In February 1923, at the age of sixty-seven, Freud noted sores on his right palate, and jaw that failed to heal. They were cancers. An operation was performed––– the first of thirty-three operations for cancer of the jaw and oral cavity which he endured during the sixteen remaining years of his life. I am still out of work and cannot swallow," he wrote shortly after this first operation. "Smoking is accused as the etiology of this tissue rebellion." 6 Yet he continued to smoke.

In addition to his series of cancers and cancer operations, all in the oral area, Freud now suffered attacks of "tobacco angina" whenever he smoked. He tried partially denicotinized cigars, but even these produced anginal pains and other heart symptoms. Yet he continued to smoke.

Buerger's disease is a condition in which the blood vessels, especially those supplying the legs, are constricted so that circulation is impaired whenever nicotine enters the bloodstream. If a patient with this condition continues to smoke, gangrene may eventually set in. First a few toes may have to be amputated, then the foot at the ankle, then the leg at the knee, and ultimately at the hip. Somewhere along this gruesome progression gangrene may also attack the other leg. Patients are strongly advised that if they will only stop smoking, it is virtually certain that the otherwise inexorable march of gangrene up the legs will be curbed. Yet surgeons report that it is not at all uncommon to find a patient with Buerger's disease vigorously puffing away in his hospital bed following it second or third amputation operation. Much the same is true of patients who suffer a heart attack, or stroke, or the onset of high blood pressure. These patients have a life-and-death incentive to abstain––– yet many go right on smoking.

Confirmation of Dr. Dole's conclusion comes from Synanon, the therapeutic community for heroin addicts and others (see Chapter 10). Prior to May 1970, the New York Times reported in 1971, 11 almost all Synanon residents were heavy cigarette smokers. Since Synanon supplied food, clothing, and all other necessities, including cigarettes, to its residents without charge, the cost to the community was high––– almost $200,000 a year for cigarettes for 1,400 residents.

In May 1970, Charles E. Dederich, founder and head of Synanon, decided not only to stop supplying cigarettes without charge but also to ban smoking on Synanon property altogether. In addition to the saving in money, Dederich was motivated by the fact that an X-ray of his own chest showed cloudy areas in the lungs, and that some 200 young people under fifteen living in the seven Synanon centers were learning to smoke there.

A New York Times reporter visited Synanon in May 1971, on the first anniversary of the smoking ban.

"Once the decision was made," he stated, "smoking became the No. 1 crime for the community and was punishable by shaved heads or eventual expulsion." Dederich, himself an inveterate smoker, was among those who quit smoking.

It wasn't easy, for Dederich and for many of the others. "I couldn't have stopped without the help of my colleagues," Dederich was quoted as saying.

The most common reactions reported were depression, irritability, and weight gains ranging from seven to thirty pounds. After a year, the reporter stated, "most of the trauma of withdrawal is over. The majority say the thought of a cigarette is rare, although some admit to an "occasional urge" or fluctuating weight.

Those who felt that the urge had receded, however, were the successes––– and not all of those who tried succeeded. "About 100 people left during the six-month period following the ban and chose possible readdiction to drugs outside Synanon to life without cigarettes," the Times added.