At the end of the 19th century, one in seven people around the world had died of tuberculosis or TB for short(肺结核), and the disease ranked as the third leading cause of death in the United States. While physicians had begun to accept that TB was caused by bacteria, this understanding was slow to catch on among the general public, and most people gave little attention to the behaviors that contributed to disease transmission. They didn't understand that things they did could make them sick. It was common for family members, or even strangers, to share a drinking cup.
In the 1890s the New York City Health Department launched a massive campaign to educate the public and reduce transmission. The "War on Tuberculosis" public health campaign discouraged cut-sharing and urged states to ban spitting inside pubic buildings and on sidewalks and in other outdoor spaces. Changes in public behavior helped successfully reduce the spread of TB.
Disease can permanently change society, and often for the best by creating better practices and habits. Crisis sets off action and response. Many infrastructure improvements and healthy behaviors we consider normal today are the result of past health campaigns that responded to serious outbreaks.
In the 19th century, city streets in the U.S. overflowed with dirt. People threw their unwanted newspapers, food scraps, and other trash out of their windows onto the streets below. The plentiful horses pulling streetcars and delivery cart dropped urine and waste every day. Human waste was a problem, too. Those in tenement(租户) housing did not have their own facilities, but had 20 to 30 people sharing a single outhouse. These toilets frequently overflowed until workers known as "night soil men" arrived to deal with waste, only to dump it into the nearby harbor.
As city and health leaders began to understand that the frequent outbreaks of TB that swept across their cities were connected to the garbage, cities began setting up organized systems for handling human waste. Indoor toilets were slow to catch on, due to the cost and need of a plumbing system. Improvements in technology helped the process along. Following Thomas Crapper's improved model in 1891, water closets became popular, first among the wealthy, and then among the middle-class. Plumbing systems, paired with tenement house reform, helped remove waste from the public streets.
Disease greatly improved aspects of American culture, too. As physicians came to believe that good ventilation(通风) and fresh air could help fight illness, builders started adding porches and windows to houses. Real estate investors used the trend to market migration to the West, encouraging Eastern physicians to convince TB patients and their families to move thousands of miles from crowded, dirty Eastern cities to the dry air and sunshine in places like Los Angeles and Colorado Springs.
Some of this influence continues today. While we know that sunshine doesn't kill bacteria, good ventilation and time spent outside does benefit children and adults by promoting physical activity and improving spirits. This fresh-air "cure" also eventually transformed the study of climate into a formal science, as people began to chart temperature, barometric pressure and other weather patterns in hopes of identifying the "ideal" conditions for treating disease.
Public health emergencies have inspired innovations in education. Starting in 1910, Thomas Edison's lab, which had invented one of the first motion picture devices in the 1890s, cooperated with anti-tuberculosis activists to produce short films on TB prevention and transmission—some of the first educational movies. Screened in public places in rural areas, the TB movies were also the first films that viewers had ever seen.
As we are seeing with the coronavirus today, disease can impact a community—changing routines and shaking nerves as it spreads from person to person. But the effects of epidemics extend beyond the moments in which they occur.
