Syphilis was seen as one of the primary public health problems in the United States in the 1930s, with a greater number of people with syphilis living in American cities during the inter-war period and thus more likely to be part of the industrialised working class. Officially, there were 700,000 cases undergoing treatment, according to an article in the journal from October 1935, with New York City registering 50,000 new cases each year. But the journal acknowledged, “We know that the exact number of cases is far beyond the number actually reported by the various public health departments’.
The disease was also costly, in terms of both human costs and economically. For the individual, syphilis was ‘an expensive disease’ as the ‘average worker cannot afford a thorough course of treatment’ and ‘must seek the free clinics which are woefully inadequate and which, in some parts of this country, do not even exist’. It was also costly on a broader scale, with the journal highlighting that ‘thousands are incapacitated by the ravages of syphilis’, which impacted negatively upon the American economy.
The journal emphasised knowing the symptoms of syphilis, because in the first two stages the disease was contagious, yet also overlooked due to the symptoms being so mild. It warned:
The microbe hides in people who look healthy – and so makes such people deadly dangerous to others. They don’t, many thousands of them, even suspect that they themselves have got it. Syphilis is the devilish disease it is because it’s like an iceberg. It travels, eight-ninths of it, under the surface…
It was stressed that there was a cure for the disease, ‘but the probability of cure depends on how early in the course of the disease proper treatment is started’. Thus one of the major campaigns of Health and Hygiene journal was to promote widespread blood testing for syphilis amongst urban workers in the United States, citing a campaign being undertaken by the city of Chicago in the late 1930s. The journal’s campaign asked for readers to send in a form requesting a free blood test with a locally organised physician and to encourage others to do the same thing. It also reassured readers that these blood tests were ‘practically painless’ and that ‘[o]nly a small amount of blood is required’, as well as the fact that the ‘results of the tests will be strictly confidential.’ It explicitly stated, ‘The only persons who will know the result of the test will be you and your doctor.’
As part of this campaign, the journal tried to shift the public view of the disease as one of embarrassment and guilt. This can be seen in the announcement of the campaign, with the journal reassuring its readers:
Intelligent people everywhere are rapidly getting rid of the idea that a stigma is attached to the person with syphilis. We know that a large proportion of syphilis is contracted innocently and that the person who contracts it is often not aware of it until it is too late.
Celebrating this sentiment, famous microbiologist Paul de Kruif wrote a few months after the campaign began:
A year ago, syphilis, for you young folks and for your parents, too, was mysterious, a secret shame. Its name could hardly he whispered among respectable people, though many good citizens are maimed by it, and die.
Today you have dared to march under syphilis-defying banners. You challenge its deadliness in the streets. It is you young fighters – God bless you – who have smoked one of mankind’s most secret enemies out into the open.
After the announcement of the campaign in the journal’s October 1937 issue, the journal noted that by December 18, 1937, 1,476 people had been referred to a local physician and that extra 15,000 ballot forms had been mailed to readers ‘for distribution to their friends’.
Another major public health problem in inter-war America was the prevalence of tuberculosis (or TB) amongst the lower classes, particularly amongst industrial workers and those living in overcrowded slum housing. In an article titled ‘TB – Workers’ Plague’, the journal made clear the threat that it posed for industrial workers:
Consumption, the ‘White Plague.’ Pulmonary Tuberculosis it is called in more learned circles. But the workers know it as ‘T.B.’ They know what the disease does to them. They know its horrible dread and the toll it takes from their ranks. T.B. is their disease.
Of the approximately 1 million people suffering from TB at the time, the journal claimed that the ‘vast majority of these sufferers are workers’ and that those workers exposed to silica dust, especially ‘hard-coal miners, stone cutters, ore-miners’, were particularly vulnerable to contracting the disease. It was also contracted via sputum mixed in with dust particles that was evident in close living quarters, where those infected lived amongst the healthy.
The journal attempted to educate its readers about the symptoms of TB and advised anyone whose cough lasted for more than four weeks needed to be checked by a doctor for TB. Furthermore it cautioned, ‘[s]pitting of blood, no matter how small the amount, is also strongly suspicious.’ But it maintained that the ‘only certain way of detecting tuberculosis of the lungs is by x-ray of the chest’. Therefore it campaigned for workers to insist on the right to an x-ray by a doctor or at a local TB clinic. Those workers exposed to dust, the journal suggested, ‘should have an x-ray examination of the chest every six months’ or ‘[i]f the exposure has been heavy, an x-ray should be had every three months’.
As the disease was also contracted in the slum conditions that many of the working class lived in at the time, the journal also called for the authorities to improve public housing. It cited a report from 1934 that stated that in 64 major cities across the United States, 600,000 homes were without a bathtub or shower, and nearly 450,000 homes did not have an indoor toilet.
Alongside these socio-economic factors, the journal also recommended that readers develop habits to ‘prevent contact with the sputum or secretion of others’. These included:
Fingers should be kept out of the mouth, and hands should be washed before each meal. Material soiled by the cough or sputum of a tuberculosis patient should be burned. One need not avoid contact with a tuberculosis patient, if the patient knows how to protect others from his secretions.
As mentioned above, milk was celebrated by the journal as nutritious for most people, but in its articles on TB, it warned that milk was ‘still an important source of infection with tuberculosis germs’. This was because bovine TB could be contracted by humans. To guard against this, it advised:
Mothers should therefore be certain that all milk used for the feeding of infants and children has been certified or pasteurized by reputable milk companies… The safest milk is that which comes from cows that have been carefully examined, tested with tuberculin, and therefore certified to be free from tuberculosis.
But as much as TB was a deadly disease amongst the working class in the 1930s, the journal acknowledged that due to advances in medicine and the treatment of TB patients, the death rate of those infected with TB has dropped dramatically since the late nineteenth century. In an article dedicated to the work of physician Edward Trudeau, who was the first to develop the TB sanatorium, it noted:
the disease that fifty years ago killed, every year, 300 young adults out of every 100,000 of population, now kills only 60.