Doctors

From the first introduction of tobacco into European societies in the sixteenth century, physicians made public assertions about the effects of tobacco use. Some condemned it on moral and social grounds as a support to idleness and wasting money; others condemned using tobacco on general hygienic grounds. By the early nineteenth century, physicians were reporting cases in which very young children died from tobacco emulsions administered as a medical treatment. Some physicians claimed that tobacco use caused or at least exacerbated specific diseases, particularly respiratory afflictions and dental conditions.

At the same time, for centuries physicians tended to use tobacco themselves in the same ways and in the same proportions as the rest of the adult population—a fact that undercut their authority when they advised patients or the public not to smoke or chew.

Hygienic enthusiasts, including the famous Seventh-Day Adventist physician John Harvey Kellogg, gained ground in the opening years of the twentieth century. On the basis of physiological tests (conducted mostly on college students), they could show that smoking affected heart and lung and possibly nervous system performance on a temporary basis. In addition, as disease entities became more exact in medical thinking, physicians used clinical impressions to assert that specific circulatory and eye disorders as well as oral lesions could be blamed on smoking. However, because hygienists' injunctions against tobacco use tended to appear in a moralistic framework, most physicians did not take them seriously.

By the 1930s, a small international circle of physician antitobacco enthusiasts, including Angel H. Roffo of Buenos Aires, were in communication with each other. Some of them, such as Fritz Lickint and Franz H. Müller, gained enough influence in Nazi Germany to affect public policy significantly. But elsewhere in the world physicians tended to endorse recreational smoking—for example as a comfort to soldiers, especially wounded soldiers, during both world wars.

The final phase of physician involvement with tobacco came in the 1950s, when epidemiological studies revealed a statistical association between cigarette smoking and lung cancer. In 1954, a British study of doctors, led by Richard Doll and A. Bradford Hill, showed that smokers had dramatically higher rates of lung cancer deaths than did nonsmoking physicians. A decade before the general public showed much reaction, physicians in substantial numbers started to cut back on cigarettes and, ultimately, tobacco use. Evidence about tobacco's harmful effects was gained through novel statistical research methods, rather than traditional laboratory animal studies. Despite the validity of these research methods, many doctors did not accept the connection between smoking and lung cancer.

The Royal College of Physicians in 1962 and the Advisory Committee to the U.S. Surgeon General in 1964 produced reports connecting tobacco use with specific diseases. Despite the appearance of these reports, some parts of the medical profession in many countries resisted those conclusions; others were afraid of alienating their patients by confronting smokers with the possible consequences of their actions. In the United States, leaders of organized medicine for decades traded their silence for political support from important politicians from tobacco areas who voted against health proposals. Rather, official medical condemnation of smoking came from specialist groups. From the mid-twentieth century on, the majority of physicians everywhere gradually converted to a more or less active antitobacco stance.

See Also Lung Cancer; Medical Evidence (Cause and Effect).

▌ JOHN BURNHAM

BIBLIOGRAPHY

Burnham, John C. "American Physicians and Tobacco Use: Two Surgeons General, 1929 and 1964." Bulletin of the History of Medicine 63 (1989): 1–31.

Proctor, Robert N. "The Nazi War on Tobacco: Ideology, Evidence, and Possible Cancer Consequences." Bulletin of the History of Medicine 71 (1997): 435–488.

Stewart, Grace G. "A History of the Medical Use of Tobacco, 1492–1860." Medical History 11 (1967): 228–268.

physiology the study of the functions and processes of the body.

epidemiological pertaining to epidemiology, that is, to seeking the causes of disease.