Women Won Over by the Cigarette

Fig. 1.4 ฀฀฀Cigarette฀advertisement฀seeming฀to฀indicate฀physician’s฀approval฀ [23] .฀Philip฀Morris฀฀ Co.฀advertises฀with฀four฀articles฀for฀their฀products Fig. 1.5 ฀฀฀Example฀of฀the฀ tobacco฀industry’s฀covert฀yet฀ obvious฀advertising฀targeted฀ at฀young฀people Fig. 1.6 ฀฀฀The฀tobacco฀ industry฀did฀not฀even฀shy฀ away฀from฀using฀macabre฀ methods฀to฀advertise฀its฀ products,฀as฀illustrated฀by฀ this฀cigarette฀pack.฀Insert฀for฀ the฀above฀cigarette฀brand as฀prestigious฀as฀that฀of฀chewing฀tobacco฀or฀the฀cigar.฀Cigars฀were฀thought฀of฀as฀male฀domain.฀ In฀1904,฀a฀New฀York฀woman฀was฀arrested฀for฀smoking฀and฀simultaneously฀driving฀her฀car฀ [29] .฀ After฀the฀First฀World฀War,฀cigarettes฀also฀became฀increasingly฀popular฀with฀women.฀The฀ dancer฀Lola฀Montez฀and฀the฀writer฀George฀Sand฀may฀be฀cited฀as฀prominent฀examples฀of฀ women฀who฀smoked.฀In฀the฀USA,฀the฀habit฀was฀observed฀mainly฀among฀well-to-do฀women,฀ especially฀in฀New฀York.฀The฀cigarette฀brands฀of฀the฀day,฀such฀as฀Herbe฀de฀la฀Reine,฀were฀ aimed฀mainly฀at฀a฀female฀clientele.฀The฀London฀tobacco฀house฀Philip฀Morris฀developed฀a฀cork฀ tip฀for฀the฀cigarette,฀and฀advertised฀this฀modiied฀cigarette฀for฀women.฀However,฀since฀these฀ cigarettes฀were฀rolled฀by฀hand,฀they฀were฀too฀expensive฀to฀capture฀broad฀segments฀of฀the฀ market.฀ This฀ situation฀ changed฀ again฀ when฀ it฀ became฀ customary฀ for฀ women฀ also฀ to฀ take฀ employment฀and,฀as฀they฀became฀increasingly฀emancipated,฀to฀smoke฀in฀public.฀The฀US฀irm฀ American฀Tobacco฀produced฀Lucky฀Strike,฀which฀became฀the฀best฀selling฀cigarette฀brand.฀ Using฀testimonials฀from฀female฀celebrities,฀such฀as฀the฀aviatrix฀Amelia฀Earhart,฀slogans฀like฀ “To฀keep฀a฀slender฀igure฀–฀reach฀for฀a฀Lucky฀instead฀of฀a฀sweet”,฀or฀endorsements฀from฀ilm฀ stars฀ Constance฀ Talmadge฀ and฀ Jean฀ Harlow,฀ who฀ appeared฀ from฀ 1929฀ onwards฀ smoking฀ Lucky฀Strike฀cigarettes฀in฀public,฀advertisements฀for฀cigarette฀smoking฀were฀systematically฀ targeted฀at฀women.฀Even฀in฀those฀days,฀advertising฀used฀slogans฀extolling฀the฀virtues฀of฀mild฀ smoking:฀“Easier฀on฀your฀throat”,฀“I฀prefer฀Luckies,฀and฀so฀does฀my฀daughter”,฀“For฀your฀ digestion฀–฀smoke฀Camel”฀or฀“Camels฀never฀jangle฀your฀nerves”฀ [2,฀30] .฀In฀its฀advertising,฀the฀ Chesterield฀company฀directed฀the฀following฀slogan฀at฀older฀women:฀“To฀help฀the฀country,฀I฀ think฀I’ll฀try฀one”. With฀these฀advertising฀practices,฀the฀US฀cigarette฀industry฀succeeded฀in฀the฀1930s฀and฀ 1940s฀in฀stylising฀the฀cigarette฀as฀an฀integral฀part฀of฀life.฀During฀the฀First฀World฀War,฀the฀ US฀General฀Pershing฀had฀stated:฀“Tobacco฀is฀as฀indispensable฀to฀the฀soldiers฀as฀the฀daily฀ ration฀of฀food”฀ [31] ฀and฀President฀Roosevelt฀later฀declared฀the฀cigarette฀to฀be฀just฀as฀ essential฀as฀food.฀Smoking฀was฀a฀conspicuously฀common฀feature฀in฀countless฀Hollywood฀ movies฀e.g.฀Humphrey฀Bogart฀and฀his฀female฀co-stars.฀Marlene฀Dietrich฀and฀Greta฀Garbo฀ were฀further฀prime฀examples฀for฀this฀advertising฀campaign฀which฀inluenced฀countless฀ women฀to฀become฀smokers฀ [32] . The฀Second฀World฀War฀brought฀a฀further฀boost฀for฀the฀cigarette฀industry฀as฀uniformed฀ women฀in฀the฀Allied฀Forces฀joined฀male฀soldiers฀in฀smoking฀either฀Camel฀or฀Chesterield.฀ Cigarette฀consumption฀during฀this฀period฀quadrupled฀worldwide.฀The฀women,฀like฀their฀ male฀counterparts,฀were฀permitted฀to฀smoke฀in฀public.฀In฀addition,฀this฀period฀saw฀the฀ arrival฀of฀king-size฀and฀mentholated฀cigarettes฀created฀especially฀for฀women.฀When฀the฀ irst฀studies฀on฀the฀lung฀cancer-producing฀properties฀of฀cigarettes฀were฀published,฀the฀cel- lulose฀mouthpiece฀was฀introduced฀in฀the฀1950s฀with฀the฀advertising฀slogans฀“Pure฀white,฀ wonderful”฀ or฀ “Just฀ what฀ the฀ doctor฀ ordered”,฀ alongside฀ arguments฀ from฀ the฀ cigarette฀ industry฀refuting฀the฀link฀between฀smoking฀and฀lung฀cancer.฀In฀1961฀in฀England฀ilter฀ciga- rettes฀were฀already฀being฀bought฀by฀some฀33฀of฀female฀smokers฀but฀by฀only฀17฀of฀male฀ smokers.฀In฀the฀1970s,฀the฀purchase฀of฀ilter฀cigarettes฀by฀both฀sexes฀had฀risen฀to฀90฀in฀ the฀hope฀that฀this฀would฀sidestep฀the฀risk฀of฀cancer.฀The฀development฀of฀“light”฀cigarettes฀ with฀a฀reduced฀tar฀yield,฀and฀therefore฀considered฀“more฀healthy”,฀may฀be฀regarded฀as฀a฀ miscalculation฀on฀the฀part฀of฀the฀cigarette฀industry฀for฀the฀smoker฀ [33] .฀What฀the฀cigarette฀ industry฀did฀achieve฀by฀this฀development฀was฀to฀ensure฀that,฀by฀1990,฀47฀of฀women฀aged฀ between฀29฀and฀41฀in฀the฀USA฀had฀become฀smokers.

1.7 The Medical Use of Tobacco in the Nineteenth Century

In฀the฀nineteenth฀century,฀tobacco฀was฀cultivated฀for฀medicinal฀purposes฀in฀the฀Alsace฀ and฀the฀Palatinate,฀and฀was฀sold฀in฀the฀form฀of฀extracts,฀powders,฀ointments฀and฀aqueous฀ solutions฀ [10] .฀Bartholin฀from฀Copenhagen฀used฀tobacco฀as฀an฀enema฀and฀into฀the฀nine- teenth฀ century฀ tobacco฀ preparations฀ were฀ occasionally฀ prescribed฀ as฀ remedies฀ for฀ strychnine฀poisoning฀and฀tetanus฀lockjaw.฀In฀the฀monograph฀by฀Müller฀ [34] ,฀tobacco฀ and฀its฀formulations฀decoctions,฀ointments,฀tinctures,฀wine,฀vinegar,฀pills฀were฀recom- mended฀for฀dropsy฀in฀the฀lower฀abdomen.฀Fowler฀ [34] ฀claimed฀to฀have฀cured฀18฀out฀of฀ 31฀patients฀this฀way.฀However,฀the฀dose฀was฀selected฀in฀such฀a฀way฀that,฀as฀far฀as฀pos- sible,฀neither฀salivation฀nor฀dizziness฀occurred.฀Other฀physicians฀in฀the฀seventeenth฀and฀ eighteenth฀ centuries฀ also฀ used฀ tobacco฀ preparations฀ for฀ the฀ treatment฀ of฀ oedema.฀ Nicotine฀preparations฀were฀further฀prescribed฀for฀“spastic฀dysuria”฀a฀category฀which฀ included฀gonorrhoea.฀Other฀authors฀from฀this฀period฀described฀its฀useful฀administration฀ as฀a฀remedy฀for฀neuroses฀and฀tetanus,฀for฀strangulated฀hernias฀primarily฀in฀the฀form฀of฀ enemas฀as฀well฀as฀for฀disorders฀of฀the฀lower฀abdomen฀associated฀with฀constipation,฀ spastic฀colitis฀and฀spastic฀ileus฀in฀this฀case฀using฀the฀so-called฀smoke฀enemas,฀and฀ many฀other฀conditions฀ [34] . As฀late฀as฀1837,฀an฀infusion฀of฀tobacco฀leaves฀was฀recommended฀as฀an฀antidote฀to฀arse- nic฀poisoning,฀and฀this฀was฀tested฀in฀dogs.฀The฀effect฀of฀tobacco฀preparation฀was฀achieved฀ by฀inducing฀vomiting฀several฀hours฀after฀arsenic฀poisoning฀ [34] .฀In฀the฀mid-nineteenth฀ century,฀ Tiedemann฀ [8] ฀ was฀ credited฀ with฀ publishing฀ a฀ comprehensive฀ monograph฀ on฀ tobacco฀and฀its฀history฀from฀the฀earliest฀beginnings.

1.8 Tobacco Research in the Twentieth Century

In฀the฀twentieth฀century,฀the฀interest฀stimulated฀in฀tobacco฀research฀paralleled฀the฀spread฀of฀ cigarette฀consumption฀coupled฀with฀the฀means฀for฀increased฀production,฀and฀the฀identiica- tion฀of฀the฀irst฀harmful฀effects฀Table฀ 1.1 .฀Dr.฀John฀Hill,฀a฀London฀physician฀and฀botanist,฀ irst฀suggested฀a฀relationship฀between฀the฀development฀of฀cancer฀and฀the฀long-term฀use฀of฀ snuff.฀He฀made฀these฀comments฀in฀1761฀and฀reported฀six฀cases฀of฀“polypusses”฀related฀to฀ excessive฀indulgence฀in฀tobacco฀snuff.฀One฀such฀“polypus”฀was฀described฀as฀a฀swelling฀in฀ one฀nostril฀that฀was฀hard,฀black฀and฀adherent฀on฀a฀broad฀base.฀It฀later฀developed฀the฀symp- toms฀of฀an฀open฀cancer฀ [35] .฀The฀huge฀increase฀in฀the฀number฀of฀male฀smokers฀was฀pre- cipitated฀by฀the฀First฀World฀War฀and฀its฀consequences฀ [7] .฀Most฀men฀who฀took฀up฀smoking฀ then฀continued฀with฀the฀habit฀as฀they฀were฀already฀addicted.฀Schoolboys฀then฀smoked฀to฀a฀ far฀lesser฀extent฀than฀50฀years฀later฀Fig.฀ 1.7 .฀Even฀at฀that฀time฀the฀anti-tobacco฀lobby฀was฀ in฀the฀minority฀because฀it฀was฀inevitable฀that฀it฀would฀lose฀the฀struggle฀against฀a฀super- power.฀ Before฀ the฀ outbreak฀ of฀ the฀ Second฀ World฀ War,฀ the฀ Dresden฀ internist฀ Lickint฀ deserved฀recognition฀for฀summarising฀what฀was฀then฀known฀about฀tobacco฀and฀its฀harmful฀ properties฀in฀a฀comprehensive฀monograph฀that฀is฀still฀available฀ [22] .฀He฀was฀also฀one฀of฀ the฀irst฀clinicians฀to฀publicise฀the฀connection฀between฀smoking฀and฀the฀development฀of฀ bronchial฀carcinoma฀in฀his฀numerous฀lectures,฀a฀state฀that฀he฀described฀in฀detail฀in฀his฀ book.฀His฀demands฀at฀the฀end฀of฀the฀book฀for฀stemming฀the฀consumption฀of฀tobacco฀are฀ understandable฀even฀today,฀with฀one฀exception฀cultivation฀of฀low-nicotine฀tobacco฀variet- ies฀Table฀ 1.2 .฀Because฀of฀the฀Second฀World฀War,฀German฀research฀into฀the฀causal฀rela- tionship฀between฀smoking฀and฀the฀development฀of฀bronchial฀carcinoma฀ [36–40] ฀could฀not฀ be฀shared฀with฀the฀international฀scientiic฀฀community,฀and฀was฀also฀ignored฀after฀the฀end฀ of฀the฀war.฀The฀text฀of฀the฀article฀by฀Schairer฀and฀Schöninger฀was฀not฀published฀in฀English฀ translation฀until฀2001฀when฀it฀appeared฀in฀the฀International฀Journal฀of฀Epidemiology฀ [41] ,฀ together฀with฀several฀commentaries฀ [42,฀43] . All฀ countries,฀ irrespective฀ of฀ the฀ prevailing฀ form฀ of฀ government,฀ “encouraged฀ and฀ promoted฀in฀every฀conceivable฀way฀their฀people’s฀passion฀for฀smoking฀simply฀for฀the฀ sake฀of฀the฀national฀purse”฀ [7] .฀Following฀the฀failure฀of฀the฀bans฀on฀smoking฀in฀the฀USA฀ in฀the฀1920s,฀with฀Kansas฀the฀last฀state฀to฀lift฀such฀prohibition฀in฀1927,฀the฀European฀ countries฀never฀seriously฀considered฀similar฀regulations;฀in฀the฀view฀of฀those฀in฀power,฀ such฀action฀might฀have฀an฀adverse฀if฀not฀disastrous฀effect฀on฀the฀economic฀and฀political฀ situation.฀ After฀ the฀ Second฀ World฀ War฀ this฀ attitude฀ continued,฀ with฀ cigarettes฀ being฀ rationed฀on฀“stamps”฀for฀the฀many฀smokers฀in฀Germany฀see฀ Chap.฀14 .฀In฀the฀immediate฀ post-war฀period,฀the฀Americans฀offered฀aid฀in฀the฀form฀of฀the฀Marshall฀Plan,฀but฀at฀the฀ same฀time฀they฀gave฀the฀Germans฀97,000฀tons฀of฀tobacco฀ [44] ฀–฀a฀gift฀with฀immense฀ potential฀for฀harm. 14 15 16 17 18 19 20 10 20 30 40 Frequency Age [years] Boys Girls 50 60 70 Fig. 1.7 ฀฀฀Age฀distribution฀ for฀cigarette฀consumption฀ among฀1,058฀students฀ attending฀higher฀educational฀ establishments฀data฀from฀a฀ 1933฀survey฀ [22] Ban฀on฀tobacco฀consumption฀for฀young฀people฀below฀the฀age฀of฀18 Strong฀warnings฀against฀tobacco฀consumption฀by฀women Cultivation฀of฀nicotine-free฀or฀low-nicotine฀tobacco฀for฀“less฀toxic฀smoking” Protection฀of฀non-smokers Creation฀of฀counselling฀centres฀for฀tobacco฀addicts฀in฀major฀cities Government-sponsored฀information฀campaign Government฀support฀for฀the฀“German฀League฀to฀Combat฀the฀Dangers฀of฀Tobacco”฀funded฀by฀ revenue฀raised฀from฀tobacco฀duty Table 1.2 ฀฀฀Lickint’s฀demands฀in฀1939฀for฀the฀regulation฀of฀tobacco฀consumption฀[21]