History of Medicine
This online exhibit is designed to introduce you to the history of images used in public health posters in the twentieth century. It utilizes the world's largest collection of poster art dealing with questions of health in the United States, housed at the National Library of Medicine. Many of these images can also be viewed through the Images from the History of Medicine (IHM) homepage. The exhibit is divided into two sections that focus on infectious diseases and environmental health concerns, revealing how posters provide an effective medium for communicating information about disease, identifying risk factors, and promoting behavioral change. Two sections on HIV/AIDS education and anti-smoking campaigns provide expanded examinations of public health campaigns that have used a variety of political, psychological, moral, cultural, and economic strategies to achieve their desired aims. By examining the history and function of public health posters, the exhibit suggests that social, biological, and cultural factors have collectively influenced the design of public health campaigns throughout the preceding century.
Posters flourished as an art form in Europe and the United States in the late-nineteenth century as advances in printing technologies allowed for mass circulation. In the 1860s, French artists ushered in a new age for the illustrated poster by introducing colored images and changing the relationship between image and text. Previously, illustrations had been used to complement or complete the text. With the new style of poster, the illustration took the central position while the text frequently only had meaning in relation to the image. In medicine, these early posters were primarily used to sell pharmaceutical products or raise money for victims of disease. Drawing on the success of posters as advertising tools, public health educators began to use posters in educational campaigns during the years of the First World War. In an increasingly visually oriented culture influenced by developments in photography and moving pictures, posters frequently relied on design and colors rather than words to communicate their message.
The emergence of "visual culture" as a field of study is partly the product of the increasing array of images in our daily lives. It includes those aspects of culture that are manifested in visual form -- including photographs, popular films, television, fine art, news images, advertising images, and ground-breaking digital media. While images from these sources take different shapes and use different technologies, each participates in the production and exchange of information, values, ideas, and meanings in our society. The earliest illustrated posters, for example, have a lot in common with the high-tech Internet of today. Each is designed to catch the attention of the viewer and communicate messages quickly, most often with limited text and strong graphics. As relatively inexpensive forms of popular media, posters in the twentieth century and the Internet in the twenty-first century are also favorite ways to advocate a cause. Both provide a forum for corporate and institutional interests alongside private and community concerns, and both can be used to appeal to a broad public audience.
These qualities have encouraged public health campaigners to use posters as a powerful medium for visually communicating knowledge about disease, identifying health risks, and promoting changes in behavior. By combining innovative imagery and text, public health posters have incorporated the techniques of advertising to sell "health" as a precious commodity. In the process, poster designers developed a visual vocabulary to help shape and define "normal" and "healthy" behaviors and conditions, which has provided the basis for a variety of campaigns against infectious diseases and environmental health hazards. At the same time, posters helped to define (and stigmatize) the abnormal, disabled, unhealthy, or contaminated individual.
Building on the widespread popularity of posters as advertising tools for commercial products, public health authorities realized that posters could be employed to motivate and inform the general public and soldiery during a time of conflict and confusion surrounding the First World War. Designed to communicate, invite action, and build consensus, the first public health posters addressed the devastating effects of uncontrolled infectious diseases. There were, however, a number of precursors to the first illustrated posters. For centuries, epidemics of smallpox, plague, typhus, and cholera had inspired counter measures designed to inform and educate citizens about health hazards. This section on precursors examines some of these images in the form of broadsides, engravings, and quarantine signs.
Broadsides were among the earliest examples of commercial printing. Local governments frequently used them to feature health matters and warn citizens of impending epidemics or to promote corrective or protective sanitary measures. This engraving by Giovanni Giaccomo Rossi includes a series of vignettes from Rome during the plague of 1656. Messages about hospital use, fumigation practices, removal of the dead, quarantine of patients in prisons, and mass burials are included.
This photoprint of a wood engraving from Harper's Weekly in 1885 illustrates another forum for public health images provided by the creation of the magazine as a form of mass media in the late-nineteenth century. The image demonstrates disease in metaphorical terms, a technique commonly used by later poster artists. In this case, the shrouded and skeletal specters representing cholera, yellow fever, and smallpox recoil in fear as an angel holding a sword and shield emblazoned with the word "cleanliness" blocks their way through the quarantine barrier at the Port of New York. Over the years serpents, skulls, monsters, thieves, and even extraterrestrial figures have been used as representations of disease. The discoveries by microbiologists inspired new visual metaphors for disease in the 19th century, such as anthropomorphic germs and grotesque bacteria.
Quarantine signs, another ancestor of illustrated public health posters, were usually placed outside homes to warn citizens about the presence of deadly diseases. Quarantine posters were common sights in front of homes in towns and villages across the United States until the middle of the twentieth century. This poster, from the San Francisco Board of Health in the 1910s, prominently identifies the presence of diphtheria. The use of bold headlines with large fonts reflects an urgent and alarmist message. The viewer is ordered to keep out of the house bearing the poster and warned that removal of the sign will result in prosecution.
Epidemics of diphtheria and scarlet fever had spread through various parts of New England as early as the mid-eighteenth century. At the time both diseases were referred to as "throat distemper" and weren't distinguished. Known as the deadly scourge of childhood because it was so difficult to treat and control, diphtheria was a highly feared disease in the nineteenth and early twentieth centuries in the United States. In major cities, thousands of cases were reported each year, with large numbers of deaths. Scarlet fever was another deadly childhood bacterial infection characterized by an extremely high fever and unique red rash. Like many other bacterial diseases, scarlet fever and diphtheria were often linked with poverty or unsanitary conditions. As a result, quarantine posters played a role in limiting the spread of these diseases, but they also likely helped perpetuate disease-related stigma by clearly identifying where the disease could be found and emphasizing isolation over education. This poster from early twentieth-century Connecticut announces that "all persons are forbidden to enter or leave these premises without the permission of the Health Officer under penalty of law." The successful control of infectious disease depended on similar quarantine efforts, along with the removal of the stigma and access to treatment and preventive vaccines for the entire population at risk.
Epidemics of diphtheria and scarlet fever had spread through various parts of New England as early as the midLaboratory-based advances in bacteriology and immunology in the late-nineteenth century helped treat and prevent these deadly diseases. By 1930, the successful immunization of thousands of children demonstrated the promise and force of the laboratory in infectious disease control. The development of antibiotics in the 1940s further revolutionized the treatment of infectious bacterial disease. Still, diseases like typhoid fever, identified in the quarantine poster to the left, remain very common worldwide over 60 years after the development of the first antibiotics. This poster illustrates the seriousness of its message in both style and content. The headline names the disease in large, distinctive font and the accompanying message informs the viewer that removal of the notice is punishable by a fine.