One of the best reads I have enjoyed this year is Robert Proctor’s, The Nazi War on Cancer, Princeton University Press, Princeton, 1999. It s the provocative story of how valuable science and public policy thrived under an anti-democratic, despicable regime.
I had been scouting around in the area of the early history of the anti-smoking movement – an entertaining diversion - and noticed, in an article by pioneering cancer researcher Sir Richard Doll, reference to a number of scientific papers published in German prior to the really famous papers published in Britain and the US in 1950. It turns out that there is a substantial literature on this German effort. With respect to smoking, and the ‘healthy living’ movement generally, fascism in Germany ended up being intertwined with science – Nazism took root in a powerful scientific culture and exploited it.
Researchers in pre-war Germany made many major health (and other) discoveries. The Third Reich involved discovery of television, jet aircraft, guided missiles, computers, electron microscopes, atomic fission and data processing. It also involved industrial murder factories and racial research. Germany was the centre of the world in many areas of science.
The Germans had long been particularly strong in the area of cancer research. In the 1830s Mϋller identified tumors as being composed of cells and Virchow in the 1860s developed a theory of cancer as caused by ‘local irritations’. The Germans were among the first to recognise the role of hormones in carcinogenesis. In the 1870s they had showed that skin cancers could be caused by coal tar distillates and that uranium mining could cause lung cancer. In 1895 they identified that aniline dye caused bladder cancer and in 1911 showed that lung cancer could also be induced by chromate manufacture. In 1984 they showed that skin cancer could be caused by exposure to the sun. In 1902 they were the first to diagnose an x-ray induced cancer and showed in 1906, using animal experiments, that x-rays could cause leukaemia. In 1907 they were the first to suggest that indoor radon might prove to be a health hazard – radon is identified as a cause of lung cancer in the home today.
For a time the language of international cancer research was German. In the 10 years after 1933 more than 1,000 medical doctoral theses explored cancer. This interest reflected, in part, the fact that Germany was a prosperous industrialised country where such issues were inevitably important and where labour unions and socialist parties emphasised occupational health issues. Moreover, Germany was experiencing rapidly increasing cancer rates in the 1920sThe fascists hopped onto this health research bandwagon. German cancer institutions became ‘Nazified’ and Jewish cancer researchers were persecuted. The Fϋhrer even suggested that Nazism might never have been established in Germany had he not given up smoking!
The Nazis forced through many progressive reforms such as checking women for early signs of uterine cancer and, in 1936, encouraging self-examination for breast cancer – campaigns did not develop along these lines in America for 20 years. Men were also encouraged to be regularly checked for cancer of the colon.
On issues other than smoking they formulated public health campaigns that would today also be seen as progressive. They stressed the importance of preservative-free diets and argued against the use of petrochemical dyes. They stressed the value of whole-grain breads and foods high in vitamins and fibre. They understood that asbestos, x-rays and radon caused cancers.
Generally, the Germans were very aware of health hazards in the workforce.
My main interests are in smoking and this is dealt with in the longest chapter of Proctor’s book. The main startling fact is that German work on the connection between smoking and cancer predated the major English language research (the papers by Levin, Doll/Hill and Wynder/Graham, published in 1950) by more than a decade. It was in Germany in the late 1930s that the addictive character of cigarettes was first recognised and the connection with lung cancer recognised. Indeed in the late 1930s the Nazis launched the world’s most aggressive anti-smoking campaign with public health campaigns, bans on certain forms of advertising and restrictions on smoking in many public places.
These discoveries were driven partly by Nazism with its ethics of racial hygiene and bodily purity. Good science was pursued in the interests of antidemocratic ideals.
Cigarettes had not even been produced in Germany until 1860 though it grew massively after 1900 to peak in 1942. The shift from pipes and cigars is of major consequence – as Henner Hess nicely put it we are talking about a ‘a revolutionary development in the history of drug consumption, roughly comparable to the invention of the hypodermic needle for opiate addiction’ (cited in Proctor, p. 183). Cigarettes got tars and other noxious chemicals into bronchial passageways.
The physician Fritz Lickint wrote a number of papers beginning in 1920 pointing out the connection between smoking and cancer and a monumental survey on smoking and cancer in 1939. He pointed to the fact that women then had much lower cancer rates because they then smoked much less. He identified nicotine as an addictive agent in tobacco comparable in its addictiveness to morphine and identified clearly the dangers of passive smoking. By 1940,anti-smoking activists even initiated much more recent compensation arguments by arguing the low-nicotine cigarettes might cause smokers to increase their smoking to maintain nicotine levels (Proctor p. 202). Lickint was not a Nazi but was heavily involved in Nazi tobacco policies.
In the early 1940s German physicians were aware that smoking caused heart disease and accurately observed that smoking reduced female fertility.
Roffo of Argentina (who published in German) had shown by 1930 that tars derived from cigarette smoking could induce cancer in experimental animals. He shifted the emphasis away from nicotine toward tars as the guilty party. Lickint by 1935 suggested nicotine was probably not a carcinogen and that benzpyrene was the cause (it is a certain carcinogen). He and a number of others had confirmed that most lung cancer sufferers were smokers.
In 1939 the ‘forgotten father of experimental epidemiology’ Franz Mϋller, and in 1943 Eberhard Schairer and Erich SchÖniger published the most sophisticated proofs to date that smoking caused lung cancer. The 1943 paper is particularly interesting as it would never have been published without the intervention of Hitler in the anti-tobacco movement.
The Mϋller study was a scientific epidemiological piece that compared cancer outcomes among smokers to outcomes among non-smokers. His findings were stronger and more accurate than the subsequent English language studies – smoking was the single most important cause of the rising smoking epidemic. Mϋller was a Nazi although his pioneering study was free of Nazi rhetoric.
The Schairer/ SchÖniger work was done at University of Jena under arch-Nazi Karl Astel who suicided in April 1945. It was a very careful statistical study of the connection between cancer and smoking. These investigators were Nazis.
The Nazi political groups reacted to these messages with a strong anti-tobacco campaign.
Smoking was banned in many workplaces and ‘no-smoking’ cars were established on trains. Smoking was banned in air raid shelters during the war. Various restrictions on cigarette advertising were introduced. Tobacco use was rationed and, although cigarettes were provided to German troops, they were very restricted.
The Nazis hated smoking because it damaged the survival potential of the German race. There was particular emphasis on women and girls not smoking – they were seen as more vulnerable to smoking and had a reproductive role. Hitler hated smoking but public health was a primary concern.
Germany also had not been through the US prohibition experience and was more likely to pay attention to anti-smoking messages than to ignore them as the ravings of Puritanism.
Proctor’s book has inevitably been misinterpreted to justify the labelling of those opposed to smoking and those supporting improved public health as ‘health fascists’. That is nonsense – smoking does cause 80-90% of all First World lung cancers and this is not altered by the fact that Nazi-era scientists were the first to point it out. Elements of this fallacious view are contained in the otherwise excellent review of this book by Pierre Lemieux – Proctor did retaliate. It is a stupid argument but I will be surprised if someone does not evoke it in response to this post.