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NUREMBERG DOCTORS' TRIALThe anti-tobacco campaign of the Nazis: a little known aspect of public health in Germany, 1933-45Robert N Proctor, professor of the history of science aa Department of History, Pennsylvania State University, University Park, PA 16802, United States Historians and epidemiologists have only recently begun to explore the Nazi anti-tobacco movement. Germany had the world's strongest antismoking movement in the 1930s and early 1940s, encompassing bans on smoking in public spaces, bans on advertising, restrictions on tobacco rations for women, and the world's most refined tobacco epidemiology, linking tobacco use with the already evident epidemic of lung cancer. The anti-tobacco campaign must be understood against the backdrop of the Nazi quest for racial and bodily purity, which also motivated many other public health efforts of the era. Medical historians in recent years have done a great deal to enlarge our understanding of medicine and public health in Nazi Germany. We know that about half of all doctors joined the Nazi party and that doctors played a major part in designing and administering the Nazi programmes of forcible sterilisation, "euthanasia," and the industrial scale murder of Jews and gypsies.1 2 Much of our present day concern for the abuse of humans used in experiments stems from the extreme brutality many German doctors showed towards concentration camp prisoners exploited to advance the cause of German military medicine.3 Tobacco in the Reich One topic that has only recently begun to attract attention is the Nazi anti-tobacco movement.4 5 6 Germany had the world's strongest antismoking movement in the 1930s and early 1940s, supported by Nazi medical and military leaders worried that tobacco might prove a hazard to the race.1 4 Many Nazi leaders were vocal opponents of smoking. Anti-tobacco activists pointed out that whereas Churchill, Stalin, and Roosevelt were all fond of tobacco, the three major fascist leaders of Europe--Hitler, Mussolini, and Franco--were all non-smokers.7 Hitler was the most adamant, characterising tobacco as "the wrath of the Red Man against the White Man for having been given hard liquor." At one point the Fuhrer even suggested that Nazism might never have triumphed in Germany had he not given up smoking.8 German smoking rates rose dramatically in the first six years of Nazi rule, suggesting that the propaganda campaign launched during those early years was largely ineffective.4 5 German smoking rates rose faster even than those of France, which had a much weaker anti-tobacco campaign. German per capita tobacco use between 1932 and 1939 rose from 570 to 900 cigarettes a year, whereas French tobacco consumption grew from 570 to only 630 cigarettes over the same period.9 Smith et al suggested that smoking may have functioned as a kind of cultural resistance,4 though it is also important to realise that German tobacco companies exercised a great deal of economic and political power, as they do today. German anti-tobacco activists frequently complained that their efforts were no match for the "American style" advertising campaigns waged by the tobacco industry.10 German cigarette manufacturers neutralised early criticism--for example, from the SA (Sturm-Abteilung; stormtroops), which manufactured its own "Sturmzigaretten"--by portraying themselves as early and eager supporters of the regime.11 The tobacco industry also launched several new journals aimed at countering anti-tobacco propaganda. In a pattern that would become familiar in the United States and elsewhere after the second world war, several of these journals tried to dismiss the anti-tobacco movement as "fanatic" and "unscientific." One such journal featured the German word for science twice in its title (Der Tabak: Wissenschaftliche Zeitschrift der Internationalen Tabakwissenschaftlichen Gesellschaft, founded in 1940). We should also realise that tobacco provided an important source of revenue for the national treasury. In 1937-8 German national income from tobacco taxes and tariffs exceeded 1 billion Reichsmarks.12 By 1941, as a result of new taxes and the annexation of Austria and Bohemia, Germans were paying nearly twice that. According to Germany's national accounting office, by 1941 tobacco taxes constituted about one twelfth of the government's entire income.13 Two hundred thousand Germans were said to owe their livelihood to tobacco--an argument that was reversed by those who pointed to Germany's need for additional men in its labour force, men who could presumably be supplied from the tobacco industry.14 Culmination of the campaign: 1939-41 German anti-tobacco policies accelerated towards the end of the 1930s, and by the early war years tobacco use had begun to decline. The Luftwaffe banned smoking in 1938 and the post office did likewise. Smoking was barred in many workplaces, government offices, hospitals, and rest homes. The NSDAP (Nationalsozialistische Deutsche Arbeiterpartei) announced a ban on smoking in its offices in 1939, at which time SS chief Heinrich Himmler announced a smoking ban for all uniformed police and SS officers while on duty.15 The Journal of the American Medical Association that year reported Hermann Goering's decree barring soldiers from smoking on the streets, on marches, and on brief off duty periods.16
Sixty of Germany's largest cities banned smoking on street cars in 1941.17 Smoking was banned in air raid shelters--though some shelters reserved separate rooms for smokers.18 During the war years tobacco rationing coupons were denied to pregnant women (and to all women below the age of 25) while restaurants and cafes were barred from selling cigarettes to female customers.19 From July 1943 it was illegal for anyone under the age of 18 to smoke in public.20 Smoking was banned on all German city trains and buses in 1944, the initiative coming from Hitler himself, who was worried about exposure of young female conductors to tobacco smoke.21 Nazi policies were heralded as marking "the beginning of the end" of tobacco use in Germany.14 German tobacco epidemiology by this time was the most advanced in the world. Franz H Muller in 1939 and Eberhard Schairer and Erich Schoniger in 1943 were the first to use case-control epidemiological methods to document the lung cancer hazard from cigarettes.22 23 Muller concluded that the "extraordinary rise in tobacco use" was "the single most important cause of the rising incidence of lung cancer."22 Heart disease was another focus and was not infrequently said to be the most serious illness brought on by smoking.24 Late in the war nicotine was suspected as a cause of the coronary heart failure suffered by a surprising number of soldiers on the eastern front. A 1944 report by an army field pathologist found that all 32 young soldiers whom he had examined after death from heart attack on the front had been "enthusiastic smokers." The author cited the Freiburg pathologist Franz Buchner's view that cigarettes should be considered "a coronary poison of the first order."25 On 20 June 1940 Hitler ordered tobacco rations to be distributed to the military "in a manner that would dissuade" soldiers from smoking.24 Cigarette rations were limited to six per man per day, with alternative rations available for non-smokers (for example, chocolate or extra food). Extra cigarettes were sometimes available for purchase, but these were generally limited to 50 per man per month and were often unavailable--as during times of rapid advance or retreat. Tobacco rations were denied to women accompanying the Wehrmacht. An ordinance on 3 November 1941 raised tobacco taxes to a higher level than they had ever been (80-95% of the retail price). Tobacco taxes would not rise that high again for more than a quarter of a century after Hitler's defeat.26
Impact of the war and postwar poverty The net effect of these and other measures (for instance, medical lectures to discourage soldiers from smoking) was to lower tobacco consumption by the military during the war years. A 1944 survey of 1000 servicemen found that, whereas the proportion of soldiers smoking had increased (only 12.7% were non-smokers), the total consumption of tobacco had decreased--by just over 14%. More men were smoking (101 of those surveyed had taken up the habit during the war, whereas only seven had given it up) but the average soldier was smoking about a quarter (23.4%) less tobacco than in the immediate prewar period. The number of very heavy smokers (30 or more cigarettes daily) was down dramatically--from 4.4% to only 0.3%--and similar declines were recorded for moderately heavy smokers.24
Postwar poverty further cut consumption. According to official statistics German tobacco use did not reach prewar levels again until the mid-1950s. The collapse was dramatic: German per capita consumption dropped by more than half from 1940 to 1950, whereas American consumption nearly doubled during that period.6 9 French consumption also rose, though during the four years of German occupation cigarette consumption declined by even more than in Germany9--suggesting that military conquest had a larger effect than Nazi propaganda. After the war Germany lost its position as home to the world's most aggressive anti-tobacco science. Hitler was dead but also many of his anti-tobacco underlings either had lost their jobs or were otherwise silenced. Karl Astel, head of Jena's Institute for Tobacco Hazards Research (and rector of the University of Jena and an officer in the SS), committed suicide in his office on the night of 3-4 April 1945. Reich Health Fuhrer Leonardo Conti, another anti-tobacco activist, committed suicide on 6 October 1945 in an allied prison while awaiting prosecution for his role in the euthanasia programme. Hans Reiter, the Reich Health Office president who once characterised nicotine as "the greatest enemy of the people's health" and "the number one drag on the German economy"27 was interned in an American prison camp for two years, after which he worked as a physician in a clinic in Kassel, never again returning to public service. Gauleiter Fritz Sauckel, the guiding light behind Thuringia's antismoking campaign and the man who drafted the grant application for Astel's anti-tobacco institute, was executed on 1 October 1946 for crimes against humanity. It is hardly surprising that much of the wind was taken out of the sails of Germany's anti-tobacco movement. The flipside of Fascism Smith et al were correct to emphasise the strength of the Nazi antismoking effort and the sophistication of Nazi era tobacco science.4 The antismoking science and policies of the era have not attracted much attention, possibly because the impulse behind the movement was closely attached to the larger Nazi movement. That does not mean, however, that antismoking movements are inherently fascist28; it means simply that scientific memories are often clouded by the celebrations of victors and that the political history of science is occasionally less pleasant than we would wish.
Funding: United States Holocaust Memorial Museum, Washington, DC; Hamburger Institut fur Sozialforschung in Hamburg. Conflict of interest: None.
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