Bedside Rounds

44 - The Great Smog


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What was behind the mysterious increase in lung cancer deaths at the turn of the 20th century? The first of a three-parter investigating the cigarette-smoking link and causality, this episode looks at that early debate, which largely focused on environmental pollution. Along the way, we’re going to talk about toxic vapors -- and not Miasma theory, but the actual literal Great Smog of London in 1952 that killed over 10,000 people -- as well as the birth of the case-control study, Nazi attempts at tobacco control programs, and the rather prosaic beginnings of a debate that rages to this day. Plus a new #AdamAnswers about the medical cause of Game of Thrones greyscale featuring Dr. Jules Lipoff!

 

Sources:

  • Bell, M. L., Davis, D. L. & Fletcher, T. A retrospective assessment of mortality from the London smog episode of 1952: the role of influenza and pollution. Environ Health Persp 112, 6–8 (2003).
  • Brunekreef B, Air Pollution and Life Expectancy: Is There a Relation? Occupational and Environmental Medicine, Vol. 54, No. 11 (Nov., 1997), pp. 781-784.
  • Des Voeux HC, Smoke and Fog, The Lancet, 1679-1680 (1904).
  • Logan WPD, Mortality in the London Fog Incident, 1952. The Lancet, 336-338 (1953).
  • Heirdorn KC, The Weather Doctor's Weather Almanac: The Infamous London Smog of 1952, 2012.
  • HOFFMAN, F. L. CANCER AND SMOKING HABITS. Ann Surg 93, 50–67 (1931).
  • Morabia, A. Quality, originality, and significance of the 1939 “Tobacco consumption and lung carcinoma” article by Mueller, including translation of a section of the paper. Prev Med 55, 171–177 (2012).
  • Ochsner, A. My first recognition of the relationship of smoking and lung cancer. Prev Med 2, 611–614 (1973).
  • Ochsner, A. & bakey. Primary pulmonary malignancy: treatment by total pneumonectomy; analysis of 79 collected cases and presentation of 7 personal cases. Ochsner J 1, 109–25 (1999).
  • Parascandola, M. Two approaches to etiology: the debate over smoking and lung cancer in the 1950s. Endeavour 28, 81–86 (2004).
  • Press, D. J. & Pharoah, P. Risk Factors for Breast Cancer. Epidemiology 21, 566–572 (2010).
  • Proctor, R. Angel H Roffo: the forgotten father of experimental tobacco carcinogenesis. B World Health Organ 84, 494–495 (2006).
  • Proctor, R. N. The anti-tobacco campaign of the Nazis: a little known aspect of public health in Germany, 1933–45. Bmj 313, 1450 (1996).
  • Proctor, R. On playing the Nazi card. Tob Control 17, 289–290 (2008).
  • Winkelstein, W. Vignettes of the History of Epidemiology: Three Firsts by Janet Elizabeth Lane-Claypon. Am J Epidemiol 160, 97–101 (2004).
  • Proctor R, The history of the discovery of the cigarette–lung cancer link: evidentiary traditions, corporate denial, global toll. Tobacco Control. 21:2 (2013).
...more
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Bedside RoundsBy Adam Rodman, MD, MPH, FACP

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