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Two different hands holding ice cream cones

Waffle Cones and Recliners: How the Public Health Campaign Against TB Changed American Culture.

Americans in recent years have become quite familiar with the ways in which infectious disease outbreaks can drastically change our everyday lives. The impact of disease can profoundly impact a community—upending routines and rattling nerves as it spreads from person to person. This is not a new phenomenon in American history. An example of this was the fight against tuberculosis (TB), which not only led to the country's very first public health campaign but also transformed how we engage with certain everyday practices—like eating ice cream. Public Health Education By the late 19th century, German physician Robert Koch had confirmed that tuberculosis was caused by bacteria, but it took time for this discovery to permeate public consciousness. Many people were still unaware of how the disease spread and gave little attention to the behaviors that contributed to disease transmission. It was common for family members, or even strangers, to share a drinking cup, even with those who were sick. No Spitting Up until the late 19th century, spitting in public was considered acceptable social behavior in America, whether it was merely spitting saliva or discarding one's chewing tobacco. With Knopf’s guidance, in the 1890s the New York City Health Department, under the leadership of Dr. Hermann M. Biggs, launched a massive campaign to educate the public and reduce transmission. The “War on Tuberculosis” public health campaign raised awareness about the dangers of shared drinking cups and public spitting. Many states began passing laws banning spitting in public spaces. Instead, the use of special spittoons, which were to be carefully cleaned on a regular basis, was encouraged. With the increased knowledge of the contagious nature of tuberculosis and other diseases at the turn of the century, flyers and newspapers warned Americans against "the filthy habit" of spitting in public. Before long, spitting in public spaces came to be considered crude, and drinking from shared bottles was frowned upon as well. These changes in public behavior helped successfully reduce the spread of TB. The Waffle Cone Ice cream had become popular in 19th-century England. The fad, once accessible only to nobility, made its way to the British general public and then ultimately to America in the form of the “penny lick”. A "penny lick" was a tiny portion of ice cream in a small glass container that vendors sold for only one penny. The glass was usually made with a thick glass base and a shallow depression on top in which the ice cream was placed. Despite this design creating the illusion of a larger portion, it often contained merely just one lick's worth of ice cream. Customers licked the glasses clean, returned them, and the vendor would then rinse the glass container in a bucket of water and reuse it for the next customer. It was hugely popular, and the demand for this inexpensive treat continued to rise. In their rush to serve as many penny licks as possible, most vendors were careless about properly cleaning their glass containers. This resulted in the transmission of contagious diseases like tuberculosis. Penny licks were banned in London in 1898, and while they were never officially prohibited in America, rising awareness of hygiene and disease prevention prompted ice cream vendors to find cleaner alternatives. Italo Marchiony worked as a pushcart vendor in the Manhattan area of New York City selling flavored ices and other frozen treats to customers. He sought an edible solution to the problems associated with penny lick glasses and developed a pastry cup to hold ice cream, which he patented in 1903. In 1904, at the St. Louis World’s Fair, another ice cream vendor, Ernest A. Hamwi, independently developed his own ice cream cone made from a crisp waffle-like pastry. With the decline of the unsanitary glass penny lick containers, this innovation quickly caught on, and by 1924, vendors were producing 245 million cones annually. What started as a sanitary response to a public health issue became a beloved staple in dessert culture. Other impacts on American Culture Shorter Skirts for Women At the turn of the 20th century, women’s fashion typically featured long skirts that reached the ground. However, as knowledge about TB spread, it became clear that long skirts could drag along germ-infested sidewalks, increasing the risk of disease transmission. As a result, women began shortening their hemlines to avoid this potential hazard, marking a subtle but significant shift in fashion. The Decline of Beards In the late 1800s, beards were popular in the US and Europe, both as a symbol of white masculinity, as well as a signal of health. Ironically, many men also sported beards to cosmetically disguise the facial scarring left from previous bouts with smallpox. Before the advent of germ theory, people thought diseases spread through fumes and dust, and beards were believed to serve as a natural filter against illness. As late as 1881, just a year before the tuberculosis bacteria was identified, The St. James’s Magazine claimed that growing a beard was the quickest way to protect oneself from disease. Following Koch’s discovery proving that germs facilitated the spread of tuberculosis, the trend began changing. In the 1890s, nurses had started shaving patients’ beards to bring down their risk of transmitting disease, pointing to studies suggesting that beards could accidentally entrap tuberculosis-laden spittle.  However, there is no factual scientific evidence supporting the idea that beards trap germs. Yet, by the time the flu pandemic struck the US in 1918, beards were declining in popularity with men opting for clean-shaven looks associated with professionalism and youthful vigor. Additionally, the rise of disposable razors made shaving at home more accessible. As a result, showing off a smooth face became the new trend for American males. Hygiene Practices and Public Health Campaigns As tuberculosis awareness grew, public health campaigns emphasized the importance of hygiene. Common practices such as covering your mouth when coughing and using a handkerchief were promoted. Institutions like libraries fumigated books, and banks sterilized coins. Public health posters even advised against kissing children to prevent the spread of disease. Schools embraced the "Modern Health Crusade," encouraging children to wash their hands before meals, brush their teeth, and sleep with their windows open for fresh air. The Sanatorium Influence: Reclining Chairs Sanatoriums frequently used different types of reclining or "cure chairs" to aid in patient treatment. These chairs, often placed on porches, had adjustable backs that allowed patients to tilt them for a comfortable, semi-reclined position while enjoying fresh air. In the early 20th century, wealthier individuals began buying sleek, fashionable versions of these chairs to enjoy the health benefits of sunbathing at home. By the 1950s, these cure chairs had evolved into a symbol of modernist style in furniture design. Credit: https://www.saranaclake.com/story/2016/03/saranac-lake-classic-cure-chair Playgrounds, Public Parks, and Recreation Centers In the 1920s, public health reformers advocated for more outdoor recreation to improve national health. They believed that promoting physical activity in parks and public spaces could help prevent diseases like tuberculosis. As a result, cities began beautifying parks and creating recreational spaces. Additionally, the encouragement of larger recreational spaces played a role in creating more space between buildings and thus reducing overcrowding. In New York, Central Park became known as "The Lungs of the City," reflecting the idea that green spaces could improve both mental and physical health. Impact on Migration and Architecture The fight against tuberculosis also influenced architecture. As doctors recommended fresh air and good ventilation as part of disease prevention, homes began to feature more porches and windows. The idea of escaping crowded, muggy Eastern cities and moving to drier, sunnier climates for better health gained popularity, especially in places like Los Angeles and Colorado Springs. This migration was so significant that, in 1872, about one-third of Colorado’s population had tuberculosis, seeking relief in the dry, healthy air. These public health campaigns against TB led to lasting changes in American culture—from the way we eat ice cream to how we think about hygiene and public health. The ripple effects of these efforts are still with us today, shaping everything from fashion to our public spaces. References American Experience. (2015). The Forgotten Plague: TB’s Surprising Results. Retrieved from                https://www.pbs.org/wgbh/americanexperience/features/plague-know/ Foss, Katherine A. (2020). How Epidemics of the Past Changed the Way Americans Lived. Retrieved from https://www.smithsonianmag.com/history/how-epidemics-past-forced-americans-promote-health-ended-up-improving-life-this-country-180974555/ Graham, Lerone. (2023). The Complete History of The Ice Cream Cone. Retrieved from https://www.thedailymeal.com/1276928/complete-history-ice-cream-cone/ (2024). The Strange History of Ice Cream, From Spreading Tuberculosis To Sweet Summer Dessert. Retrieved from https://www.timesnownews.com/lifestyle/food/news/the-strange-history-of-ice-cream-from-spreading-tuberculosis-to-sweet-summer-dessert-article-109986556 Waters, Michael. (2020). A Brief History of Beards and Pandemics. Retrieved from https://www.vox.com/the-goods/2020/3/30/21195447/beard-pandemic-coronavirus-masks-1918-spanish-flu-tuberculosis

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Members of World BioHazTec including the President, Kerstin Haskell holding the proclamation

How a Simple Click Turned Into Maryland’s First “Biosafety Day”

By Kerstin Haskell, President, World BioHazTec and 2024–2025 President, Chesapeake Area Biological Safety Association (ChABSA) Back in January, I was on the State of Maryland’s website—why, I honestly can’t remember—but there on the homepage I saw a link: “Request a Proclamation.” Something about that link sparked a thought: What if ChABSA's annual symposium had an official proclamation to recognize biosafety and the professionals who safeguard our labs and communities every day? As the President of World BioHazTec and the 2024–2025 President of ChABSA (Chesapeake Area Biological Safety Association), I’m constantly thinking about how we can raise awareness and elevate the biosafety profession—not just within our community, but in the broader public sphere. This felt like a unique opportunity to do just that. So I clicked. What followed was a journey that reminded me of the power of persistence, collaboration, and simply asking. After clicking through, I realized I had to write the proclamation myself. I turned to artificial intelligence, which helped me shape the language, structure, and tone—guiding me through examples and best practices for proclamation writing. With that support, I drafted the text and submitted it through the official portal. Then I waited. A week went by. Silence. I started wondering if it had gone into a bureaucratic black hole. That’s when I remembered my colleague and friend, Brian Castleberry at the Maryland Department of Commerce. I had met Brian through World BioHazTec’s participation in the 2023 Arab Health Show, which was supported by a Maryland export promotion grant for small businesses. I reached out, shared the proclamation request, and Brian kindly forwarded it to a deputy director at the Governor’s Office. Another month passed. Still nothing. Brian followed up again on my behalf (thank you, Brian!), and I continued to wait. Then came a stroke of serendipity. I was in Annapolis testifying before the Maryland House Ways and Means Committee on a proposed tax on life sciences services. Sitting beside me on the panel was Kelly Schulz, President of the Maryland Tech Council. I had long admired Kelly’s work supporting the state’s life sciences community, and this was my chance to finally meet her. After the hearing, we exchanged contact information and started texting. I told her about the proclamation and asked if she might be willing to help. Without hesitation, she said yes. Kelly advised me to follow up after the state’s budget cycle closed at the end of March. I did—and when we met in person, she followed up with the Governor’s Office...right there in front of me.  Around the same time, Tracey Brown, World BioHazTec’s Training Manager, who also serves as ChABSA’s Treasurer, reached out to our long-standing partners at the Universities at Shady Grove (USG). ChABSA has proudly supported USG’s Biosafety and Biosecurity Scholarship Program, and the relationship has grown through collaborative events and shared goals. In response to the outreach, Tom Clifford and Joyce Fuhrmann submitted a formal letter of support to the Governor’s Office, strongly advocating for the proclamation to recognize Biosafety Day. Then, just a week before the symposium, I received the news: Governor Wes Moore had officially proclaimed June 4, 2025, as “Biosafety Day” in Maryland. This would not have happened without the advocacy and belief of people like Brian, Kelly, Tom, Joyce, Tracey and others who understand the value of biosafety to Maryland’s workforce, research institutions, and public health system. It’s a reminder that biosafety professionals are making a difference every day—and that our work deserves to be seen and celebrated. Sometimes, all it takes is a click. And a follow-up. And a little courage to ask. Proclamation: Biosafety Day June 4, 2025 WHEREAS, The field of biosafety plays a critical role in protecting public health, scientific research, and the environment by ensuring the safe handling and containment of biological materials in laboratories and research settings; and WHEREAS, Biosafety professionals work diligently to establish and maintain policies, procedures and physical containment measures that prevent accidental exposure to harmful biological agents and promote the responsible use of biotechnology; WHEREAS, Maryland is home to one the nation’s strongest life sciences industries, employing more than 54,000 people across a wide range of roles in research and development, manufacturing, and laboratory operations; and WHEREAS, The Chesapeake Area Biological Safety Association will hold its 35th Scientific Symposium at the Universities at Shady Grove in Rockville, Maryland; and WHEREAS, Through ongoing training, inspections, risk assessments and containment measures, biosafety professionals uphold rigorous standards that protect against biological risks and support safe scientific progress; WHEREAS, The establishment of Biosafety Day serves as an opportunity to highlight the achievements of biosafety professionals, encourages collaboration across disciplines and raise awareness about the importance of effective biosafety programs and protocols. Now therefore, I, Wes Moore, Governor of the State of Maryland, do hereby proclaim June 4, 2025 as Biosafety Day in Maryland, and do commend this observation to all of our citizens.  

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TB and America’s First Public Health Campaign: A Look Back at Early Efforts to Combat Tuberculosis

Early History of Tuberculosis in the U.S. Tuberculosis (TB) has a long, devastating history in the United States. Once known as “The Captain of Death” and the “White Plague,” this deadly disease shaped not only the public’s health but also everyday behaviors and how we as a society responded to infectious threats. Though its grip on the nation has loosened with modern medicine, TB’s early impact on the U.S. led to the creation of some of our first organized public health campaigns. A Devastating Disease: TB’s Early Years in America In the 1700s, tuberculosis earned ominous nicknames like “The Robber of Youth” and “The Captain of Death.” In the 1800s, it became known as the “White Plague,” referencing the pale appearance of its sufferers. It was also commonly called “Consumption” because of its high mortality rate and how victims were consumed by hacking, bloody coughs, debilitating pain in their lungs, and fever, making it impossible to get out of bed. The disease, caused by the bacterium Mycobacterium tuberculosis, spread primarily through the air when an infected person coughed or sneezed.  The disease became rampant, thriving in overcrowded urban areas where poor sanitation and malnutrition were common. Without effective treatments, TB was often fatal, leading to widespread fear and stigma. (Stolley & Spector, 1966). 80% of those individuals who developed active tuberculosis died of it. At the time, there was little understanding of how the disease was transmitted, and medical knowledge regarding its treatment was limited. Public health infrastructure was still in its infancy, and many people with TB were left untreated, which further contributed to the spread of the disease. A Public Health Crisis At the beginning of the 19th century, tuberculosis had killed one in seven of all people that had ever lived. During the nineteenth and early twentieth centuries, it was the leading cause of death in the United States, and one of the most feared diseases in the world. It was estimated that, at the turn of the century, 450 Americans died of tuberculosis every day, mostly between the ages of 15 and 44. The death rate in 1900 measured 194 per 100,000 persons.  Comparatively, the death rate in America during the COVID-19 pandemic was 61.3 per 100,00 persons. At the turn of the century, TB was a ubiquitous component of American society and culture. While it was a disease that typically impacted lower socio-economic classes who often resided in overcrowded cities, living and working in poorly ventilated structures, more prominent Americans were not beyond TB’s reach. Among the list of well-known Americans who succumbed to TB included former Presidents James Monroe and Andrew Jackson, two of Abraham Lincoln’s sons, two of Richard Nixon’s brothers, First Lady Eleanor Roosevelt, authors Henry David Thoreau, Edward Bellamy, George Orwell, Stephen Crane, and Thomas Wolfe, actor W.C. Fields, business tycoon Jay Gould, musicians Chick Webb and Jimmy Blanton, and Clara Barton, founder of the American Red Cross, just to name a few. Early Infectious Disease Control: America’s First Public Health Campaign The Sanatorium Movement By the late 1800s, public health leaders in the U.S. recognized the need to address TB through organized medical and social interventions. One of the earliest responses to TB was the establishment of sanatoriums, specialized treatment centers designed to isolate and care for people with tuberculosis. The idea behind sanatoriums was simple: fresh air, rest, and good nutrition were believed to help patients recover. By the late 1800s and early 1900s, doctors and health officials discovered that TB was most contagious during the active stages of the disease. Isolating patients in sanatoriums reduced the risk of spreading TB to the general population. These institutions were typically located in rural areas or places with clean air, and patients were encouraged to spend most of their time outdoors. These facilities not only provided physical care but also helped reduce the stigma surrounding TB, as they became recognized as centers for both healing and hope. Many sanatoriums were funded by a combination of public funds, charitable donations, and private contributions, reflecting the community-wide effort to address the epidemic. Image from the University of Virginia's Claude Moore Health Sciences Library as appeared in the digital exhibit, "The American Lung Association Crusade" at http://exhibits.hsl.virginia.edu/alav/tu Life in the Sanitorium In the first decades of the 20th century, one out of every 170 Americans lived in a sanatorium, some for many years. For many, these institutions were their last hope. While sanatoriums were not a cure for TB, they provided some relief, particularly for patients in the early stages of the disease. However, life in the Sanitoriums was not easy. Patients often left for sanatoriums in the middle of the night, without telling people. They quit their jobs, or they just left to protect their families. Entering a sanatorium required complete submission. Physicians and nurses regulated every moment of the day. When people first came to a sanatorium, many were put on 24-hour rest. All their meals were brought to bed on trays. They were required to use bedpans. Many facilities were segregated by race, and some African Americans, barred from whites-only sanatoriums, helped start their own. Despite the hardships, sanatoriums offered a sense of community for those afflicted by the disease. They were isolated from the fear of infecting others and often found solace in the companionship of fellow patients. For all the freedoms they lost, patients were able to embrace the idea of healing and hope in a place that was devoted to their care. The success of these early sanatoriums served to influence later public health policy in the U.S. The idea of isolating infected individuals, as seen in the sanatoriums, laid the groundwork for quarantine practices, which were later used for controlling other infectious diseases, including influenza, smallpox, and even COVID-19. TB Public Health Campaign: The Foundation for Modern Infectious Disease Control By the early 20th century, public health officials realized that isolating TB patients was just one part of the solution. The other part was educating the public about TB transmission and prevention. The establishment of the National Tuberculosis Association in 1904 (now the American Lung Association) marked an important milestone in raising awareness about TB. The association’s work centered around educating the public on the importance of early detection, promoting hygiene practices like covering one’s mouth when coughing, and encouraging people to seek medical treatment as soon as symptoms appeared. Public health campaigns also emphasized the importance of improving living conditions. Poor nutrition, overcrowded housing, and lack of access to healthcare were known to exacerbate TB, and improving these factors became a key focus for public health advocates. As TB research progressed and medical treatments were developed, quarantine and isolation protocols continued to be important public health tools. The early emphasis on isolating individuals with active TB in sanatoriums eventually led to more formal quarantine measures for individuals diagnosed with the disease. This practice of isolation not only reduced the risk of transmission but also contributed to the eventual creation of specialized infectious disease units in hospitals. Conclusion Early public health responses to tuberculosis in the United States laid the foundation for modern practices in infectious disease prevention and management. The establishment of sanatoriums, public health campaigns to educate the public, and advances in medical research helped reduce TB-related mortality. Additionally, the development of isolation protocols and laboratory biosafety measures, informed by TB research, established the groundwork for how the U.S. manages infectious diseases today. Though TB is no longer the threat it once was, the lessons learned during this time continue to influence how we approach modern public health crises. References Ahmad FB, Cisewski JA, Xu J, Anderson RN. (2022). COVID-19 Mortality Update — United States, Retrieved from https://www.cdc.gov/mmwr/volumes/72/wr/mm7218a4.htm American Experience. (2015). The Forgotten Plague. Retrieved from https://www.pbs.org/wgbh/americanexperience/films/plague/#transcript American Lung Association. (2020). A Brief History of Tuberculosis in the United States. Retrieved from https://www.lung.org/research/trends-in-lung-disease/tuberculosis Centers for Disease Control and Prevention (CDC). (2021). Tuberculosis (TB) History and Timeline. Retrieved from https://www.cdc.gov/tb/about/history/default.htm Fennell, M. L. (2018). The Rise and Fall of the Tuberculosis Sanatorium: The Role of Sanatoriums in Early Public Health Responses. Journal of the History of Medicine, 73(2), 130-142. Mackenzie, R. W. (2002). Public Health and Tuberculosis Control in the United States. Health Affairs, 21(3), 182-192. Rosen, G. (1993). A History of Public Health. Johns Hopkins University Press. Rothman, Sheila M. Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in American History (New York: BasicBooks, 1994) Snider, G.L. (1997). Tuberculosis then and now: a personal perspective on the last 50 years. Retrieved from https://pubmed.ncbi.nlm.nih.gov/9027277/ Stolley, P. D., & Spector, W. S. (1966). Tuberculosis in the United States: The Role of Medical Interventions and Public Health Efforts in Reducing Tuberculosis Mortality. The Journal of Infectious Diseases, 118(3), 184-197.

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