By Charles Rosenberg ~
Originally published in Hidden Treasure: The National Library of Medicine, 2011.
The history of public health cannot be understood without artifacts such as those pictured here—the handbills, forms, public notices, signs, educational circulars, and pamphlets that document and in part constitute the street-level history of public health. They are relics of the infectious-disease prevention campaigns of late-nineteenth- and twentieth-century state and local public health agencies as they sought to isolate the sick, encourage physicians to report cases, and educate ordinary men and women. Such humble pieces of disposable paper and cardboard document vital links between the worlds of law and medicine, the laboratory and the bedside, public policy and the political and professional stakeholders who created and enforced those policies.
Disposable printed items, called “ephemera” in the book and printing trades, until recently had only a small place in our most prominent libraries. The shelves of our established medical libraries are laden with words written to be preserved: theses, medical journals, monographs, and textbooks. Learned books and articles were the history of medicine for generations of its chroniclers. This cumulative record of intellectual achievement excluded by definition the ephemeral—print with an instrumental, transactional, or commercial purpose, to be used and discarded. But in recent years a new historical sensibility has made such ephemera indispensable, as we seek to link high culture with low, theory with practice, medical institutions with everyday life. Only the more prescient libraries, such as the National Library of Medicine, have purposefully collected such undignified materials.
These objects reflect a changing consensus of epidemiological and laboratory knowledge. They also illuminate the not always direct relationship between that knowledge and public health practice. Smallpox, for example, had been known to be transmitted from person to person since at least the eighteenth century, yet late-nineteenth-century outbreaks of the disease, which gave rise to an aggressive policy of isolation and official encouragement of vaccination, had to struggle against resentment of compulsory measures and in some instances the organized opposition of anti-vaccinationists. Newer immunizations for scarlet fever, diphtheria, and whooping cough, which joined the list of reportable ills in the late nineteenth and early twentieth centuries, similarly required the education and mobilization of an often wary public. And thus ongoing campaigns for childhood immunizations remain a reality in the twenty-first century—just as they were a half century earlier in the era of Jonas Salk’s novel polio vaccine.
Each threatened epidemic has provided a new focus for debate and discussion. Today fears of emerging diseases, and the needs and anxieties of a global health community, under-score the continued importance of outreach and implementation as well as research. The past half century has witnessed a revolution in mass media, and the need to deploy old and new modes of communication remains as central to the tasks of medicine and public health today as when these health signs were printed many decades ago.
Charles Rosenberg is Ernest Monrad Professor in the Department of the History of Science, Harvard University. He has written widely on American medicine and science and has a long-time interest in the place of print in the culture of medicine.