Tuning in to Tuberculosis

By Danielle Aloia, Special Projects Librarian

WNYC-LogoTo mark World TB Day, we are going to tune in to the 1950s radio series “For Doctors Only.” Selections from this series and several others produced by The New York Academy of Medicine and WNYC were recently digitized and cataloged by the Academy and the New York Public Radio (NYPR) Archives.

The program “The Biological and Social Aspects of Tuberculosis” was the 26th Hermann M. Biggs Memorial Lecture, held at the Academy in 1951.The lecture was given by Pulitzer Prize-winning author René Jules Dubos in honor of physician and public health champion Hermann Biggs and his contribution to the control and elimination of tuberculosis (TB).

At the beginning of his career, Dubos focused on developing antibiotics. But after his first wife, Marie-Louise, died of pulmonary TB in 1942, he changed the focus of his research. His lab determined a way to more quickly culture strains of tubercle bacilli, which led to a better understanding of their virulence and properties. In 1946, he married Jean Porter, who worked alongside him in his lab. Dubos likely based his lecture on the research he did for his book The White Plague, which he published with his wife in 1952.1

Oil portrait of Hermann M. Biggs by Renwick, held in our Oil Portrait Collection.

Oil portrait of Hermann M. Biggs by Renwick, held in our Oil Portrait Collection.

In the lecture, Dubos discussed Biggs’ contribution to tuberculosis prevention in the 1900s. Biggs graduated from Cornell in 1881. In his dissertation, “he expressed his conviction that filth and poor hygiene were the primary causes of contagious disease and microorganisms were only byproducts of disease.”2

Dubos pointed out in his lecture that when Robert Koch discovered the Tubercle bacillus in 1882, it revolutionized the perception of TB. It was no longer a social disease but a biological one. The bacteriological era had begun!

Biggs was quick to realize the profound effect of this germ theory. He formulated a practical way to control TB, shifting the emphasis from patients passively taking physicians’ orders to actively participating in the eradication of the disease as a community through the following formula:

  1. Check the spread of the infection and minimize contacts
  2. Help humans develop higher resistance
  3. Educate to mobilize the community to take action

His TB-control formula began the anti-tuberculosis movement, which eventually led to the formation of the National Tuberculosis Association in 1905.3

In 1889 Biggs and his colleagues “presented to the Health Department of New York City a communication calling attention to the communicability of tuberculosis and recommending that measures be taken to prevent the spread of the disease.” As a result, the Health Department published and distributed a leaflet in large quantities. As noted in A History of the National Tuberculosis Association, “So far as we are able to ascertain, this is the first leaflet ever published for distribution among the general public. It is certainly the first one published and distributed by a health department, and as such marks an epoch in tuberculosis education.”4

The Health Department leaflet, reprinted in Knopf SA. A History of the National Tuberculosis Association: The Anti-Tuberculosis Movement in the United States. New York: National Tuberculosis Association; 1922.

The Health Department leaflet, reprinted in Knopf SA. A History of the National Tuberculosis Association: The Anti-Tuberculosis Movement in the United States. New York: National Tuberculosis Association; 1922.

Over the years, public-health measures helped reduce the spread of TB. Despite these efforts, the population was still susceptible to infection. Mortality rates had been falling faster than infection rates, which Dubos noted in The White Plague. He also showed a connection between industrialization and reduced mortality.

In Dubos, RJ, Dubos J. The white plague: Tuberculosis, man, and society. New Brunswick : Rutgers University Press; 1987.

In Dubos, RJ, Dubos J. The white plague: Tuberculosis, man, and society. New Brunswick : Rutgers University Press; 1987.

Complete eradication of the disease was almost impossible. Instead, Dubos suggested two ways to attack the progression of the disease: 1) decreasing risk of infection and 2) boosting resistance. To do this, thought Dubos, researchers must focus on fostering new and unorthodox ways to determine resistance to infection and adventure into unexplored fields.

Dubos stressed in his lecture that it was imperative to investigate the human and environmental factors that determine resistance to infection. But according to the Global Tuberculosis Report 2014, “tuberculosis (TB) remains one of the world’s deadliest communicable diseases. In 2013, an estimated 9.0 million people developed TB and 1.5 million died from the disease.” Today, efforts to prevent and control TB infection are similar to those championed by Biggs and Dubos: drug-resistant surveillance, community-based TB activities, and collaboration across sectors in research and policy-making.


1. Hirsch JG, Moberg CL. Rene Jules Dubos 1901-1982. Washington, D.C.: National Academy of Sciences; 1989. Available at: http://www.nasonline.org/publications/biographical-memoirs/memoir-pdfs/dubos-rene.pdf. Accessed March 20, 2015.

2. Dubos RJ, WNYC (Radio station : New York NY). Biological and Social Aspects of Tuberculosis. New York : WNYC; 1951. http://www.wnyc.org/story/biological-and-social-aspects-of-tuberculosis-26th-hermann-m-biggs-memorial-lecture.

3. Knopf SA. A History of the National Tuberculosis Association: The Anti-Tuberculosis Movement in the United States. New York: National Tuberculosis Association; 1922.

4. Knopf SA. A History of the National Tuberculosis Association: The Anti-Tuberculosis Movement in the United States. New York: National Tuberculosis Association; 1922.

School Breakfast Week: “Take Time for School Breakfast”

By Danielle Aloia, Special Projects Librarian

Starting the day with a hearty, healthy breakfast allows your body to maintain the physical and mental agility needed to function without fatigue during the course of the day. Today, the Food Research and Action Center recognizes that “school breakfast participation is linked with increased food security, improved health outcomes, and numerous educational benefits, particularly for low-income children.”1

In 1790, Germany began the first school feeding program on record. In the early 1900s, the U.K. and several other European countries passed bills to enact school lunch programs. The following table shows the nutrition requirements for school children in Switzerland, Germany, and England circa 1900:2

Recommended nutritional requirements.2 Click to enlarge.

Recommended nutritional requirements.2 Click to enlarge.

The U.S. was late to follow, not passing legislation for a school lunch program until the 1940s. However, U.S. researchers had previously looked at the nutrition status of school aged children. In 1906, a Dr. Lechstecker in New York City examined 10,707 children and found that 439 had no breakfast and 998 had just coffee or coffee and bread. In 1908, of 10,090 children studied in Chicago, 825 suffered from malnutrition.2

In the 1940s, West Virginia surveyed students from various cities about their eating habits. They found that poor breakfasts were the biggest problem. By 1947 the state established the Good Breakfast for Every Man, Woman, and Child program with the slogan “Start the Day the Good Breakfast Way.”3

Some of the findings reported by West Virginia School Children’s Diet Study.3 Click to enlarge.

Some of the findings reported by West Virginia State Nutrition Committee.3 Click to enlarge.

In 1966, the Child Nutrition Act enacted The School Breakfast Program (SBP) as a pilot project. “During the first year of operation, the SBP served about 80,000 children at a federal cost of $573,000.”4 In fiscal year 2007, “the participating schools served . . . 1.7 billion breakfasts at a federal cost of $2.2 billion.”5 Current research shows that “10.8 million low-income children participated in the School Breakfast Program on an average day in school year 2012-2013, an increase of more than 310,000 children from the previous year.”6 And “for Fiscal Year 2012, the School Breakfast Program cost $3.3 billion, up from $1.9 billion in Fiscal Year 2005.”1

Today’s programs must meet the U.S. Dietary Guidelines for Americans, 2010, which provide evidence-based nutrition standards. The government will implement new guidelines in 2015 under the Federal Rule Nutrition Standards in the National School Lunch and School Breakfast Program. “This rule requires most schools to increase the availability of fruits, vegetables, whole grains, and fat- free and low-fat fluid milk in school meals; reduce the levels of sodium, saturated fat and trans-fat in meals; and meet the nutrition needs of school children within their calorie requirements.”7

ChooseMyPlateChoose MyPlate is an easy way for people to adhere to the dietary guidelines set out by the U.S. Dept. of Health and Human Services and the Dept. of Agriculture.

Breakfast is not just for school children. Remember to take time for breakfast no matter your age.


1. Hewins J, Burke, Mike. School Breakfast Scorecard: 2012-2013 School Year. Washington, DC: Food Research and Action Center (FRAC); 2014. http://frac.org/pdf/School_Breakfast_Scorecard_SY_2012_2013.pdf. Accessed January 31, 2014.

2. Bryant, Louise Stevens. School Feeding; Its History and Practice at Home and Abroad. Philadelphia: J. B. Lippincott Company; 1913. Access at: https://ia700505.us.archive.org/3/items/schoolfeedingits01brya/schoolfeedingits01brya.pdf

3. State of West Virginia. Start the Day the Good Breakfast Way: A Statewide Nutrition Program Sponsored by The West Virginia State Nutrition Committee September 1947-August 1948. State of West Virginia; 1948.

4. USDA Food and Nutrition Service website. http://www.fns.usda.gov/sbp/school-breakfast-program. Accessed February 10, 2014.

5. National Research Council. School Meals: Building Blocks for Healthy Children. Washington, DC: The National Academies Press; 2010. http://www.nap.edu/openbook.php?record_id=12751&page=1. Accessed on: January 31, 2014.

6. The School Breakfast Program:  Fact Sheet. Washington, DC:  USDA Food and Nutrition Service; http://www.fns.usda.gov/sites/default/files/SBPfactsheet.pdf. Accessed February 11, 2014.

7. Nutrition Standards in the National School Lunch and School Breakfast Programs. Fed Regist. 2012;77(17):4088-4167. To be codified at 7 CFR §210 and 220. http://www.gpo.gov/fdsys/pkg/FR-2012-01-26/pdf/2012-1010.pdf. Accessed on: January 31, 2014.

New Year’s Luck—and How to Keep Safe, 1950s Style

Bert Hansen, professor of history at Baruch College and author of Picturing Medical Progress from Pasteur to Polio: A History of Mass Media Images and Popular Attitudes in America, wrote today’s guest post. Dr. Hansen will give a Friends of the Rare Book Room talk, “Louis Pasteur: Exploring His Life in Art,on January 14. Join the Friends and register for the talk by clicking here.

At the start of every New Year, people’s attention turns to health and safety (a popular New Year’s resolution is to lose weight). And as we again confront the passage of time, thinking about what’s permanent and what is not, ephemera come to mind. Printed materials of temporary use, when they have luckily been saved and not casually discarded, are especially important for historians as sources to understand ordinary people’s life in the past.

In that spirit, it is a pleasure to share with blog followers a sampling of Lucky Safety Cards from the 1950s, recently donated to NYAM’s Rare Books and Special Collections.

Card 45, featuring Popeye.

Card 45, featuring Popeye. Click to enlarge.

Distributed free in newspapers around 1953, these 2-by-4-inch cards featured characters from popular comic strips and offered ways to be smart and prevent accidents.1 Although children appear in the frame with such cartoon characters at Popeye, Dagwood Bumstead, and the Katzenjammer Kids, it seems likely the messages were aimed at adults as well since people of all ages read newspaper comic strips assiduously.

With vivid two-color printing and graphic styles characteristic of the time, these little collectibles vividly illustrate the history of a popular public health campaign in the decade after World War II. It may not be a coincidence that during the war, cartoon and comic strip figures had been used on health and safety posters and in military instruction and recruitment.2

Modern readers may be struck by the formality of language and styles of dress, quite different than the comics’ drawing styles and casual language used from the 1960s onward. And if the points appear less flashy than modern public service announcements, we would still do well to heed most of their concerns. Each card supplements the illustration with two short texts: a very brief general rule at the bottom (suitable for memorization, perhaps) and a more concrete explanation within the frame. The rules were often puns or contained a rhyme.

“Caution, care, and common sense / eliminate home accidents.”
“Use your ears, eyes, and knows.”
“The right-of-way isn’t worth dying for.”
“Don’t learn the traffic laws by accident.”
“A slip for a trip / may break a hip.”

Each card carried a safety slogan number from 1 to 48 identifying its message (and perhaps encouraging people to collect a complete set), along with a unique serial number. The serial numbers were part of a lottery offering cash prizes. Readers were advised to check for the winning numbers in the newspaper.

It is not clear how many newspapers distributed Lucky Safety Cards. All the examples in NYAM’s collection come from three newspapers: the Albany Times-Union, the Baltimore News-Post and American, and the New York Journal-American.

The Academy holds 31 of the 48 published cards. Missing numbers are 5, 12, 13, 16, 17, 19, 21, 24, 26, 28, 29, 31, 33, 34, 37, 39, and 40. If you have one of the missing cards and want to help fill the seventeen gaps in the set, donations will be warmly received and greatly appreciated.

Although in the truest sense of the word, these cards were ephemeral, historians and artists now—and long into the future—will have permanent access to them thanks to modern conservation and preservation practices in the Academy Library’s Rare Books and Special Collections.

April 2014 update:

Thanks to a “New Yorker who enjoys flea markets,” our set of Lucky Safety Cards is one card closer to completion. Here’s card No. 24 from the set.

Lucky Safety Card 24. Click to enlarge.

Lucky Safety Card 24. Click to enlarge.

April 2017 update:

Our collection now includes cards 13, 17, 29, and 39, thanks to Diane DeBlois and Robert Harris. Just 12 more cards to go!


1. For a handy orientation to the wide range of advice and information in comics formats, see Sol Davidson, “Educational Comics: A Family Tree,” in the open-access journal ImageTexT 4:2, Supplement (2008) at http://www.english.ufl.edu/imagetext/archives/v4_2/davidson/.

2. Michael Rhode, “She may look clean, but. . . .  Cartoons Played an Important Role in the Military’s Health-Education Efforts during World War II,” Hogan’s Alley, 8 (Fall 2000).

Two entries in Hidden Treasure: The National Library of Medicine ed. by Michael Sappol, Bethesda, MD: National Library of Medicine / New York: Blast Books, 2012:  “Malaria Pinup Calendars (1945): Frank Mack, for the U.S. Army,” on pp. 172-173, by Sport Murphy, and “Commandments for Health (1945): Hugh Harman Productions, for the U.S. Navy,” on pp. 174-175, by Michael Rhode.

Many fascinating examples are listed in a ten-page finding aid for materials in the Otis Archives Collections, “Cartoons and Comics in the National Museum of Health and Medicine” by Michael Rhode, which may be accessed in PDF format at http://www.medicalmuseum.mil/index.cfm?p=collections.archives.collections.index.

Burn These Handkerchiefs

By Johanna Goldberg, Information Services Librarian

With cold and flu season upon us, it’s the perfect time to remind ourselves how to prevent the spread of disease.

A pamphlet from New York City’s Department of Health, likely printed in 1929, gives advice still relevant today, complete with some fabulous illustrations. The recommendations vary only slightly from those now given by the CDC.

Side one of the unfolded pamphlet.

Side two of the unfolded pamphlet.

Stay healthy!

Item of the Month: Posters from the Special Programme on AIDS, World Health Organization, 1987–1995

By Paul Theerman, Associate Director

The WHO Special Programme on AIDS was the first response of the United Nations to the pandemic that had gained world attention by the mid-1980s.1 The offspring of the first two international conferences on AIDS, in Atlanta in 1985 and in Paris the following year, the Programme was founded in February 1987. The Programme’s dynamic director, Jonathan M. Mann, had great hopes and grand plans for combating AIDS through a coordinated worldwide response—the only feasible way to control the virulent and widely spreading disease, he thought. From the beginning he also saw the AIDS outbreak as a focus for engaging global human rights issues. Under Mann, the WHO moved beyond its role of technical advisor to national governments, for it tried to take a directive role, actively engage non-governmental organizations, and promote non-discriminatory policies towards AIDS sufferers. Between 1987 and 1989, the Special Programme—which also came to be known as the Global Programme on AIDS—developed a comprehensive strategy for attacking the virus.


These two posters—one design in two languages—come from the heady days of the Programme’s beginning. Produced in 1987, these posters announced its slogan, “AIDS: A worldwide effort will stop it.” The posters’ design inadvertently reveals how difficult it was to talk about AIDS in the 1980s. AIDS seemed different from other diseases. First of all, it was a pandemic experienced in the west, perhaps the first such experience since the polio epidemic in the early 1950s, and before that, the influenza pandemic in 1918–19. With the rise of antibiotics and vaccination, widespread disease outbreaks in the developed world were no longer supposed to happen! As Dr. Gerald Friedland, a doctor on the front lines during the height of the pandemic, said at an event at Columbia University earlier this month, the disease caused the “inverse of the life cycle,” as it mostly impacted young people, leading to parents burying their children. “The only thing comparable was war.”

With AIDS, neither antibiotics nor vaccination worked, so epidemiologists were forced back to classic means of halting pandemics: stopping the means of transmission. Here also AIDS proved difficult. Those means—chiefly sexual contact and sharing needles—provoked strong reactions. Coupled with a long latency and an invariably fatal outcome after a horrific decline, AIDS did not have a simple profile.

The posters display that cultural unease. The UN commissioned noted New York graphic designer Milton Glaser, an internationally known logo and poster designer, with such readily recognizable designs as “I ♡ NY,” Esquire and New York magazines, and Sony, among many others. Certainly Glaser knows about the power of images to convey meaning. For these UN posters, he combined three elements, two hearts and a skull, to make a W—presumably to stand for “world” in the World Health Organization, and to reference the caption, “A worldwide effort will stop [AIDS].” But it’s not clear—and it doesn’t work in the Spanish version of the poster. Even more puzzling is the relationship of the hearts to the skulls. Is it cautionary: in the midst of love—erotic love, that is—lurks death? Is it hopeful: compassionate hearts will combine to crush AIDS? Is it both? Glaser produced a striking image, but he also produced an ambiguous one. By 1991, the red ribbon had been introduced as the predominant AIDS symbol, and it soon the supplanted the “heart-and-skull-W,” even at the UN itself.

The year that this poster came out proved to be the Programme’s high point. In 1988 a new director-general came to the World Health Organization. AIDS could not have two masters. By late 1989, the Programme’s efforts, strategies, and budget were brought up short, and Mann departed in 1990. The Programme limped along for another five years, until replaced by UNAIDS, the locus for United Nations action today. In the words of Mann’s successor,  Michael H. Merson: the Programme “was unable to muster the necessary political will . . . , and its effectiveness was compromised by . . . an increasing preference of wealthy governments for bilateral aid programs.”2 That seems where matters stand now, as we approach World AIDS Day, December 1. The story of the Special Programme on AIDS is a cautionary tale of the difficulties of grappling with a worldwide disease in a disjointed world.


1. Much of the history of the Special Programme on AIDS is found in two article by its founding director: Jonathan M. Mann, “The World Health Organization’s global strategy for the prevention and control of AIDS,” in AIDS—A Global Perspective [Special issue] Western Journal of Medicine 1987 Dec; 147:732–734; and Jonathan M. Mann and Kathleen Kay, “Confronting the pandemic: the World Health Organization’s Global Programme on AIDS, 1986–1989,” AIDS 1991; 5 (suppl. 2): S221–S229.

2.  Michael H. Merson, “The HIV–AIDS pandemic at 25—the global response,” New England Journal of Medicine 2006; 354:2414–2417 (June 8, 2006), quotation from page 2415.