From TB to Today – An Evolution of Public Health

 The human body is pretty amazing.

It can heal itself, adapt to change, and provide mechanisms to rid itself of bad stuff.

Of course, there are many instances when the body needs help, and medicines step in to take care of what the body can’t. Our current technologies to fight disease and sickness are truly amazing. I only need to refer you to our newest publication Cell and Gene Therapy Review for evidence that our disease fighting and curing capabilities have never been more advanced.

But let’s talk for a moment about a more basic problem and activity – over production of mucous and coughing/spitting.

Before everyone goes “eeww gross,” let’s face it – we’ve all dealt with a cold, sinus infection, or allergy that overwhelmed us with mucus. And while we’re at it, the Mucinex guy is just a big blob of phlegm – and he’s all over TV – and as far as I know, no one has tried to “cancel’ him.

The body’s response to excessive respiratory mucus is the cough reflex. Designed to clear the airways of irritants, foreign particles, and excessive secretions, coughing ensures unobstructed airflow and reduces the risk of infection or aspiration. This reflex is essential for maintaining respiratory health and preventing complications from inhaled substances or infections.

But, as capable as the human body is to remove mucous, it does need some help. This is where expectorating, or spitting, comes in.

You don’t need to do an in-depth Google search or ask ChatGPT to know that spitting has been around since humans first emerged on this planet. And, up until fairly recently, spitting was a pretty normal thing; our ancestors knew that expectorating was required for health reasons, even if they didn’t understand the science behind it.

After dealing with a whopping head cold that lasted two weeks, I began thinking about coughing and expectorating (I mean – what else is there to think about sometimes?). In particular, I became interested in when “public” spitting became a health issue and when laws were enacted to deal with the problem.

The first significant anti-spitting law in the United States was passed in New York City in 1896. This ordinance banned "expectorating" in public spaces such as sidewalks and streetcars. The primary motivation was to curb the spread of tuberculosis, which was a leading cause of death at the time, especially in densely populated urban areas. Public health officials recognized that sputum from infected individuals could transmit TB, leading to widespread campaigns against spitting.

By 1910, nearly 150 American cities and towns had enacted similar laws. These ordinances were often supported by public health boards and reform groups like the Women’s Health Protective Association. Enforcement varied, with fines typically imposed on violators. For example, in New York during the early 1900s, fines for spitting ranged from $1 to $500, although enforcement was inconsistent.

Over time, as tuberculosis became less prevalent due to medical advancements, the focus shifted away from anti-spitting campaigns.

So, if you have followed along through all of the above, you could make the case that public spitting laid the groundwork for modern public health regulations aimed at controlling communicable diseases.

And that’s nothing to sneeze at. As long as you cover your mouth and use hand sanitizer afterwards.

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