International Journal of Epidemiology 2001;30:31-34
© International Epidemiological Association 2001
Commentary: Schairer and Schöniger's forgotten tobacco epidemiology and the Nazi quest for racial purity
Pennsylvania State University, University Park, Pennsylvania 16802, USA.
It is important to see Schairer and Schöniger's paper against a backdrop of the history of tobacco, the history of cancer, and the history of how a causal link between the two came to be recognized. Schairer and Schöniger's paper also has to be seen, though, as a political document, a product of the Nazi ideological focus on tobacco as a corrupting force whose elimination would serve the cause of ‘racial hygiene’. Nazi Germany was governed by a health-conscious political elite bent on European conquest and genocidal extermination, and tobacco at this time was viewed as one among many ‘threats’ to the health of the chosen Volk.
Exploring this larger political context in this sense tells us something interesting about the nature of the Nazi regime. Nazism was a movement of muscular, health-conscious young men worried about things like the influence of Jews in German culture and the evils of communism, but also about the injurious effects of white bread, asbestos and artificial food dyes. Hitler himself was a vegetarian and did not smoke or drink; Nazi anti-tobacco activists often pointed out that while the three leading fascist leaders of Europe all abstained from tobacco (Mussolini, Franco, and Hitler), the three leading Allied leaders (Churchill, Roosevelt and Stalin) were all heavy users.1
Cancer rates on the rise
Tobacco use skyrocketed at the end of the nineteenth century, following the invention of safety matches (in 1852), the rise of mass consumer marketing, and the invention of the Bonsack cigarette rolling machine (in 1884), which allowed industrial-scale production. Cigarettes were given to soldiers in the First World War, creating an entirely new generation of addicts; national governments also found in tobacco a marvellous source of income, since sales were easily regulated and effectively taxed. Cigarettes became the preferred mode of smoking toward the end of the century, following the development of ‘flue-curing,’ a fermentation process that allowed tobacco smoke to be inhaled without coughing. Cigarettes were also more easily packaged and carried than other kinds of tobacco—the prepackaged white casings being interestingly similar in this regard to the prepackaged ammunition cartridges invented about this time, with comparable deadly effects.
As a result of the rapid growth of cigarette consumption, cancer rates rose explosively in the first decades of the twentieth century. Lung cancer had been an extremely rare disease prior to 1900—with only 140 documented cases worldwide2—though by the 1930s the disease was the number two cause of cancer death among males in Germany, second only to stomach malignancies.3 A 1944 study would show that lung cancer had actually surpassed stomach tumours to become the leading cause of cancer death among soldiers in the German army, a result not inconsistent, in this military man's view, with a tobacco aetiology.4
Though German pathologists in the 1920s were among the first to recognize the reality of a lung cancer epidemic,5 cigarettes were not widely blamed until the 1930s. Cigarettes had occasionally come under suspicion (not before 1900, interestingly), but the more common view held that road tar or car exhaust or the flu epidemic of 1919 or even racial mixing or the chemical warfare agents used in World War I were the primary culprits. There were some stragglers who thought that the entire phenomenon might be a statistical artefact of either better diagnosis (notably by X-rays, but also improved bronchoscopy) or more extensive hospitalization, but by the late 1920s pathology institutes in the German-speaking world had mortality statistics reliable enough to show that the Lungenkrebs epidemic was real, and accelerating.
Fritz Lickint of Dresden published the first good statistical evidence of a lung cancer tobacco link in 1929, based on a case series showing that lung cancer sufferers were likely to be smokers. Lickint also argued that tobacco use was the best way to explain the fact that lung cancer struck men four or five times more often than women (since women smoked much less) and that in countries where women also smoked, the sex difference was much smaller.6
Adam Syrek in 1932 at the University of Cracau argued similarly that it was hard to reconcile a non-tobacco aetiology with the mortality patterns he was finding in rural Poland. Syrek showed that many of the lung cancer deaths recorded at his institute were from rural areas, where cigarette smoking had become popular and polluting industries were virtually non-existent. Syrek also showed that the epidemic had struck Cracau itself, where there were still very few cars and little industry to speak of. The flu epidemic was also an unlikely cause, in his view, since both sexes were equally afflicted by flu. By a process of elimination, Syrek came to the conclusion that tobacco was the most likely cause of the epidemic.7
The Nazi impulse
The rise of the Nazi regime to power in January 1933 produced several major transformations in German science. Many areas of science with strong Jewish representation—psychoanalysis and certain areas of theoretical physics, for example—lost many of their leading lights, though other fields, with relatively few Jews, fared better. Sciences that could be regarded as free of Jewish influence, or as useful to the military or racial goals of the regime, were often encouraged.
Prevention-oriented cancer research was one such area. Part of this had to do with the ‘homeopathic paranoia’ of the regime (my term)—the fear that small but powerful agents were undermining the German Volkskörper. The carcinogenic effects of food dyes became a focus of considerable interest, as did the radiogenic lung carcinomas of uranium miners (the so-called ‘Schneeberger’ or ‘Joachimstaler Krankheit,’ caused by exposure to radon gas in the Erzgebirge of southeast Germany and the German-Czech border), the perils of mercury dental fillings, and the carcinogenic impact of asbestos. By 1939, for example, occupational authorities were routinely listing lung cancer as one of the occupational hazards of exposure to asbestos dust.8 There was a great deal of worry about how to maintain the ‘purity’ of Germany’s food, air and water, a concern linked ideologically to the more notorious (and eventually criminal) efforts to eliminate ‘foreign racial elements’ from the German population.
This quest for bodily purity was not unique to Nazi Germany, of course—think of the eugenic fervour of some of America's early natural food advocates or even the post-World War II fear of fluoridation, captured dramatically in a remarkable sequence in Stanley Kubrick's film, Dr Strangelove, which has a Cold War-era general obsessing over threats to his ‘precious bodily fluids’. The Nazis carried this quest further than other contemporary nations, prompting them to engage in certain areas of cancer research that from today's vantage point look surprisingly progressive. This becomes particularly clear if you look at the source of support for Schairer and Schöniger's research.
Schairer and Schöniger's case-control epidemiological study was financed by Karl Astel's Institute for Tobacco Hazards Research (or ‘Institute for the Struggle Against Tobacco Hazards’, as it was also known), established in 1941 at Jena University by a 100 000 Reichsmarks grant from Hitler's Reich Chancellery. We do not know who first suggested the study, though it could well have been Prof. Dr. med. Astel himself, who ruled over much of this intellectual territory with the iron hand expected from a Nazi Führer. Astel was a high-ranking SS officer and from 1939 president of the University of Jena; he was also an ardent anti-Semite and euthanasia advocate who served as head of Thüringia's Office of Racial Affairs, an important instrument in the propagation of Nazi political ideals.
Astel was an early devotee of Hitler, having already marched alongside his beloved Führer in September 1923 at a Nuremberg rally, earning him the coveted Nazi ‘Golden Badge of Honor,’ awarded to the first 100 000 people to join the Nationalsozialistische Deutsche Arbeiterpartei (NSDAP) (more than ten million people eventually joined the Party). Astel was also a rabid anti-tobacco activist, who quickly made a name for himself on the Jena campus by snatching cigarettes from the mouths of smoking students. His institute therefore, not surprisingly, sought to combine both scientific and propagandist work. The institute purchased and distributed 2000 copies of Hans FK Günther's 8-page Trinken, Rauchen, Gattenwahl (Drinking, Smoking, and Spousal Choice) along with 15 copies of Lickint's Tabak und Organismus (at 50 RM each), hundreds of reprints from Reine Luft (Pure Air), the most important anti-tobacco journal of the era, and 3000 copies of Emil Skramlik's compilation of Goethe's views on tobacco. Skramlik also received at least 15 000 RM to produce an anti-tobacco film (Genussmittel Tabak)—and though much of it was apparently finished by 1944, the film itself has since disappeared. Skramlik went on to become president of the University of Jena after the war, succeeding Astel, who shot himself in the University Medical Clinic in April of 1945, after apparently destroying all his files.
Schairer and Schöniger's paper was largely based on Schöniger's medical dissertation, submitted in 1944. Schöniger's, though, was only one of several dissertations produced at Astel's institute. Gabriele Schulze and Käte Dischner in their jointly written Die Zigarettenraucherin (‘The Female Cigarette Smoker’, Jena, 1942), for example, interviewed 165 women as part of a study of the physical and psychological effects of nicotine withdrawal. Most of the women studied were incarcerated at prisons in Weimar, Gera or Kleinmuesdorf near Leipzig, where smoking was forbidden; the dissertation records the women's cries for cigarettes, and attempts to classify female smokers by menstrual patterns, ‘constitutional type’ (asthenic, pyknic, leptosome, etc.), and criminal behaviour. The authors claimed that smoking made one vulnerable to tuberculosis and called for a total smoking ban for women, consistent with the Nazi slogan ‘Die deutsche Frau raucht nicht!’ (The German woman does not smoke!).
Racial hygienists distinguished ‘positive’, ‘negative’ and ‘preventive’ racial hygiene, encompassing: (1) encouragement of breeding among the ‘fit’ (e.g. by marital loans and prizes for large families); (2) limitation of breeding among the ‘unfit’ (especially by sterilization); and (3) prevention of exposure to genotoxic hazards. For Astel, preventive racial hygiene translated into a research effort to determine whether nicotine was a mutagen, in accordance with his view that ‘We cannot change our genes, but at least we can safeguard them from future damage.’9
Astel therefore funded inquiries into whether nicotine or other constituents of tobacco smoke could be considered mutagens. The racial theorist Günther Just of Würzburg's Rassenbiologisches Institut was appointed a ‘Mitarbeiter’ at the tobacco institute in March of 1943, and over the next 2 years received 6000 RM to explore the genetic and hormonal damage caused by nicotine. The pharmacologist Gustav Kuschinsky of Prague received a total of 17 444 RM that same year from Astel's institute, to conduct a series of rat experiments to prove (with Karl Thums of Prague) that smoking caused heritable genetic damage. Kuschinsky was still doing work on this project (without success) as late as September 1944; he also worked for the Reemtsma tobacco company after the war, doing similar work.
The Nazi government enacted numerous legal sanctions limiting tobacco use. Tobacco was banned in theatres and cinemas, and on buses and in many public buildings. Astel implemented the nation's first (modern) university tobacco ban, and smoking was barred in post offices, military hospitals, and all Nazi party offices. Rationing was implemented at the outbreak of the campaign against Poland, making it hard even for Astel's institute to obtain tobacco for research purposes. In 1942, for example, Astel had to ask his anti-tobacco comrade, Reich Health Führer Leonardo Conti, for help in obtaining adequate supplies.
One reason tobacco was in short supply was that tobacco was used to finance the war. In September 1942 a war tax nearly doubled the price of cigarettes, which when coupled with agricultural shortages and the impoverishment late in the war caused a drastic drop in the number of cigarettes smoked in Germany. Per capita cigarette consumption fell by half from 1940 to 1950, whereas in the US, per capita consumption doubled over the same period.
Hitler in 1942 said that he regretted having given his soldiers tobacco at the start of the war. And though the decision was clearly a pragmatic one, the power of tobacco manufacturers at this time should not be underestimated. The industry had strong friends in the ministries of economics and finance, both of which were clearly afraid of interrupting the steady flow of cash from tobacco taxes, which in 1941 accounted for one twelfth(!) of all revenues flowing into the national treasury. Anti-tobacco activists often lamented the financial clout of the industry, as we can see from the following passage in a letter of 21 April 1941, from Fritz Lickint to Astel, celebrating the founding of the anti-tobacco institute:
Finally it will be possible to establish a true bulwark against efforts by the heretofore omnipotent ‘tobacco interests’ to monopolize tobacco research. Finally it will be possible to counter the impression, created by the industry's research institutes in Vienna and Forchheim, that they alone have the right to speak the truth about tobacco, and to shape or even dominate public opinion concerning matters of tobacco.
The industry's voice was not so easily countered, however. Shortly after the founding of Astel's institute, the industry established its own information organ, the ‘Tabacologia medicinalis,’ in a clear attempt to win the tobacco-health propaganda war. Leonardo Conti ordered the closing of the organization shortly thereafter, but it is possible to see this as the beginning of a new kind of clash that would re-emerge in America in the mid-1950s, with the formation of the Tobacco Institute and the Council for Tobacco Research, bodies skilfully designed to counter the evidence of a global tobacco health catastrophe.
It was not the power of the tobacco industry that crushed Astel's institute, but rather the defeat of Germany's armies. The institute came to an end in the spring of 1945, when Astel committed suicide, recognizing his future in a post-Nazi world would not be a pleasant one. Astel had helped to organize the euthanasia operation that murdered some 200 000 mentally and physically disabled; he had also assisted in the ‘Final Solution of the Jewish Question’ as head of the Thüringia's Office of Racial Affairs. Had he managed to survive the war, he most likely would have been tried as a war criminal. Astel had also made the Jena medical faculty a hotbed of Nazi activism—some instances of which can be seen in the highly questionable research promulgated under his reign.
The Waffen-SS physician Erich Wagner, for example, had done his notorious dissertation on classifying tattoos among the concentration camp inmates of Buchenwald under Astel's tutelage; Wagner committed suicide in 1959, when a court in Offenburg began legal proceedings against him for murder.10 Members of the Jena medical faculty had done other work at Buchenwald, some of which utilized their tobacco expertise. Friedrich Timm of Jena's Institute for Forensic Medicine, for example, autopsied the body of an SS Hauptscharführer by the name of Rudolf Köhler, who had died while interned in the camp on suspicion of corruption; Timm concluded that the man had committed suicide by ingesting a ‘large quantity of cigarette butts’. Astel's institute also entertained proposals to study how racial mixing, tobacco use, and ‘exploitation by Jewish capital interests’ affected the health of people living in tobacco-growing regions. Tobacco in the words of the author of this proposal was to be classified not as a Lebensmittel (food) but rather as a Sterbemittel (death agent).
Some of the institute's work involved human experiments. The radiologist Wolf Dietrich von Keiser on 6 November 1941, for example, wrote to Astel, asking for his assistance in procuring 400 stormtroopers for a series of experiments to determine the effects of nicotine on gastric function. The subjects were required to appear for 2 days in Keiser's surgical clinic at the University of Jena; one day they were fed nicotine, the other they were not. The men were then X-rayed to determine effects on the stomach. Human experiments were also carried out on prisoners, and there was a fair amount of animal experimentation.
Schairer and Schöniger's work on tobacco and lung cancer is of interest, among other things, for what it tells us about the fate of science in a totalitarian dictatorship. For one thing, it shows that certain kinds of science can actually flourish, if they are not seen as contrary to the ideological goals of such a state. Had Germany won the war, one can imagine that Astel's institute would have continued producing sophisticated science; as it was the institute was formally dissolved in November 1945, when Russian military authorities confiscated the funds of Jena's Thüringische Staatsbank.
However, there is another interesting element to this story, which is that the paper translated here was by and large ignored by post-war scientists. The Science Citation Index reveals that the paper was cited three or four times in the 1960s, only once in the 1970s, and then not again until 1988, when Ernst Wynder cited it in an article in Public Health Reports. The paper was unknown even in Germany, where one might have expected more sympathetic treatment. A 1953 German-language bibliography devoted exclusively to the topic of ‘Tobacco and Cancer’ does not include Schairer and Schöniger's article.11 Even today, Germans tend to present the history of tobacco/cancer research as if it were entirely an Anglo-American affair, ignoring local contributions. The fear may be that by acknowledging such a work, one might somehow give credence to Nazis ideals or policy. The conventional view seems to be that Nazism gave birth only to monsters, and that anything with roots in this era must be tainted.
There are other areas of biomedical science where similar views held sway. James Watson in his book, The Double Helix, tells the story of how Gerhard Schramm's subtle studies on viral biochemistry were ignored or dismissed by post-war scientists, thinking that good work simply could not have been done by Nazi scientists12 (Schramm was a member of the SS and a key figure in Adolf Butenandt's Kaiser Wilhelm Institute for Biochemistry). Similar prejudices may have been at play with regard to German tobacco work—though language barriers may also have played a role. Many wartime-era German journals were never shipped abroad, a casualty of the disintegration of international co-operation, but also a result of subscription cutbacks, communications breakdowns, and the boycott of German journals by several professional groups in Allied nations.
Tobacco epidemiology was also not the kind of thing Allied military authorities were interested in, when they began to comb through German science and engineering in search of exploitable findings. No effort was made to exploit Germany's pioneering tobacco work, e.g. in the FIAT reviews of German science, a veritable Encyclopedia Naziana published shortly after the war by US and British military authorities. The focus was rather on sciences that might prove of ‘strategic’ interest—defined in military terms. There is an interesting irony here, insofar as rocket bombs and aerotechnical engineering skills were exploited—often to the point of kidnapping and transferring the scientists themselves abroad—when sciences that could have clearly helped save lives were ignored. US priorities in this area became clear when an effort was launched to resupply Germany with tobacco. In 1948 and 1949, the US shipped 93 000 tons of blond Virginia-blend tobacco free of charge to the defeated nation as part of the Marshall Plan.13
Perhaps I may end with a speculation, that the net effect of the Nazi war on tobacco—and I am talking only about Germany here—was actually to forestall the development of effective anti-tobacco measures by several decades. Nazi ideals seem to have helped foster some world-class tobacco science (think also of Franz Müller's paper, which actually came to stronger conclusions than Schairer and Schöniger's),14 but they ultimately dragged it down, both by destroying the German economy and by tainting Nazi-era research with some of history's most inhumane policies. In the post-war era, memories of Nazi-endorsed asceticism were not exactly pleasant ones. Nor did tobacco control fit very well with the consumerist urges of the 1950s or the more carefree bacchanalian ethics of the late 1960s and 1970s. Germany today has one of Europe's worst records in the area of tobacco control, despite being home to some of the world's first tobacco epidemiology. European and American tobacco companies have both tried to play the Nazi card, associating smoking restrictions with Nazi-like policings.15
One of the jobs of the science historian, however, is to explore how strange and unexpected historical forces can influence the flourishing (or stifling) of science. The resurrection of this pioneering paper will hopefully throw new light on a largely forgotten chapter of tobacco science, and the curious political circumstances in which it arose.
15 Proctor, RN. The Nazi war on tobacco: Ideology, evidence, and public health consequences. Bulletin of the History of Medicine 1997;71:435–88.[Medline]