The Anti-Spitting Campaigns Designed to Stop the Spread of Tuberculosis

A Dr. Dettweiler sputum flask, circa 1910
A Dr. Dettweiler sputum flask, circa 1910

In the 19th century, cities were grimy places, where thousands of people lived in overcrowded tenement buildings and walked streets polluted with trash, sewage, and the carcasses of dead animals. Unsurprisingly, these cities were also hotbeds of infectious disease.

One of the leading causes of death was tuberculosis, which spreads from person to person in the tiny droplets that spray through the air when an infected person coughs or sneezes. "In the 19th century, tuberculosis [was] the greatest single cause of death among New Yorkers," explains Anne Garner, the curator of rare books and manuscripts at the New York Academy of Medicine Library and the co-curator of the Museum of the City of New York’s new exhibition, "Germ City: Microbes and the Metropolis."

In the 19th century, tuberculosis killed one in every seven people in Europe and the U.S., and it was particularly deadly for city dwellers. Between 1810 and 1815, the disease—then commonly known as consumption, or the white plague—was to blame for more than a quarter of the recorded deaths in New York City. While New York wasn't alone among urban centers in having startlingly high rates of tuberculosis, its quest to eradicate the disease was pioneering: It became the first U.S. city to ban spitting.

"BEWARE THE CARELESS SPITTER"

Anti-tuberculosis pamphlets
Tuberculosis warnings from the Committee on Prevention of Tuberculosis that appeared on New York City streetcar transfers in 1908, reprinted by the Michigan Board of Health in 1909

In 1882, Robert Koch became the first to discover the cause of tuberculosis: a bacterium later named Mycobacterium tuberculosis, which he isolated from samples taken from infected animals. (Koch won the Nobel Prize in 1905 for his work.) He determined that the disease was spread through bacteria-infected sputum, the mix of phlegm and spit coughed up during a respiratory infection. That meant that rampant public spitting—often referred to as expectorating—was spreading the disease.

In 1896, in response to the growing understanding of the threat to public health, New York City became the first American metropolis to ban spitting on sidewalks, the floors in public buildings, and on public transit, giving officials the ability to slap wayward spitters with a fine or a jail sentence. Over the next 15 years, almost 150 other U.S. cities followed suit and banned public spitting [PDF].

The New York City health department and private groups like the National Tuberculosis Association, the Women’s Health Protective Association, and the Brooklyn Anti-Tuberculosis Committee generated anti-spitting slogans such as "Spitting Is Dangerous, Indecent, and Against the Law," "Beware the Careless Spitter," and "No Spit, No Consumption." They made posters decrying spitting (among other unhealthy habits) and reminding people of the ban. Members of the public were encouraged to confront defiant spitters, or, at the very least, give them the stink eye. While there were many other factors to blame for the spread of tuberculosis—like dangerously overcrowded, poorly ventilated tenement housing and widespread malnutrition—public spitters became the literal poster children of infection.

New York City officials followed through on the threat of punitive action for errant spitters. More than 2500 people were arrested under the statute between 1896 and 1910, though most only received a small fine—on average, less than $1 (in 1896, that was the equivalent of about $30 today). Few other cities were as committed to enforcing their sputum-related laws as New York was. In 1910, the National Tuberculosis Association reported that less than half of cities with anti-spitting regulations on the books had actually made any arrests.

Despite the law, the problem remained intractable in New York. Spitting in streetcars posed a particularly widespread, and disgusting, issue: Men would spit straight onto the floor of the enclosed car, where pools of phlegm would gather. Women wearing long dresses were at risk of picking up sputum on their hemlines wherever they went. And the law didn’t seem to stop most spitters. As one disgusted streetcar rider wrote in a letter to the editor of The New York Times in 1903, “That the law is ignored is evident to every passenger upon these public conveyances: that it is maliciously violated would not in some cases be too strong an assertion.”

The situation wasn’t much better two decades later, either. “Expectorating on the sidewalks and in public places is probably the greatest menace to health with which we have to contend,” New York City Mayor John Francis Hylan said in a 1920 appeal for citizens to help clean up the city streets.

THE BLUE HENRY

A blue sputum flask
New York Academy of Medicine Library

Spitting laws weren't the only way that health authorities tried to rein in the spread of TB at the turn of the century. Anti-tuberculosis campaigns of the time also featured their own accessory: the sputum bottle.

Faced with the fact that sick people would cough up sputum no matter what a poster in a streetcar told them, in the late 19th century, doctors and health authorities all over the world began instructing people with tuberculosis to spit into pocket-sized containers, then carry it around with them. “A person with tuberculosis must never spit on the floor or sidewalk or in street cars, but always into a cuspidor or into a paper cup, which he should have with him at all time, and which can be burned,” advised the New York City Department of Health’s 1908 publication Do Not Spit: Tuberculosis (Consumption) Catechism and Primer for School Children. These containers were known as cuspidors, spittoons, or simply sputum cups or sputum bottles.

Among the most well-known of these sputum-carrying receptacles was the “Blue Henry,” a pocket flask made of cobalt-blue glass that was originally manufactured by the German sanatorium pioneer Peter Dettweiler, who himself had suffered from tuberculosis.

“The sputum bottle was like a portable flask that could be used to collect this sticky phlegm that was produced by the irritated lungs of a person suffering from tuberculosis,” Garner says. While they came in various shapes, sizes, and materials, the fancier versions would have a spring-loaded lid and could be opened from both sides, so that you could spit into a funnel-like opening on one side and then unscrew the bottle to clean out the sputum receptacle later.

Dettweiler's device and the similar devices that followed became popular all over the world as doctors and governments sought to contain the spread of tuberculosis. These receptacles became a fixture in hospitals and at sanatoriums where tuberculosis patients went to recuperate, and were a common hand-out from anti-tuberculosis charities that worked with TB-afflicted patients.

In the early 1900s, the New York Charity Organization Society was one of them. Its Committee for the Prevention of Tuberculosis raised money to buy its New York City-based clients better food, new beds, and of course, sputum cups. (Likely the paper kind, rather than the glass Dettweiler flasks.) The generosity wasn't unconditional, though. The society would potentially pull its aid if charity workers showed up for a surprise home inspection to find unsanitary conditions, like overflowing sputum cups that were not being properly disinfected [PDF].

Eventually, the city itself began handing out sputum cups. In an effort to reduce the contagion, by 1916 a large number of cities—such as Los Angeles, Seattle, and Boston—dedicated part of their municipal budgets to paying for tuberculosis supplies like paper sputum cups that would be handed out to the public for free.

A ad for anti-TB supplies from the Journal of Outdoor Life
An advertisement that ran in the Journal of Outdoor Life—which billed itself as “the anti-tuberculosis magazine"—in 1915

Though paper sputum cups could be burned, glass or metal flasks had to be cleaned regularly. Doctors recommended that the sputum bottles contain a strong disinfectant that could kill off the tuberculosis bacilli, and that the receptacles be cleaned and disinfected every morning and evening by rinsing them with a lye solution and boiling them in water. As for the sputum itself, burning was the preferred method of sanitizing anything contaminated with TB at the time, and sputum was no exception—although rural consumptives were encouraged to bury it in the garden if burning wasn’t practical.

In an era where infectious disease was often associated with poor, immigrant communities, sputum bottles made it possible to go out in public without drawing the same attention to your condition that hacking up phlegm into the street would. “You could discreetly carry them around and then take them out and people wouldn’t necessarily know that you were suffering from the disease,” Garner explains. Or at least, somewhat discretely, since they soon became widely associated with consumptives. A Dr. Greeley, for one, argued that ordinary sputum bottles were “so conspicuous as to be objectionable," and suggested people spit into toilet paper and put that in a pouch instead. That idea didn't quite take off.

And while hiding your infectious status is not good for public health, the sputum flasks did lower the risk that you were infecting the people around you as you coughed and sneezed. “As long as you were doing it into the bottle, you probably were not infecting other people,” Garner says.

Not many of these sputum bottles have survived, in part because it was standard practice to burn everything in a tuberculosis patient’s room after they died to prevent germs from spreading. Those that remain are now collector's items, held in the archives of institutes like Australia's Museums Victoria; the Museum of Health Care in Kingston, Canada; and the New York Academy of Medicine Library.

TUBERCULOSIS TODAY

Unfortunately, neither anti-spitting propaganda nor sputum flasks managed to stop the spread of tuberculosis. Real relief from the disease didn’t come until 1943, when biochemist Selman Waksman discovered that streptomycin, isolated from a microbe found in soil, could be an effective antibiotic for tuberculosis. (He won the Nobel Prize for it, 47 years after Koch won his.)

And while carrying a cute flask to spit your disease-ridden phlegm into sounds quaint now, tuberculosis isn’t a relic of the past. Even with medical advances, it has never been eradicated. It remains one of the most devastating infectious agents in the world, and kills more than a million people worldwide every year—the exact number is debated, but could be as high as 1.8 million. And, like many infectious diseases, it is evolving to become antibiotic resistant.

Sputum flasks could come back into fashion yet.

From Abe Lincoln Chia Pets to FDR Baseballs: 11 Products to Celebrate President’s Day

iStock.com/malerapaso
iStock.com/malerapaso

While President’s Day originated in 1885 as a holiday celebrating George Washington, it has now grown to recognize all 44-and-counting chief executives in U.S. history. If you’re feeling truly patriotic, check out these 11 incredible products inspired by some of the most distinguished leaders to hold America's highest office, and feel free to gift them to your favorite future politician.

1. George Washington’s Teeth Magnet

George Washington's illustrious hair may have been totally real, but his teeth certainly weren’t. In fact, Washington had only one real tooth left in his head when he was sworn in as president, and he wore several sets of dentures throughout his life (though none of them were made of wood, as the legend claims). Mount Vernon has one of the last surviving sets—made of human and cow teeth—in its collection, and fans can get a copy of the historic chompers in the form of a fridge magnet.

Buy it from George Washington’s Mount Vernon for $10.

2. John Adams Mouse Pad

A John Adams mousepad
MyHeritageWear, Amazon

Compared to the other Founding Fathers, John Adams doesn't get much love. There's reason to admire the pugnacious leader, though: He may have been the nation’s second-ever president, but he was second to none when it came to dishing out insults. If you’re looking for a subtle way to pay tribute to Adams, this mouse pad will do the trick. After all, who doesn't want a president at their side in the office?

Buy it on Amazon for $10.

3. Founding Fathers Gift Box

If you’re looking for other ways to honor the Founding Fathers, this commemorative gift box includes four hefty Old Fashioned tumblers bearing the likenesses of old-fashioned presidents James Madison, Thomas Jefferson, George Washington, and John Adams. The glasses—which are made in America—are the perfect way to toast the country's early leaders. They'd also be a great accessory for your next Drunk History marathon. (As would Fishs Eddy's many other politician-themed kitchenware products, for that matter.)

Buy it from Fishs Eddy for $22.

4. Abraham Lincoln Chia Pet

A Chia Pet Abraham Lincoln
Chia, Amazon

Honest Abe is known for a great many things: leading the United States through the Civil War, abolishing slavery, and—according to Hollywood—maybe being a vampire hunter. However, we rarely celebrate his very lush head of hair. (Though a few strands of it did sell for $25,000 in 2015.) This Chia Pet planter offers a way to spice up your kitchen while honoring the classic elegance of the 16th president's silhouette. The handmade statuette grows a full head of presidential chia-sprout hair in one to two weeks and includes quotes from President Lincoln transcribed on its sides.

Buy it on Amazon for $26.

5. Edmund Morris’s Theodore Roosevelt Trilogy

A set of three Edmund Morris books on Theodore Roosevelt
Random House, Amazon

This Pulitzer-Prize-winning biographical trilogy on Theodore “Teddy” Roosevelt from Edmund Morris is a must-have for all the TR fans out there. Written over the course of more than 30 years, Morris's opus is considered essential reading for any Roosevelt scholar, and it's well worth the money. As The New York Times wrote in its review of the first volume in 1979, it's a “splendid, galloping narrative of the great galloper. The insights are keen. The pages turn quickly. There are few who will not get from it a more satisfying conception of the man almost everyone thinks he knows … It is one of those rare works that is both definitive for the period it covers and fascinating to read for sheer entertainment.”

Buy it on Amazon for $78.

6. FDR Collectible Baseball

Like many Americans, Franklin Delano Roosevelt had an intense love of baseball. He even argued that the national past time was an essential morale booster during World War II, ensuring that the league could continue playing throughout the war. He made eight Opening Day appearances during his presidency, and this collectible baseball is a perfect monument to one of them. The custom ball features a photograph of FDR throwing the ceremonial first pitch for the 1935 Opening Day game between the Washington Senators and Philadelphia Athletics at Griffith Stadium in Washington, D.C.

Buy it from the National Archives store for $7.

7. "Dewey Defeats Truman" Ceramic Tile

The result of the 1948 presidential election between incumbent Democrat Harry S. Truman and Republican challenger Thomas E. Dewey was, by all accounts, one of the greatest upsets in history. Nearly every analyst at the time got their predictions wrong, including the Chicago Daily Tribune (now just the Chicago Tribune), which led to the famous photograph that helped cement the election's legacy in American politics—and media history—forever. While history nerds would surely appreciate a copy of the actual newspaper, this option from the National Archives is a joyously clever alternative.

Buy it from the National Archives store for $7.50

8. JFK for President Mug

For political history buffs and design obsessives alike, this mug is a throwback to the campaign posters made by John F. Kennedy when he ran for president in 1960. The mug is emblazoned with JFK's own smiling mug as well as his 'Leadership for the 60's" slogan. (You can see one of the originals at the Library of Congress.)

Buy it from the John F. Kennedy Presidential Library and Museum for $15.

9. Lyndon B. Johnson Bobblehead

A Lyndon Johnson bobblehead depicting the president holding a dog
Royal Bobbles, Amazon

Lyndon B. Johnson—who assumed the presidency following the assassination of John F. Kennedy on November 22, 1963—is best known for his "Great Society" programs and his role in passing laws like the Civil Rights Act and Medicare. This bobblehead in his likeness from Royal Bobbles, however, represents another side of LBJ: his love for dogs. Johnson and his family were often photographed with their beloved beagles, Him and Her, as well as subsequent White House pets Freckles, Edgar, Blanco, and Yuki. (Royal Bobbles doesn't specify which dog this design is based on.) Standing over 8 inches tall, the bobblehead comes with a collector’s box to keep it pristine, because you'll want to display it prominently.

Buy it on Amazon for $26.

10. Presidential IQ Trivia Game

The 'Presidential IQ' card game on a table
Presidential IQ, Amazon

If you're like us, you love some good-old-fashioned trivia—and almost 250 years of presidential history has left us with a bevy of facts to mine for questions. Featuring 1200 questions across a number of categories, including famous quotes, foreign affairs, and geography, Presidential IQ is perfect for game night.

Buy it on Amazon for $25.

11. 1000-Piece U.S. Presidents Jigsaw Puzzle

A puzzle with all of the U.S. presidents surrounding a map of the United States
White Mountain Puzzles, Amazon

This puzzle by White Mountain illustrates the entire presidential timeline of the United States with portraits of each of the presidents and a map of notable historical sites relating to the former chief executives. In addition to stimulating your brain, it provides a great opportunity to plan your next presidential road trip.

Buy it on Amazon for $18.

11 Words You Might Not Realize Come From “Love”

iStock.com/PeopleImages
iStock.com/PeopleImages

1. BELIEVE

In Old English, believe was geliefan, which traces back to the Germanic galaubjan, where laub is the root for “dear” (so “believe” is “to hold dear”). Laub goes back to the Proto-Indo-European root for “love,” leubh.

2. FURLOUGH

We got furlough from the Dutch verlof, which traces back to the same Germanic laub root as in believe. It is also related to the sense of leave meaning "allowance" or "permission" (“get leave,” “go on leave”). The “leave” in a furlough is given with pleasure, or approval, which is how it connects back to love.

3. FRIDAY

Old English Frigedæg was named for Frigg, the Germanic goddess of love (and counterpart to the Roman Venus). According to the OED, frīg was also a noun for “strong feminine” love.

4. VENOM

Venom comes from the Latin venenum, which shares a root with the love goddess Venus, and originally referred to a love potion.

5. AMATEUR

The root of amateur is Latin amare, “to love.” An amateur practices a craft simply because they love it.

6. CHARITY

The Latin caritas, which ended up as charity in English, was a different kind of love than amor, implying high esteem and piety, rather than romance and passion. It was used to translate the Ancient Greek agape, the word used in the New Testament to express godly love.

7. PHILOSOPHY

Greek had another word for love, philia, that—in contrast to agape and eros (sexual love)—meant brotherly or friendly love. It’s used in many classical compounds to signify general fondness or predilection for things. Philosophy is the love of sophos, wisdom.

8. PHILANTHROPY

This one means love of anthropos, humanity.

9. PHILADELPHIA

You might know it as the “city of brotherly love,” but you might not know that the tagline is right there in the name. It’s love for adelphos, brother.

10. PHILIP

The name Philip comes from the compound phil- + hippos, love of horses.

11. ACIDOPHILUS

Have you been taking acidophilus probiotic supplements for digestive health? It’s made from acid-loving bacteria, i.e., bacteria that easily take up an acid dye for viewing under the microscope.

This list originally ran in 2015.

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