Infectious Disease

"The hyper-stimulus of modern visual culture from the nineteenth century to the present day has been dedicated to trying to saturate the visual field, a process that continually fails as we learn to see and connect ever faster. In other words, visual culture does not depend on pictures themselves but the modern tendency to picture or visualize experience. This visualizing makes the modern period radically different from the ancient and medieval worlds. While such visualizing has been common throughout the modern period, it has now become all but compulsory."

– Nicholas Mirzoeff, An Introduction to Visual Culture


This section on infectious disease begins with an examination of two prototypical campaigns against tuberculosis and venereal disease. Tuberculosis was the first infectious disease to stimulate a nationally coordinated campaign while venereal disease became the scourge most widely targeted by the federal government during the First and Second World Wars. The section concludes with visual representations of broader themes in the history of many infectious disease campaigns including immunization and eradication.

The threat of infectious disease was heightened in nineteenth-century America as a combination of rapid urbanization, industrialization, and immigration led to major problems with overcrowding in many cities. Poor housing and nutrition and inadequate or nonexistent water supplies and waste-disposal systems created ideal conditions for a series of devastating outbreaks of cholera, dysentery, typhoid fever, influenza, malaria, diphtheria, and tuberculosis. By the turn of the century, however, many of these diseases had begun to decline due to the combination of new scientific methods for identifying and treating diseases and ongoing public health improvements in sanitation and hygiene.

At the same time, public health educators found a new tool in the fight against infectious disease. Borrowed from commercial advertisers, illustrated posters attracted attention and communicated their messages rapidly. Designed to persuade viewers, sell products or ideas, and change behavior, posters reflected and helped shape the history of important public health problems faced by governments and citizens alike. As such, these posters provide a visual record of strategies used to fight infectious diseases throughout the twentieth century.


During the nineteenth and early twentieth centuries, tuberculosis (TB) was the leading cause of death in the United States and one of the most dreaded diseases known to mankind. Until Robert Koch's discovery of the disease-causing tuberculosis bacteria in 1882, many scientists believed that TB was hereditary and could not be prevented. Doctors offered few effective treatments. A new understanding of TB in the bacteriological era not only brought hopes for a cure but also bred fear of contagion. A disproportionate majority of TB victims lived in urban slums, where crowded and unsanitary conditions provided an ideal environment for transmission. The tubercular invalid was frequently labeled an outcast.

In the 1880s, Dr. Edward Livingston Trudeau ushered in a new era in the history of TB by promoting isolation as the best means not only to spare the healthy, but also to heal the sick. Based on his own experience with TB, Trudeau argued that rest, moderate exercise, fresh air, and a healthy diet were the keys to recovery. A new tuberculosis institution, known as the sanatorium, confined the sick and helped perpetuate the stigma associated with TB, but also led to the first national organization committed to fighting the disease with a program of research and education.

Public health reformers used the illustrative poster as a means of communication, propaganda, and persuasion to support their cause. This new medium quickly became an effective educational and fundraising tool in the widespread campaign against TB.

Venereal Disease

Along with tuberculosis, progressive reformers and social critics in the late nineteenth and early twentieth centuries identified venereal disease as the quintessential product of a series of transformations in American life in the post-Civil War years including the rapid growth of cities, the increase in immigration, and the changing nature of the family. As historian Allan Brandt argues, venereal disease provided a means of organizing and explaining many social dilemmas that Progressivism sought to address. The tenets of Victorian respectability, however, prohibited open dialogue about the effects of venereal disease on American society. Progressive physicians suggested that lifting the veil of silence would have an immediate ameliorative impact on the incidence of the disease.

True to their faith in education and publicity as radical forces of reform, authorities during the First World War employed posters to motivate and inform the general public and soldiery. Designed to communicate, invite action, and build consensus, posters became an effective means for targeting venereal disease as a major threat to both military efficiency and personal health. Public health educators used films, lectures, pamphlets, and demonstrations, but posters were particularly well suited for campaigns designed to appeal to a broad range of servicemen and the general public. Visual impressions created by posters could communicate messages more quickly, more often, and more cheaply.

Emphasizing the relationship between patriotism, morality, health preservation, and disease prevention, images of the infected soldier and disease-carrying prostitute in posters during the First and Second World Wars came to symbolize both moral failure and social decay. The posters in this section of the exhibit use images of "loose" women, patriotic iconography, and frightening symbols to grab the attention of the viewer and inspire behavior modification. These images not only reflected attitudes, values, and beliefs about the causes and consequences of venereal disease but also affected responses to the problem.


While tuberculosis and venereal diseases remained significant public health threats at the beginning of the twenty-first century, strategic vaccination campaigns have virtually eliminated previously devastating infectious diseases including diphtheria, measles, mumps, rubella, tetanus, poliomyelitis, and smallpox. As a result, the Centers for Disease Control include vaccination among the ten great public health achievements in the United States in the twentieth century. State and local health departments began instituting vaccination programs in the early 1950s with the licensure of diphtheria and tetanus treatments, and by 1955 the introduction of the Salk poliovirus vaccine led to federal funding of state and local vaccination programs. In 1962, the Vaccination Assistance Act established a federally coordinated program that supplies funds for the purchase and administration of a full range of childhood vaccines. In order to encourage parents to vaccinate their children, public health administrators worldwide have used posters in promotional campaigns. By appealing to parental instincts of protection and responsibility through images and text, these public health posters have been a valuable part of efforts to extend vaccination coverage.


The success of vaccination programs inspired the new concept of disease eradication--the idea that a selected disease could be wiped out or destroyed from all human populations through global cooperation. In 1977, after a decade-long campaign, smallpox was the first disease to be eradicated through such a worldwide effort. This success reawakened interest in disease eradication as a public health strategy after the failures of an earlier malaria eradication program. There were, however, critics of the eradication strategy who suggested the smallpox campaign epitomized the worst of anachronistic, authoritarian, "top-down" programs, which they saw as anathema to the ideal of national autonomy. Subsequent moves toward the eradication or elimination of other target diseases including polio, leprosy, and chagas disease have experienced only limited success. Posters, nonetheless, have proven valuable tools in eradication efforts. They provide a forum for promoting preventive behaviors and encouraging participation in public health surveillance programs.