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IN 1941 THE nazi magazine auf der wacht (On Guard) published an illustration reminding Germans of a new public-health ordinance. The poster showed a cigarette, a cigar, and a pipe, all smoldering beneath a menacing black boot and an eagle-and-swastika insignia.

The illustration, and dozens others like it, is reproduced in a new book by the Penn State science historian Robert N. Proctor. In The Nazi War on Cancer (Princeton), Proctor argues that medical and scientific research under Hitler produced some significant, verifiable breakthroughs. Nazi Germany was decades ahead of the democracies in discovering that cigarette smoking causes lung cancer, and its scientists worked to identify carcinogens in the workplace and the environment. What’s more, the Third Reich promoted a series of public-health measures that might well be called forward-looking: banning smoking in certain public places, running an aggressive antismoking propaganda campaign, and placing restrictions on how tobacco could be advertised. Proctor asks a stunning question: Could the most extensive cancer-prevention campaign of this century have been initiated by Hitler?

At this point, the answer is unclear. Though dozens of scholars have written about science and medicine in Nazi Germany, few have even glanced at the anticancer effort. For good reason: The cruel and needless medical experiments performed on prisoners in concentration camps, the mass sterilizations, and the "euthanasia" of those with mental disabilities and physical handicaps tend to command the attention of historians and medical ethicists alike. Even Proctor took a while to get interested in the Nazi war on cancer. His first book about fascist science, Racial Hygiene: Medicine Under the Nazis (Harvard, 1988), concentrated on the connections between racial ideology and medical practice. Though it included a chapter on the Nazi obsession with natural foods, Proctor presented that history as an odd sidebar to the racism and genocide. Only years later, when he was a fellow at the Holocaust Museum and needed a related research topic, did Proctor revisit the subject. "I started thinking that it had been completely hushed up, or ignored, depending on how you look at it," he says.

Cancer, little understood, and relatively uncommon before the late nineteenth century, emerged as a socially important, and politically charged, issue at the beginning of the twentieth. Germans, even more than their counterparts in most of the industrial world, seemed to be obsessed with the disease–in part because Germany was a major producer of carcinogenic coal dyes and other potentially dangerous products and had a disproportionate share of cases as a result. In Nazi ideology, cancer became a powerful symbol, a disease of modernity the nation would have to purge. Jews were doubly scapegoated: Because they were imagined to spread "diseased genes," they were seen as agents of the disease; because they were metaphorically viewed as a tumor on the volk, they were also seen as cancerous themselves.


Hitler, needless to say, shaped many of these theories. A nonsmoking, nondrinking vegetarian, the Führer promoted the idea that through asceticism one could improve the health of the race. This helped orient German medicine away from trying to cure cancer and toward trying to prevent it. Nazi-friendly researchers did important research on the dangers posed by long-term exposure to X rays, while other physicians warned early on about the dangers of asbestos and quartz dust. Perhaps most striking, though, was Nazi research on the links between cigarette smoking and lung cancer. Reviewing the work of dozens of now-forgotten Nazi-era German researchers, Proctor concludes that the link between smoking and lung cancer–typically credited to American and British researchers of the 1950s–was the consensus view among German cancer experts by the early 1940s.

History hasn’t been kind to some of Hitler’s critics in the medical professions. As researchers in Germany and elsewhere began to connect repeated exposure to X rays with cancer, prominent left-wing doctors worried that the findings would play into the hands of antitechnology eugenicists. So they dismissed the findings as fascist propaganda: A 1932 article for Sozialistischer Arzt, the journal of the Association of Socialist Physicians, chalked up the research to "racial fanaticism." Critics of the Nazi diet managed only slightly better. Martin Gumpert, an émigré physician, laid into Nazi food policy in his deliciously titled polemic, Heil Hunger!: Health Under Hitler (1940). But a quick look at Gumpert’s main evidence–he was concerned that Germans were eating more carbohydrates and not enough meats, fats, and eggs–hardly suggests a crisis in nutrition.

The Nazis translated their scientific discoveries into public policy. Propaganda campaigns promoted the Führer’s clean-living lifestyle as a benchmark for all Germans, who were called on to live healthily for the good of the race. The Nazis began a temperance campaign, although they avoided demonizing beer for fear of alienating the German workingman. Smoking was a different story. The habit, Proctor reports, "was associated with jazz, and with swing dancing, with rebellion, with Africa, with degenerate blacks, Jews, and Gypsies, with many of the other fears that inspired the Nazi retreat into a paranoid, xenophobic fortress of purity, cleanliness, and muscular macho health fanaticism." The Nazis passed criminal sanctions against driving "under the influence" of cigarettes. Reich health führer Leonardo Conti worried that tobacco’s addictive qualities would compete with political loyalty. One medical paper discussed a final, if nonlethal, "solution to this difficult problem of smokers." And the Nazis even sentenced one unlucky worker to death after a stray cigarette ash started a fire at a spray-paint factory.


All this may sound like fodder for libertarians, who sometimes argue that any policy to deter a particular behavior leads us down the road to fascism (and who already compare Hillary Clinton to Adolf Hitler). But Proctor insists that isn’t the point. A consultant for the plaintiffs in an Ohio-based class-action lawsuit against tobacco companies, Proctor describes himself as "firmly antismoking." And he points out that the Nazi propaganda campaign ultimately failed to wipe out the habit. "The best way to combat tobacco is taxation, and then to cut back on the economic advantages that the tobacco industry enjoys," he says. In Germany, tobacco fought back. It financed its own tobacco research center and took on the health führer when he tried to close it. In the end, the Nazis proved unwilling to dismantle the industry completely. They continued to supply the Wehrmacht with tobacco rations and eventually made a deal with German tobacco makers that guaranteed the industry’s survival. Perhaps that’s the important lesson for today: The tobacco industry was able to thwart even the Nazis.

Is there a danger in giving the Nazis credit for their medical insights? "We have to remember primarily Auschwitz and the role of doctors at Auschwitz," insists Robert Jay Lifton, the author of The Nazi Doctors (Basic, 1986). "These additional areas are very important to bring out, and much of their importance lies in their illustrating how an evil regime can have aspects of respectable intellectual and scientific behavior."

Proctor suggests that his predecessors may have passed on this project in part because "it’s kind of an embarrassing fact. Who’s going to be interested? Even in Germany, they don’t like to see anything ‘good’ come out of the Nazi era." In the end, he argues, "We do not want to forget Mengele’s crimes, but we should also not forget that Dachau prisoners were forced to produce organic honey and that the SS cornered the European market for mineral water."


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