Tobacco in Europe

Among American Indians, from Canada to Brazil, tobacco was widely smoked for its intoxicating ef­fects, as a medicinal, and for ceremonial pinposes. The spread of tobacco use from the New World gave rise to the first great drug controversy of global dimensions.

Yet the popularity of tobacco in England was chal­lenged by James I, who became monarch of the Brit­ish Isles after the death of Queen Elizabeth in 1603. His ^uCounterblaste to Tobacco,” published anony­mously in 1604 and considered extreme and rather quaint during intervening centuries, can now be ap­preciated as somewhat prescient:

And now good countrey men let us (I pray you) consider, what honour or policie can move us to imitate the barba­rous and beastly manners of the wild, godlesse, and slavish Indians, especially in so vile and stinking a coustome?... A custome Iothesome to the eye, hateful to the nose, harm­full to the braine, dangerous to the lungs, and in the black stinking fume thereof neerest resembling the horrible stigian smoke of the pit that is bottomless. (Quoted in Austin 1978)

The following year he organized, at Oxford, the first public debate on the effects of tobacco, at which - to get his point across - he displayed black brains and black viscera allegedly obtained from the bodies of smokers. To discourage tobacco sales and use, James I increased the tax thereupon 40-fold; but when use and smuggling increased, he reduced the tax in 1608 to one shilling per pound of tobacco and sold the monopoly right to collect it. With the estab­lishment in 1607 of his namesake colony on the James River in Virginia and on the initiative of John Rolfe, tobacco quickly became its principal crop and export.

' An outbreak of plague in London in 1614 gave further impetus to smoking, in that doctors declared that steady smokers were not as subject to infection as others and recommended tobacco as a disinfec­tant. At that time, 7,000 shops were selling tobacco in London, with use spreading among the poor de­spite high prices. By 1615 tobacco imports had risen to such an extent that James revoked his 1608 mo­nopoly grant and reassigned it at a higher price. In 1620 he ordered that all tobacco bear the govern­ment seal, and in 1624 he decreed that only Virginia tobacco be imported. Thus, despite the high costs and discomfort of smoking, chewing, and snuffing and despite intense repressive actions of such sover­eigns as KingJames I of England, King Christian IV of Denmark, Tsar Michael Romanov of Russia, and Sultan Murad of Turkey, tobacco continued to in­crease in popularity.

Snuffing Cancer

Among the lower classes, pipe smoking was the com­mon method of tobacco consumption; among the Eu­ropean upper classes during the 1700s, pipe smoking was largely supplanted by snuffing (the practice of sniffing tobacco dust). Within a few decades the wide­spread practice of snuffing generated the first clini­cal reports of cancer caused by tobacco - cancer of the nasal passages, as described by an English physi­cian, John Hill, in 1761:

This unfortunate gentleman, after a long and immoderate use of snuff, perceived that he breathed with difficulty through one of his nostrils; the complaint gradually encreased ’till he perceived a swelling within.... It grew slowly, till in the end, it filled up the whole nostril, and swelled the nose so as to obstruct the breathing... he found it necessary to then apply for assistance. The swell­ing was quite black and it adhered by a broad base, so that it was impossible to attempt to the getting it away... and the consequences was the discharge of a thick sharp hu­mor with dreadful pain, and all the frightful symptoms of cancer...

Also in 1761, the Italian anatomist Giovanni Battista Morgagni described lung cancer at postmor­tem without identifying its cause. A few years later, in 1775, Percival Pott described a scrotal cancer epi­demic among London chimney sweeps, documenting the carcinogenicity of chimney smoke, which should have alerted many to the pathogenic implications of chronic exposure of respiratory tissues to tobacco smoke.

Although tobacco-induced lung cancer must have produced many thousands of deaths from the six­teenth to the nineteenth century, all such progres­sive chest diseases were lumped under the rubric of phthisis or consumption until the late-nineteenth- century scientific advances of histology, bacteriol­ogy, and X-ray. At that time, because of the often obvious relationships between snuffing and nasal cancer, pipe smoking and lip cancer, tobacco chewing and cancer of the mouth, cigar smoking and cancer of the mouth and larynx, there was a growing real­ization that tobacco use produced cancers of directly exposed topical tissues.

Nineteenth-Century Wars and Tobaccosis

British soldiers returning from campaigns on the Ibe­rian Peninsula during the years 1808-14 introduced cigarettes to England. Likewise, veterans returning from the Crimean War (1853-6) increased cigarette smoking in Britain - a practice soon brought to the United States by returning tourists, including New York society women.

During the U.S. Civil War (1861-5) the use of all kinds of tobacco, including that of cigarettes, in­creased, and after the war tobacco factories mush­roomed. By 1880, with a population of 50 million people, the United States consumed 1.3 billion ciga­rettes annually, 500 million made locally and the rest imported. Nonetheless, chewing tobacco — a U.S. concoction of tobacco and molasses - remained the leading form of tobacco in the United States through­out the nineteenth century. Along with a great in­crease in tobacco consumption during the nineteenth century came increasing reports of tobaccosis, espe­cially cancers of directly exposed tissues.

In 1851, for example, James Paget saw a patient with leukoplakia (“smoker’s patch”) on the tongue where he always rested the end of his pipe, and “told him he certainly would have cancer of the tongue if he went on smoking” (quoted in Whelan 1984). And in 1857 Lancet commented:

Tobacco... acts by causing consumption, haemoptysis and inflammatory condition of the mucous membrane of the larynx, trachea and branchae, ulceration of the lar­ynx; short, irritable cough, hurried breathing. The circu­lating organs are affected by irritable heart circulation. (Quoted in Whelan 1984)

In 1859 a French physician reported a remarkably thorough study of 68 cases of cancer of the oral cavity in a French hospital. Ascertaining the habits of 67 of these patients, he found that 66 smoked tobacco and the other chewed tobacco. He also noted that cancer of the lip ordinarily occurred at the spot where the pipe or cigar was held.

In 1882 the Boston Medical and Surgical Journal offered this prescient view of cigarettes:

The dangers, then, which are incident to cigarette smok­ing are, first, the early age at which it is taken up; second, the liability to excess; and, third, the bad custom of inhal­ing the smoke. These are dangers super-added to those attendant upon the ordinary use of tobacco, and should be considered by all medical men.

Despite such examples, however, leading physi­cians of the late nineteenth century were generally oblivious to the hazards of tobacco. In the monumen­tally detailed Medical and Surgical History of the War of the Rebellion, prepared under the direction of Surgeon General of the Army Joseph K. Barnes by J. J. Woodward and colleagues and published in six huge volumes from 1875 to 1888 under the author­ity of the U.S. Congress, there are only two com­ments about tobacco: that tobacco clyster may be used for the treatment of zymotic disease and that abuse of tobacco may cause “irritable heart.” Nor was tobaccosis frequently mentioned by John Shaw Billings, founder of the Index Medicus, the National Library of Medicine, and author of voluminous analyses of late-nineteenth-century U.S.

With the advent of cigarette-making machines, which made possible the nearly unlimited produc­tion of cigarettes, and portable “safety” matches (in­troduced at the turn of the century), which enabled smokers to light up whenever and wherever they wished, the stage was set for a vast increase in cigarette consumption. However, as tobacco compa­nies intensified promotional activities, a powerful antitobacco movement developed, led by Lucy Page Gaston and the Women’s Christian Temperance Movement, which substantially curbed cigarette sales during the 1890s and early 1900s.