Smokeless tobacco--health hazards from a good 'ole habit.

History of tobacco use A LTHOUGH tobacco is now almost always associated with smoking, this is a relatively new trend in the long-recorded history of tobacco. For almost 500 years, snuff or chewing tobacco were the predominant forms and may even have been the original methods of taking tobacco. As early as Columbus' second voyage in 1493, Friar Roman Paine's journals described the taking of snuff and chewing tobacco in addition to 'drinking smoke'.2 This friar probably introduced tobacco to Europe but it was not successfully cultivated there until 1556 when Andre de Thevet grew seeds from Brazil in his herbal garden at Angouleme.2 There was great interest in the pharmaceutical potential of tobacco as it was known that it was widely used as a medicine in the New World. However, one of the most famous early 'trials' ended disasterously in 1559 when Jean Nicot (immortalized in the word nicotine), the French ambassador to Lisbon, recommended snuff to Francis II for asthma.3 The King's subsequent death enabled his widow, Mary Queen of Scots, to return to Scotland, thus setting in train the events which made possible the union of Scotland and England. It is not known if the tragic queen used tobacco in any form, but her son James VI (and I) certainly detested the various tobacco habits and wrote a pamphlet denouncing the 'stinking weed'.4 James used many of the techniques recommended by modern crusaders against tobacco. In addition to written materials like his Counterblaste to tobacco he raised tobacco taxes by 4000'70 and even demonstrated anatomical specimens such as black brains and viscera attributed to the effects of tobacco.5 In spite of royal disapproval, snuff quickly became a popular habit helped by a reputation as a powerful prophylactic against the plague as well as medicine 'for all lethargy, all long griefes, paines, and aches of the head, continued senselesses or benumming of the brain'.2 The preference for snuff over tobacco smoked in pipes has been attributed variously to the Royal Navy which banned smoking in its wooden vessels in the eighteenth century, and to the patronage of George III and Queen Charlotte. Nicknamed 'snuffy Charlotte', she was reputed to keep an entire room at Windsor Castle stocked with snuff. Whatever the reason, tobacco taken by sniffing or 'dipping', that is a pinch dissolved between gum and cheek, had displaced smoking in England by the middle of the eighteenth century. The habit was almost universal among adults of both sexes and snuff was regarded 'as the final reason for the human nose'.6 Chewing tobacco leaf was the tobacco habit preferred by American frontiersmen. 'Plug' tobacco was invented in North Carolina in the early nineteenth century. The term originates from the method of production which involved filling auger holes in sweet-sapped trees (such as the maple) with leaf tobacco. After a few months, the plugs of sap-sweetened tobacco were harvested by splitting the logs.7 The Lorillard family who had been in the snuff business since arriving in America as Huguenot refugees in 1760, also came to dominate the market for plug tobacco. By the time of Charles Dickens' visit to America in 1842, chewing tobacco was an almost universal habit among American men and he described Washington as the 'headquarters of tobaccotinctured saliva'.2 Modern US senators have lost their predecessors' reputation for chewing tobacco and spitting but polished spittoons are still prominent in the Senate Building. Two large snuff boxes are also maintained just behind the Vice President's dias and $161.10 is allowed in the budget for snuff.8 Public opinion slowly turned against smokeless tobacco towards the end of the nineteenth century with the acceptance of the germ theory and the recognition that many diseases, especially tuberculosis, could be spread by tobacco spitting and sneezing. The trend towards smoking was accelerated by the invention of a cigarette machine by James Bonsak in 1880. By 1885 production of cigarettes in USA reached one billion but it took until 1921 for cigarettes to surpass all other forms of tobacco; this trend was assisted by mass production and innovative advertising, particularly by the Camel Company. The First World War was probably an important contributor to the dissemination of the cigarette smoking habit and by the 1920s smoking tobacco had come to dominate the market. In the quarter century 1950-79, smokeless tobacco became regarded as a 'quaint' habit restricted to specific groups such as older farmers or to occupations where smoking was particularly hazardous, for example, the mining, petroleum and chemical industries. Snuff-dipping persisted as a habit of women in the deep south of the USA.9