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IDEAS

Outbreak infrastructure through the years: yesterday’s sputum flask is today’s hand sanitizer

The once ubiquitous spittoon disappeared after a worldwide outbreak of tuberculosis.
The once ubiquitous spittoon disappeared after a worldwide outbreak of tuberculosis.Sophia Janowitz

As health officials try to manage the spread of Covid-19 cases, we’re being encouraged to change our habits (Wash your hands thoroughly! Wear a face mask if you’re sick! Stay out of crowds! And for goodness’ sake, clean your screens!) while officials take novel measures like disinfecting T stations. Will any of these new practices stick around longer than the outbreak? History gives us several examples of social customs and infrastructure forever changed by disease outbreaks.

Spittoons — The once-ubiquitous receptacles for chewing tobacco and phlegm all but disappeared from public spaces by the mid-20th century, after a global tuberculosis outbreak. It was thought that spit that missed the spittoons helped spread the illness. Public spitting was also outlawed in many places.

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Sputum flasks — The tuberculosis outbreak also led to the adoption of something new: the sputum flask. The pocket-sized receptacles allowed tuberculosis patients to spit into their own personal container, in another effort to stop the disease’s spread.

Sophia Janowitz

Handwashing — Even though the idea of handwashing to stop the spread of disease was established two centuries ago, it was not until the 1980s that the Centers for Disease Control and Prevention published guidelines for hand hygiene in hospitals. Today, we take for granted that handwashing is a best practice not just for health care professionals but for all of us.

Sophia Janowitz

Water fountains — Having a hard time finding a water fountain these days? Despite the fact that there is little evidence to connect drinking fountains (or bubblers, if you’re from Boston) with disease outbreaks, according to the Drinking Water Alliance, these amenities are disappearing nonetheless. Water-borne diseases such as Legionnaire’s, norovirus, and giardia have made drinking fountains an object of suspicion. According to the CDC, the fountain itself is usually not to blame.

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Sophia Janowitz

Quarantine — The concept of quarantine began in the 14th century, according to the CDC, though the practice wasn’t introduced in the United States until outbreaks of yellow fever in 1878. The outbreaks led Congress to pass federal quarantine legislation. The word quarantine comes from the Italian quaranta giorni, which means 40 days — the amount of time that ships arriving in Venice from infected ports were required to sit in port before coming ashore. Today the CDC operates 20 quarantine stations around the country, including one in Boston, where international travelers with infectious diseases can be made to wait.

Sophia Janowitz