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

Posted on November 26, 2013 by nyamhistofmed

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.

References

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.

Good eyes are your protection

Posted on July 26, 2013 by nyamhistofmed

By Rebecca Pou, Project Archivist

“Wear glasses if the doctor advises you to do so.” “Don’t rub your eyes with dirty hands.” “If you suspect eye trouble, see an oculist at once.” This sound advice comes from a 1917 trifold leaflet aimed at school children and published by the Illinois Society for the Prevention of Blindness (ISPB), which was founded in 1916.

While the pamphlet contains helpful recommendations on eye health, the illustrations and design are particularly charming. Eyes peer out from the sign on the front cover, but we discover that those eyes belong to a boy in spectacles on the page beneath and the sign has cut outs. The eye holes must have been irresistible to children and are surrounded by guidelines for healthy eyes.

Click to enlarge.

The pamphlet stresses that proper eye care beginning in childhood confers life-long benefits, especially in a cartoon comparing two couples from an eye screening in childhood through old age. The pair that cares for their eyes flourishes in life, excelling in academics, extracurricular activities, and, in the case of the man, his profession. The other couple is plagued with nervousness and headaches, and both have trouble with work. While the pamphlet is aimed at children, the lesson is for parents as well. In her old age, the content woman is grateful to her mother for getting her the eye care she needed, while the unfortunate pair’s parents had dismissed the eye examiners’ recommendations.

Click to enlarge.

And for anyone who might need further convincing, the Society contrasts good sight and bad sight in black and white.

In his landmark book, The Evolution and Significance of the Modern Public Health Campaign, published in 1923, C-E. A. Winslow asserts that education and changed behavior are central to modern public health efforts. He says, “the fight must be won, not by the construction of public works, but by the conduct of the individual life.” In this pamphlet, the ISPB is clearly appealing to individuals, encouraging them to choose good care over neglect, preventing the difficulties in life caused by blindness and eye disease.

Almost a century after the publication of “Good eyes are your protection,” the ISPB still exists and maintains a website. While their efforts seem more expansive, consisting of education, research and programs, the organization remains “dedicated to the care, protection, and preservation of sight.”

Uncle Sam, M.D.

Posted on July 5, 2013 by nyamhistofmed

By Paul Theerman, Associate Director

Health Almanac, 1920 front cover.

How to get the word out? For the last two hundred years, health has been as much about education and prevention as intervention and response. And so an intrepid young doctor in the U.S. Public Health Service (USPHS) latched onto using the almanac as a public health vehicle. Health Almanac 1920 (Public Health Bulletin No. 98; Washington, GPO, 1920) was a 12-page almanac entwined in a 56-page public health pamphlet. Amid checking for the phases of the moon or the times of sunrise and sunset, one could find short pieces giving warning signs for cancer, means to prevent the spread of malaria, the necessity of registering births, and how to build a good latrine. These and many other topics were all presented by “Uncle Sam, M.D.”; the almanac was free for the asking.

Health Hints and Notable Events for July 1920. Click to enlarge.

In the distant past, almanacs became linked to health through “astro-medicine” or “iatromathematics,” that is, medical astrology. Each of the signs of the zodiac was held to influence a system of the body, from Ares controlling the head to Pisces the feet, and so for everything in between. Almanacs were calendrical and astronomical, and in addition to marking sunrise and sunset, the phases of the moon, and religious holidays, they charted the day-by-day progress of the moon through the zodiac, with its supposed medical consequences. To this technical data, the most famous American almanac, Benjamin Franklin’s Poor Richard’s Almanac, added moralistic lessons and practical advice, wittily presented. Health Almanac 1920 provided these same features within the context of progressive secular government. The publication started with inspirational statements from President Woodrow Wilson, the Secretary of the Treasury, and the Surgeon General —who together formed the chain of command for the Public Health Service! Instead of a calendar of religious seasons and saints’ days, the almanac noted national days and significant events in the history of medicine and in “The Great War,” just concluded. Everywhere were health aphorisms: “Good health costs little, poor health costs fortunes” (from the back cover), and “Large fillings from little cavities grow” (April 20). Some “health hints” were quite flatly presented: “Every home should have a sewer connection or a sanitary privy” (July 20), and “Food, fingers, and flies spread typhoid fever” (July 31). Some were just to the point: “Be thrifty” (November 15) and “Wear sensible shoes” (December 18). Throughout, the almanac highlighted the role of the USPHS in promoting health.

Health Almanac, 1920 back cover.

The Health Almanac was published in 1919 and 1920—we have the 1920 edition—as was a parallel publication called the Miners’ Safety and Health Almanac, put out by the Bureau of Mines. Both were the brainchild of Dr. Ralph Chester Williams (1888–1984), then at the outset of his successful career with the Public Health Service. Born in Alabama and a 1910 graduate of the University of Alabama Medical School, Williams entered the USPHS in 1916 and was posted to the Bureau of Mines during World War I. Pulled into the Office of the Surgeon General, he edited Public Health Reports, served as Chief Medical Officer to the Farm Security Administration, as Medical Director of the USPHS’s New York City office, and starting in 1943, as Assistant Surgeon General and head of its Bureau of Medical Services. In that capacity he oversaw a third of the operations of the USPHS, including immigration inspection and USPHS hospitals. In 1951 the Commissioned Officers Association of the USPHS published his standard history, The United States Public Health Service, 1798–1950. At almost 900 pages, it dwarfs the Health Almanac 1920, but both show their author’s dedication to getting the word out about health and, not incidentally, about the agency that helped make that happen.

There is Death in the Pot

Posted on May 22, 2013 by nyamhistofmed

By Johanna Goldberg, Information Services Librarian

While in the stacks recently, we came across this intriguing cover.

How can you not open the book? The title page did not disappoint.

Food adulteration was a dangerous problem in 19th-century London. In 1820, chemist Fredrick Accum wrote A Treatise on Adulterations of Food and Culinary Poisons, the first book of its kind to attempt to expose the dangers of the food, water, and beverage supply.¹

Among many other practices, Accum cautioned against alum in the bread supply, used to make bread whiter; fraudulent peppercorns, made of lintseed, clay, and a small bit of Cayenne; vinegar laced with sulphuric acid; red lead used to color cheese; and beer mixed with a poisonous narcotic plant, cocculus indicus.² Forty years after the book’s publication, Parliament passed the Food Adulteration Act.¹

The Royal Society of Chemistry’s Library and Information Centre offers an excellent online exhibit on the life and times of Accum (including a career-ending scandal involving mistreatment of library books). Learn more here.

Edit: A reader recognized the artwork as that of Berkeley King and kindly provided us with the following image of the cover of Accum’s Plans of the Gas Works in London, which King also designed.

1. The fight against food adulteration. (n.d.). Retrieved May 16, 2013, from http://www.rsc.org/education/eic/issues/2005mar/thefightagainstfoodadulteration.asp

2. Accum, F. (1820). A treatise on adulterations of food, and culinary poisons exhibiting the fraudulent sophistications of bread, beer, wine, spirituous liquors, tea, coffee, cream, confectionery, vinegar, mustard, pepper, cheese, olive oil, pickles, and other articles employed in domestic economy, and methods of detecting them. London: Longman, Hurst, Rees, Orme, and Brown.

For your viewing pleasure

Posted on May 17, 2013 by nyamhistofmed

This Wednesday’s 2013 New York Academy of Medicine Gala featured the following video on the Center for the History of Medicine and Public Health. If you would like to learn more about our work or visit us in person, please email history@nyam.org and library@nyam.org.

Coughing, Sneezing, or Spitting Will Not Be Permitted

Posted on January 22, 2013 by nyamhistofmed

By Johanna Goldberg, Information Services Librarian

As the United States experiences high flu activity, we thought we’d look back on the 1918 flu pandemic, which lead to the deaths of 50 million people worldwide, including nearly 675,000 people in the United States.¹

The first case of the so-called Spanish Influenza in the United States originated at Boston’s Commonwealth Pier on August 28, 1918.² On September 3, it landed in nearby Brockton, Mass., where the disease became widespread by the middle of the month.

Brockton’s Volunteer Leaders

Ernest A. Burrill detailed the efforts of the city in Brockton’s Fight Against Influenza. One problem faced was a lack of food—sick parents could not cook for children, and residents were afraid to enter infected homes. A well-organized food department came to the rescue, preparing food at a community kitchen and delivering it to 388 sick people at its peak on October 10.²

Brockton officials established a field hospital to centralize medical staffing. “A tented city grew up over night,” and within days of its opening, patients moved from area hospitals to the tents. During its two weeks of operation, the field hospital treated more than 300 patients. The food department provided the makeshift hospital with “5 dozen ham sandwiches, 3 quarts chicken stew, 2 dozen cakes, 32 quarts of gruel, 27 quarts of broth, 35 quarts of milk, 9 loaves of bread, in addition to jellies, preserves, etc.”²

Brockton’s Field Hospital

The flu peaked in Chicago in mid-October. A month earlier, an ambitious public health campaign instructed residents to cover their mouths when sneezing and coughing. In a 1918 report, Commissioner of Health John Dill Robertson wrote, “The danger of uncovered coughing and sneezing has probably been so thoroughly impressed upon the people of the City of Chicago that fruit will be borne from this source for years to come.”³ (Chicagoans, is this fruit still being borne?)

A poster from Chicago’s Public Health campaign, presumably released prior to the Health Department closing the theaters.

In Chicago as in much of the country, “places of amusement were closed” at the peak of the pandemic. “This included theaters of all kinds, cabarets, dance halls, athletic meets, and everything of this kind. People were advised to go home and to get nine hours of sleep, on the theory that rest was the best preventive medicine that could be had. In fact, by cutting out all these night assemblages there was no place for the people to go and they had to remain home.”³

In addition, Chicago and other cities banned public funerals. In Chicago, only 10 mourners, not including clergy, could attend for fear of spreading the disease from the family of the deceased and through contact with infected premises.

Chicago churches, schools, and workplaces remained open, although clergy were instructed to keep services short and officials closely monitored school conditions. “Nothing was done to interfere with the morale of the community,” wrote Dill. The Health Department did require closing, thorough cleaning, and subsequent inspection of places of public assembly.³

A selection of captions from Chicago newspapers.

Scientists had developed a vaccine for pneumonia, which often co-occurred with the flu in 1918, and health officials distributed 174,264 doses in Chicago once determining the severity of the pandemic.³The Brockton report indicates that the New York City Health Department prepared a vaccine for the flu strain, but it was not yet available to them.²

While the current flu outbreak does not compare to the 1918 pandemic, we can learn from earlier experiences. Cover your mouth, do what you can to avoid contact with sick people, and be grateful that you can get vaccinated.

For more on the 1918 flu, visit http://www.flu.gov/pandemic/history/1918/

References

1. Flu.gov. (n.d.). Pandemic Flu History. Retrieved January 17, 2013, from http://www.flu.gov/pandemic/history/index.html#

2. Burrill, E. A. (1918). The story of Brockton’s fight against influenza. Brockton: Press of Nichols & Eldridge.

3. Robertson, J. D. (1918). A report on an epidemic of influenza in the city of Chicago in the fall of 1918. Chicago: Dept. of Health.

History Night: Seeking Submissions

Posted on January 10, 2013 by nyamhistofmed

The New York Academy of Medicine (NYAM) Section on the History of Medicine and Public Health is pleased to announce its Third Annual History Night to be held on April 8, 2013, 6:00 pm – 8:00 pm. The event will take place at NYAM located at 1216 Fifth Avenue at the corner of 103rd Street.

We are inviting all those interested in presenting to submit papers on topics in the history of medicine and public health for consideration. Papers submitted previously at other educational events are eligible for submission. The time allotted for those papers chosen for presentation will be 15 minutes, with an additional 3-5 minutes for Q & A.

A panel of members of the NYAM Section on the History of Medicine and Public Health will select the papers to be presented.

The submission deadline is February 1, 2013. Papers may be submitted electronically to Donna Fingerhut at dfingerhut@nyam.org. Questions may be directed to Donna at 212-419-3645.

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