War and cigarettes

Service and work

Before he went to France to fight in some of the war’s bloodiest battles, my granddad Jack had worked for Lancashire and Yorkshire Railway in Newton Heath in Manchester, England (Newton Heath railway workers were the founders of the football team that eventually became the famous Manchester United). Young men going off to fight were led to believe that when, or more likely if, they returned home they would have their old jobs back. When Granddad returned missing a leg, he was told there was no job for him. Only those who were conscripted had that right, not those young men like him who were so eager to fight for their country that they voluntarily enlisted.

His discharge paper, No. 5956, 3 pieces stained by the cellophane tape that once held them together, hints at much. John Pimlott, gunner in the Royal Horse Artillery, enlisted at age 22 on September 2, 1914, at Bury, Lancashire, England, soon after the war began. He was discharged on May 2, 1919, 4 years and 243 days later, “being no longer physically fit for war service.” The document is deceptive, as he spent months in the hospital in Liverpool, England, before he was finally discharged. The initial amputation of his left leg was eventually extended above the knee.

Eventually my granddad got a clerical job with the Bury town council, a job he held for the rest of his life. The newspaper clipping is more than 60 years old now, and falling apart. In the photograph that accompanies the article, my granddad is flanked by the mayor and the borough engineer. He is tall but slightly stooped, slender, and dressed in a suit, tie, and waistcoat. His eyes look sunken, his face gaunt, and his thinning hair gray. The article proudly proclaims that it is the second time that “Jack” Pimlott is being honoured in his lifetime.

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My dad says that Granddad walked to work every day, there and back, and he has memories of his father trudging off to work down Bury Old Road on that artificial leg in all kinds of weather. In his 38 years as a payroll clerk he was never late, nor did he miss a day of work.

Solace and necessity

Now, as a grandson-doctor, I wonder how much he suffered—did he have phantom pain or did it just plain ache walking on that stiff, lifeless leg? And what of the psychological suffering? My father has no idea, as Granddad did not complain. My father remembers that Granddad Jack was always a heavy smoker—up to 60 unfiltered Gold Plate cigarettes a day. During World War II, when cigarettes, along with everything else, were rationed, my father worked as a paper boy and recalls one of his chief jobs was to hunt down the scarce Gold Plates for his dad. My father mischievously told me that if he and Granddad had fallen out, he would moderate his efforts at cigarette procurement accordingly.

For many soldiers in World War I, cigarettes became a companion, a solace, an item of trade while at war. Although it was common knowledge that smoking could be bad for your health (cigarettes were known among ordinary people as “coffin nails”), British writer G.K. Chesterton compared the risks of smoking in combat to “the perils of gluttony in a famine.”¹ Like many soldiers in World War I, my granddad brought cigarette smoking back with him. By the late 1940s, 8 out of 10 British men and 4 out of 10 British women were cigarette smokers.¹ Cigarettes, once a luxury item, were now a necessity of everyday life.

Things have not really changed that much since World War I. As recently as the Gulf War of 1990, tobacco companies targeted soldiers with free cigarettes, direct advertising, branded items, ways to communicate with their families, and “welcome home events,” frequently enabled by military authorities.²

Addiction and empathy

To mitigate the effects of his heavy smoking, my father remembers that Granddad Jack would sit by the fireplace so that the second-hand smoke would go up the chimney. My grandmother would regularly scrub the ceilings and walls to remove all traces of his habit. My father says that smoking “eased his nerves” and helped him cope with the things he had experienced during the war.

By the time a link between smoking and lung cancer was formally demonstrated by Richard Doll and Austin Bradford Hill in the mid-1950s, my grandfather had been smoking for more than 60 pack-years. I wonder now if the simplistic stages of change model of smoking behaviour and motivational interviewing techniques would have had any effect on my granddad Jack’s habit. I doubt it.

The addiction to smoking is a powerful one, as I have seen many times in my own practice. One of the most heavily addicted smokers that I have looked after managed to quit crack cocaine around the time I became his family physician. More than 20 years of repeated discussions about his smoking and its eventual effects on his health and repeated attempts to use nicotine replacement therapy and eventually medications like varenicline failed to help him quit smoking. It was only after a serious chest infection and a lung cancer scare about a year ago that he was able to quit. The thought of dying and being separated from his daughter was finally enough to motivate him.

My granddad Jack died in his 70s from a “heart condition,” but my father reckons that in the end it was his smoking, the very thing that eased his nerves and helped him get through life, that killed him.

My father, too, is a smoker and has only been able to quit once, briefly, in more than 50 years. He, too, saw and experienced unspeakable things during his mandatory national service.

The stories of my grandfather and my father, revealed in the search for the origins of that brass box, have deepened my empathy for those addicted to cigarettes.