Tuberculosis: Don't Kiss Me!

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Tuberculosis: Don't Kiss Me!

Poster

By: Anonymous

Date: c. 1936

Source: Library of Congress. "By the People, For the People: Posters from the WPA, 1936–1943." 〈http://memory.loc.gov/ammem/wpaposters/wpahome.html〉 (accessed July 23, 2006).

About the Author: The United States Library of Congress is the nation's official library, with responsibility for collecting and organizing historically significant documents, photographs, and digital media.

INTRODUCTION

In the late 1800s and early 1900s, tuberculosis was the leading cause of death in the United States. The disease, first isolated and named in the late 1830s, is caused by a bacterium that attacks the lungs but can also affect the central nervous system, joints, and circulatory system. Tuberculosis (TB) became a feared condition. With no known cure and a high contagion rate, the disease soon became the primary public health concern for doctors and later government officials who monitored and controlled disease in urban areas.

Tuberculosis is highly contagious, spread by droplets when infected persons cough or sneeze. Known by a variety of names such as "consumption," "white plague," "lung sickness," and known to the ancient Greeks as "pthisis," a single infected person can transmit the disease to twenty people within one year. Crowded living conditions, such as those experienced in cities and in poor tenements and slums, create systems of transmission that breed tuberculosis epidemics. Such epidemics were rampant in the early 1900s in the United States as immigrants and rural citizens clustered in densely-populated sectors of cities, migrating to the city for job opportunities as manufacturing expanded at the turn of the century.

Tuberculosis treatment consisted largely of quarantining and, if the patient had the means, sending the patient to a sanatorium, a quasi-hospital in the countryside or the mountains, designed to provide the patient with fresh air to help heal infected lungs. Hermann Bremer, a German physician who contracted TB, traveled to the Himalayas and found himself cured of his symptoms. Convinced that fresh air at high altitudes combined with healthy food was the key to curing TB, Bremer wrote about his theories, and some sanatoriums changed their procedures. Another doctor, Edward Trudeau, conducted a series of experiments with rabbits, finding that a diet of healthy vegetables in the Adirondack mountains helped to cure or slow down the progression of TB. People from the upper classes frequented sanatoriums for long periods to regain health; middle-class patients struggled to afford the sanatoriums, often using precious resources to send an ill father or mother. The poor, however, could not take time off work, be away from household responsibilities, or afford the fees required of such treatment.

Public health campaigns at the turn of the century focused on the prevention of public spitting, and encouraged people to eat well, get plenty of fresh air, and to exercise. For poor, urban workers who spent fourteen hours a day, six or seven days a week, in poorly ventilated factories with few breaks, this advice was impossible to follow. In the 1920s, a TB vaccine became popular, but it was ineffective against adults with pulmonary TB and lost popularity as other treatments became available.

The following poster was designed in approximately 1936 as part of a public health campaign supported by the Works Progress Administration, a "workfare" program designed under Franklin D. Roosevelt's presidency as the country worked to pull itself out of the Great Depression.

PRIMARY SOURCE

TUBERCULOSIS: DON'T KISS ME!

See primary source image.

SIGNIFICANCE

Shortly before the end of World War II, antibiotics such as streptomycin became the treatment of choice for TB, but until then, controlling the agents of infection was the only major tool public health officials had in controlling TB. While infection rates had dropped from the high rates at the turn of the century, by 1936 TB was still a major source of mortality and morbidity worldwide.

Lung x-rays could help doctors to diagnose and monitor TB. On VE Day after World War II, residents of Harlem received free chest x-rays, one of many such campaigns designed to help detect and control tuberculosis. By the time streptomycin and other drugs became common treatments, researchers found that the drugs could halt the progress of the disease in children, preventing it from reaching the brain. Stopping the disease from spreading, though, was as important as treating existing cases. Public education campaigns focused on families of small children, to preserve their health and prevent children from becoming carriers.

As of 2005, nearly one third of the population worldwide has TB, either an active case or an asymptomatic version. Five to ten percent of all TB carriers will develop a full-blown case of the disease. The incidence rate is lowest in the Americas and highest in Southeast Asia, with Africa a close second. More than fifteen million people die each year worldwide from TB.

Before the use of antibiotics in the 1940s, family members of an infected TB patient had a twenty-two percent infection rate. Children were at further risk, given the nature of feeding, toileting, and domestic care of children. The quote "your kiss of affection: the germ of infection" was designed to make adults think twice about common practices such as kissing babies on cheeks and mouths. This poster, part of a widespread campaign to educate the public, helped families to manage TB, reduce transmission, and help keep children safer.

FURTHER RESOURCES

Books

Rothman, Sheila M. Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in American History. Baltimore, MD: Johns Hopkins University Press, 1995.

Smith, Jason Scott. Building New Deal Liberalism: The Political Economy of Public Works, 1933–1956. Cambridge, UK: Cambridge University Press, 2005.

Watkins, T.H. The Hungry Years: A Narrative History of the Great Depression in America. New York: Owl Books, 2000.