The battle for our hearts and lungs


The battle for our hearts and lungs

JUAN JANSE VAN VUUREN shares the history and consequences of the smoking habit: from the first Spanish smoker who was imprisoned as ‘devil-possessed' by the Inquisition in the 15th century, to ‘vapes' and Stoptober.


IT has many names: smoke, silla, ciggie, gwai, zaan — or cigarette — and (some) smokers have an extensive, specific vocabulary. For example, if you want to buy only one on the street, you ask for a “loosie". If you can afford 10, you can ask for a pack of “skaam" (shy). If you ask for a whole pack, you get 20, and there are 200 in a carton.

A “stompiebak" is any container with dry, loose sand to put your “butts" in. If you get interrupted while you're smoking, you don't have to waste the cigarette — you “nip" it for later. But if you belong to the “vaping nation", it doesn't bother you at all. You can put down your device  without starting a fire.

Until 1987, South Africans smoked wherever they wanted. There were ashtrays in every office, conference room and council chamber. In elevators, too, as well as on the backs of seats in trains and buses. Even on aeroplanes, but only until 1989. You could sit at a busy restaurant table and light up your pipe, cigar or lady cigarette without any consequences. Cigarettes were cheap, and the tax on them was among the lowest in the world.

Teachers smoked in staff rooms and pupils in changing rooms. On the silver screen and on television, there was often a comfortable puff on a cigarette. “Smoke-free" meant you were free to smoke wherever you wanted.

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The path of the spittoon

In the old days, when we could still smoke in cinemas, you could also take a “pinch". No, I don't mean stroking someone's thigh. Besides cigarettes, there were also snuff and chewing tobacco.

The former was a finely cut tobacco product that you would pinch with your thumb and forefinger and sniff through your nostrils. It was believed that using it would clear your head of germs.

The latter was a coarsely cut, flavoured tobacco product that you would put in your mouth and chew for hours. The civilised way to eventually get rid of it was to spit it into a spittoon, or spit bucket. The uncivilised way was to spit it out on the sidewalk, which supposedly fuelled the spread of respiratory diseases such as tuberculosis.

Snuff and chewing tobacco have all but disappeared from store shelves, and the anti-tobacco movement is confident ashtrays will soon follow the same path as the spittoon.

Diluted warnings

According to research in 1995, 34% (seven million) of adult South Africans smoked. The tobacco industry was a behemoth that, in addition to its enormous influence on the government, also had its grip on numerous gold mines, banks and insurance companies. The press, which heavily relied on income from tobacco advertisements, conveniently diluted warnings about tobacco use.

But not everyone accepted this state of affairs — after all, the tobacco smoke from a cigarette contains 7,000 different chemicals, says the Irish Cancer Society, and more than 60 are carcinogenic, such as:

  • Nicotine: an addictive alkaloid that affects the brain and increases blood pressure.
  • Tar: a thick, brown tobacco substance that cools and condenses in the lungs.
  • CO2: up to 15% of a smoker's blood contains carbon monoxide instead of oxygen.
  • Ammonia: added to enhance the effect of nicotine.
  • Arsenic: also found in pesticides and rat poison.
  • Toluene: also used in adhesives, ink, cleaning agents and explosives.
  • Methylamine: found in sunscreens.
  • Methanol: also used as aircraft fuel.
  • Polonium-210: it is the radioactive element of nuclear weapons and atomic heat sources.

The first smoker in Europe

Resistance against tobacco use is a battle that has been raging since the 15th century, when nicotine-containing tobacco leaves were first ignited in Europe.

One of Christopher Columbus's expedition members, Rodrigo de Jerez, was confronted upon his return from the Americas in 1492 about the fumes he was inhaling from a strange, smouldering, leafy plant. The Spanish Inquisition promptly arrested him and tried for seven years to exorcise his demons.

In the 17th century, the king of England prohibited the use of tobacco. For James I, the smoking habit was “disgusting to the eye, hateful to the nose, harmful to the brain and dangerous to the lungs". Papal policy in Rome was to banish smokers, while in China, Turkey, Persia and Russia, cases were recorded where smokers were flogged or had their nostrils cut open.

It wasn't until the early 20th century, in response to the mass-production of tobacco products for the middle class, that the anti-tobacco movement began gaining momentum worldwide. Scientists raised alarms for the first time about the dangers of second-hand smoke.

Some employers refused to hire smokers, and bills were introduced to label cigarette packages with poison stamps or skulls and crossbones. Prominent figures such as Henry Ford and Thomas Edison publicly denounced the smoking habit.

Medical professionals in South Africa and the rest of the world began sounding the alarm about the increase in lung cancer. Research increasingly showed clear links between the incidence of this cancer and cigarette smoking. Today, we know smoking causes many more types of cancer, such as those of the mouth, throat and oesophagus; stomach, colon and rectum; liver and pancreas; kidneys and renal pelvis; vocal cords (larynx); windpipe (trachea); lungs (bronchus); bladder and cervix; as well as acute myeloid leukaemia (blood cancer).

Non-governmental organisations such as the American Cancer Society and independent publications including the South African Medical Journal have increasingly pressured their governments to intervene in the public interest.


Break the camel’s back

Finally, in 1964, the camel's back was broken when the US surgeon general's advisory committee submitted a report directly linking lung cancer to smoking. The report swept the discourse about individual and consumer choices off the table and brought to the fore more critical issues like epidemiology, public health and the risk to smokers and non-smokers.

In the 1970s, the US enacted a law that mandated a separate smoking section on aeroplanes. Advocates of the individualistic “choice" argument that elevated smoking to a matter of personal preference were quick to play the “most people smoke" card. However, they fell silent when it became evident to everyone that smoking sections on planes were never as fully booked as smoke-free seats.

The result of this onslaught on people's hearts and lungs is clearly visible in the percentage of American adults who smoke:

The first of three significant salvos fired at the South African tobacco industry — Rembrandt, et al — was in May 1995, when even FW de Klerk, our chain-smoking former president, had his parliamentary ashtray confiscated. He was referred to the “butt bucket" in the open square. The result of that legislation and subsequent amendments mean the following in South Africa in 2023:

  • You may not buy or sell tobacco products if you are under 18.
  • You may not smoke in a car if any of the passengers are under 12.
  • You may not smoke on partially enclosed public premises such as pavements, balconies, walkways or car parks.
  • You may not smoke on premises where children attend school or a creche operates.
  • You may not smoke in cinemas, on domestic flights or any public transport.
  • Businesses may not allocate more than 25% of a public premise as a smoking area.
  • Smoking areas must be physically isolated from the rest of public premises and adequately ventilated.
  • You will never again be able to buy a candy cigarette.


The South African assault on tobacco was also a success, and available statistics show how use has declined, from 34% in 1995 to barely 20% in 2020.

It seemed the anti-tobacco movement had succeeded worldwide in making smoking socially unacceptable. But they failed to anticipate one thing: the technological disruption of the 21st century. With the advent of vaping devices, or e-cigarettes, a new culture emerged, especially among young people who identify as the “vape nation".

This trend has been smouldering since 2000, and by 2018 about a million South Africans had started vaping. Vaping devices are electronic nicotine delivery systems (ENDS) that do not ignite tobacco or tobacco leaf extracts, and therefore do not emit tar or carbon monoxide. They deliver an aerosol formed when the battery-powered device heats a solution containing nicotine and formaldehyde, among other things. An article by Rally Health that cites various research studies explains exactly what the solution consists of and what it does to your body:

  • Nicotine: disrupts synapse formation in the brain.
  • Benzine: causes irritation of the eyes, nose and throat, as well as headaches and nausea, and can damage the liver, kidneys and nervous system.
  • Nickel, tin and lead: carcinogenic metals that can make you cough or become short of breath.
  • Diacetyl and pentanedione: destroy cells in the lung airways.
  • Propylene glycol: allows cleaning agents to absorb more water.
  • Formaldehyde and acrolein: apparently pose a danger to DNA.
Image: CDC

Vaping devices in some ways work like a nebuliser through which asthmatics inhale liquid medications. Instead of covering lung tissue with therapeutic mist, vaping coats the lungs with a mixture of harmful chemicals.

For a long time, there was no legislation regulating vaping products in South Africa. However, this changed in June when they became subject to excise tax like all other tobacco products. Manufacturers and distributors must now register their premises with the South African Revenue Service and will soon begin applying for licences.


These days, smoking is no longer as unrestricted, and the “choice" to smoke is becoming more costly. The battle for hearts and lungs continues, and even though the anti-tobacco movement has long won the argument, it's not so easy to eradicate the smoking habit.

Stoptober is a British smoking cessation campaign that encourages smokers to quit smoking for 28 days in October. It is based on research that has shown that smokers who can go without a cigarette for that long are five times more likely to quit smoking altogether. The campaign, which also takes place in France, the Netherlands and New Zealand, operates a social media movement for the 28 days to support participants.

Although only 4% of British participants have so far quit smoking entirely after four weeks, more than 12% have made an attempt.

Stoptober may be a better approach in the war against smokers like me because it replaces the usual “quit" with “endure" and doesn't waste precious parliamentary time and taxpayers' money.


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