History of Medicine
During the nineteenth and early twentieth centuries, tuberculosis (TB) was the leading cause of death in the United States and one of the most dreaded diseases known to mankind. Until Robert Koch's discovery of the disease-causing tuberculosis bacteria in 1882, many scientists believed that TB was hereditary and could not be prevented. Doctors offered few effective treatments. A new understanding of TB in the bacteriological era not only brought hopes for a cure but also bred fear of contagion. A disproportionate majority of TB victims lived in urban slums, where crowded and unsanitary conditions provided an ideal environment for transmission. The tubercular invalid was frequently labeled an outcast.
In the 1880s, Dr. Edward Livingston Trudeau ushered in a new era in the history of TB by promoting isolation as the best means not only to spare the healthy, but also to heal the sick. Based on his own experience with TB, Trudeau argued that rest, moderate exercise, fresh air, and a healthy diet were the keys to recovery. A new tuberculosis institution, known as the sanatorium, confined the sick and helped perpetuate the stigma associated with TB, but also led to the first national organization committed to fighting the disease with a program of research and education.
Public health reformers used the illustrative poster as a means of communication, propaganda, and persuasion to support their cause. This new medium quickly became an effective educational and fundraising tool in the widespread campaign against TB.
The National Association for the Study and Prevention of Tuberculosis was formed in 1904 to unify and expand the country's regional anti-tuberculosis programs. Inspired by the identification of the tuberculosis bacteria in sputum, its mission included an aggressive campaign against public spitting. The amazing discovery that bacteria could survive in spit for an entire day even convinced many women to stop wearing their long, trailing dresses into town for fear they might pick up sputum and drag it into their homes. This poster from the Rensselaer County Tuberculosis Association in Troy, NY expresses faith in the ability to prevent disease by educating the public about transmission. Countering the stigma associating disease with poverty or filth, this illustration features a finely dressed, well-groomed young man demonstrating the proper alternative to "careless spitting, coughing, and sneezing."
Among the more eye-catching and emotionally evocative tuberculosis posters were those designed to raise funds for veterans who had contracted the disease while serving in the First World War. An annual fundraising campaign backed by a private French group with support from the French and American governments, the Journée Nationale des Tuberculeux used posters commissioned by leading artists. This illustration is from French caricaturist Abel Faivre. Faivre became famous for his posters supporting the French military effort during the war. This image of a weary soldier with a nurse's hands on his soldiers is accompanied by the powerful message, "Save them.".
In this poster by the celebrated French symbolist painter Lucien Lévy-Dhurmer, a retired soldier under a blossoming tree supports himself with a walking stick. An impressionistic sea separates the soldier from the city in the background. Contrasting the soldier's feelings of isolation and despair with the beauty of the landscape, the painting is designed to provoke an empathic response from the viewer.
Dire financial pressures faced by operators of sanatoriums in the United States led to the Christmas Seal campaign, a fundraising effort begun by American Red Cross worker Emily Bissell in 1907. Since that time, Christmas Seals have become the official source of fundraising revenue for the battle against TB. This 1919 poster from the Red Cross promised that tuberculosis would be "The Next To Go." The illustration shows the protector of the family pushing the dreaded visitor out the door. The shrouded image of tuberculosis is comparable to the depiction of disease from the Harper's Weekly 1885 photoprint at the beginning of this exhibit. In the earlier image, however, the sword-wielding angel of cleanliness vanquished the disease, whereas here the overall-wearing man of the house pushes TB out of the door like he might do to an unwanted intruder. The nurse, meanwhile, simply looks on while comforting the family. Her uniform bears the emblem of the Christian double-barred cross. A modification of the Cross of Lorraine, commandeered during the First Crusade in 1099, it became the official symbol of the anti-TB "crusade" in 1920.
By the time this poster was produced in 1924, sponsorship for the Christmas Seal Campaign had shifted from the American Red Cross to the National Tuberculosis Association (NTA). The iconic Santa Claus is used to suggest a relationship between purchasing the stamp and helping innocent children. In the image, Santa protectively holds a small angelic child in one arm and the celebrated NTA stamp in the other. The stamp features an angel holding a torch and a shield emblazoned with the anti-tuberculosis emblem. The juxtaposition of image and text creates an association between "health" and "Christmas," providing a safe way to fight tuberculosis and offer the gift of health without getting to close too the infectious patient.
The image of Santa Claus in this 1924 poster, proudly holding a letter bearing a Christmas Seal, also equates buying the stamp with offering a gift in the popular tradition of the holidays. Borrowing from the commercial advertising technique of sloganeering, and implying that the money used to buy the stamps could lead to elimination of the disease, the message "Stamp out tuberculosis" is included. Stamp buying allowed average people to feel like they were contributing to the voluntary, professional, and governmental effort.
This 1935 poster uses the technique of modeling -- encouraging the viewer to mimic the depicted behavior. In the illustration, a woman makes her way through the snow to mail her gifts and letters, all adorned with Christmas Seals. The headline provides a motivation complementary to the portrayal of generosity, inspiring confidence that "Tuberculosis is preventable and curable." Another common technique, the inclusion of the annual Christmas Seal itself in the design, was used to encourage yearly purchase of newly minted and collectable stamps.
The National Tuberculosis Association used proceeds from Christmas Seal campaigns to develop educational posters that emphasized both prevention and control. This 1930s poster uses a common technique in public health posters involving the juxtaposition of text and image to create a message that works against viewer expectations. In this poster, the viewer may come to the image with the expectation that it is an advertisement for an exercise program or vitamin supplement, only to learn, by reading the text in the image, that it is a warning that you can look healthy but still have tuberculosis. The image of the healthy man is accompanied by an illustration of how an X-ray machine can be used to identify TB long before symptoms appear. By fostering faith in the value of science and preventive technologies, this technique also confirms the value of the Christmas Seals campaign in supporting additional research.
This poster by famous portrait artist Ernest Hamlin Baker reflects a distinctive 1930s style of illustration. Rays of light, emanating from the double-barred cross emblem of the NTA, illuminate scenes of health personnel working in laboratories and caring for patients. The figures, design, and composition of this poster reflect a modernist style appropriate for the promotion of newly developed scientific solutions to an age-old problem. A series of illustrations described as "modern weapons" in the fight against tuberculosis include a man looking into a microscope, a nurse and doctor monitoring a woman receiving intravenous treatment, a young boy receiving an injection, and an X-ray displayed prominently in the background. As part of the campaign to solicit contributions, the message in the bottom corner of the poster suggests, "Christmas Seals help fight Tuberculosis."
This illustration, also from the 1930s, combines two powerful graphic motifs including the personification of disease as a thief and reference to the historical origins of the NTA emblem. The lurching thief, dressed in a tunic and holding a bag of leaking gold coins in his left hand and burning torch in his right hand, cowers before a knight holding a drawn sword and displaying the double-barred cross symbol from the First Crusade on his surcoat. The portrayal of disease as a thief robbing you of your health remains a common metaphor in public health imagery and in this case the noble Christian knight is the symbol of public health as protector. The caption at the bottom of the poster, "Christmas Seals finance the campaign against tuberculosis," is designed to inspire confidence in the value of the viewer's contribution.
This poster is an early example of a common design in public health posters that uses the photograph of a child combined with a message of protection. In this case, the image of a child, designed to appeal to parental instincts, is framed by the NTA emblem and instructions for protecting children from TB: "Keep them away from sick people. Insist on plenty of rest. Train them in healthy habits. Consult the doctor regularly." In contrast to the faith in "modern weapons" seen in the tuberculosis poster above, these instructions reveal the limits of the prevailing knowledge about tuberculosis in 1930 and the general quarantine and hygienic strategies encouraged by the medical profession.