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Foreward
The exhibition, An Iconography of Contagion, is the result of a collaboration between the Cultural
Programs of the National Academy of Sciences (CPNAS) and the National Library of Medicine
(NLM) of the National Institutes of Health. The intent of this exhibition, like all of the exhibitions
presented by CPNAS, is to explore the nexus of visual culture and science. The posters here,
which are only a small sampling of the NLM’s collection, offer a glimpse at a visual system of
iconography developed and used to communicate health concerns in the 20th century. From a
historical perspective, the posters offer much more than originally intended. They are mirrors, reflect-
ing the perceptions, biases, and attitudes of the culture and era in which they were created.
I would like to thank curator Michael Sappol and the National Library of Medicine for the collaborative
spirit that has created this exhibition. Additionally, I am grateful for the time and generosity of
Dr. Mary Wilson for contributing the essay that follows. I also wish to acknowledge the following
contributors, organizers, and supporters of the exhibition: Eva Åhrén, American Lung Association,
Douglas Atkins, Liping Bu, Ralph J. Cicerone (President, National Academy of Sciences),
Carol M. Cicerone, William Colglazier, Roger Cooter, Rachel Core, Todd Danielson, Elizabeth Fee,
Harvey V. Fineberg (President, Institute of Medicine), Kenneth R. Fulton, Anja Bla_un (University
Clinic of Respiratory & Allergic Disease, Golnik, Slovenia), Saska Zdolsek (University Clinic of
Respiratory & Allergic Disease, Golnik, Slovenia), Mitja Kosnik (dir., University Clinic of Respiratory
& Allergic Disease, Golnik, Slovenia), Jonathan Ingram, Jan Lazarus, Patrice Legro, Joan Mathys,
Barbara Pope, Alana Quinn, Nadgy Roey, Nils Rosdahl, William Schupbach, Erika Shugart, William
Skane, Thomas Söderqvist, Claudia Stein, Sandy Taylor, Terrence Higgins Trust (London, England),
Paul Theerman, Dan Todes, and Charles M. Vest (President, National Academy of Engineering).
JD Talasek
Director
Cultural Programs of the National Academy of Sciences (CPNAS)
An Iconography of Contagion
About a hundred years ago, public health took a visual turn. In an era of devastating epidemic and
endemic infectious disease, health professionals began to organize coordinated campaigns that
sought to mobilize public action through eye-catching wall posters, illustrated pamphlets, motion
Impressed by the images of mass media that increasingly saturated the world around them, health
campaigners were inspired to present new figures of contagion, and recycle old ones, using
Health campaigns had to compete with billboard advertising, comic strips, monthly magazines,
tabloids, animated cartoons, pulp fiction, Hollywood, and later television. The designers and artists
who were recruited for such campaigns came out of the same commercial visual culture. They
devised a new iconography of contagion that emphasized visual legibility and the pleasure of the view.
The first job of the health poster is to recruit the viewer’s gaze.
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The use of poster campaigns, with visually compelling graphics and slogans, originated in the These icons were created for this exhibition
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and are used to emphasize visual elements
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mid-1800s in Western and Central Europe and North America. Wall posters and billboards were
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deployed in mass media campaigns to advertise theatrical performances, sell products, or
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and a new group of professionals participated in it: commercial artists, graphic designers,
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marketers, consultants. By the early 20th century, a riot of images festooned the walls, kiosks,
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and streets of Europe and North America.
MASS MEDIA DISEASE CARRIER FLIES MASS HUMANITY BLOB MILITARY ENEMIES
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professionalized, they took on the mission of changing public behavior, gaining funding and�����
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with lectures, pamphlets, exhibition displays, health mobiles, slide shows, films, and other media.
EXPULSIONS SEXUAL CONTACT RODENTS MOSQUITOES MICRO-ORGANISMS
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A contagion of icons
The result was a proliferation of health posters, and a proliferation of visually compelling images
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of disease and disease agents — which became a distinctive practice of the modern health campaign.
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Health posters spoke in the idiom of the larger visual culture of graphic design, using artists and
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designers who worked for magazines, newspapers, and advertising agencies. Outside Europe and North
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America, public health authorities and advocacy groups also commissioned posters, which combined ������
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imported cultural elements with indigenous elements, shaped by local political and economic conditions.
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Images, producers, viewers or domesticated. The thing that kills is the thing that
What do health posters actually do? visually entertains. The health poster is a sugar-coated pill.
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Some posters attempt to incite anxiety. Do health posters really do the job?
Health posters often represent contagion through an
iconography of death: skulls, skeletons, shadows. Disease
Since the opening years of the 20th century, health
professionals have been impressed with the advertising � ��������������� ����
proliferates, spread by ominous agents. We are beset model. Visually compelling ad campaigns measurably ������������� ��������
by germs, flies, rats, mosquitoes, prostitutes, swarming increase sales. But advertising is not an exact science
masses of humanity, even seemingly innocent figures such and reasons for the effectiveness of particular advertising
as little girls or old men. The disease agent is not us, images are often difficult to discern. ����
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but something else, an Other. Even so, we may harbor ������ �������
it within our bodies and unintentionally spread it by our Health behavior is complex: Much is at stake. Health
conduct. campaigns often have limited budgets and usually cannot
saturate the media. And even if they do, the public can ������ ���� ������� ���������
But they also offer reassurance. always ignore them. History shows that mass media
Collective and individual action, under the guidance of health campaigns best succeed as part of coordinated
medical authority, are depicted as effective counters to mobilizations that involve public health workers,
disease. The health campaign does not want to scare the communities, government officials and grass-roots activists
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viewer off by showing the details of the horrors of disease. at the local, regional, national and international level.
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The disease agent is therefore often ridiculed
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Syphilis: A million new victims A dark hand opens a calendar to reveal a photograph of a swarming Don’t worry about what you’ll A series of ominous photos of darkly lit human hands touching or
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crowd. Underneath, the outline of an amoeba-like blob overlays a shadowy
field of red.
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pick up at work. grasping for objects commonly used in the workplace. The caption
reassures the public that hands and the objects they touch are not carriers
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U.S. Public Health Service, United States, Health Education Authority,
mid-1940s. Great Britain, 1980s. of the AIDS contagion.
Photomechanical print: color; 56 x 71 cm. Photomechanical print: color; 60 x 42 cm.
Artist: Dorothy Darling Fellnagel
(1913 – 2006).
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Preservez-vous du SIDA T-cells infected with retrovirus as vector, juxtaposed with condom. Unforgivable mistakes. Translation: “Mistakes are difficult to avoid. Mistakes can be corrected
(Save yourself from AIDS.)
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devrait être contagieuse” (Tuberculosis bacilli.) once people�������������
realize their errors; and people can be forgiven, if the mistake
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Ministry of Health, Luxembourg, ca. 1990. (“It’s prudence which should be contagious”). China Anti-Tuberculosis Association, is not committed again. In spite of government efforts, the average person
Photomechanical print: color; 42 x 60 cm. Shanghai, China, 1953. still does not think spitting is wrong. Any time, any place. Spit once, spit
����� again. Not only does this lack public morality, but, if the phlegm contains
Photomechanical print: color; 12.7 x 19 cm.
the TB bacillus, this can spread thousands upon thousands of bacilli. Spit,
on the ground, or on common tools, is inhaled into the lungs. People next
to you don’t����
know or feel it, but can catch the disease. TB is rampant in our
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country because of the error of spitting anywhere. This is unforgivable!
If you have the habit…, please stop doing it. Spit into a handkerchief and
��������������������� boil it, or spit into paper and burn it. This not only ensures virtue but is a
gift to mankind.”
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Beware… Drink only approved A soldier, about to drink from a microbe-infested jungle stream, is surprised Ali si zdrav? (Are you healthy?) An outlined figure in red fuses with a shadowy skeletal x-ray, in front of a
water. Never give a germ a break!
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to see in the reflection his face transformed into a figure of death.
����� Golnik, Slovenia, Yugoslavia, 1950s. swarming crowd. The caption reads: “You get reliable answers if you are ������ ���
Photomontage. War Department, Photomechanical print: color; 42 x 60 cm. examined by x-ray (fluorography). The Institute for Tuberculosis (Golnik)
United States, 1944. provides examinations.” The poster was produced for a nation-wide
Photomechanical print: color; 36 x 51 cm. campaign to mass screen for tuberculosis through x-ray.
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La course a la mort. Death watches a thoroughbred race of deadly diseases. The statistics
(The race with death.) below compare the annual mortality rates of tuberculosis, syphilis
Ligue Nationale Française contre le Peril and cancer.
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Vénérién, France, ca. 1926.
Color lithograph; reproduction of a pastel
drawing; 69 x 88 cm.
Artist: Charles Emmanuel Jodelet
(1883-1969).
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An Iconography of Contagion
Infectious diseases are dramatic, dynamic, and often unpredictable. They affect every individual
and every population. They reveal the intimate exchanges between individuals and among networks
of individuals. Through contagion, they link us. They have changed the outcome of wars, destroyed
economies and societies, spawned social upheaval, shifted the demographic profiles of countries,
and shaped history. And they remain with us, still making front page news as they exploit new
vulnerabilities in human populations. Science has revealed many facts about microbes and
Hans Zinsser in his classic book, Rats, Lice and History, published in 1934 wrote: “Infectious
disease is one of the great tragedies of living things – the struggle for existence between different
forms of life.” This struggle has inspired imagination and creativity of visual artists who have
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Health posters provide a window through which the recent history of infectious diseases can be
viewed. They show the diseases, the health problems, and the public health responses that have
preoccupied health leaders over the years. They provide context and a setting; some tell a story. ���
Each is the product of a specific time and culture, though some images seem to evoke universal
comprehension: skulls, skeletons, the image of the grim reaper, and the representation of microbes
as ugly demons or monster-like creatures. Not surprisingly, several of these posters focus on ��
some of the gravest infectious disease scourges of the 20th century, including tuberculosis and
Posters have been used to educate the public in ways to prevent the spread of infections. The
images and words on the posters are intended to convey facts, to change perceptions, to alter
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behavior, to gain support for a particular approach, and sometimes to elicit donations. In posters
one can see a fusion of art, culture, science, religion, and values. Posters from the period of World
Tuberculosis Undiscovered A father reads the newspaper in his armchair as his happy family gathers
War II integrate messages about the war and link fighting infection with combating the enemy. In
Endangers You: Discover the round — oblivious to the dangers of contagious tuberculosis carried by � ���
Unknown Spreaders! the dense mass of people behind them.
giving a human face to these infections, the posters helped stigmatize “the enemy.” National Tuberculosis Association,
United States, ca. 1940. Reprinted with permission ©2007 American Lung Association. For information about
Photomechanical print: color; 28 x 39 cm. the American Lung Association or to support the work it does, call
1-800-LUNG-USA (1-800-586-4872) or log on to www.lungusa.org.
Different infectious diseases carry different moral weight. Influenza is just “flu,” but plague was ��
the Black Death and tuberculosis the White Plague. Infections that carry stigma are typically those
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Atisch. Sådan begynder en Epidemi. An old man sneezes, sending a spray into a crowded auditorium.
Tuberculosis bacilli. A scientist studies deadly tuberculosis bacilli through (Achoo. Thus begins an epidemic.)
Chinese Anti-Tuberculosis Association,
������������� a microscope. �������� Københavns Sundhedskommission, �������������
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Shanghai, 1953. Copenhagen, Denmark, 1930s.
5000 poster print run. Lithograph; color; 62 x 85 cm.
Translation: “The TB bacillus and weak Artist: Storm P (Robert Storm Petersen,
resistance are the primary reasons TB 1882-1949).
occurs. The goal of prevention is to
strengthen the body’s resistance and
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thoroughly eliminate the TB bacillus.” �����������������������
Lithograph: color; 38.1 x 50.8 cm.
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Cover coughs and sneezes. A young girl covers her mouth and nose with a tissue to prevent disease
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United States, ca. 1962.
Photomechanical print: color; 32 x 44 cm. Reprinted with permission ©2007 American Lung Association. For information about
Artist: Stevan Dohanos (1907 – 1994). the American Lung Association or to support the work it does, call 1-800-LUNG-USA
(1-800-586-4872) or log on to www.lungusa.org.
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She may be…a bag of TROUBLE. A sultry, heavily-made-up woman squints provocatively, while smoking She may look clean, but…pick-ups, An appealing, seemingly innocent, young woman smiles. Three men, a
Syphilis – Gonorrhea. a cigarette. WWII posters usually addressed men — and figured “good time” girls, prostitutes spread sailor, a civilian and a soldier, look toward her.
U.S. Public Health Service, promiscuous women as the source of contagion. syphilis and gonorrhea.
United States, 1940s. ����� U.S. Public Health Service, �������
Photomechanical print: color; 41 x 51 cm. United States, 1940s.
Artist: “Christian.” Photomechanical print: color; 37 x 51 cm.
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that are transmitted sexually (HIV/AIDS, syphilis, gonorrhea) or via intravenous drug use (e.g.,
HIV/AIDS), or are associated with poverty and crowding (tuberculosis), poor sanitation (cholera),
or disfigurement (leprosy). Stigma typically results in patients being rejected and isolated beyond
It is revealing that the posters about venereal disease from the 1940s depict the woman as the
villain - the source of sexually transmitted infection for the theoretically “clean” man. The message
portrayed was that wily women, whether the seductress or the innocent appearing young woman,
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could tempt unwary men and trap them with sexually transmitted infections. Women were suspect,
deceptive and dangerous, and the savvy man was to stifle his sexual desires.
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With HIV/AIDS, condoms came out of the closet and from behind the counter at the pharmacy.
as favors at events, and shown in places of social gathering. A whimsical poster that the
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Brazilian Ministry of Health used in a media campaign to counter statements by religious leaders
questioning whether condoms worked showed a knotted inflated condom filled almost completely
������� ������ with water and with a goldfish swimming in it – a symbol of life, renewal, continuity, hope, and
suggesting an impenetrable characteristic of the condom. The message “Nothing passes through a
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If AIDS exposed condoms, SARS similarly propelled face masks onto the public consciousness.
More than any other recent infection, SARS moved face masks out of the hospital and into ads,
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on covers of magazines, and on posters. In an earlier era, during the influenza pandemic of 1918
and1919, face masks were also displayed on posters and on public health alerts.
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While many of the early posters provide messages about dangers and activities or people to avoid,
the HIV posters show a distinct reversal. One depicts the ways that HIV cannot be spread with the
Discover safer sex. This poster, from the Love sexy, Love safe campaign, shows an intimate implicit message that contact with HIV-infected individuals is safe. This is meant to allay fears and
Terrence Higgins Trust, London,
������������� scene of a couple in bed. A tattooed man places his head between the legs
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mid-1980s. of a sexually indeterminate partner. The precise nature of the activity is
playfully obscured. Against the stigmatization of gay sex and AIDS sufferers
allow interactions that some had curtailed because of fear. Another showed expression of affection
Photomechanical print: color; 42 x 60 cm.
����� as a source of contagion — and a larger atmosphere of panic — the poster
presents sexual activity in a positive light and urges the use of reasonable that would be safe - a contrast from the moralistic rendering of sex.
measures to make sex safe.
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������� a dinner party, an assortment of disease-carrying verminous
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(Rats are a plague on the land.) Rottebesøg paa kommunekontoret-og Bekæmp selv med alle midler” des rats, souris, moustiques, ravets, animals feeds on a pile of rubbish.
Statens Annonce & Reklamebureau, (“Immediately tell the city authorities if you have rats in your house, and use mouches. Vous dit: merci.
Denmark, 1946. all possible means to exterminate them”). (The Martinique Association
Color lithograph; 54 x 86 cm. of Rats, Mice, Mosquitoes, Ravets,
Artist: Aage Rasmussen (1913-1975). Flies, say to you: Thanks.)
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Direction de la Santé et du Développement �
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Social (DDASS), Martinique, ca. 1990.
Photomechanical print: color; 50 x 70 cm.
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Most of the posters in this collection focus on infections that are transmitted from person to
person and via vectors. A World Health Organization report in 1995 broke down the 17.3 million
deaths globally that year from infectious diseases according to mode of transmission and found
that 65% were caused by microbes transmitted from person to person (like tuberculosis and
HIV/AIDS). About 22% were foodborne, waterborne, or soil borne (like cholera and typhoid fever)
and about 13% were transmitted by mosquitoes, like malaria. One of the most deadly diseases
Antituberculosis societies, which began more than a century ago, were instrumental in educating
the public. The National Association of the Study and Prevention of Tuberculosis formed in the
U.S. in 1904 was renamed the National Tuberculosis Association (NTA). It attempted to base health
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messages on the best science available at the time. The NTA borrowed devices and approaches
developed by advertising and business agencies and developed others of its own. In 1906,
exploiting the concept of a trademark used by companies, such as Quaker Oats, it adopted the
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double-barred Lorraine cross as its symbol. This was used on advertising, on posters, and on toilet
articles sold to raise money for tuberculosis patients. The symbol was also used on Christmas
seals, sold to raise money. The NTA used simple slogans, trying to make messages short (Don’t
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spit!) and memorable. It is noteworthy that the double-barred cross symbol appears on the poster
created by the China Anti-Tuberculosis Association in mid-1930s, with its basic message of “don’t
������ spit” presented in a much longer, perhaps culturally more acceptable, Chinese text in a poster that
tells a story. It reveals the connectedness of the anti-tuberculosis campaigns in many countries.
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���������� Although the NTA used fear-based warnings and moralistic advertising in their early decades, they
later moved to more positive messages and images. One circular included: “Don’t ever spit on any
Many posters in the exhibit deal with activities that are under the control of the individual. The
Man-Made Malaria. 6 mosquitoes War-time U.S. military health campaigns often conflated the Japanese recommendation to cover coughs and sneezes and the danger that an individual poses to the
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10 breed in water in unnecessary enemy with disease-carrying flies and mosquitoes. Here, an anopheles
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ruts, abandoned roads, blocked mosquito is given the stereotypical features of the Japanese enemy and
has the rising sun of the Japanese imperial flag on his wings.
general population in possibly starting an epidemic will resonate with the public today in an era
ditches, fox and shell holes.
U.S. Navy, Bureau of Medicine &
of continued spread of respiratory infections and the threat of pandemic influenza or a more
Surgery, U.S. Government Printing Office,
United States, 1945.
Photomechanical
������ print: color; 21 x 23 cm. transmissible avian influenza virus. Although some posters showing ways to limit spread of
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When a fly wipes his feet on your During the war, anti-fly health campaigns linked the insects to outbreaks of Sleeping sickness kills… Spread The fly, alive at the top of the poster, sits atop a jagged large red lightning
dysentery and other infectious diseases. The caption below reads: “Never �����
bolt. It follows the path of the red bolt through the traps one suspended �
food, he’s����������
spreading
disease!
��������������������� by tse tse flies. Traps kill tse tse flies.
War Department, U.S. Government give a germ a break.” Use them. from a tree branch, the other hanging off a line between two poles — to the
Printing Office, United States, 1944. African Medical & Research Foundation bottom of the poster, where it lies dead.
Photomechanical print: color; 36 x 51 cm. (AMREF), Nairobi, Kenya, ca. 1970.
Artist: Vernon Grant (1902-1990). Photomechanical print: color; 45 x 64 cm.
remains relevant and appropriate today because of shared mechanisms of transmission for many
respiratory infections.
Posters developed to support tuberculosis control advocate use of x-rays to discover unknown
spreaders of infection. One poster shows a healthy-appearing middle class family – suggesting
that anyone could be infected with tuberculosis. In the middle part of the 20th century (especially
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during the1940s and 1950s) mass chest x-ray screening programs were established in many
cities, some employing specially equipped vans that toured the cities offering free chest imaging.
shielding, so screened individuals ended up receiving large doses of radiation. Although these
mass screening programs detected some cases of unrecognized tuberculosis (some studies
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suggested that early programs detected about 20% of all cases of active tuberculosis), they also
delivered radiation and its risks, which were not fully appreciated at the time. As the incidence of
tuberculosis dropped, the yield from mass screening of the general population dropped and the
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approach was discontinued. Now routine screening x-rays are used only in selected populations
with high risk of tuberculosis, such as prison populations in some cities or immigrants to the US
Some posters speak to the dangers from drinking unclean water at a time when many in the U.S.
���� had come to take safe drinking water for granted. One poster, dating from 1944, suggests the
risk of death from drinking unclean water in a jungle stream and advises the soldier to drink only
approved water. By this time in the U.S., many municipal water systems had come to rely on
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filtration and disinfection to virtually eliminate waterborne infections like typhoid fever and hepatitis
A. It is a sad commentary that safe drinking water remains unavailable decades later to about a
billion persons globally, and waterborne infections continue to claim lives, especially in
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No home remedy or quack doctor A human figure — formed from news clippings and advertisements about developing countries.
ever cured syphilis or gonorrhea. different non-prescription “cures” for venereal diseases — pours out a
No home remedy or quack doctor dose of medicine. Contagious disease goes unchecked due to the false
ever cured syphilis. See your advertising of unlicensed and unqualified medical practitioners, which are
doctor or local health officer. disseminated to the public through advertising in the uncontrolled and Mary Elizabeth Wilson, MD
U.S. Public Health Service, proliferating mass print media. Associate Clinical Professor of Medicine, Harvard Medical School
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United States, ca. 1945. Associate Professor of Population and International Health
Photomechanical print: color; 56 x 71 cm.
Harvard School of Public Health
Artist: Leonard Karsakov (1917-1993).
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Bibliography: Zinsser H. Rats, Lice and History: A Study in Biography. Boston: Little Brown & Company, 1934; Okie S. Fighting HIV – Lessons from Brail. N Engl J Med 2006;354:1977-81; Tomes N.
The Gospel of Germs. Men, Women, and the Microbe in American Life. Cambridge: Harvard University Press, 1998; Reichman LB, Hershfield ES. Tuberculosis. A Comprehensive International Approach.
Second ed. New York: Marcel Dekker, 2000; World Health Organization. The World Health Report, 1996. “Fighting Disease, Fostering Development.” Geneva: World Health Organization, 1996.
The National Library of Medicine (NLM), on the campus of the National Institutes of Health in Bethesda, Maryland, is the world’s
largest medical library. The Library collects materials and provides information and research services in all areas of biomedicine
and health care. The materials in this exhibition, from the Library’s History of Medicine Division, come from its extensive collection
of public health posters.
The National Academy of Sciences (NAS) is a private, nonprofit, self-perpetuating society to which distinguished scholars are
elected for their achievements in research, and is dedicated to the furtherance of science and technology and to their use for the
genera
government on scientific and technical matters. The mission of the office of Cultural Programs of the National Academy of Sciences
(CPN
cultural programs.
Acknowledgements