In the early 20th century, German researchers found additional evidence linking smoking to health harms, which strengthened the anti-tobacco movement in the Weimar Republic and led to a state-supported anti-smoking campaign. Early anti-tobacco movements grew in many nations from the middle of the 19th century. The 1933–1945 anti-tobacco campaigns in Nazi Germany have been widely publicized, although stronger laws than those passed in Germany were passed in some American states, the UK, and elsewhere between 1890 and 1930.Fifteen states prohibited the sale or use of cigarettes at various times between 1890 and 1930 as a result of the activities of the Anti-Cigarette League of America. After 1941, anti-tobacco campaigns were restricted by the Nazi government.
The German movement was the most powerful anti-smoking movement in the world during the 1930s and early 1940s. However, tobacco control policy was incoherent and ineffective, with uncoordinated and often regional efforts by many actors. Obvious measures were not taken, and existing measures were not enforced. Some Nazi leaders condemned smoking and several of them openly criticized tobacco consumption, but others publicly smoked and denied that it was harmful.
There was much research on smoking and its effects on health during Nazi rule, and it was the most important of its type at that time. A directly supported tobacco research institute produced work of only marginal scientific importance, but substantial academic work was done privately, with little to negative official support.
Adolf Hitler's personal distaste for tobacco and the Nazi reproductive policies were among the motivating factors behind the Nazi campaigns against smoking. The Nazi anti-tobacco campaign included banning smoking in trams, buses, and city trains, promoting health education, limiting cigarette rations in the Wehrmacht, organizing medical lectures for soldiers, and raising the tobacco tax. The Nazis also imposed restrictions on tobacco advertising and smoking in public spaces, and regulated restaurants and coffeehouses. However, these measures were widely circumvented or ignored.
The movement did not reduce the number of smokers. Tobacco use increased rapidly in the early years of the Nazi regime, between 1933 and 1939. The number of smokers increased from 1939 to 1945, but cigarette consumption declined; rationing towards the end of the war and post-war poverty meant that the increasing numbers of smokers could not buy as many cigarettes. Nazi-related nicotine marketing messages have often been used to oppose tobacco control, and criticized for historical inaccuracy. Even by the end of the 20th century, the anti-smoking movement in Germany had not attained the influence of the Nazi anti-smoking campaign. Germany has some of the weakest tobacco control measures in Europe, and German tobacco research has been described as "muted".
Prelude
Anti-smoking measures have a long history in German-speaking areas. For instance, in 1840, the Prussian government reinstated a ban on smoking in public places. The 1880s invention of automated cigarette-making machinery in the American South made it possible to mass-produce cigarettes at low cost, and smoking became common in Western countries. This led to a backlash and a tobacco prohibition movement, which challenged tobacco use as harmful and brought about some bans on tobacco sale and use.
The German Empire also had anti-tobacco sentiment in the early 20th century. Critics of smoking organized the first anti-tobacco group in the country, named the Deutscher Tabakgegnerverein zum Schutze der Nichtraucher (German Tobacco Opponents' Association for the Protection of Non-smokers). Established in 1904, this organization existed for only a brief period. The next anti-tobacco organization, the Bund Deutscher Tabakgegner (Federation of German Tobacco Opponents), was established in 1910 in Trautenau, Bohemia. Other anti-smoking organizations were established in 1912 in the cities of Hanover and Dresden.
After World War I, anti-tobacco movements continued in the German Weimar Republic, against a background of increasing medical research. German researchers were heavily involved with early research into tobacco harms. In the 1920s and 1930s, the Weimar Republic was at the cutting edge of tobacco research.
In 1920, a Bund Deutscher Tabakgegner in der Tschechoslowakei (Federation of German Tobacco Opponents in Czechoslovakia) was formed in Prague, after Czechoslovakia was separated from Austria at the end of World War I. A Bund Deutscher Tabakgegner in Deutschösterreich (Federation of German Tobacco Opponents in German Austria) was established in Graz in 1920. These groups published journals advocating nonsmoking. The first such German language journal was Der Tabakgegner (The Tobacco Opponent), published by the Bohemian organization between 1912 and 1932. Deutscher Tabakgegner (German Tobacco Opponent) was published in Dresden from 1919 to 1935, and was the second journal on this subject. Anti-tobacco organizations were often also against consumption of alcoholic beverages.
Research
Research on tobacco's effects on population health were more advanced in Germany than in any other nation by the time the Nazis came to power. While a link between smoking and cancers had been observed as early as the 1700s, the first good statistical evidence that linked smoking to lung cancer and other illnesses was published in Germany and eastern Europe before the Nazi takeover (though some sources claim that the link between lung cancer and tobacco was first proven in Nazi Germany). Physicians were also aware that smoking was responsible for cardiac diseases, which were considered to be the most serious disease resulting from smoking. Use of nicotine was sometimes considered to be responsible for increased reports of myocardial infarction in the country. In the later years of World War II, researchers considered nicotine a factor behind the coronary heart failures suffered by a significant number of military personnel in the Eastern Front. A pathologist of the Heer examined thirty-two young soldiers who had died from myocardial infarction at the front, and documented in a 1944 report that all of them were "enthusiastic smokers". He cited the opinion of pathologist Franz Buchner that cigarettes are "a coronary poison of the first order".
The term "passive smoking" ("Passivrauchen") was coined in Nazi Germany, by Fritz Lickint, a researcher purged from his public position by the Nazis in 1934 for political reasons. While in private practice, Lickint continued his research. In 1935 he published Der Bronchialkrebs der Raucher ("Bronchial cancer in smokers"), a follow-up to his 1930 review, Tabak und Tabakrauch als ätiologische Faktoren des Carcinoms ("Tobacco and tobacco smoke as aetiological factors in carcinoma"). The 1935 review attributed the rapidly-rising rates of cancers of the airway to smoking. In 1939 Lickint published Tabak und Organismus ("Tobacco and the body"), a book that ran to over 1,200 pages, giving a definitive review of existing research into the physiological effects of tobacco. It described smoking as a cause of cancers, cardiovascular diseases, changes in blood composition, lowered fertility, and mutations. It described nicotine use as an addiction, likening it to alcoholism and suggesting similar treatments. It also suggested anti-smoking public health measures, including measures against passive smoking. Lickint was in military service from 1939 to 1945; he survived and continued his research after the war.
Further observational studies were done in Nazi Germany and the wartime Netherlands. Nazi Germany supported epidemiological research on the harmful effects of tobacco use. Hitler personally gave financial support to the Wissenschaftliches Institut zur Erforschung der Tabakgefahren (Scientific Institute for the Research into the Hazards of Tobacco) at the University of Jena, in Thuringia, headed by Karl Astel. Established in 1941, it was the most significant anti-tobacco institute in Nazi Germany. However, it never had its own buildings or staff, nor regular funding, and overall its research into the dangers of tobacco was limited, and only of marginal scientific significance and repute. Further research into the effects of tobacco on health was carried out with Nazi funding. In 1939, Franz H. Müller (a member of the National Socialist Motor Corps or NSKK, and the Nazi Party) published a study reporting a higher prevalence of lung cancer among smokers. The study had serious weaknesses in its methodology, but study design problems were better addressed in subsequent studies. Dietrich Eberhard Schairer also used case-control epidemiological methods to study lung cancer among smokers, in 1943. Due to the research institute and local political support, including from Fritz Sauckel (the Gauleiter of Thuringia) and Leonardo Conti (the Reich Health Leader), Thuringia became a test bed for anti-smoking measures, most of which were never implemented elsewhere.
After 1941, Nazi tobacco research was deliberately slowed, along with other restrictions on anti-tobacco publications. At the end of the war, the fates of those involved in supporting and carrying out research varied. Karl Astel, who was heavily involved in mass murder and research practices which would probably have seen him tried as a war criminal, killed himself. Fritz Sauckel was executed for crimes against humanity. Leonardo Conti killed himself while awaiting trial for his involvement in mass murder of ill people. Hans Reiter (the Reich Health Office president) was interned for two years and spent the rest of his career in private practice. Others worked in the field after the war; pharmacologist Gustav Kuschinsky continued work similar to that begun with funding from Astel's institute with funding from the cigarette company Reemtsma. Fritz Lickint was appointed to public hospital and teaching posts again after the war.
Many wartime research publications were never shipped abroad, and after the war, pre-war and wartime publications on nicotine were ignored even within Germany. Post-war researchers were unaware of the earlier non-English-language studies. They therefore duplicated the case-control studies showing the association with illness before doing prospective cohort studies that established causality in the 1950s. There is a popular belief that American and British scientists first discovered the health harms of tobacco in the 1950s.
Political motives
Hitler's attitude towards smoking
Hitler viewed smoking as "decadent" and "the wrath of the Red Man against the White Man, vengeance for having been given hard liquor", lamenting that "so many excellent men have been lost to tobacco poisoning". He was unhappy because both Eva Braun and Martin Bormann were smokers and was concerned over Hermann Göring's continued smoking in public places. He was angered when a statue portraying a cigar-smoking Göring was commissioned. Hitler is often considered to be the first national leader to advocate nonsmoking; however, James VI and I, king of Scotland and England, was openly against smoking 330 years prior, and the near-contemporary 1600s Chinese emperors Chongzhen and Kangxi both decreed the death penalty for smokers.
Hitler disapproved of the military personnel's freedom to smoke, and during World War II he said on 2 March 1942, "it was a mistake, traceable to the army leadership at the time, at the beginning of the war". He also said that it was "not correct to say that a soldier cannot live without smoking". He promised to end the use of tobacco in the military after the end of the war. Hitler personally encouraged close friends not to smoke. He even began to offer a gold watch to any of his inner circle who could quit. However, Hitler's personal distaste for tobacco was only one of several catalysts behind the anti-smoking campaign.