaretteasanintegralpartoflife.DuringtheFirstWorldWar,the USGeneralPershinghadstated:“Tobaccoisasindispensabletothesoldiersasthedaily
rationoffood” [31]
andPresidentRooseveltlaterdeclaredthecigarettetobejustas essentialasfood.SmokingwasaconspicuouslycommonfeatureincountlessHollywood
moviese.g.HumphreyBogartandhisfemaleco-stars.MarleneDietrichandGretaGarbo werefurtherprimeexamplesforthisadvertisingcampaignwhichinluencedcountless
womentobecomesmokers [32]
. TheSecondWorldWarbroughtafurtherboostforthecigaretteindustryasuniformed
womenintheAlliedForcesjoinedmalesoldiersinsmokingeitherCamelorChesterield. Cigaretteconsumptionduringthisperiodquadrupledworldwide.Thewomen,liketheir
malecounterparts,werepermittedtosmokeinpublic.Inaddition,thisperiodsawthe arrivalofking-sizeandmentholatedcigarettescreatedespeciallyforwomen.Whenthe
irststudiesonthelungcancer-producingpropertiesofcigaretteswerepublished,thecel- lulosemouthpiecewasintroducedinthe1950swiththeadvertisingslogans“Purewhite,
wonderful” or “Just what the doctor ordered”, alongside arguments from the cigarette industryrefutingthelinkbetweensmokingandlungcancer.In1961inEnglandilterciga-
retteswerealreadybeingboughtbysome33offemalesmokersbutbyonly17ofmale smokers.Inthe1970s,thepurchaseofiltercigarettesbybothsexeshadrisento90in
thehopethatthiswouldsidesteptheriskofcancer.Thedevelopmentof“light”cigarettes withareducedtaryield,andthereforeconsidered“morehealthy”,mayberegardedasa
miscalculationonthepartofthecigaretteindustryforthesmoker [33]
.Whatthecigarette industrydidachievebythisdevelopmentwastoensurethat,by1990,47ofwomenaged
between29and41intheUSAhadbecomesmokers.
1.7 The Medical Use of Tobacco in the Nineteenth Century
Inthenineteenthcentury,tobaccowascultivatedformedicinalpurposesintheAlsace andthePalatinate,andwassoldintheformofextracts,powders,ointmentsandaqueous
solutions [10]
.BartholinfromCopenhagenusedtobaccoasanenemaandintothenine- teenth century tobacco preparations were occasionally prescribed as remedies for
strychninepoisoningandtetanuslockjaw.InthemonographbyMüller [34]
,tobacco anditsformulationsdecoctions,ointments,tinctures,wine,vinegar,pillswererecom-
mendedfordropsyinthelowerabdomen.Fowler [34]
claimedtohavecured18outof 31patientsthisway.However,thedosewasselectedinsuchawaythat,asfaraspos-
sible,neithersalivationnordizzinessoccurred.Otherphysiciansintheseventeenthand eighteenth centuries also used tobacco preparations for the treatment of oedema.
Nicotinepreparationswerefurtherprescribedfor“spasticdysuria”acategorywhich includedgonorrhoea.Otherauthorsfromthisperioddescribeditsusefuladministration
asaremedyforneurosesandtetanus,forstrangulatedherniasprimarilyintheformof enemasaswellasfordisordersofthelowerabdomenassociatedwithconstipation,
spasticcolitisandspasticileusinthiscaseusingtheso-calledsmokeenemas,and manyotherconditions
[34] .
Aslateas1837,aninfusionoftobaccoleaveswasrecommendedasanantidotetoarse- nicpoisoning,andthiswastestedindogs.Theeffectoftobaccopreparationwasachieved
byinducingvomitingseveralhoursafterarsenicpoisoning [34]
.Inthemid-nineteenth century, Tiedemann
[8] was credited with publishing a comprehensive monograph on
tobaccoanditshistoryfromtheearliestbeginnings.
1.8 Tobacco Research in the Twentieth Century
Inthetwentiethcentury,theintereststimulatedintobaccoresearchparalleledthespreadof cigaretteconsumptioncoupledwiththemeansforincreasedproduction,andtheidentiica-
tionoftheirstharmfuleffectsTable 1.1
.Dr.JohnHill,aLondonphysicianandbotanist, irstsuggestedarelationshipbetweenthedevelopmentofcancerandthelong-termuseof
snuff.Hemadethesecommentsin1761andreportedsixcasesof“polypusses”relatedto excessiveindulgenceintobaccosnuff.Onesuch“polypus”wasdescribedasaswellingin
onenostrilthatwashard,blackandadherentonabroadbase.Itlaterdevelopedthesymp- tomsofanopencancer
[35] .Thehugeincreaseinthenumberofmalesmokerswaspre-
cipitatedbytheFirstWorldWaranditsconsequences [7]
.Mostmenwhotookupsmoking thencontinuedwiththehabitastheywerealreadyaddicted.Schoolboysthensmokedtoa
farlesserextentthan50yearslaterFig. 1.7
.Evenatthattimetheanti-tobaccolobbywas intheminoritybecauseitwasinevitablethatitwouldlosethestruggleagainstasuper-
power. Before the outbreak of the Second World War, the Dresden internist Lickint deservedrecognitionforsummarisingwhatwasthenknownabouttobaccoanditsharmful
propertiesinacomprehensivemonographthatisstillavailable [22]
.Hewasalsooneof theirstclinicianstopublicisetheconnectionbetweensmokingandthedevelopmentof
bronchialcarcinomainhisnumerouslectures,astatethathedescribedindetailinhis book.Hisdemandsattheendofthebookforstemmingtheconsumptionoftobaccoare
understandableeventoday,withoneexceptioncultivationoflow-nicotinetobaccovariet- iesTable
1.2 .BecauseoftheSecondWorldWar,Germanresearchintothecausalrela-
tionshipbetweensmokingandthedevelopmentofbronchialcarcinoma [36–40]
couldnot besharedwiththeinternationalscientiiccommunity,andwasalsoignoredaftertheend
ofthewar.ThetextofthearticlebySchairerandSchöningerwasnotpublishedinEnglish translationuntil2001whenitappearedintheInternationalJournalofEpidemiology
[41] ,
togetherwithseveralcommentaries [42,43]
. All countries, irrespective of the prevailing form of government, “encouraged and
promotedineveryconceivablewaytheirpeople’spassionforsmokingsimplyforthe sakeofthenationalpurse”
[7] .FollowingthefailureofthebansonsmokingintheUSA
inthe1920s,withKansasthelaststatetoliftsuchprohibitionin1927,theEuropean countriesneverseriouslyconsideredsimilarregulations;intheviewofthoseinpower,
suchactionmighthaveanadverseifnotdisastrouseffectontheeconomicandpolitical situation. After the Second World War this attitude continued, with cigarettes being
rationedon“stamps”forthemanysmokersinGermanysee Chap.14
.Intheimmediate post-warperiod,theAmericansofferedaidintheformoftheMarshallPlan,butatthe
sametimetheygavetheGermans97,000tonsoftobacco [44]
–agiftwithimmense potentialforharm.
14 15
16 17
18 19
20 10
20 30
40
Frequency
Age [years] Boys
Girls
50 60
70
Fig. 1.7
Agedistribution forcigaretteconsumption
among1,058students attendinghighereducational
establishmentsdatafroma 1933survey
[22]
Banontobaccoconsumptionforyoungpeoplebelowtheageof18 Strongwarningsagainsttobaccoconsumptionbywomen
Cultivationofnicotine-freeorlow-nicotinetobaccofor“lesstoxicsmoking” Protectionofnon-smokers
Creationofcounsellingcentresfortobaccoaddictsinmajorcities Government-sponsoredinformationcampaign
Governmentsupportforthe“GermanLeaguetoCombattheDangersofTobacco”fundedby revenueraisedfromtobaccoduty
Table 1.2
Lickint’sdemandsin1939fortheregulationoftobaccoconsumption[21]