'Your body belongs to the Fuhrer' (1919-49)

"Prohibition is won, now for tobacco," proclaimed the great anti-saloon preacher Billy Sunday in 1919 (1). Within months of the war in Europe coming to an end, the US federal government passed the 18th Amendment and the sale and consumption of alcohol was banned across the nation. The temperance dream was now a reality and, for those who had spent years campaigning for it, prohibition was just the first step towards the moral regeneration of the country. The next step was to stamp out tobacco. In 1919, Frederich W. Roman published a book with the ominous title Nicotine Next and its author confirmed smokers' fears in an interview with the New York Tribune, saying: "We have been holding back our agitation during the war for patriotic reasons, but now that the war is over we intend to push it vigorously."(2) 'Nicotine Next' was soon adopted by the WCTU as their pithy, post-war slogan and Clarence True Wilson, leader of the Anti-Saloon League, urged anti-tobacconists to "strike while the iron is hot."(3)

For a time a total nationwide ban on tobacco seemed within reach. Gaston's Anti-Cigarette League set up eight new chapters and in 1919 changed its name once again, this time to the Anti-Cigarette League of the World. Gaston petitioned the Food and Drug Administration (FDA) to reclassify cigarettes as a 'habit forming drug'. The federal government increased tax on cigarettes by 50%, a policy the tobacco industry blamed on "professional reformers and honest lunatics."(4) Across the country companies refused to employ smokers, the YMCA resumed its anti-smoking stance, and Charles Pease of the Nonsmokers' Protective League announced that "we shall launch our campaign for legislation that will prohibit the growth, importation and sale of tobacco." (5)

Anti-smoking groups believed they could start from where they had left off before the war but they failed to appreciate how much the public's attitude to cigarettes had changed in the intervening years. They had banished alcohol and they expected to banish tobacco. But alcohol had never been described as "indispensable" by the supreme commander of the US armed forces. Tobacco had. While the federal government busy was outlawing booze, Nebraska, Tennessee and Oklahoma were quietly repealing their bans on cigarette sales. Wisconsin and South Dakota had already done likewise. Of the thirteen states that had banned cigarettes in their entirety only four had their bans in place by the end of 1919. At least 22 other states contemplated legislation but decided against it. In 1921 alone, no fewer than 92 anti-smoking measures were being considered in 28 states but very few of them ever made it into law and those which did focused on the relatively uncontroversial issue of juvenile smoking.

The tobacco industry set up the Tobacco Merchants Association to fight the anti-smoking lobby and it was joined by grass-roots organisations, for the anti-smokers did not have a monopoly on lobbying groups. Anti-Prohibitionists set up the Allied Tobacco League of America in 1919 and New Yorkers formed Smokers Against Tobacco Prohibition. In Utah, the Freeman's League argued that the state's tobacco ban was illiberal, ill conceived and bad for the economy; the law was overturned in 1923.

The sheer number of people smoking cigarettes after the war made the anti-smokers' task a difficult one. By the reckoning of the Assistant Secretary of War, 95% of the military used tobacco in some form during World War One. Previously, cigarette smoking had been largely confined to the nation's cities. Many in middle America would not have known a cigarette smoker personally and it was easy for them to believe the worst of what was said about 'coffin nails'. The return of the troops to American shores shattered these prejudices. The Camel smoking heroes of the Western front bore little resemblance to the weak-bodied, brain-damaged, degenerate cigarette fiends of popular imagination.

With solid medical evidence against smoking thin on the ground and with many physicians stoutly defending the habit, the public began to scrutinise the anti-smokers' claims against the cigarette. The likes of Lucy Page Gaston and Henry Ford, it was pointed out, had no medical qualifications and there was little or no scientific evidence behind the multitude of allegations made against tobacco. By what authority did the WCTU label cigarettes, tea, aspirin and ginger as narcotics?

Stories of boys dropping dead after one cigarette and opium being mixed into tobacco were treated with greater scepticism once the cigarette began to transcend class boundaries. Having donated to the war-time Smoke Funds it would have been somewhat incongruous for the public to demonise tobacco and the anti-smokers could not persuade them to perform such a U-turn.

Alcohol prohibition was proving to be as unworkable as it was unpopular. Billy Sunday had welcomed in the Prohibition era, saying: "The reign of tears is over. The slums will soon be a memory. We will turn our prisons into factories and our jails into storehouses."(6) This was as woeful a prediction as any in history. Fuelled by the trade in illicit liquor, organised crime reared its head in the early 1920s and the murder rate began a steady rise that peaked in 1933, when the year the law was finally overturned. Alcohol consumption soon returned to 60-70% of pre-1919 levels, tens of thousands were killed by bad moonshine, half a million people were prosecuted for alcohol violations, respect for the law was undermined and large sections of the public became resentful of authority.

The unpopularity of Prohibition only served to stiffen opposition to further anti-cigarette measures. Many feared for the future of the country if its leaders continued to pander to the illiberal and puritanical element that appeared to be holding the whip hand. When it became clear that the reform movement would not be appeased by outlawing drink, the nation's libertarian spirit reasserted itself. Where would it stop? The New York World cautioned its readers:

"The unprotesting generation that lost its right to drink may yet lose its right to smoke, and also, if it submits gracefully, its right to walk under a full moon or sit on the grass."(7)

Reformers, police and politicians were finding that removing alcohol from the country was not as simple as getting a bill signed into law. The WCTU, anxious to protect the 18th Amendment at all costs, spent more time monitoring speak-easies than they did campaigning for further legislation. Ageing and increasingly directionless, the WCTU and the Anti-Saloon League were prepared to keep their own counsel on the smoking issue for the sake of public relations. Both groups issued statements distancing themselves from the Anti-Cigarette League and assured the public that Prohibition was not the thin end of a hefty wedge. The WCTU continued to publish F. W. Roman's Nicotine Next but diplomatically dropped the word 'next' from its title. By 1921, even Billy Sunday was assuring the public: "I have never been a crank about tobacco."

As the inherent problems of Prohibition came to the surface, the wisdom of criminalising another hugely popular vice was seriously questioned. There was also a financial aspect, and not just for tobacco farmers and their supporters on Capital Hill. Not only was there the issue of how much a ban would cost to enforce but states were faced with a deficit if they had to operate without tobacco tax revenue. This was doubly important now that alcohol could no longer be taxed. Rather than banning tobacco, politicians were increasingly inclined to raising the duty on it to make up the tax shortfall caused by alcohol prohibition.

In 1921, Iowa set the tone for the years ahead by repealing its ban on cigarettes and adding a tax of two cents a pack instead. Other states took notice and followed the centuries old practice of justifying tax rises on health or moral grounds while boosting their own finances. The WCTU came to reluctantly support this approach and in the process abandonned their pre-war view that taxing cigarettes was a recognition of their status as a legitimate product. In the 1920s the anti-smoking movement, aside from a scattering of Gastonites, focussed on raising the price of cigarettes and limiting advertising. The movement gradually dropped moral arguments and instead talked up the rights of nonsmokers.

Politicians continued to contemplate fresh anti-smoking legislation but rarely passed it into law. With the anti-tobacconists now emphasising the comfort of nonsmokers, public smoking bans were proposed in South Carolina and Minnesota in the early 1920s. The latter went the furthest, covering theatres, streetcars, railway coaches, train stations, buses, taxis, barber shops and all state-owned buildings. Although neither made it into law, Minnesota revived the bill in all its essentials half a decade later when it became the first US state to impose restrictions on smoking in public places.

The early 1920s saw Idaho and Utah bring in bans on the sale of cigarettes but, at the same time, two other states repealed their laws and the Idaho law was reversed during the same session of legislature, leaving just two states with laws prohibiting the product.

The decline of the Anti-Cigarette League

Lucy Page Gaston, meanwhile, was not for turning. In 1920, she announced her intention to run for the presidency of the United States against the 'cigarette face' William Harding and she wasted what little money she had left on this futile endeavour. Harding was elected to the White House and soon became the first sitting president to be photographed smoking a cigarette.

Gaston's unkind remarks about cigarette smokers became so vociferous, and fell so far out-of-step with mainstream opinion, that she suffered the indignity of being fired by her own organisation in 1921. In a measured statement to the press, the ACL announced that it "contented itself with spreading scientific and other information to protect the youth from forming the cigarette habit" and that its decision would "leave Miss Gaston free to carry out her more drastic and prohibitory methods."(8)

Still adored by a small retinue of dedicated abolitionists, Gaston left for the tobacco-free haven of Kansas where she joined the local Anti-Cigarette League. She lasted just two months, during which time she compared herself to Jesus Christ, before her comments were found to be too rich for Kansas and she was fired again. She retreated to her adopted city of Chicago to form the all new National Anti-Cigarette League but after six months she was, again, asked to leave.

Gaston's failure to compromise in her later years left her an isolated figure, considered by the press and even some of her erstwhile supporters to be a dogmatic zealot. Whatever else might have been said about her, she was consistent. She was calling for cigarettes to be criminalised long after others had reduced their ambitions to clamping down on underage smoking. She wrote strongly worded letters to such well-known smokers as Queen Mary and President Harding and she was virtually penniless in January 1924 when she was run over by a street-car after attending an anti-smoking meeting. Aged 64, she was sufficiently robust to survive this ordeal only to succumb, somewhat ironically for someone who never drank or smoked, to throat cancer, from which she died in late 1924.

The year Gaston died, 73 billion cigarettes were being sold into the US alone, five times the number consumed a decade earlier and more than fifty times the number sold when Gaston began her campaign against them. Three years later, Kansas became the last state to repeal its ban on cigarettes. In 1930, Outlook magazine published an article reviewing Lucy Page Gaston's life and work. It was simply entitled 'Lost Cause'.

Women smokers

The anti-smoking crusade would have collapsed entirely in the 1920s had it not been for the controversy over women smoking. It was a curious paradox that while cigarettes were branded effeminate, no respectable woman would want to be seen smoking one. In the mid to late 19th century some feminists took up smoking as a statement of equality and, by the 1890s, women who smoked were generally assumed to be anarchists, Suffragettes or prostitutes. Cigarettes were considered bad enough for men and boys. For women, with all their perceived emotional instability, delicate nervous systems and weak bodies, they were assumed to be disastrous.

That anti-tobacconists continued to garner popular support on the issue of women smoking was due, in part, to the widely held belief in the weaker constitution of the fairer sex. In 1920 the Surgeon General advised women not to smoke because, as he delicately put it, "a woman's nervous system is more highly organised than a man's."(9) The Journal of the Indiana State Medical Association said they should avoid tobacco because of "the generally recognised emotional instability of the female sex."(10)

These notions of feminine fragility were allied with more odious beliefs in Social Darwinism and eugenics. The US minister Josiah Strong made the bond between progressive reform and white supremacy explicit in his book Our Country (1885) and such theories had already inspired a programme of sterilisation in California in the 1890s. These ideas did not come from an obscure corner of political thought nor were they espoused by a small group of racist ideologues. They were a largely uncontested part of mainstream thinking, informing debate about the future of mankind in the first half of the 20th century and only came to a halt with the discovery of the death camps of Auschwitz and Belsen.

If smoking was injurious to women, the argument went, physical degradation would be passed onto their children and drag down the Anglo-Saxon race. Mrs John B. Henderson, the widow of a US Senator, campaigned vigorously against the cigarette and recommended US colleges expel female smokers in 1925 on the basis that they would "inevitably lead, sooner or later, to physical bankruptcy and race degeneracy."(11)

Dr Charles G. Pease, as we have seen, preached a similar message in New York and it was in that city that women's fight for the right to smoke came to a head*. Female New Yorkers took to cigarettes in growing numbers and there was a concerted attempt by conservatives and anti-tobacconists to nip this unwelcome trend in the bud.

In 1908, women were banned from smoking in public buildings. The Non-Smokers' Protective League applauded the ban but called for a fresh law making it an offence to smoke in the presence of women. Two attempts were made, in 1908 and 1911, to outlaw women smoking in the street. Both failed, as did similar proposals in Washington DC and Massachusetts, but the police made arrests anyway. In 1908, a 29 year old woman was jailed for a day after being caught smoking in public and, in the same year, a woman was jailed for 30 days for "endangering her children's morals" by smoking in front of them (12). In 1922, an 18 year old Brooklyn woman was charged with disorderly conduct for smoking a cigarette while with her 15 year old friend. She was acquitted on appeal but was immediately rearrested for the same incident on a charge of 'corrupting the morals of a minor.'(13) In 1912, a court acquitted a man of assaulting his wife after he smacked her in the face while trying to knock a cigarette out of her mouth. The judge recommended he spank his wife for smoking (14).

Marketing cigarettes at women was unheard of. Buck Duke was fiercely opposed to women smoking and never contemplated breaking this taboo, but his successors wondered if he might be worth the risk. Although the anti-smoking movement dwindled in this decade, the threat of a nationwide ban following the passage of the 18th Amendment was, for a time, real enough to put the tobacco industry on its best behaviour. When the threat receded in the 1920s - and with the prospect of doubling its business if cigarette use amongst women became acceptable - the tobacco companies began to aim its advertising towards this emerging market.

In 1919, Lorillard launched two brands aimed at women including Murad, a cigarette cheekily named after the brutal anti-smoking ruler of 17th century Turkey, Murad IV. Both failed to make an impact and the industry did not make another attempt to cross the gender divide until 1927 when Philip Morris re-branded Marlborough as Marlboro and gave it the slogan 'Mild as May.' One Marlboro advert from 1927 read: "Women quickly develop discerning tastes. That is why Marlboros now ride in so many limousines, attend so many bridge parties, and repose in so many handbags." Liggett & Myers came closest to breaking the taboo on showing women smoking in their advertisements in 1926 with their Chesterfield advert showing a young lady requesting her smoking gentleman friend to "Blow some my way". The following year American Tobacco went beyond invitations to be be exposed to passive smoke with a Lucky Strikes campaign which showed an emancipated woman enjoying a cigarette.

By this time, cigarette use amongst women was becoming common enough for the tobacco industry to exploit it and no company did so more effectively than American Tobacco. In 1928 it appealed to women on diets by suggesting they 'Reach for a Lucky instead of a sweet' if they wanted to 'Avoid that future shadow'. The company had its gamble repaid with a trebling in sales in just one year. The following year, American Tobacco pulled off a marketing masterstroke with a 'Freedom March' in New York City in which women dressed as the Statue of Liberty walked down Fifth Avenue holding cigarettes aloft as 'torches of freedom'. By the end of the decade a tobacco industry insider estimated that half the women in New York were smoking cigarettes, total cigarette US consumption had doubled and Lucky Strikes had overtaken Camel as the nation's favourite brand.

In Britain, where the tobacco industry faced little opposition and had no reason to fear a popular backlash, gold tipped cigarettes and scented cigars had been marketed towards women since the 1890s. Tobacco use was not uncommon amongst female factory workers whose numbers rose sharply during the war. Working for the war effort gave women a level of independence they could not have enjoyed as domestic servants and an income they would not have received as housewives. Newly liberated, female munitions workers took to cigarettes in sufficient quantities for several groups, including the Young Women's Christian Association, to register their disapproval but to little avail.

Although prejudice against women who smoked was less pronounced in Europe than in the US, it was not until the late 1920s that smoking began to lose its down-market reputation in respectable society. Thereafter, female smoking rates soared. By the time the next world war had come to an end, around 40% of women were regular, usually light, smokers.

Certain rules continued to apply to middle and upper class ladies. An etiquette book from 1933 entitled No Nice Woman Swears considered it perfectly acceptable for a lady to smoke in a car or taxi but noted that "it's still not the thing for a woman to smoke on the street."(15) A guide to good hospitality, also from 1933, indicated the dominance of the cigarette in the inter-war years, instructing that a good hostess always keeps cigarettes "to hand in every reception room whether you smoke yourself or not."(16) For many years the description of Agatha Christie, as written on the back of her hugely popular detective novels, mentioned that she was a reluctant nonsmoker. She had tried "many times" to smoke but could not enjoy it. She described this with no pride and just a little shame.

Britain's National Society of Nonsmokers spoke out against this new threat to the nation's womenfolk from its inception in 1926. Echoing the arguments about racial degeneration that were being heard in America and Germany at the same time, its newsletter Clean Air asserted that tobacco damaged the reproductive system and that even if it did not, smoking had such a negative effect on a woman's appearance that no man would want to marry her anyway. Similar rhetoric was being spouted by Charles Pease and his Nonsmokers' Protective League but neither they, nor the National Society of Nonsmokers, had more than a negligible influence on public opinion.

Cigarette smoking had become an unstoppable phenomenon among both sexes and anti-smoking as a movement was at its lowest ebb, all but completely disappearing for the next thirty years. By the time Count Corti published his History of Smoking in 1931, he was in no doubt that the anti-tobacconists were now an irrelevance, concluding that "Although the fight between smokers and nonsmokers still drags on, a glance at the statistics proves convincingly that the latter are but a feeble and ever-dwindling minority."(17)

Health fears begin to emerge

Few were aware of it, but a growing body of evidence on the dangers cigarettes posed to health was coming to light in the 1930s. Lung cancer deaths in the US rose from 0.6 per 100,000 in 1914 to 1.7 in 1925. In the UK, the rate rose from 1.0 per 100,000 in 1910 to 2.33 in 1926. Although the increase was observable to doctors who dealt with the disease, few suspected a connection with cigarettes. Little was known about lung cancer and the numbers dying of it were still small when compared to other cancers, tuberculosis or epidemics like the recent and devastating Spanish 'flu that famously killed more people than the First World War. An indication of the disease's lowly status amongst health professionals was provided by Isaac Adler, who wrote the first medical guide on lung cancer in 1911, a book that began with an apology for writing about such an obscure ailment. In 1919, a Washington University student, Alton Ochsner, was offered the rare chance to witness lung cancer surgery. He was told he would probably never get such an opportunity again and yet in 1937, in the space of 8 months, he saw another six cases. All were men and all were heavy smokers of cigarettes.

The Lancet noted in 1927 that nearly every case of lung cancer studied involved smokers. A 1928 study of 217 cancer cases in Massachussetts found that of the 35 sites-specific cancer cases (e.g. lung, lips, tongue etc.), 34 were heavy smokers. Still, after the First World War, most men were smokers and the authors found little difference in overall cancer risk between smokers and nonsmokers. The following year the American Review of Tuberculosis said there was "no definite evidence" that smoking contributed to lung cancer. But in Argentina, A.H. Roffo of the Buenos Aires Cancer Institute conducted experiments on animals and by the end of the 1930s he had concluded that cigarette tar caused tumours of the lung.

The most compelling evidence came from Germany. In 1929, Fritz Lickint showed a link between smoking and lung cancer and in 1935 said there was "no doubt" that it caused bronchial cancer too. Another German doctor, Franz Muller, wrote the pioneering 'Tobacco misuse and lung carcinoma' in 1939 and reported that 83 of the 86 lung cancer patients he studied had been smokers. Muller also found that lung cancer victims were six times more likely to be "extremely heavy smokers".

Had they been taken together, these studies would have made a compelling case against the cigarette, but these researchers were scattered throughout the world and their reports appeared without fanfare over two decades. Since the most authoritative research was carried out in Nazi Germany it was largely ignored by the rest of the world at the time and was disregarded after the Second World War. Franz Muller disappeared during the war, possibly killed in combat, and Fritz Lickint's work on lung cancer faded into obscurity even in his homeland. Those who warned of a growing public health problem were treated with scepticism thanks, in part, to their warnings being so reminiscent of discredited scare stories peddled by abolitionists in recent memory and by other fanatics in preceding centuries.

To the disgust of the temperance movement and the delight of drinkers, the 18th Amendment was repealed in 1933. As if making a concession to prohibitionism, the US government chose the same year to outlaw marijuana. Post-Prohibition America was not a fertile breeding ground for reformers wanting to dictate to people how to live their lives. Even if cigarettes posed a threat, went the popular argument, it was not of epidemic proportions, it did not outweigh the perceived benefits of smoking and it was, in any case, a calculated risk. In 1938, Scientific American told its readers that smoking damaged the body "to some extent, usually not great" but added that it was also dangerous "to climb mountains and stepladders, play football, cross the street, or merely to exist, but the risk is so small that we willingly accept it."(18) As late as 1948 the Journal of the American Medical Association was saying that "more can be said on behalf of smoking as a form of escape from tension than against it."(19)

Cigarette consumption nearly doubled again in the 1930s. In 1940, the US had 7,121 cases of lung cancer, up from 2,357 in 1930 and dramatically up from 1914 when the recorded figure was just 371. Still, few were exclusively blaming smoking for the rise and, as the tobacco industry pointed out, there was no causal relationship. Smokers were dying of lung cancer but so were nonsmokers and the vast majority of both groups remained unaffected. Perhaps the blame lay elsewhere. This was the age of the cigarette but it was also the age of X-Rays, asphalt, urban living, motor cars and better diagnosis of disease. All were considered possible culprits. In Europe, some blamed the rise in lung cancer on the influenza pandemic or the use of chemical weapons during the war.

One perfectly valid partial explanation for the rise of lung cancer - and all other forms of cancer - was that people were simply living longer. In 1900, average life expectancy was 47. The average age of lung cancer death is 71. With more people making it into their sixties, seventies and beyond, it was inevitable rates of cancer would increase, but this hardly explained why smokers were dying of lung cancer at a much faster rate than nonsmokers. For the time being, however, there was sufficient confusion for the public to give cigarettes the benefit of the doubt.

'Just what the doctor ordered'

The tobacco industry was aware of the murmurings that cigarettes might be deleterious to health and began to subtly market their products towards the more health-conscious smoker. Reluctant in the extreme to concede that their products had any seriously unpleasant side-effects, and lacking any evidence to show their brands were safer than their rivals', they resorted to pseudo-science, suggestion and euphemisms.

The most famous example was Liggett & Myers' unforgettable 'Just what the doctor ordered' slogan but Lorillard set the ball rolling with their "Not a cough in carload" campaign for Old Gold in 1925 and by 1933 Chesterfield was being marketed as "Just as pure as the water you drink". Lucky Strikes' long-running but ambiguous "It's toasted" slogan referred to the way the tobacco was heated and treated before being put in the cigarette but the unspoken message was that Luckies benefited from some unique process that effectively removed irritating and harmful elements. In reality, the process was neither unique nor effective and the Federal Trade Commission rapped American Tobacco on the wrists for misleading consumers when it investigated industry marketing practices in 1942. The commission also criticised RJ Reynolds for their claim that Camels "renew and restore bodily energy."

Philip Morris and American Tobacco brought in doctors - many of whom were themselves prolific smokers and were given cartons of smokes for their support - to back up their spurious health claims. American Tobacco told the public that '20,679 physicians say Luckies are less irritating' while Philip Morris placed an advertisement in the National Medical Journal claiming that three out of four smokers found their cough "cleared up" after switching to their brands. Philip Morris advertised their eponymous brand on the basis that it "takes the FEAR out of smoking" and lined up scientists to support the company's claim that, by substituting glycol for glycerine, their smokes caused less 'irritation' than rivals. Neither the FTC nor the magazine Consumer Reports found any evidence that this procedure made any difference in clinical trials. Consumer Reports found that, once blindfolded, smokers could find little difference between competing brands and it was particularly dismissive of "the 'scientists' whom they [Philip Morris] directly or indirectly subsidise."

In a further bid to diminish and deflect growing health fears, the tobacco industry introduced filter tips. Parliament was the first brand to carry a filter in 1931 and in 1936, Brown & Williamson introduced Viceroy, with the claim that its cellulose acetate filter removed half the particles from the smoke. This counter-offensive by the tobacco industry was more than enough to quell what little public concern there was about smoking in the 1930s. Smoking became the norm and anti-smokers were viewed as, at best, eccentric throw-backs and, at worst, deranged obsessives. Even uncomplaining nonsmokers were eyed with suspicion. Discussing the effect of tobacco on the mind, the International Journal of Psychoanalysis concluded that it caused neither psychosis nor neurosis and added: "One is more justified in looking with suspicion at the abstainer...most of the fanatic opponents of tobacco I have known were all bad neurotics."(20)

The Nazi war on smoking

By the mid-1930s, anti-smoking was a spent force as a social movement in the US and Europe. The lone exception was Nazi Germany. The German anti-smoking tradition was stronger than most. Germans had not taken to tobacco until the Thirty Years War (1618-48) and its introduction was swiftly followed by laws restricting its use. In some parts of the country, smoking was punishable by death as late as 1691. Tobacco was banned in Bavaria, Berlin, Saxony, much of Prussia and parts of Austria until the mid-19th century, whereupon it was condemned as a scourge on society, a debilitator of public health and a destroyer of families.

Germany's first modern anti-smoking organisation was the short-lived German Anti-Smoking Association for the Protection for Non-Smokers, formed in 1904, which was succeeded in 1910 by the Federation of German Tobacco Opponents. Both groups had affiliations with the temperance movement and opposed tobacco on the by-now familiar grounds that it led to drug use, wasted land, infertility, degeneracy and a whole host of medical ailments both real and imagined. In 1919, while the anti-smoking movement in the rest of the world was beginning its slide towards obscurity, Germany saw the formation of its most successful anti-smoking group. Founded in the cigarette producing capital of Dresden, the German Anti-Tobacco League flew the flag for anti-smoking in the 1920s, before National Socialism adopted it in government.

Under the Nazis, Germany embarked on an unprecedented campaign against tobacco use. Age-old prejudices against tobacco were wedded to theories of racial hygiene, eugenics, public health and Social Darwinism to become a potent political force. All these ideas had surfaced in other parts of the world in the preceding century but only in the Third Reich were they able to flourish unhindered by compassion, logic or restraint.

Lavishly funded by the state, German scientists soon forged ahead of the pack in the field of smoking and health. In 1939, Franz Muller identified tobacco use as the "single most important cause of the rising incidence of lung cancer"(21), a view that would not be shared by the worldwide scientific community for another twenty years. In the same year Fritz Lickint published Tobacco and the Organism, a book that ran to 1,100 pages and that has been described by the historian Robert Proctor as "the most comprehensive scholarly indictment of tobacco ever published."(22) Lickint is also remembered for coining the term 'passive smoking' (Passivrauchen) in 1936, a phrase with far-reaching consequences for Germany and, many years later, the rest of the world.

No profession was better represented in the Nazi party than doctors (closely followed by lawyers) and it was they who pushed the policies of preventive medicine and social engineering, with smoking an obvious target. The Reich Health Office viewed tobacco as the chief threat to public health and its leader Leonardo Conti led the crusade. Blind to irony, the Nazis branded tobacco 'the enemy of world peace'.

Beginning in 1938, laws were passed to ban smoking in public places, including air raid shelters, post offices, theatres and government buildings. Himmler banned policemen and SS officers from smoking on duty and Goering banned soldiers from smoking in the street. Smoking was banned in cars and trams in all the major cities. Schools were ordered to educate schoolchildren against smoking and the boys of the Hitler Youth were obliged to make a smoke-free pledge in the name of the Fuhrer. Tobacco taxes were raised, ostensibly to protect public health but in reality to fund the war effort and as the war escalated so too did cigarette prices. By 1941, 80% of the price of a pack of cigarettes went in tax, a rate not matched in Britain until the 1990s.

The onset of war did not slow down the anti-smoking campaign. German troops were given no more than six cigarettes a day and those who refused them were rewarded with extra food. Women serving as part of military operations were denied a tobacco ration of any kind. In 1941, advertising restrictions were brought in. Cigarette companies had their marketing strategies closely monitored by the authorities and were banned from portraying their product as sexy, healthy or harmless. Women could not be shown in advertisements nor could the tobacco industry be seen to direct their campaigns at them. The male models who did appear could not be portrayed as manly or sexually attractive. The law also made it clear that "advocates of tobacco abstinence or temperance must not be mocked."(23)

Thus shielded from mockery, the German Anti-Tobacco League demanded still tougher measures, through the pages of its journal Pure Air. Although complete abstinence was the Aryan ideal, lower yield cigarettes were recommended for those who could not or would not give up. With nicotine wrongly considered to be the carcinogenic agent in cigarettes, the Reich Institute for Tobacco Research set about developing cigarettes with low nicotine and zero nicotine levels. In 1939, a law was passed to regulate nicotine levels. The German Anti-Tobacco League sneered at these measures and responded by saying that no cigarette was safe and that smokers would adjust their smoking habits when smoking lower yield cigarettes to draw out maximum nicotine. Instead they called for tobacco advertising to be banned entirely and for still higher taxes on cigarettes. These abolitionists had no cause to worry about half-measures from the Nazi party. Hitler talked about banning tobacco completely once the war was over and more far-reaching legislation was only prevented by the destruction of the Reich.

It is tempting to view the Nazi war on smoking as a natural consequence of the pioneering work their scientists were conducting into lung cancer, abetted by a regime which put little value on the freedom of the individual. This ignores that fact that Nazi anti-smoking ideology predated the work of Muller and Lickint and it was only because Hitler was prepared to fund them so generously that they come reach their conclusions (24). However prescient their research into smoking and health may have been, it cannot adequately explain the scale of the Nazi anti-tobacco endeavour. The tail did not wag the dog. Other countries would later amass a body of evidence against tobacco that dwarfed that of the Third Reich without launching anti-smoking measures of the scale seen in Hitler's Germany. Many of those within the Nazi party did not share Hitler's hatred of smoking and some, including top officers like Goering, were prolific smokers themselves. Germany had a tradition of opposition to tobacco but there was nothing inevitable about National Socialism embracing anti-smoking policies and, like the party's fanatical anti-semitism, the Nazi war on smoking was largely a reflection of its leader's own obsessive prejudices.

Adolf Hitler smoked two packs a day as a young and aspiring artist but he was forced to give up when he ran short of money. Thereafter, he became a vehement, life-long anti-smoker. He strongly encouraged his close acquaintances to quit and rewarded those who did so with a gold watch (Goering was never able to summon enough willpower to earn his, and his girlfriend Eva Braun smoked until the end). In some speeches Hitler even attributed his success, and therefore the success of National Socialism, to the moment he threw his cigarettes in a river. One of these, from May 1942, suggested that the world would never have heard of him had he continued smoking:

"I am convinced that if I had been a smoker, I never would have been able to bear the cares and anxieties which have been a burden to me for so long. Perhaps the German people owe their salvation to that fact."

Hitler was the driving force behind the creation of the Reich's anti-smoking institutions, including the Bureau Against the Hazards of Alcohol and Tobacco and the Bureau for the Struggle against Addictive Drugs. The grandest of these was the Jena Institute for Tobacco Hazards Research. The centre cost 100,000 Recihmarks and, in 1941, while waging total war on several fronts, Hitler found time to send a telegram to those attending the its opening ceremony, saying: "Best of luck in your work to free humanity from one of its most dangerous poisons."(25) (At the same opening ceremony Professor Otto Graf proposed banning smoking from all workplaces because of the risks of passive smoking.)

The Jena Institute was run by Karl Astel, a brutal anti-Semite and eugenicist who been actively involved with the Nazi party since its earliest days and an enthusiastic supporter of euthanasia. When not plotting tobacco's downfall, he toured mental hospitals selecting patients for extermination. He sacked Jews and smokers from academic posts at the University of Jena and compiled lists of Jews to be sent to concentration camps. Under his directorship, all smokers and non-Aryans were refused employment and, like Hitler, he made plans to completely eliminate smoking once the war was concluded.

In the Nazi world-view smoking was an insidious habit that crept under the skin of the Aryan race, enslaving their minds and debilitating their bodies. In the paranoid fantasy of Nazi propaganda this could only be the work of the countless perceived enemies who lined up to undermine the German people, above all the Jews. The German Seventh-Day Adventists openly called smoking an 'un-German' habit propagated by Jews and the Nazi party shared this bizarre belief. Grinning, devilish Jewish caricatures were often portrayed on posters, and on the cover of Pure Air, showering cigarettes and pipes on helpless Germans.

Neither truth nor sanity were prerequisites for Nazi smear campaigns and the anti-tobacconists cast their net far and wide. Tobacco was viewed as fit only for blacks, gypsies and communists. One Nazi poster declared that smoking was the habit of "Jews, Africans, Indians, loose women and decadent intellectuals." The 1939 peace treaty with the USSR and the heavy-smoking Stalin posed a public relations problem that was overcome by airbrushing the pipe from his mouth in billboards celebrating the accord. When Operation Barbarossa abruptly ended the rapprochement in June 1941, anti-smokers were again free to publicise the fact that Stalin - like Churchill and Roosevelt - was a 'nicotine addict'. Hitler was always proud that his allies Mussolini and Franco were both nonsmokers.

The Nazi anti-smoking effort was part of a broader 'clean life' crusade which also attacked caffeine, meat-eating, alcohol and drugs. Organic food and high-fibre diets earned government approval. Foods containing fat or preservatives did not. Nor did anything containing stimulants. The Bureau for the Struggle Against Addictive Drugs spent much of its time attacking tobacco but it also denounced Coca-Cola, sleeping pills and morphine. This healthy living campaign was not without public support - a 1939 rally in Frankfurt held to oppose tobacco and alcohol was attended by no fewer than 15,000 people. Accompanying this obsession with health, country living and racial purity was the assault on liberal decadence, American degeneracy, jazz music, abstract art and swing-dancing. Even white bread fell under suspicion after the Nazis accused it of being a 'French revolutionary invention.'

The belief that individuals were free to do what they wanted with their bodies was considered a Marxist invention; one that undermined a strong and disciplined society. The doctrine of 'public health' disputed the notion that health was an essentially private matter and was fully embraced by a totalitarian regime which viewed it as a suitable target for state regulation. The individual could not make decisions without considering his or her part in the Reich. Citizens had a 'duty to be healthy' (Gesundheitspflicht) - to be fit for war and to be fit to breed - a concept epitomised by the contemporary slogan: "Your body belongs to the Fuhrer!"

As future mothers to the master race, women were targeted above all. Tobacco was "a genetic poison" which caused infertility and corrupted the all-important German "germ plasm." At best, it would undermine and debase future generations and, at worst, leave women unable to conceive at all. Fritz Lickint had already established that nicotine was not a carcinogen but the Nazis used the fact that the substance was present at trace levels in breast milk to support their bizarre rhetoric about 'racial poisoning'(26). After a campaign by the Federation of German Women, restaurants and cafes were prohibited from selling cigarettes to women and tobacco rations were not given to women who were under 25, over 55 or pregnant. The Anti-Tobacco League went further, demanding a ban on all sales of tobacco to women of all ages.

Hitler remained closely involved with the crusade against tobacco to the very end. He banned smoking at his Austrian base, the Wolf's Lair, and in the Fuhrerbunker in Berlin. In 1942, he voiced regret that he had ever allowed his troops a tobacco ration; a ration he would soon be forced to increase to boost morale when the war went from bad to worse. In 1943 he made it illegal for persons under the age of 18 to smoke in public places. A year later, with the Third Reich crumbling around him, Hitler personally ordered smoking to be banned on city trains and buses to protect female staff from secondhand smoke.

Throughout all this, per capita cigarette consumption continued to rise, nearly doubling between 1935 and 1940; overtaking that of heavy-smoking France in the process. Like Germany's military success, cigarette consumption peaked in 1942 and only fell when the economy collapsed in the last months of the war. By that time conditions for German troops had become so desperate that even avowed anti-smokers were sympathising with soldiers who wanted to smoke.

Hitler committed suicide in April 1945 and, after burning his body, SS troops lit cigarettes in the Fuhrerbunker for the first time. Within weeks, cigarettes had become the unofficial currency of Germany, with a value of fifty US cents each. Hitler ultimately, if inadvertently, succeeded in reducing smoking in Germany but only by bringing the country to its knees. With the post-war German economy in meltdown, per capita cigarette consumption in 1950 was lower than it had been in 1935; a reflection of nothing more than the perilous state of the nation's finances. As the country rebuilt itself, Germans were again able to buy cigarettes and by 1963 per capita consumption had more than trebled (27).

My lady nicotine

At the height of the Nazi war on tobacco the only notable anti-smoking voice in the United States was the strikingly less totalitarian Readers Digest. The onset of war had a familiar effect on smoking habits of Americans. Cigarette use doubled again during the 1940s and by the time the peace was concluded more than half of all men and a third of women were regular smokers. In Britain, four out of five men were smokers. War had once again been a boon to the cigarette companies but tobacco industry insiders were becoming increasingly uncomfortable about the effect their products were having on health. Research from John Hopkins University added to the small but growing body of evidence against cigarettes when it showed that smokers were simply not living as long as nonsmokers. This news was brought to the American public's attention to great effect by former heavy-weight champion Gene Tunney. Published in Readers Digest in 1941, his article - 'Nicotine Knockout' - was a full-blooded condemnation of tobacco as something that makes you unfit while alive and makes you die before your time. He promised he would beat current champion Joe Lewis if only Joe would start smoking.

And yet, tobacco - and specifically cigarettes - had become more popular than ever before. What was it about cigarettes that made them almost universally popular by the mid-twentieth century? The question of why people smoke is one for which the modern world has an easy, ready-made answer: They begin to smoke because of peer pressure and cigarette advertising when they are young and continue smoking because they quickly become hooked. In this analysis, nicotine does nothing for the body except keep it wanting more. By smoking cigarettes, the smoker gets back to a state of normality akin to that enjoyed every moment by the nonsmoker. Why else would smokers claim that cigarettes both give them energy and help them relax? Or help them both concentrate and unwind? Surely these contradictory claims indicate that smokers are engaging in self-delusion; they are merely satisfying a craving.

This tidy answer, beloved of anti-smokers and often used to strengthen the resolve of those trying to quit, does not tell the whole story. Physical dependence cannot explain the number of people who return to tobacco weeks, months or years after giving it up. The physical withdrawal symptoms last only a few days and most quitters are able to abstain for this period. Most of those who 'relapse' do so when there is no longer any physical reason to do so. The idea that these full-grown men and women are drawn back into the habit purely because of peer pressure or advertising will not do. Like every drug from coffee to cocaine, it provides tangible pharmacological benefits which provide pleasure whether one is trying it for the first time or whether one is a long-term user.

That cigarette addiction has a psychological element is widely known. Smoking provides a channel for 'divergent activities'. When others might doodle, touch their hair or fiddle with coins, the smoker smokes. This is of greatest use when uncomfortable or bored - smoking is often merely a way of killing time. Doodling, however, is not a worldwide phenomenon engaged in by a billion people twenty times a day and the displacement theory can therefore hardly explain the full appeal of nicotine. The pharmacological effects of nicotine have been described superbly in David Krogh's The Artificial Passion (1991) in which he shows that, although its benefits may not outweigh its hazards, it is an extraordinary drug.

Nicotine behaves like acetylcholine, a neurotransmitter which acts on a number of 'nicotinic sites' in the body. It will, for example, prompt the adrenal glands to release epinephrine, also known as adrenaline. It will also prompt the blood vessels to release norepinephrinen and increase dopamine in the brain's 'reward centres'(28). These stimulants cause the heart rate to rise and blood pressure to go up, making the smoker feel more alert. But at higher doses nicotine impedes transmission at the synapses and cause the nerve signals to become temporarily blocked, providing a feeling of relaxation. The downside comes when the nicotine is suddenly withdrawn and the nerve cells that were shut down become hyperactive, creating tension and craving. A nineteenth century anti-tobacco tract described the drug's pharmacologically addictive nature well, saying it "produces, for the time, a calm feeling of mind and body, a state of mild stupor and repose. This condition changes to one of nervous restlessness and a general feeling of muscular weakness when its habitual use is temporarily interrupted."(29)

This is the remarkable thing about nicotine. It can sedate as well as stimulate. Furthermore, smokers can easily, and often unconsciously, 'self-medicate', giving themselves the appropriate dosage for their mood and environment. Mangan and Golding carried out experiments with smokers, putting them in situations of extreme boredom and extreme tension to study their smoking habits. Those put in sensory isolation took sharper and shorter drags on their cigarettes and took fewer drags in order to achieve a stimulating effect on mind and body. Those put in rooms filled with loud white noise took bigger and more frequent drags to calm themselves (30). It has also been well-documented that not only do psychiatric patients smoke more, they draw harder on their cigarettes, literally self-medicating themselves into a state of sedation.

Dozens of studies have showed that nicotine makes smokers less aggressive than nonsmokers. Norma Heimstra, for example, took 20 smokers who weren't allowed to smoke, 20 who were and 20 nonsmokers and had them drive a car for six hours straight. In all cases concentration levels fell and tiredness increased but it was nonsmokers who became most aggressive and their levels of 'social warmth' fell more quickly than that of the smokers. Perhaps surprisingly, the smokers who were not allowed to smoke did not become any more aggressive or irritable than the other smokers (31).

Another experiment showed the calming effect of nicotine. In 1984, D. R. Cherek performed an experiment in which volunteers were given three buttons to press. One button accumulated money from the bank, one took money from other volunteers and the third assaulted fellow volunteers with white noise. Those who smoked during the sessions were less likely to take money from others and more likely to accumulate money from the bank and those smoking high nicotine cigarettes took even less money from the other volunteers than the other smokers.

In the pantheon of drugs, nicotine is unusual because, unlike other sedatives and tranquillisers, it induces neither docility nor slow-wittedness. Nor does it create a 'high' like opium or marijuana and because of the subconscious self-medication, even heavy smokers will not 'overdose' or become overwhelmed by its effects. Nicotine use does not lead to hallucinations, paranoia, apathy, violence, hangovers or insanity. As Bismarck once said of his cigar: "It acts as a mild sedative without in any way impairing our mental faculties."(32) Like coffee, it is a mild drug that can be used throughout the day without intoxicating. This is a point often overlooked by those who argue that since psychedelic and narcotic drugs are banned, then tobacco - which is more harmful to health and more addictive - should also be made illegal. This ignores the fact that such drugs are banned not because they kill those who take them (they rarely do) but because their mind-bending properties make it difficult for their users to lead a productive and organised life and can lead to mental illness.

Far from unbalancing the mind, nicotine can help it focus. It causes electroencephalograph arousal; that is, it arouses and stimulates the brain. Experiments have shown that it is especially useful in maintaining concentration and alleviating boredom during tedious and repetitive tasks. As Dr Johnson noted: "It preserves the mind from total vacuity."(33) Nicotine helps filter out external stimuli and allows the smoker to focus on a single task better than a nonsmoker and for longer. This does not mean that nicotine gives a smoker superior concentration skills over a nonsmoker initially, but after several hours the smoker will remain focussed while the nonsmoker's mind will begin to wander or become tired (34). But when deprived of nicotine for over eight hours brainwaves will slow (35) and performance levels and reaction times will fall (36) (37).

The writer Richard Kluger regarded such findings only as proof that "smokers remain attentive during the performance of long, boringly repetitive tasks." Such tasks became the work of millions in the age of Henry Ford and may explain why smoking remains far more popular with the working class than with those with more cerebrally challenging jobs even though such workers are least able to afford it.

Just as nicotine contrarily provides energy and slumber, it offers concentration and dreaminess. While it does not have sufficient psychoactive power to be called mind-altering in the 1960s sense of the word, it can provide a five minute respite from reality without sacrificing lucidity. As one woman said, when asked why she smoked: "Do you want the honest answer? I smoke because it provides a sort of stopgap between myself and life. While I smoke I am not quite in the moment...It's a subtle, constant, consistent, reliable break from life."(38)

When an anti-tobacco reformer appealed to a professor to give up his plug habit in the nineteenth century he was told "I chew a little, if I did not, I should be as fat as a pig"(39) and nicotine's role in aiding weight-loss is no illusion. On average, smokers weigh seven pounds less than nonsmokers and, as Krogh says, the "weight disparity between smokers and nonsmokers increases with age."(40) Despite smokers tending to have a poorer diet than nonsmokers, they are significantly less likely to become obese (41). Contrary to popular belief, this is not because cigarettes are an appetite suppressant or because ex-smokers overeat to compensate when they give up. Smokers and nonsmokers eat roughly the same amount but tobacco reduces the desire for sweet foods and increases the metabolic rate, particularly during exercise (42).

Why do some people smoke when others do not? "Why," as Tolstoy once asked, "do gamblers almost all smoke? Why among women do those who lead a regular life smoke least? Why do prostitutes and madmen all smoke?"(43) Unsurprisingly, smokers tend to be risk-takers and they are more likely to believe in fate and luck. Studies show they are more impulsive, more rebellious, have a higher sex drive and are less concerned about what people think of them. With the exception of pipe-smokers, who are generally quieter, they tend to be outgoing and are much more likely to be extroverts. A very high number of high achievers, artists and geniuses have smoked.

Before smokers get too smug, let us also remember that smokers are also statistically more likely to be poor, badly educated, drinkers and jailbirds. Smokers are more likely to have suffered depression and are twice as likely to commit suicide. One study showed that 60% of heavy smokers had a history of depression (44). The vast majority of schizophrenics smoke and more than half of psychiatric patients and homeless people smoke.

Above all, if you smoke cigarettes you will die, on average, seven years before your nonsmoking friends. The key difference between cigarettes and other forms of smoking is that the tobacco in cigarettes is cured in a way that makes it acidic while pipe and cigar smoke are alkaline. And because the mouth is acidic, the alkaline cigar smoke allows nicotine to be absorbed through the gums while being too harsh to be readily inhaled. The lungs, however, are alkaline and the (acidic) cigarette smoke is able to be absorbed by them, allowing nicotine to go almost instantly into the blood stream and to reach the brain within seconds. This provides all the pleasures and benefits of smoking listed above at a heightened level and accelerated pace and explains the phenomenal popularity of cigarettes by the 1940s, But, as scientists of the time were beginning to suspect, this process poses a serious risk to health. It allows carcinogenic components in the smoke to make contact with the delicate lining of the lungs and bronchial tubes and makes the development of cancer in these areas more likely.

In 1914, America's lung cancer rate was 0.6 per 100,000 people. By 1950 it was 13 per 100,000 and had risen by fivefold since 1938; only stomach cancer was more common. Privately, the tobacco industry was coming to terms with the fact that their products were killing people.

Copyright: Christopher J. Snowdon 2007-09