Views & Reviews Between the Lines

Smoking: out for the count

BMJ 2009; 339 doi: (Published 24 November 2009) Cite this as: BMJ 2009;339:b5023
  1. Theodore Dalrymple, writer and retired doctor

    The first campaigner against passive smoking was probably the greatest novelist the world has ever known, Leo Tolstoy. In his essay “Why do Men Stupefy Themselves?”—published in 1890 as an introduction to a book by his medical brother in law, Dr S P Alexeyev, with the title Drunkenness (he was against it)—Tolstoy wrote: “Everyone of average education considers it inadmissible, ill bred, and inhumane to infringe the peace, comfort, and yet more the health of others for his own pleasure. But out of a thousand smokers not one will shrink from producing unwholesome smoke in a room where the air is breathed by non-smoking women and children.”

    Bravo for Tolstoy, you might say. And with his usual grasp of psychology he understands that the polite question “Do you mind if I smoke?” is not a genuine request for information on the acceptability of smoking to a non-smoker, any more than the question from a nurse to patient “What would you like to be called” is neutral as to whether first name or surname is proffered. For “Do you mind if I smoke?” almost invariably calls forth the answer “Not at all,” even when the non-smoker detests smoking and all its works; just as the nurse’s question is answered “Bill” rather than “Professor Smith,” even if this is what he wants to be called.

    The problem with the essay is that Tolstoy is mad, in the loose sense of the term. He begins it with a very pertinent question that I am sure we all as doctors have often asked—about our patients, of course, not about ourselves: “What is the explanation of the fact that people use things that stupefy them—vodka, wine, beer, hashish, opium, tobacco, and other things less common: ether, morphia, fly-agaric, etc?”

    The answer for Tolstoy is crystal clear, for once he starts thinking about anything, doubt and qualification are removed from his mind (Chekhov once called him an ignoramus). It is that stupefaction is the means by which they quieten or suppress their conscience.

    For Tolstoy there is no such thing as moderation. Nor is there any other possible reason for people to resort to things that stupefy them. And he has it in for smoking particularly, not on health grounds but because it clouds consciousness and makes people do stupid or wicked things they wouldn’t otherwise do. He says that all decisions taken while smoking are like decisions taken by a drunkard.

    His prime example is a rather surprising one: “Without any need whatever, a company is formed, capital collected, men labour, make calculations, and draw plans; millions of working days and thousands of tons of iron are spent to build the Eiffel Tower; and millions of people consider it their duty to climb up it, stop awhile on it, and then climb down again.”

    And this, all because they smoke! In case the reader should still harbour any doubts about the evils of smoking, Tolstoy goes on to attribute European militarism to the fact that all Europe’s leaders smoked and were therefore “drunkards who never reach a state of sobriety.”

    There is really only one possible explanation for how the world’s greatest writer of his time could have come to write such terrible nonsense. He must have been drunk.


    Cite this as: BMJ 2009;339:b5023

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