If i can add to the question. What was the society's reaction to smoking. Did anyone ever complain of a room full of smoke? Or was it considered normal.
Disclaimer, I’m an epidemiologist, not a historian. To answer the above question briefly, smoking was suggested as a cause of health problems for much of the first half of the 20th century, but there was a real fight in the medical literature about whether or not it could be proven as a cause of the more serious health effects. As such, smoking likely didn’t seem very dangerous.
I’m going to mostly stick to lung cancer rather than more common conditions, like coughing, since that’s better recorded in the literature. Lung cancer was incredibly rare prior to the 20th century, so much so that in “1900 only about 140 cases were known in the published medical literature” (Proctor, RN 2012). That’s 140 cases ever, rather than 140 cases per year. Smoking became more commonplace towards the end of the 1800s and the first decades of the 1900s, but the increase in lung cancer took some time. By the 1920s, lung cancer was much more frequent than it used to be, and there were a variety of reasons given for this increase. Smoking was blamed, but so was asphalt dust, industrial air pollution, prior exposure to the poison gases used in WWI, or even the latent effects of the 1918 global influenza.
So while smoking was blamed, it certainly wasn’t accepted as the cause of lung cancer, particularly by the medical field. Part of the reason for this was the model/concept of how causes for diseases were determined.
During the end of the 1800s and the early 1900s, the primary conceptual model for how to determine a causative relationship between a particular exposure (e.g., microbe) and a particular disease were Koch’s postulates (published 1890). There were four basic criteria that had to be met for a microbe to be a cause of some disease: 1. those with the disease must have the microbe present in their tissue; 2. The microbe has to be isolated and grown in pure culture; 3. When injected into a healthy animal, that microbe must cause the disease; and 4. You have to isolate the same microbe from the newly infected and diseased animal.
Koch’s criteria for establishing a cause of a disease really break down when it comes to most environmental exposures. Often, a single exposure (like smoking) can cause many different health outcomes (lung cancer, heart disease, death), so you don’t get a good one-to-one relationship like the microbe and infectious disease relationships that were being proved using Koch’s postulates.
So researchers were sort of in a stage of “association does not equal causation” stage. One quote to illustrate: “While most students of the problem of the aetiology of lung cancer admit to an association between smoking and lung cancer, some question whether this association also represents causation” (Wynder, E.L. 1957)
There really needed to be an avalanche of evidence for the smoking-lung cancer causation to be proven. And there was. Chemists found cancer-causing chemicals in cigarette smoke, cell line experiments found that cigarette smoke caused damage to cells that were similar to lung cells, animal experiments found that tumors could be created by painting cigarette smoke tar onto the skin of mice, and there were several population studies of smokers and non-smokers showing increased incidence of lung cancer, heart disease, and mortality not only among smokers compared to non-smokers, but among heavier smokers compared to more casual smokers.
Even so, many in the public and even doctors were unconvinced. “In 1954, for example, George Gallup sampled a broad swath of the US public to ask: ‘do you think cigarette smoking is one of the causes of lung cancer, or not?’ 41% answered ‘yes’, with the remainder answering either ‘no’ or ‘undecided’. Even large numbers of doctors remained unconvinced. In 1960, in a poll organised by the American Cancer Society, only a third of all US doctors agreed that cigarette smoking should be considered ‘a major cause of lung cancer’. This same poll revealed that 43% of all American doctors were still smoking cigarettes on a regular basis, with occasional users accounting for another 5%. With half of all doctors smoking, it should come as no surprise that most Americans remained unconvinced of life-threatening harms from the habit.” –Proctor,RN 2011
The public at the time was probably used to seeing many of their peers smoking, with no apparent health effects (it takes years for these to develop), and it was a habit they likely enjoyed. Researchers were still arguing about how to go about proving causation, so for many, it probably seemed like cigarettes weren’t all that bad.
It might make more sense to think about a health exposure that might be harmful today. The generation that smoked was probably very similar to our generation with regard to eating unhealthy food or not exercising, in that there were likely some observable, well-recognized drawbacks, but not enough to stop altogether. Smoking was likely known to have some downsides like coughing, but the sense that a single cigarette was dangerous just wasn’t there.
Doll R, Hill AB. Lung Cancer and Other Causes of Death in Relation to Smoking. British Medical Journal. 1956;2(5001):1071-1081.
Wynder EL. Towards a Solution of the Tobacco-cancer Problem. British Medical Journal. 1957;1(5009):1-3.
Proctor RN. The history of the discovery of the cigarette-lung cancer link: evidentiary traditions, corporate denial, global toll. Tobacco Control. 2012; 21:87-91
Korteweg R. The Significance of Selection in Prospective Investigations into an Association between Smoking and Lung Cancer. British Journal of Cancer. 1956;10(2):282-291.
Hill AB. The Environment and Disease: Association or Causation? Proceedings of the Royal Society of Medicine. 1965;58(5):295-300.
You're asking particularly about cigarettes, but my answer is actually an example of negative reactions to tobacco smoking in general. I hope this gets the ball rolling in the short time I have before I have to run off to work.
Before the British colonies in North America began cultivating their own tobacco, Europeans often traded with the Native Americans for tobacco. As such, it was an increasingly popular product in Europe, Britain especially. It would eventually become the cash crop of the first Southern colonies.
That does not mean that contemporary people were ignorant of its negative health effects. While belief in the four humors was still prevalent, obvious physical damage caused by tobacco smoking created resistance to the proliferation of the product. The most notable of those against tobacco was King James I, who in 1604 published A Counterblaste to Tobacco. James considered it "inconsiderate and childish affectation of Noveltie" that the British would need to control.
James first argues that the origins of tobacco smoking are unwholesome and beneath the British. The Native Americans used them the "common herbe" to prevent smallpox; James argues that it is ineffective and that they suffer from the disease mainly because of their general uncleanliness:
For Tobacco being a common herbe, which (though under divers names) growes almost every where, was first found out by some of the barbarous Indians, to be a Preservative, or Antidot against the Pockes, a filthy disease, whereunto these barbarous people are (as all men know) very much subject, what through the uncleanly and adust constitution of their bodies.
Tobacco smoking, James argues, is a popular activity for the barbarous Native Americans. By engaging in the activity themselves, the British are lowering themselves to the same level as the uncivilized inhabitants of the New World.
James then considers the positive and negative health effects of tobacco smoking in relation to the four humors, a long argument that fits with the concept at the time but will seem confusing and illogical to the modern reader. He concludes with an emphasis on smoking being habit forming. He the smoker to a person who eats meat and drinks alcohol continually, falling into lethargy and addiction and being unable to disengage such behavior:
Many in this kingdome have had such a continuall use of taking this uusavorie smoke, as now they are not able to forbeare the same, no more then an olde drunkard can abide to be long sober, without falling into an uncurable weaknesse and evill constitution: for their continuall custome hath made to them, habitum, alteram naturam [Latin: habit, second nature].
He then launches into smoking's intrusion into social customs, where it does not belong. Particular contempt is reserved for men who smoke at the dining table in the presence of non-smokers. He also claims that addiction to smoking tobacco precludes service to King and Country.
Embedded within this diatribe is a particularly important observation: the physical damage done to the lungs by smoking tobacco.
And for the vanities committed in this filthie custome, is it not both great vanitie and uncleanenesse, that at the table, a place of respect, of cleanlinesse, of modestie, men should not be ashamed, to sit tossing of Tobacco pipes, and puffing of the smoke of Tobacco one to another, making the filthy smoke and stinke thereof, to exhale athwart the dishes, and infect the aire, when very often, men that abhorre it are at their repast? Surely Smoke becomes a kitchin far better then a Dining chamber, and yet it makes a kitchin also oftentimes in the inward parts of men, soiling and infecting them, with an unctuous and oily kinde of Soote, as hath bene found in some great Tobacco takers, that after their death were opened. [emphasis mine]
James concludes by condemning tobacco smoking as "a custome lothsome to the eye, hatefull to the Nose, harmefull to the braine, dangerous to the Lungs, and in the blacke stinking fume thereof, neerest resembling the horrible Stigian smoke of the pit that is bottomelesse."
Source: Bonevac, Dan. "A Counterblaste to Tobacco. King James I of England." University of Texas at Austin. Last modified April 16, 2002. http://www.laits.utexas.edu/poltheory/james/blaste/blaste.html. This source provides the text of the original Counterblaste in a modernized form for readability. It is also accessible to the public.
I have a follow up as well. Was the realization to the public that this was a major health crisis denied similarly to how say, climate change is denied today? What were societies initial reactions to this?
Follow up question, was it always a mainstream thing to smoke, or was it first a counter-culture cool thing? I guess: who smoked first, and who followed? I've read the freedom sticks thing before, but it's rather US-centric, is there more to it or was it really the first-first spread to female smokers?
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