There is no written record in reference to tobacco prior to the 15th century. However, it is generally acknowledged that indigenous Americans used tobacco as a medicine and smoked tobacco. In 1492, Christopher Columbus (1451–1506) and his crew, when returning to Europe from the Americas, brought the first tobacco leaves and seeds into Europe. In 1560, Jean Nicot (1530–1600), French diplomat and importer, introduced tobacco in France and Portugal. By the end of the 16th century, tobacco use had became a custom among fashionable people in Europe and tobacco was being exported to India, China, and Japan [1,2].
Tobacco is an annual plant belonging to the eggplant family. Tobacco was named after Tobago, the island in the West Indies from whence the major part of the tobacco used in Europe was imported. Although the leaves have an acrid taste, tobacco enjoyed widespread medicinal use from the beginning of the 16th century to the end of the 19th century. According to two privately printed monographs, the beneficial uses of tobacco were almost endless [3,4]. Finely ground tobacco, snuff, was sniffed as a remedy for colds, headache, and eye problems. Chewing tobacco was sold in the form of loose leaf or plugs to be held in the cheeks. In Asian countries, tobacco was chewed mixed with betel nuts and lime. Chewing tobacco was recommended for toothache, gum diseases, aches in the throat, and mental depression. Decanted liquor of boiled tobacco was used internally to treat indigestion, aches in the belly, and urinary obstruction. Ashes of burned tobacco were mixed with hog grease and applied as an ointment to ulcerated skin, warts, and dermal cancer. Smoking tobacco was claimed to improve body odor and to prevent the plague. Persons of all ages and classes smoked excessively during the great epidemics. Smoking tobacco was believed to calm the nerves and relieve anxiety by purging the brain. Smoke blown into the ear cured earache and when applied to the anus relieved constipation and bloody discharge. Tobacco juice dropped into the ears improved deafness. Tobacco that was made into a syrup with honey was used to treat asthma, chest diseases, cough, and syphilis [3,4]
As time went by, it was recognized that tobacco was not a cure for all. In 1601, an anonymous pamphlet, “Work for Chimney-Sweepers,” was distributed in London. The pamphlet described tobacco as a poison and indicated that medicinal use of tobacco or smoking was harmful because it deprived the body of nourishment, dried up men’s sperm, and had a stupefying effect, not unlike opium. The pamphlet added that tobacco should be avoided by young people and pregnant women because tobacco weakened the body [5].
In 1604, King James I of England rendered a written warning that smoking was harmful to the eye, nose, brain, and lungs [6]. He placed a heavy duty and a local tax on imported tobacco. Korea and Japan introduced a ban on smoking to prevent fires. China and Turkey prohibited smoking to prevent an inbalance of trade with foreign countries. In 1660, England prohibited the planting of tobacco and placed restrictions on selling imported tobacco. Coalitions of women were formed against tobacco in many countries. They claimed, among other things, that tobacco diminished male virility and they advised women not to marry smokers. For those who were married to a smoker, it was lawful to become divorced [5].
In 1620, Thomas Venner of London warned against smoking [7] (Fig. 1⇓). In his book, he wrote that immoderate use of tobacco hurts the brain and the sight, diminishes digestion, and induces trembling of the limbs and the heart. He advised that tobacco should be limited to medicinal use and should not be consumed for pleasure.
In 1761, John Hill (1716–1775), a London surgeon, reported ulcerated cancers of the nose in two men who had used large quantities of snuff for many years [8]. In 1795, Samuel T. Soemmerring (1755–1830), Professor of Anatomy at Mainz, reported an association between pipe smoking and cancer of the lower lip [9]. In 1844, Walter Walshe (1812–1892), a London pathologist, published a book on cancer [10] in which he cited smoking, mechanical irritation, mental affliction, drunkenness, and constitutional predisposition as causes of neoplasia.
In the 1800s, chemists isolated the active ingredient in tobacco and named it nicotine in memory of Jean Nicot, who imported tobacco into Europe in the 1500s. Nicotine is an alkaloid, C10H14N2, that is one of the most potent vegetable poisons. The proportion of nicotine in different varieties of tobacco varies from 2 to 8 percent. Pure nicotine is a colorless oily liquid. It boils at 240°F, it becomes brown and crystallizes on exposure to air, and it dissolves in water, alcohol, and oils [11]. The smallest quantity of nicotine capable of causing death of a person is unknown, but it is probable, that 2 or 3 drops of pure nicotine may be fatal. The poisonous effects of freshly prepared nicotine may be almost as rapid as those of cyanide or hemlock. Death is caused by respiratory arrest. Several cases were reported of accidental, suicidal, or homicidal fatalities by medicinal infusions or enemas of tobacco, or by the ingestion of food and wine contaminated with snuff or chewing tobacco [11].
Medicinal use of tobacco gradually decreased in the 1800s, but was replaced by the habit of smoking for pleasure. Celebrities, for example the Baroness de Dudevant, Frederic Chopin’s mistress, who was reportedly the first woman to smoke in public in Paris, gave a helping hand to tobacconists to sell a new product, hand-rolled cigarettes. The chewing of tobacco and pipe smoking continued into the 1900s and cigarette smoking became increasingly popular. In the 1920s, Frederick Hoffman, statistician of the Prudential Company of America, carried out a statistical survey to see if there were any health problems associated with tobacco smoking [12]. He analyzed his cases with consideration of the kind of tobacco used, the method of smoking, the quantity smoked, and the age at which the subject had begun to smoke. He concluded that the increase in cancer of the lung, to a certain extent, was directly traceable to cigarette smoking and he added that older methods of smoking (eg, pipe, cigar) were more injurious than the smoking of cigarettes.
In 1941, Alton Ochsner and Michael DeBakey, two American thoracic surgeons, observed that the increase in lung cancer was due to increased production of automobiles and consumption of tobacco [13]. They added that, despite the gravity of pulmonary cancer, due to its early detection and advances in surgical therapy, the prognosis was becoming relatively favorable.
In 1950, a retrospective study in the United States implicated tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma [14]. The authors, Ernest Wynder and Evarts Graham, reported that 94% of 605 men with bronchiogenic carcinoma were cigarette smokers, 4% were pipe smokers, and 2% smoked cigars. The influence of tobacco smoking on the development of adenocarcinoma was much less than on the other histologic types of bronchiogenic carcinoma. Also in 1950, a preliminary prospective study of a cohort of lung cancer patients in England by Richard Doll and Bradford Hill [15] showed that 100% of the men and 68% of the women were smokers. The authors emphasized that 32% of the female lung cancer patients were nonsmokers.
In 1957, Oscar Auerbach (1905–1997), an American pathologist, and his associates compared tissue sections from the tracheobronchial tree of smokers vs nonsmokers [16]. They found that basal cell hyperplasia, squamous metaplasia, and carcinoma in situ were less frequent in those who never smoked, and that the microscopic changes were progressively more severe in the moderate and heavy smokers.
In 1958, Cuyler Hammond and Daniel Horn [17] analyzed the mortality of men in the USA and concluded that the death rate of regular cigarette smokers was 68% higher than that of a comparable group of men who had never smoked [17]. The death rate of those who had smoked only occasionally was not significantly different from the death rate of men who had never smoked. Furthermore, the death rate of men who had given up cigarette smoking for a year or more was lower than that of men who continued smoking.
In 1964, the Surgeon General of the United states, Luther Terry, supported by an Advisory Committee, announced that cigarette smoking is hazardous to health and causally related to lung cancer and cancer of the larynx [18].
Trends in tobacco use in the United States from 1890 to 1990, published by the National Institutes of Health [19], show that before 1930, consumption of smokeless tobacco (ie, snuff and chewing tobacco) was most common, but that cigarette use climbed during and after World War II, so that by 1950, 50% of adults in the United States smoked cigarettes. The trends in tobacco consumption in the United States during the century from 1890 to 1990 are illustrated in Fig. 2⇓.
Five hundred years of recorded history of the use of tobacco is more informative and educational than many other topics in medical history. It is worth remembering the way that medicinal uses of an herb, tobacco, induced its consumption for pleasure hundreds of years ago. Despite sporadic warnings about the potential harm that tobacco may inflict on its abusers, it took nearly 450 years to apprehend and distinguish the true and falsely claimed consequences of tobacco use.