History of Cigarette Smoking and Lung Cance
The most salient fact in the history of lung cancer is that it was very, very rare before the invention of cigarettes.
If one goes into a medical library and pages through old medical texts from the nineteenth century, one finds almost no reference to lung cancer. If one searches through the medical literature up to the year 1900, there are only references to a total of 100 cases of lung cancer. Even as late as 1912, Adler could find only 374 cases. Grosse reviewed 100 years of autopsies in Dresden, Germany, and found that the incidence of lung cancer had gone from 0.3% in 1852 to 5.66% in 1952.
In the nineteenth century, tobacco was smoked by gentlemen only in the form of cigars . Cigarettes, which were basically the sweepings off the floor of the cigar factory, were only smoked by the very poor.
As machines to mass produce cigarettes came into the fore in the 1880s, smoking cigarettes became more common but the number of cigarettes smoked was still, relatively small. During World War I tobacco companies gave away free cigarettes to millions of soldiers, and it was only after the war that large numbers of Americans smoked cigarettes.
Since there is a time lag of approximately 20 to 30 years between the onset of smoking and the development of lung cancer, the damage done was not immediately apparent. Doctors were surprised to see a sudden epidemic of lung cancer cases in the 1930s. They quickly discovered the association between smoking and lung cancer. Large statistical studies in England and the United States in the 1950s (Doll and Hill, Cutler) conclusively proved beyond any shadow of a doubt that cigarette smoking markedly increased the chances of developing lung cancer.
By the 1970s, lung cancer had gone from one of the rarest of cancers to the number one killer cancer in the Western world.
Women did not smoke in the early twentieth century U.S.A.. They were therefore, targeted by an intense marketing campaign in the 1930s, featuring elegant women in evening dresses smoking Lucky Strikes in Cigarette holders. Later they were the target of Virginia Slims. When I was in surgical training at the Mayo Clinic in the early 1970s lung cancer in women was still unusual, but by 1985, lung cancer had became the number one cause of cancer death in women.
The 1990s are the era of discovery, as defectors from the tobacco industry provide an inside view of the treacherous behavior of the tobacco industry and our elected officials. Hopefully, the 1990s will end as the era of tobacco CONTROL.
I have posted an essay on the history of thoracic surgery.
A interesting history of tobacco is located at the Tobacco BBS- Gene Borio A Capsule History of Tobacco
Frederic W. Grannis Jr. M.D
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