Robert Proctor – The Nazi War on Cancer
Antitobacco activists pointed to the fact that while Churchill, Stalin, and Roosevelt were all fond of tobacco, the three major fascist leaders of Europe Hitler, Mussolini, and Franco–were all nonsmokers. Hitler was the most adamant of the lot, characterizing tobacco as “the wrath of the Red Man against the White Man, vengeance for having been given hard liquor.”
American military leaders knew that German scientists had not slept through the Hitler era, and after the war commissioned dozens of leading scholars to write book-length summaries of their fields, a veritable Encyclopedia Naziana with entries on everything from biophysics to tropical medicine. It is interesting what fields they chose to ignore: occupational health and antitobacco research, for example.
Germans were also apparently the first to suggest that secondhand tobacco smoke might be a cause of lung cancer – in 1928.
Germany becomes the most X-rayed nation in the world (see chapter 4), a nation obsessed with tracking, diagnosing, registering, grading, and selecting.
The dead, of course, were not to be excluded from surveillance, and by the middle of the 1930s Germany had become perhaps the most autopsied nation in the world. Somewhere between 6 and 10 percent of all dead bodies were being subjected to autopsy.
Some examples are amusing: Germans were not supposed to use the traditional expression “catastrophe aid” but rather the more upbeat “first aid”; also barred was any media use of the expression “Yellow Peril,” in deference to the Japanese.33 There are efforts to modernize medical discourse: the shift from “cripple” (Krüppel) to “handicapped” (Behinderte) occurs in this period, for example, as does the shift from idiot and asylum to retarded and clinic. Strange as it may seem, both of these latter terms were introduced in the early 1940s by physicians orchestrating the “euthanasia” operation. The term “handicapped” (Behinderte), for example, was first used in 1940 by physicians and bureaucrats organizing the murder of the physically and mentally handicapped.
The “aging” of the German population was a major fear of racial hygienists, to which now could be added the additional threat of cancer, notorious for striking down the elderly. Haubold cautioned that a nation losing its “will to bear children” (Wille zum Kind) would suffer higher and higher rates of tumorous malignancies.
Civilization was blamed for nervousness, for the growing use of alcohol, tobacco, and illegal narcotics, for countless other diseases–including cancer.
Yet another element slowing the spread of natural medicine was the Rudolf Hess Fallschirm fiasco, one of the oddest events of the oddity-filled Third Reich. […]. Hess had long been a follower of homeopathic methods, and his was the name given to the nation’s most ambitious naturopathic hospital–the Rudolf Hess Krankenhaus, founded in Dresden in 1933.
but the flight of the Stellvertreter des Führers also opened up an opportunity to attack medical quackery–and quackery more generally” On June 12, 1941, the propaganda minister announced the arrest of “all astrologers, magnetopaths, anthroposophists, and so forth”.
At Dachau, naked women were forced to embrace the frozen, near-dead victims of hypothermia experiments, the theory being that their “organic” heat would prove more effective than, say, submersion in a bath of warm water.
Nazism pervaded orthodox medicine as deeply as alternative traditions; academics were as eager as “quacks” to vilify their Jewish colleagues, for example.
”Lifestyle” theories of carcinogenesis were actually quite popular in the Nazi era- even among committed Nazis.
Lehmann found that while noses with “exceptionally good filtering capacity” were able to capture 60 percent or more of the dust introduced, there were also noses that allowed almost all of the dust to enter the lungs. He used his apparatus to examine several hundred miners and found that those who had remained healthy after sixteen years tended to have much better nasal filtration than those who had fallen ill from silicosis. He also found that “mouth breathers” were more likely to contract the disease than “nose breathers.”
Hitler’s party did not scare off business as did the communists: when asked whether he would nationalize industry, Hitler replied: “why nationalize industry when you can nationalize the people?”
The rate of fatal accidents rose by 10 percent in the first four years of Nazi rule, an increase health officials openly traced to the escalating tempo of work. (Brewery-workers suffered the highest accident rates, higher even than those of miners.)
The number of “factory physicians” (Betriebsärzte) grew from only 467 in 1939 to an astonishing 8,000 in 1944. Most of these physicians had multiple duties, including maintaining labor discipline and doing whatever else was necessary to ensure optimal employee performance.
German military authorities wanted to know whether a pilot downed in the North Sea and exposed to water at a temperature of, say, ten degrees Celsius for three hours might still be alive and worth a rescue effort. Many of the most notorious experiments were designed to answer practical questions of this sort.
That same day [Dec. 23 1938] the Youth Protection Law of April 1938 was amended to permit boys under the age of sixteen to work in steel mills until 9 P.M. in weekly rotations; young men over the age of sixteen were allowed to work all hours, including night shifts between the hours of 8 P.M. and 6 A.M. Similar amendments were drafted for work in other hazardous industries, like glassworks, and a 1939 ruling empowered the Ministry of Labor “to invalidate the provisions of the youth protection laws for other industries connected with armaments.” Backsliding such as this led Martin Gumpert to denounce the labor protection laws of the Reich: “Behind a propaganda facade of humaneness there is the most shameless exploitation of child and youth labour which any legislator has ever dared to institute.”
Nazi leaders in many instances took steps to improve workers’ health and safety, though not everyone was equal when it came to obtaining help. Being sick or injured became more and more dangerous. Inability to work could itself become a death sentence, especially if there were doubts about your “racial fitness.’
According to Hermann Holthusen, an influential Hamburg radiologist, there was in the mid-1920s “not a major hospital in Germany without patients suffering from the delayed effects of radiation”
Eugenicists had earlier objected to the use of radiation as a form of temporary birth control; permanent sterilization, by contrast, seemed morally, medically, and racially unobjectionable.
During the Second World War, as plans were underway to create a “radiologic bomb” - using conventional explosives to scatter hazardous radioisotopes discussions were also begun concerning the construction of an X-ray weapon for use in aerial combat, the idea being that a sudden burst of X-rays might be enough to kill or injure the crew of an enemy’s aircraft.
Millions of Germans traveled to the radioactive spas of Kreuznach, Gastein, and Oberschlema in the first half of the twentieth century, hoping to be revitalized by the experience. (Some of these are still open today, with just as much radon to inhale.)
Ja, selbst heute noch.
As late as 1956, American epidemiologists could claim there were “too few cases and too little epidemiologic data to establish a significant relationship” between lung cancer and asbestos; […] The Nazi scholars who, two decades earlier, had claimed to have established the link relied not on epidemiology but on clinical and pathological in-sights. Clinicians examining patients and pathologists dissecting corpses had noticed asbestotics coming down with the disease, but also that lung cancers were most often found in those parts of the lungs where the inhaled fibers tended to concentrate (espe-cially the lower lobes). Detailed study of individual cases was sufficient, for these early scholars, to generate reliable conclusions about causality. […] The “higher” standard of proof required by the new field of epidemiology prejudiced scholars against the insights gained through clinical investigations, a loss Chris Sellers has characterized as “the vanishing clinician’s eye.”
The war on disease turned into a war on the diseased. As one prominent Nazi doctor put it after the war, Nazi physicians wanted “to eliminate sickness by eliminating the sick.” I. G. Farben’s Auschwitz plant put this into practice by never allowing more than 5 percent of its total workforce (all of whom were slave laborers) to be hospitalized at any given time. When the 5 percent figure was exceeded, camp physicians performed a selection, and the unfortunate selectees were sent to Birkenau and gassed.
The goal of occupational medicine likewise became a worker who would remain productive until retirement and then pass away shortly thereafter. As Hermann Hebestreit of the German Labor Front put the matter, the aim was to reduce the difference between the age of retirement and the age of death–ideally to zero.
In the idealized Nazi scheme of things, workers would work long and hard and then die saving for the Volksgemeinschaft the financial burdens of the elderly and “unproductive” infirm.
Nazi nutritionists mounted a frontal attack on Germans’ excessive consumption of meat, sweets, and fat, and argued for a return to “more natural” foods such as cereals, fresh fruit, and vegetables.
As one Hitler Youth health manual put it: [Nutrition is not a private matter!” The body of the German citizen, after all, was supposed to be the material property of the German state.
Nazi philosophers and politicians contrasted this notion of “health as a duty” (officially embraced as a national slogan in 1939) with the purportedly “Marxist” notion of health as “the right to do whatever you want with your own body.”
Equally lamentable was the “senseless swallowing of drugs” (sinnlose Medikamentenschluckerei) encouraged by doctors in the pocket of the pharmaceutical industry. Overmedication was a “pathology of therapy” caused by uncritical addiction to scientific medicine.
A mid-1930s Hitler Youth manual, Health through Proper Eating, for example, includes an entire section under the rubric “Too Much Meat Can Make You Sick.” The manual talks about the dangers of “empty calories” and champions soybeans as a wholesome (vollwertig) substitute for meat.
“Heil Göring!” The lab animals of Germany saluting Hermann Göring for his order barring vivisection. The Reichsmarschall in August of 1933 announced an end to the “unbearable torture and suffering in animal experiments” and threatened to commit to concentration camps “those who still think they can treat animals as inanimate property.”
Goebbels, at least, had reached this point by February of 1942, cautioning that “no one will listen to well-reasoned arguments if butter and meat are taken away from him.”
That same day, when his Gestapo chief tried to broach with him the need to simplify the party’s complicated bureaucratic structure, Hitler responded that there were “far more important things than politics-reforming the human lifestyle, for example. What this old woman told me this morning is far more important than anything I can do in my life.”
we are in the hands of the food companies, whose economic clout and advertising make it possible for them to prescribe what we can and cannot eat. City folk, living through the winter largely on canned food, are already at their mercy, but now they attack the countryside with their refined flour, sugar, and white bread. The war has interrupted these proceedings; after the war we shall take energetic steps to prevent the ruin of our people by the food industries.
The most famous joke from the era asked: “What is the ideal German? Blond like Hitler, slim like Göring, masculine like Goebbels. …”)
Historian Brian S. Katcher has pointed out that cirrhosis of the liver, cardiomyopathy, fetal injuries, and esophageal cancer were all well-known effects of alcohol at the turn of the century–and were later forgotten.
Hitler himself attacked alcohol in a 1926 article in the Völkischer Beobachter, the official Nazi party newspaper, mourning “the valuable people especially Germans–destroyed or rendered useless by alcohol, exceeding by an order of magnitude even the numbers of those lost on the field of battle.” The NSDAP leader predicted that “a people managing successfully to rid itself of this poison” would likely come to dominate other parts of the world “unprepared to take that step.”
Nonalcoholic fruit ciders, for example, had an official stamp of approval (Jugendwert) printed on their labels; Coca-Cola, by contrast, was declared unsuitable for children.
Martin Gumpert in 1940 concluded that Germans were poisoning themselves with alcohol on a scale comparable to the poisoning of the Chinese by opium: alcohol was “the Nazi opium for Germany.”
Prussian health minister Arthur Gütt in 1937 pointed out that Germans were spending a staggering 3.5 billion reichsmarks on alcohol and another 2.3 billion on tobacco every year: the total of 5.8 billion RM was 10 percent (!) of the entire German national income (Volkseinkommen).
There were times – they now seem far away and almost incomprehensible – when the ideal German was the man who could handle his beer and hard liquor. Today, we no longer look to the guy who can handle his drink, but rather to the young man who can tough it out in rough weather, the hard young man. The point is not how much beer you can drink but how many blows you can take (Schläge aushalten), not how late you can stay out but how many miles you can march. We look no longer to the beer drinker as the ideal German, but rather to the men and women who are healthy, erect, and tough.”
The flip side of the economic argument, of course, is that alcohol Was a cash cow for the state. In 1937 alone, the Reich treasury took in RM 840 million in alcohol taxes. But alcohol was also a convenient way to drown sorrows. Many an evil deed must have been forgotten by perpetrators who drank themselves into a stupor (recall Gumpert’s “opium” equation).
On February 1, 1942, Joseph Goebbels ordered workers at high-performing factories to be given special rations of cigarettes and alcohol. He also barred the public sale of alcohol in Berlin, insisting that all available liquor be used instead “as a reward for outstanding performance in the factories.”
A 1941 Hitler Youth handbook declared that for young people at least, caffeine was a poison “in every form and in every strength.”
At Dachau, Nazi doctors fed prisoners mescaline to see whether it might be possible to manipulate their opinions. The general consensus, after thirty prisoners were treated with the drug, was that it was “impossible to impose one’s will on another person as in hypnosis, even when the strongest dose of mescaline had been given.”
Nazi officials cracked down hard on cocaine, heroin, and other illegal narcotics: American drug enforcement officials in the mid-1930s praised German efforts in this area as among the best in the world.
Ordinary foods were also explored for their performance enhancing power. A 1942 study found that a warm meal could “increase performance by 10 percent” among women doing night-shift work. A 1941 investigation reported that workers exposed to extremes of heat were best served by foods high in carbohydrates. Reduction of fatigue was a focus of many investigations of this sort: experiments done by Otto Ranke in 1940 and 1941, for example, showed that a high-protein diet could, under certain circumstances, stave off fatigue and increase capacity to work.
Searches were launched to find new substitutes for coffee (malt coffee and a brew derived from oats), protein (soybeans were a hot item, earning them the label “Nazi beans”), and diverse fats and oils (hardened walnut oil, for example, used as a lard substitute)
Germany in the 1930s had the world’s largest commercial whaling fleet.
When rations were cut in March of 1942, a public opinion survey conducted by the Sicherheitsdienst (Heydrich’s SS security service) found that no other announcement since the onset of war had delivered such a blow to public morale.
[Tabacco] Cultivation was common in many parts of Germany by the end of the seventeenth century, though certain towns were not exactly tobacco-friendly. In the late 1600s, smoking bans were enacted in Bavaria, Kursachsen, and certain parts of Austria. Smoking was banned in Berlin in 1723, in Königsberg in 1742, and in Stettin in 1744. Penalties for violating such bans could be severe. In Lüneberg in 1691, for example, persons found smoking or “drinking” tobacco within the city walls could be put to death.
When Friedrich the Great of Prussia banned public smoking in 1764, the fear again was that smoking could pose a fire hazard. Goethe in 1806 sniffed at smoking as a companion of drunkenness, a corruption of the spirit, and a financial burden on the German nation, costing 25 million taler per year. The philosopher Arthur Schopenhauer derogated smoking as “a substitute for thought,” and Immanuel Kant proclaimed tobacco a habit-forming nuisance that, like alcohol, was especially dangerous for children.
Tobacco had been suggested as a cause of cancer as early as the eighteenth century: the English physician John Hill in 1761 had tied smoking to cancer of the nasal passages, and Samuel T. von Soemmerring in Germany three decades later identified pipe smoking as a cause of cancer of the lip.
These early insights were confirmed in the 1850s, when a French physician by the name of Etienne-Fréderic Bouisson in Montpellier found that sixty-three of his sixty-eight patients with cancer of the mouth (cancer des fumeurs) were pipe smokers.
In 1912, when Isaac Adler produced the first book-length review of the anatomy and pathology of lung cancer, he felt he had to apologize for writing on such a rare and insignificant disease.
Cigarettes were not even manufactured in Germany until the 1860s, and even then the factory girls of Dresden were able to produce only about 120 per hour.
The introduction of milder types of tobacco and flue curing made it easier for smokers to inhale the burning fumes, encouraging a shift from pipes and cigars to cigarettes. The change was not a trivial one: indeed, as Henner Hess observes, we are talking about “a revolutionary development in the history of drug consumption, roughly comparable in significance to the invention of the hypodermic needle for opiate addiction. By contrast with pipe smokers, cigarette smokers tended to draw the fumes more deeply into the lungs, delivering a much higher dose of tar, nicotine, and other noxious substances to their bronchial passageways.
The Chemnitz (and later Dresden) physician Fritz Lickint in 1929 was one of the earliest to publish statistical evidence joining lung cancer and cigarettes. He was not the first to suggest a link – Isaac Adler and others had already done this – but his was the most thorough review up to that time, while also presenting new statistical information.
[Licking] also compared tobacco addicts to morphine addicts and made a convincing argument that “passive smoking” (Passivrauchen –he seems to have coined the term) posed a serious threat to nonsmokers.
Müller concluded not just that tobacco was “an important cause” of lung cancer, but that ”the extraordinary rise in tobacco use” was ”the single most important cause of the rising incidence of lung cancer” in recent decades (emphasis in original) This is an extraordinary claim – the strongest ever issued up to that time, stronger even than any of the claims made by British or American scientists until the 1960.
Anyone who doubts that tabacco companies have “manipulated “ the nicotine content of cigarettes need only consult German tobacco literature, where we have countless examples of such manipulation. The proliferation of “low-nicotine” and “nicotine-free” tobacco products – often with varying levels of the intoxicant – led to efforts to regulate advertisements and to standardize nicotine contents. The Ordinance on Low-Nicotine and Nicotine-Free Tobacco of May 12, 1939, for example, required “low-nicotine” tobacco to contain less than 0.8 percent of the alkaloid, and nicotine-free cigarettes no more than 0.1 percent. Antitobacco activists by this time were fond of pointing out that nicotine was only one of many harmful elements of tobacco, and that low-nicotine products might actually cause smokers to increase their smoking to maintain a comfortable level of nicotine intake.
Hitler seems to have regretted having allowed his soldiers to smoke: on March 2, 1942, he noted that “it was a mistake, traceable to the army leadership at the time, to have started giving our soldiers daily rations of tobacco at the beginning of the war.” He added that it was “not correct to say that a soldier cannot live without smoking,” and vowed to put an end to military tobacco rations once peace was achieved.
[Hitler] also claimed – strange as this sounds today – that Germany might never have achieved its present glory if he had continued to smoke: “perhaps it was to this, then [that is, his giving up smoking], that we owe the salvation of the German people.”
experiments conducted by the German military in the late 1930s found that smoking impaired a soldier’s marksmanship and reduced his ability to march for long distances.
the myth that English and American scientists were first to show that smoking causes lung cancer (Richard Doll was knighted for his work in this area) was a convenient one – both for scholars in the victorious nations and for Germans trying to forget the immediate past. The hoary specter of fascism is perhaps healthier than we are willing to admit.
Wartime urgencies led a military physician in 1944 to write that “only a fanatic” would withhold a drink or a smoke from a soldier trying to calm his nerves after the horrors of battle.
Shortages remained so severe that American authorities decided to ship tobacco, free of charge, into Germany as part of the Marshall Plan. Twenty-four thousand tons were shipped in 1948, followed by another sixty-nine thousand tons in 1949. The net cost to the U.S. government was on the order of seventy million dollars; the benefit, at least for American tobacco firms, was a gradual shift in German tobacco tastes from the traditionally favored black tobacco to the milder, blond-Virginia blend (the latter was also purportedly more popular among women). American tobacco companies were understandably pleased with the arrangement.
There are also well-known cases, however, where aspects of human health actually improved as a result of wartime privations. We know from the First World War, for example, that while rickets and other vitamin deficiency diseases rose in many European nations (from the low consumption of fresh fruits and vegetables), diabetes rates actually plunged from the unavailability of refined sugar. Many similar effects were observed after the Second World War –low rates of arteriosclerosis, for example, caused by the low consumption of meat and fat.
I would tend to agree with Michael Burleigh that “the Nazi analogy is pretty marginal to contemporary discussions about euthanasia”; I would also agree with Arthur Caplan that comparisons invoking Nazi medicine must be drawn with care lest we mischaracterize contemporary policies or diminish the genuine extremity of the Nazi experience.
The Nazi campaign against tobacco and the “whole grain bread operation” are, in some sense, as fascist as the yellow stars and the death camps. Appreciating these complexities may open our eyes to new kinds of continuities binding the past to the present; it may also allow us better to see how fascism triumphed in the first place.