Royal insights on smoking - BMJ
March 22, 2010

Wendy Moore

Monarchs and their heirs are not always noted for their rational medical advice. But James VI of Scotland, who became James I of England in 1603, certainly earnt his nickname as "the wisest fool in Christendom" for his visionary insights into smoking.

Published anonymously in 1604 but immediately credited to the king, A Counterblaste to Tobacco flew in the face of prevailing medical opinion by outlining some of the chief health risks of smoking more than three centuries before scientists made the connection. Possibly the first official antismoking campaign, the royal pamphlet highlighted cost and passive smoking as two of the most powerful arguments against tobacco, while it lamented that addiction, peer pressure, and fashion were among the most difficult obstacles to overcome.

Introduced into Europe in the previous century, tobacco had already gained an enthusiastic following with the zealous encouragement of the medical establishment. The Spanish physician Nicolas Monardes listed 36 illnesses in 1571 that smoking either cured or prevented, including toothache, halitosis, and cancer. Since the plant had arrived from North America at the same time as syphilis, tobacco was frequently prescribed, with the scientific logic of the age, as an antidote to the infection.

James I was having none of it. Employing the xenophobia he knew was one of his strongest propaganda weapons, he argued that just as the English disdained the customs of the French and Spanish so they should n ot mimic the "barbarous and beastly maners of the wilde, godlesse, and slavish Indians."

And with impeccable rationality the king speedily dismissed medical claims that tobacco had cured illnesses ranging from gout to ague. Just because a sick man got better after smoking did not prove that tobacco caused his recovery, he argued. This was like an "olde harlot" attributing her long life to "harlotrie." The "natural course" of a disease and the "apprehension and conceit of the patient" were more likely to have effected the cure, he explained.

The habit of smoking enslaved men who could no longer "forebear the same," cost up to "foure hundred pounds a yeere," and pervaded public places with its "filthy smoke and stinke," the king argued.

Furthermore, the custom was so prevalent that people felt obliged to smoke rather than seem "peevish and no good company" or, li ke those who ate garlic, so as not to be disgusted by the smell of it on others.

Rising to a crescendo, James I condemned tobacco as a "custome lothsome to the eye, hatefull to the Nose, harmefull to the braine, daungerous to the Lungs, and in the blacke stinking fume thereof, neerest resembling the horrible Stigian smoke of the pit that is bottomlesse." He should have saved his breath. Medical professionals would blithely advocate smoking for health for the next 350 years.

Sources: Anon (James I), A Counterblaste to Tobacco, London, 1604; SL Gilman, X Zhou, eds, Smoke: A Global History of Smoking, London: Reaktion, 2004.

BMJ 2010;340:c1408 Published 11 March 2010