Ever-increasing tobacco taxation; highly visible anti-smoking campaigns; vigorous efforts to prohibit the sale of cigarettes to youth; strict control over the content and placement of tobacco-industry advertisements; the banning of smoking from many public spaces; the marginalisation of smokers - all are familiar features of late 20th-century American life. And all, according to historian Robert Proctor, occurred in Nazi Germany. Indeed, at the height of the Third Reich, activists sought to outlaw smoking in the work place and smoking while driving, established tobacco counselling centres to help wean Germans from the addiction and waged a veritable war against the tobacco companies. German trains began to feature non-smoking cars, and over the course of the Nazi dictatorship smoking was eliminated on trams in 60 German cities. In 1939 the Nazis barred smoking from all party offices, and not long afterwards Himmler prohibited officers of the SS and the police from enjoying cigarettes while on duty and in uniform. Imbued with organistic metaphors, Nazi discourse depicted Jews, Marxists and other enemies as cancers on the German national body ( Volkskörper ); in turn cancer cells appeared in public health propaganda as insidious, parasitic Jews.
Perhaps we should not be so surprised that the Nazis were obsessed with cancer - a regime centrally concerned with national fitness and public health would naturally devote considerable energies to combating a disease that took 100,000 German lives a year in the 1930s. But what does come as a shock is the success of the cancer research carried out under the Nazis and the progressiveness of Nazi-sponsored health campaigns.
Contrary to the widely held belief that the link between smoking and lung cancer was established by scientists in the US and Britain after the war, Proctor's startling research reveals that the connection was actually made by Germans and was reinforced by a number of epidemiological studies conducted during the Nazi period. Almost as interesting is the fact that such a significant story has slipped into obscurity. Nazi-sponsored cancer research was forgotten (or repressed) for decades in the German medical community's eagerness to turn its back on the whole Nazi episode, which conveniently coincided with the interests of ambitious cancer researchers from the Allied countries.
Physician Fritz Lickint first published studies linking lung cancer and cigarette smoking in 1929, and although he was not the earliest scientist to establish this connection, his investigations amassed an unprecedented amount of rigorous statistical evidence. Lickint's 1939 Tabak und Organismus (Tobacco and the Organism), which Proctor calls the "most comprehensive scholarly indictment of tobacco ever published", linked tobacco usage with cancers of the lips, tongue, mouth, jaw, oesophagus, windpipe and lungs. The tome also characterised cigarette smoking as addictive and demonstrated the dangers of passive smoking. Although an active socialist before the Nazi assumption of power, Lickint flourished under the Nazis, since his research resonated with the regime's anti-smoking culture, a climate shaped by Reich health leader Leonardo Conti and inspired by Hitler himself, who attributed Nazi (and therefore German) triumphs to the fact that he had quit smoking, prohibited Eva Braun from smoking in his presence and continually chided Goring for the latter's ever-present cigar. (Goebbels, an erstwhile chain smoker, succeeded in kicking the habit in 1944, only to succumb again after the Stauffenberg plot nearly took the Fuhrer's life that July.) In addition to its formidable research programme, the Nazis' "war on cancer", a crucial component of their attempts to create a healthy, productive nation (of Aryans), emphasised prevention and included such forward-looking measures as work-place safety precautions and regulation of carcinogenic toxins, dyes and food additives.
In this book Proctor returns to themes he raised in Racial Hygiene: Medicine under the Nazis , his pathbreaking 1988 study of German eugenics and racial science. Both works interrogate the relationship between science and politics and undermine assumptions about the impossibility of doing "good" science under repressive regimes. The earlier book attacked the premise that Nazi leaders imposed their murderous, racialist pseudo-science on a reluctant medical profession, showing the tremendous support for National Socialism in Germany's biomedical community and establishing the complicity of respected doctors in designing and even carrying out the regime's unspeakable atrocities. Proctor frames his research on cancer similarly, and forces us to acknowledge that good science can occur - and prosper - under fascism. For Proctor, the "flip side of fascism", his unfortunately glib phrase, denotes the possibility of real scientific advance and genuinely salutary health measures under a regime of unprecedented cruelty and barbarism. Nazi initiatives, he argues, did partially reduce cancer rates, at least among women, whom the regime's paternalistic policies strongly discouraged from smoking.
Historians have known for some time that Nazism was a complex phenomenon that accommodated diverse and disparate tendencies, navigated endless internecine struggles and unleashed the most modern means in its murderous pursuit of the most reactionary aims. Science and medicine display these tendencies in microcosm, defying simple categorisation as reactionary, anti-modern or crackpot. Thus, alongside beliefs in mysterious rays, absurd racial theories and utopian breeding schemes, one finds solid scientific work, like that of Franz H. Muller, a party member whose pathological investigations and meticulous case-control studies further confirmed Lickint's findings. For Proctor the fact that Muller's work was promoted by a racist and morally bankrupt regime does not taint his findings or their potential health implications for us.
The Nazi War on Cancer is a provocative and powerful book. It presents a great deal of research in an accessible, even breezy style and makes important contributions both to the history of medicine and to our understanding of fascism's many dimensions. Yet Proctor shies away from some of his book's broader implications. Conscientiously dissociating himself from organisations which castigate anti-smoking initiatives as fascistic and complain of "Nico-Nazis" and "health fascists", he seems uninterested in the alarming parallels between Nazi-era anti-cancer measures and our own culture of health. Writing from my Los Angeles office, at the epicentre of the anti-smoking movement (and an ex-smoker myself), I concede that there is nothing fascistic or Nazi-like about combating a dirty, dangerous and addictive habit; however, one can infer from Proctor's research that in matters of public health our assumptions alarmingly approximate those of the Nazis. Perhaps now would be a good time to problematise our own "war on cancer". Proctor's disturbing findings might suggest that the Nazis' privileging of productivity, public health and fitness, like our own, represents not a departure from, but an inherent part of the western path to modernity.
Paul Lerner is assistant professor of history, University of Southern California, United States.
The Nazi War on Cancer
Author - Robert N. Proctor
ISBN - 0 691 00196 0
Publisher - Princeton University Press
Price - £17.95
Pages - 365