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.

Susan B. Anthony’s Childhood Home in Upstate New York Is Getting a $700,000 Renovation

George Grantham Bain Collection, Library of Congress // No Known Restrictions on Publication
George Grantham Bain Collection, Library of Congress // No Known Restrictions on Publication

In 1833, a 13-year-old Susan B. Anthony moved with her family to a two-story brick house in Battenville, New York, where her father managed a cotton mill. Though Anthony only lived there a few years before financial troubles caused her family to relocate once again, it was in that house that she first became aware of the deplorable state of women’s rights—setting her on a path to change the course of history.

According to The Cultural Landscape Foundation, Anthony’s father started homeschooling her after a local teacher refused to teach Anthony long division on the grounds that women didn’t need the skill. Then, a temporary stint at her father’s mill revealed that the wages of many female employees went directly to their husbands or fathers, and Anthony learned about the gender pay gap firsthand when she was hired as a schoolteacher for a much lower salary than her male predecessor.

Right now, there are only two small indicators of Anthony’s history in the Battenville house—a placard on a nearby stone retaining wall and a sign on a post in the front yard—and the house itself is riddled with black mold and moisture damage.

But that’ll change soon: House Beautiful reports that New York’s Office of Parks, Recreation and Historic Preservation, which purchased the foreclosed property for just $1 back in 2006, is now planning a $700,000 renovation that includes general repairs, drainage improvements, and mold abatement. A considerable portion of those funds was collected by Senator Betty Little and Assembly member Carrie Woerner.

Whether the house will eventually become a museum remains to be seen. It’s located on a perilous curve on Route 29, and there’s very limited surrounding land or space for parking. Having said that, locals are committed to finding a worthy purpose for it after the restoration is complete. Debi Craig, former president of the Washington County Historical Society, told the Times Union that she thinks there’s potential for an international research center or library on women’s rights.

Regardless of what the Battenville house’s second life ends up looking like, the focus on this particular historic site is perfectly timed—not only does 2020 mark the 100th anniversary of the ratification of the 19th Amendment, it’s also Susan B. Anthony’s 200th birthday.

Learn more about the trailblazing suffragette here.

[h/t House Beautiful]

15 Facts About the Westminster Dog Show

Sarah Stier/Getty Images
Sarah Stier/Getty Images

One of America's oldest sporting events is also its most slobbery. This year, the Westminster Kennel Club dog show returns to New York City for the 144th time, promising one preeminent pooch the coveted title of "Best in Show" and a lifetime supply of positive reinforcement. While the show has evolved over its many years, it remains a beguiling spectacle for dog fanatics and casual observers alike. Here are 15 facts to get you competition-ready.

1. The original show was for gun dogs.

Champion Stingray of Derryabah, aka Skipper, a British Lakeland Terrier, wins Best In Show at the 92nd Westminster Kennel Club show at Madison Square Gardens, New York City, February 1968
H. William Tetlow, Fox Photos/Getty Images

Around 1876, a group of sportsmen began to hold regular meet-ups in a Manhattan bar to swap hunting stories. Their trusty canine companions eventually made their way into the conversation, and the idea for a dog club was formed. The group met at a bar in The Westminster Hotel, and aptly named themselves the Westminster Breeding Association (later the Westminster Kennel Club). It was after helping to stage a dog show in Philadelphia that the group decided to hold their own to compare and showboat their pups.

The first show, featuring primarily Setters and Pointers, was an immediate success. A total of 1201 dogs entered the first year, with tens of thousands of spectators by the second day. The first prizes included such items as a "Gold and Silver Mounted Pearl Handled Revolver"—an appropriate reward for an active hunter.

2. The show has seen its share of tragedy.

A photo of J.P. Morgan.
Historica Graphica Collection/Heritage Images/Getty Images

A champion collie belonging to J.P. Morgan, who spent millions on his obsession with dogs and competed in Westminster regularly, drowned itself. Its trainer called the dog's death "a clear case of suicide" in an 1895 New York Times article.

3. You don't have to be young to win.

Vintage Westminster Dog Show photo.
Lady Iddo at the 53th Westminster Dog Show in 1935.
Imagno/Getty Images

In 2009, a 10-year-old Sussex spaniel named Stump (registered name: Clussexx Three D Grinchy Glee) broke the record for oldest dog ever to win "Best in Show." He later appeared on the cover of AARP magazine.

4. Nepotism has made its way into the competition.

Westminster Dog Show 2019
Sarah Stier/Getty Images

Dog-judging has always been subjective. Judges at the first modern dog show ever, in Newcastle in 1859, were also the owners of the show's two winners. Today, the Westminster Kennel Club website acknowledges that's it's not a precise science. "Each judge, applying their interpretation of the standard, gives their opinion on that day on which dog best represents its breed," it explains.

5. Life has imitated art.

A dog competes in the Masters Agility Championship during the Westminster Kennel Club Dog Show in 2018.
Stephanie Keith/Getty Images

Parker Posey, famous for playing a manic, metal-mouthed Weimaraner-owner in the 2000 dog show parody Best in Show, has also spent some time backstage at the Westminster Dog Show. As she told The Wire at the 2014 WKC Dog Show, she met some personalities resembling her own persnickety character while on set: "[Director Christopher Guest] brought over a professional groomer. She came over right before a take and she criticized our dog. She said, 'The coat's all wrong.'"

6. The top dog gets the royal treatment.

The 2019 winner of the Westminster Dog Show.
Gary Gershoff/Getty Images

The winner of the Westminster Dog Show traditionally eats a celebratory lunch at famed Broadway watering hole Sardi's—breaking New York City's health codes which prevent animals from entering restaurants.

7. It's not all about good looks.

Maximus from the Westminster Dog Show 2019.
Sarah Stier/Getty Images

The show doesn't only value looks. A two-legged dog named Nellie participated in the first Westminster show ever in 1877, and 1980's "Best in Show" was a true underdog: Cinnar, a Siberian husky missing part of its ear, won with handler Trish Kanzler—one of the few amateurs to ever win the title.

8. The dogs are refined, but their names sometimes aren't.

Westminster Dog Show 2015 photo.
Andrew Burton/Getty Images

The 2015 WKC Dog Show featured a Pomeranian named Starfire's Spank Me Hard Call Me Crazy, a basset hound named Easthill Broxden Woodland Lettuce Entertain You, and a border terrier named McHill's His Royal Highness Prince Gizmo House of Gremlin.

9. Things have even turned criminal.

A very good boy at a dog show.
MarijaRadovic/iStock via Getty Images

Eight dogs belonging to one prominent New York City dog breeder were poisoned during the 1895 Westminster Dog Show. Despite the story making the front page of The New York Times, no suspect was ever prosecuted for the crime.

10. A bunch of your favorite breeds have never won "best in show."

A chihuahua poking its head out.
Paffy69/iStock via Getty Images

Despite being a favorite among dog-lovers, there has never been a chihuahua, Great Dane, dachshund, or golden retriever crowned "Best in Show." Here's the full list of breeds to never win, as of 2019.

11. Mutts are slowly making their way into the competition.

A dog looking at the camera.
BiancaGrueneberg/iStock via Getty Images

In 2014, mutts, a.k.a. "All-Americans," were allowed to participate in Westminster's Agility Championship for the first time since 1884—but they’re still ineligible for "Best in Show."

12. Labs are voted most popular, but not head of the class.

Lacey, a Labrador, runs through a sport course during a press preview for the Westminster Dog Show on February 12, 2015 in New York City
Andrew Burton, Getty Images

Despite being the most popular dog in the country, a Labrador retriever has never won "Best in Show." The reason? Experts say their friendly temperament prevents them from desiring the spotlight. Labs can also be disqualified for deviating by half an inch from height standards (between 22.5 and 24.5 inches for males and 21.5 and 23.5 for females)—a regulation that was nearly challenged in the U.S. Supreme Court in 1994.

13. Some practices are ancient—and weird.

A dog receiving a prize at a dog show.
Apple Tree House/iStock via Getty Images

While nowadays some breeders cut their dogs' tails for aesthetic reasons, the practice originated with 5th century BCE Greek statesman Alcibiades, who cut the tail of his dog so that the Athenians would have something else to talk about rather than Alcibiades.

14. The dogs have friends (and relatives) in high places.

A photo of a Portuguese water dog.
Ines Arnshoff/iStock via Getty Images

Matisse the Portuguese water dog (officially registered as GCH Claircreek Impression De Matisse) has quite the pedigree. In addition to being the most decorated male show dog in the United States, he is also related to the country's former First Family; his cousin, Sunny, belongs to the Obama family.

15. Naturally, there have been some great underdog stories.

A very tiny dog at the Westminster Dog Show.
Matthew Eisman/Getty Images

Tickle Em Jock, "Best in Show" winner at the 1911 Westminster Dog Show, was a Scottish terrier and a dark horse to boot. His original owner was a butcher who sold him for 2 pounds (or about $15), which turned out to be the Scottish terrier's lucky break. After a few years with trainer Andrew Albright, Tickle Em Jock was valued at $5000. Once, after winning the title of "best of breed," the scrappy champ bit a judge's wrist.

A version of this list first ran in 2016.

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