US surgeon Alton Ochsner recalled that when he was a medical student in 1919 his class was summoned to observe an autopsy of a lung cancer victim. At that time, the disease was so rare it was thought unlikely the students would ever get another chance.
But by the year 2000, it was estimated that 1.1 million people were dying annually from the disease, with about 85% of those cases stemming from a single cause - tobacco.
"The cigarette is the deadliest artefact in the history of human civilisation," says Robert Proctor of Stanford University. "It killed about 100 million people in the 20th Century."
Jordan Goodman, the author of Tobacco in History, says that as a historian he is careful about pointing the finger at individuals, "but in the history of tobacco I feel much more confident saying that James Buchanan Duke - otherwise known as Buck Duke - was responsible for the 20th Century phenomenon known as the cigarette."
Not only did Duke help create the modern cigarette, he also pioneered the marketing and distribution systems that have led to its success on every continent.
In 1880, at the age of 24, Duke entered what was then a niche within the tobacco business - ready-rolled cigarettes. A small team in Durham, North Carolina, hand-rolled the Duke of Durham cigarettes, twisting the ends to seal them.
Two years later Duke saw an opportunity. He began working with a young mechanic called James Bonsack, who said he could mechanise cigarette manufacturing. Duke was convinced that people would want to smoke these neatly-rolled, perfectly symmetrical machine-made cigarettes.
Bonsack's machine revolutionised the cigarette industry.
"It's essentially a cigarette of infinite length, cut into the appropriate lengths by whirling shears," says Robert Proctor. The open ends meant it has to be "juiced-up with chemical additives". They added glycerine, sugar and molasses, and chemicals to prevent it drying out.
But keeping cigarettes moist was not the only challenge that Bonsack's contraption presented to Duke. While his factory girls typically rolled about 200 cigarettes in a shift, the new machine produced 120,000 cigarettes a day, about a fifth of US consumption at the time.
"The problem was he produced more cigarettes than he could sell," says Goodman. "He had to work out how to capture this market."
The answer was to be found in advertising and marketing. Duke sponsored races, gave his cigarettes out for free at beauty contests and placed ads in the new "glossies" - the first magazines. He also recognised that the inclusion of collectable cigarette cards was as important as getting the product right. In 1889 alone, he spent $800,000 on marketing (about $25m in today's money).
Bonsack retained the patent to his machine, but as thanks for Duke's support in developing it, he offered him a 30% discount on the lease.
This competitive advantage - coupled with vigorous promotion - was key to Duke's early success. As he had suspected, people liked mechanised cigarettes. They were modern-looking and more hygienic - one campaign emphasised this point over cigars, which were manufactured using human hands and saliva.
But although cigarette smoking in the US quadrupled in the 15 years to 1900, it remained a niche market, with most tobacco being chewed or smoked through pipes and cigars.
Duke - a cigar smoker himself - saw the potential for cigarettes to be used in places closed to cigars and pipes, such as drawing rooms and restaurants. The ease with which they could be lit and - unlike pipes - remain lit, also suited them to coffee breaks in modern city life.
"The cigarette was really used in a different way," says Proctor. "And it was milder - and this is one of the great ironies, that cigarettes were widely thought to be safer than cigars, because they are just 'little cigars', right?"
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