Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
[Report of the Medical Officer of Health for Greenwich Borough]
have up to thirty times the death rate of non-smokers and,
inter alia, it has been shown that cigarette smokers are much more
affected than pipe or cigar smokers and also that those who had
given up smoking had lower death rates than those who continued
Naturally there has been vigorous criticism to the effect that
these results have been based on errors of selection and of diagnosis
and that the association between smoking and lung cancer in these
studies is therefore spurious. Despite the fact that these criticisms
have been substantially refuted and that it is generally agreed by
authoritative bodies that there is an association between lung cancer
and cigarette smoking, it has been sincerely postulated that there
may be possible explanations of this association other than the
straightforward one of cause and effect. These have been itemised
(a) That people who are going to get lung cancer have an
increased desire to smoke throughout their adult lives.
(b) That smoking produces cancer only in the lungs of people
who are in any case going to get cancer somewhere in the
body so that smoking determines only the site of the
(c) That lung cancer affects people who would have died of
tuberculosis in former times but have now survived with
lungs susceptible to cancer.
(d) That smokers inherit their desire to smoke and, with it,
inherit a susceptibility to some other undiscovered agent
that causes lung cancer.
(e) That smokers are, by their nature, more liable to many
diseases including lung cancer, than the "self protective"
minority of non-smokers.
(f) That smokers tend to drink more alcohol than nonsmokers
so that drinking and not smoking may cause lung
(g) That motor car exhausts, or
(h) that generalised air pollution may render the lungs of
smokers more liable to cancer.
Of the abovementioned explanations, none fits the facts
enumerated in the Report as well as the "obvious" one, viz.: that
smoking is a cause of lung cancer and from the point of view of
public health importance, perhaps only items (d), (g) and (h) warrant