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"

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 1909Michigan Board of Public Health

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

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.

An advertisement that ran in the Journal of Outdoor Life—which billed itself as “the anti-tuberculosis magazine"—in 1915Journal of Outdoor Life

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.

12 Creative Ways to Spend Your FSA Money Before the Deadline

stockfour/iStock via Getty Images
stockfour/iStock via Getty Images

If you have a Flexible Spending Account (FSA), chances are, time is running out for you to use that cash. Depending on your employer’s rules, if you don’t spend your FSA money by the end of the grace period, you potentially lose some of it. Lost cash is never a good thing.

For those unfamiliar, an FSA is an employer-sponsored spending account. You deposit pre-tax dollars into the account, and you can spend that money on a number of health care expenses. It’s kind of like a Health Savings Account (HSA), but with a few big differences—namely, your HSA funds roll over from year to year, so there’s no deadline to spend it all. With an FSA, though, most of your funds expire at the end of the year. Bummer.

The good news is: The law allows employers to roll $500 over into the new year and also offer a grace period of up to two and a half months to use that cash (March 15). Depending on your employer, you might not even have that long, though. The deadline is fast approaching for many account holders, so if you have to use your FSA money soon, here are a handful of creative ways to spend it.

1. Buy some new shades.

Head to the optometrist, get an eye prescription, then use your FSA funds to buy some new specs or shades. Contact lenses and solution are also covered.

You can also buy reading glasses with your FSA money, and you don’t even need a prescription.

2. Try acupuncture.

Scientists are divided on the efficacy of acupuncture, but some studies show it’s useful for treating chronic pain, arthritis, and even depression. If you’ve been curious about the treatment, now's a good time to try it: Your FSA money will cover acupuncture sessions in some cases. You can even buy an acupressure mat without a prescription.

If you’d rather go to a chiropractor, your FSA funds cover those visits, too.

3. Stock up on staples.

If you’re running low on standard over-the-counter meds, good news: Most of them are FSA-eligible. This includes headache medicine, pain relievers, antacids, heartburn meds, and anything else your heart (or other parts of your body) desires.

There’s one big caveat, though: Most of these require a prescription in order to be eligible, so you may have to make an appointment with your doctor first. The FSA store tells you which over-the-counter items require a prescription.

4. Treat your feet.

Give your feet a break with a pair of massaging gel shoe inserts. They’re FSA-eligible, along with a few other foot care products, including arch braces, toe cushions, and callus trimmers.

In some cases, foot massagers or circulators may be covered, too. For example, here’s one that’s available via the FSA store, no prescription necessary.

5. Get clear skin.

Yep—acne treatments, toner, and other skin care products are all eligible for FSA spending. Again, most of these require a prescription for reimbursement, but don’t let that deter you. Your doctor is familiar with the rules and you shouldn’t have trouble getting a prescription. And, as WageWorks points out, your prescription also lasts for a year. Check the rules of your FSA plan to see if you need a separate prescription for each item, or if you can include multiple products or drug categories on a single prescription.

While we’re on the topic of faces, lip balm is another great way to spend your FSA funds—and you don’t need a prescription for that. There’s also no prescription necessary for this vibrating face massager.

6. Fill your medicine cabinet.

If your medicine cabinet is getting bare, or you don’t have one to begin with, stock it with a handful of FSA-eligible items. Here are some items that don’t require a prescription:

You can also stock up on first aid kits. You don’t need a prescription to buy those, and many of them come with pain relievers and other medicine.

7. Make sure you’re covered in the bedroom.

Condoms are FSA-eligible, and so are pregnancy tests, monitors, and fertility kits. Female contraceptives are also covered when you have a prescription.

8. Prepare for your upcoming vacation.

If you have a vacation planned this year, use your FSA money to stock up on trip essentials. For example:

9. Get a better night’s sleep.

If you have trouble sleeping, sleep aids are eligible, though you’ll need a prescription. If you want to try a sleep mask, many of them are eligible without a prescription. For example, there’s this relaxing sleep mask and this thermal eye mask.

For those nights you’re sleeping off a cold or flu, a vaporizer can make a big difference, and those are eligible, too (no prescription required). Bed warmers like this one are often covered, too.

Your FSA funds likely cover more than you realize, so if you have to use them up by the deadline, get creative. This list should help you get started, and many drugstores will tell you which items are FSA-eligible when you shop online.

10. Go to the dentist.

While basics like toothpaste and cosmetic procedures like whitening treatments aren’t FSA eligible, most of the expenses you incur at your dentist’s office are. That includes co-pays and deductibles as well as fees for cleanings, x-rays, fillings, and even the cost of braces. There are also some products you can buy over-the-counter without ever visiting the dentist. Some mouthguards that prevent you from grinding your teeth at night are eligible, as are cleaning solutions for retainers and dentures.

11. Try some new gadgets.

If you still have some extra cash to burn, it’s a great time to try some expensive high-tech devices that you’ve been curious about but might not otherwise want to splurge on. The list includes light therapy treatments for acne, vibrating nausea relief bands, electrical stimulation devices for chronic pain, cloud-connected stethoscopes, and smart thermometers.

12. Head to Amazon.

There are plenty of FSA-eligible items available on Amazon, including items for foot health, cold and allergy medication, eye care, and first-aid kits. Find out more details on how to spend your FSA money on Amazon here.

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You Can Make the Royal Family's Traditional Christmas Pudding At Home

BHOFACK2/ISTOCK VIA GETTY IMAGES
BHOFACK2/ISTOCK VIA GETTY IMAGES

You don't need an invitation to Sandringham House to feast like a royal this Christmas. As Town & Country reports, the royal family has published its traditional figgy pudding recipe, so anyone can whip up a holiday dish fit for the Queen at home.

The royal family's official Instagram account shared the recipe on November 29, which is also known as Stir-up Sunday. Traditionally, the Sunday before the start of the Advent season is when home cooks in Britain stir up the pudding mixture they plan to serve on Christmas.

"This year, chefs in the Royal kitchens have shared their recipe for a traditional Christmas pudding," the post reads. "We hope that some of you enjoy making it in your own homes."

The recipe calls for raisins, currants, sultanas, citrus peel, suet, breadcrumbs, flour, and spices. After mixing the dry ingredients together, add eggs and alcohol and transfer the mixture to a bowl to steam it. The pudding can be prepared ahead of time and reheated on Christmas Day. The full recipe, plus a video with step-by-step instructions, is included in the Instagram post below.

Figgy pudding, or plum pudding, doesn't necessarily contain plums or figs. The classic British dish can be made with practically any type of dried fruit. And unlike American pudding, it's more cake-like than custard-like.

This isn't the first time the royal kitchen has revealed its secrets to the public. Earlier this year, former royal chef Darren McGrady shared his recipe for the chocolate biscuit cake that's enjoyed by the Queen.

[h/t Town & Country]