Emily Bissell and the first Christmas Seal, 1907

The fledgling National Association for the Study and Prevention of Tuberculosis (NASPT) could not financially support every sanatorium in the country. Many, like the tiny Brandywine Sanatorium near Wilmington, Delaware, were barely able to stay open. In 1907, Dr. Joseph Wales, a physician at Brandywine, asked his cousin, Ms. Emily Bissell, for help. Ms. Bissell was an active member of the American Red Cross with considerable experience in fund-raising. Her mission was to raise the $300 necessary to keep Brandywine Sanatorium in operation through the winter.

Bissell got the idea for a sale of Christmas Seals from an article written by a Danish-American journalist and social worker named Jacob Riis. In his article, Riis referred to a successful sale of Christmas seals in 1904 in Denmark that raised $20,000 in the fight against tuberculosis. Bissell agreed with Riis’s suggestion that America do the same. She borrowed money from friends to print the first 50,000 Seals, got permission from the Wilmington postmaster to sell them in the post office lobby, and sold the first Christmas Seal on December 7, 1907.

Emily Bissell buying the first Seal at the Wilmington post office, 7 December 1907

The Seals were placed in envelopes on which the following message was printed:

Put this stamp with message bright
On every Christmas letter;
Help the tuberculosis fight,
And make the New Year better.
These stamps do not carry any kind of mail
but any kind of mail will carry them.

“Gimme one — me sister’s got it.”

On her first day, Bissell raised $25. But when sales tapered off during the next several days, she realized that she was no longer on pace to reach her goal of $300. Desperate, she jumped on the train to Philadelphia, where she hoped to find a voice for her cause in The North American, one of the city’s most popular newspapers. She succeeded. Every day articles appeared in the paper under the heading, “Stamp Out Tuberculosis.” One story was about the “ragged little newsboy” who bought a Christmas Seal early in the Philadelphia campaign. According to Leigh Mitchell Hodges, senior staff writer for The North American, the newsboy’s purchase of a Seal proved that people believed in the Christmas Seal Campaign and its goal to eradicate TB. With the articles in the newspaper, Bissell’s Seals sold so quickly that she had to order another 250,000. The Philadelphia campaign caught the attention of President Theodore Roosevelt, who enthusiastically endorsed the Seals. By the end of the Christmas season, Emily Bissell had raised $3,000.[1]

Christmas Seals and the American Red Cross

Amy Hughes, age 6, with Seals, 1967

Bissell’s Christmas Seal Campaign went national the following year with the official sponsorship of the American Red Cross. In its second year, the sale of Christmas Seals raised $135,000 against tuberculosis. In 1909, the campaign produced $250,000. The American Red Cross sponsored the Christmas Seal until 1919, when the National Tuberculosis Association (the new name for the NASPT) was finally strong enough to assume exclusive control of the project. The emblem of the NTA, the double-barred cross, appeared for the first time on a Christmas Seal in 1920.

The double-barred cross is a modification of the Cross of Lorraine, which is itself a variation of the Jerusalem, or Patriarchal, Cross. Godfrey, Duke of Lorraine and a leader of the First Crusade, commandeered the cross in 1099 when he was made ruler of Jerusalem. In 1902, Dr. Gilbert Sersiron of Paris proposed that the Lorraine Cross be made the emblem of the anti-TB “crusade” at the International Conference on Tuberculosis held in Berlin. The NASPT adopted the cross in 1906 and registered their new emblem as an official trademark in 1920.[2]

Lee Trevino, Christmas Seal Chair, 1971

Since 1959, celebrities have chaired the Christmas Seal Campaign, including Jacqueline Kennedy Onassis, Bob Hope, Lee Trevino, Johnny Bench, Pearl Bailey, and Cybill Shepherd. Early Christmas Seals have attracted the attention of stamp collectors, some of whom pay several hundred dollars for a single Seal. In 1980, Ms. Emily Bissell, “Crusader Against Tuberculosis,” and the double-barred cross of the ALA appeared on a postage stamp. Now one of the best known fund-raisers in the country, the Christmas Seal Campaign raises millions of dollars to prevent, cure, and control lung disease.[3]

Sources

[1] The Story of Christmas Seals (American Lung Association, 1987), 2-5.
[2] S. Adolphus Knopf, A History of the National Tuberculosis Association: The Anti-Tuberculosis Movement in the United States (New York: NTA, 1922), 152-54.
[3] The Story of Christmas Seals, 5-13.

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Catawba Sanatorium near Roanoke, ca. 1915

When the National Association for the Study and Prevention of Tuberculosis (NASPT) formed in 1904, there were approximately one hundred Trudeau-style sanatoriums in the United States; by 1910, there were nearly four hundred. One of the many sanatoriums built during this period was the Catawba Sanatorium near Roanoke, the first sanatorium in the state of Virginia.

William Washington Baker (1844-1927)

In 1908, Captain William Washington Baker (1844-1927), a member of the Virginia General Assembly, introduced a bill to reorganize the State Board of Health. The “Baker Bill” appropriated $20,000 “for the establishment and maintenance of a suitable sanatorium for consumptives.” Baker had lost four of his six children to tuberculosis. For his pioneering efforts, he is justly called “the father of Catawba Sanatorium.” Baker was also instrumental in the formation of the Virginia Anti-Tuberculosis Association (which became the American Lung Association of Virginia) in October 1909.[1]

Piedmont Sanatorium, ca. 1918

In 1918, the State Board of Health and the Negro Organization Society founded Piedmont Sanatorium as a rest home for African-Americans. Before its establishment, the only treatment facilities for African-Americans were the Central State Hospital for Mental Diseases and the State Penitentiary. Miss Agnes D. Randolph, Director of the Educational Department of the State Board of Health, requested in 1916 an appropriation from the General Assembly to build the sanatorium and purchase three hundred acres of land near Burkeville. The first building at the site was named in her honor.[2]

Blue Ridge Sanatorium, ca. 1920′s

Blue Ridge Sanatorium opened in April of 1920. The close proximity of the University of Virginia Medical School was a major factor in the government’s selection of the Charlottesville area as the site for the new facility. The State Board of Health and the University agreed that a special course in tuberculosis would be developed for third and fourth year medical students, to be taught by the Medical Director of Blue Ridge Sanatorium and his staff. The city of Charlottesville donated $15,000 for the building project and promised free water from the city supply for five years.[3]

Sources

[1] Ernest Drewry Stephenson, Catawba Sanatorium, 1909-1929 (Publisher unknown, 1930); S. Adolphus Knopf, A History of the National Tuberculosis Association: The Anti-Tuberculosis Movement in the United States (New York: NTA, 1922), 135-136.
[2] Ethel C. Dodson, “A Very Brief Sketch of the History of Piedmont Sanatorium, Burkeville, Virginia” (Unpublished, 1956).
[3] Jennifer Davis McDaid, editor’s note to Margaret V. Rastetter, “Blue Ridge: Eight Months in a Tuberculosis Sanatorium,” in Virginia Cavalcade, vol. 46, no. 6 (Autumn 1997): 244-255; “The Story of Blue Ridge,” reprint from Sunbeams (n.d., in ALAV Collection).

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The building and maintenance of sanatoriums was only one part of the National Association for the Study and Prevention of Tuberculosis (NASPT) mission. As a result of Jean Antoine Villemin and Robert Koch discovering tubercle bacilli in sputum, the NASPT and its state affiliates campaigned aggressively against public spitting. In his book, The Great White Plague, Dr. Edward Otis, President of the Boston Tuberculosis Association, printed a list of nineteen rules for children that highlights the anti-spitting campaign:

B&O Railroad anti-spitting card, 1917

1. Do not spit.
2. Do not let others spit.
3. If you have a cough, and must spit, use a paper napkin or a piece of newspaper, and put it in the stove.
… 19. And last as well as first, DO NOT SPIT.[1]

The amazing fact that tubercle bacilli could survive in spit for an entire day convinced many ladies to stop wearing their long, trailing dresses into town for fear they might pick up sputum and drag tuberculosis into their homes.[2] Many communities outlawed spitting in the streets and on the floors of shops, theaters, and taverns and required managers of public gathering spots to have spittoons available for their guests. Newspapers, street signs and bulletin boards carried warnings against “the filthy habit:”

Denver Anti-Spitting Campaign, ca. 1920

BEWARE OF THE CARELESS SPITTER

DON’T SPIT, SAVE LIVES

WHO LOVES A SPITTER?

MEN! IT’s UP TO US! SPITTING SPREADS DISEASE–AND WOMEN DON’T SPIT!

PROTECT THE CHILDREN, DON’T SPIT

NTA anti-spitting notice, 1943

Though everyone was expected to follow the new spitting rules, people with tuberculosis were more carefully monitored than anyone else. Spittoons used by “lungers” were immediately disinfected with carbolic acid or boiling water; their handkerchiefs and napkins were placed in designated containers and burned.[3]

The Modern Health Crusade

Crusaders in Richmond, Virginia, ca. 1915

In 1915, the NASPT launched the Modern Health Crusade, originally to involve children in the Christmas Seal Campaign. Any child who sold ten or more Seals was given a “Crusader certificate of enrollment” on which was printed a list of health rules such as “keep windows open” and “get a long night’s sleep.” The Crusade quickly grew into a new health education system for elementary schools.

Crusaders in Richmond, Virginia, ca. 1915

Crusade directors sought to arouse children’s interest in health by introducing elements of play, chivalry, and competition into the study and practice of hygiene. The program was based on eleven tasks:

Christmas, 1956.

Crusader Christmas Seal play, 1956.

1. I washed my hands before each meal today.
2. I washed not only my face, but my ears and neck, and I cleaned my finger-nails today.
3. I kept fingers, pencils, and everything likely to be unclean or injurious out of my mouth and nose today.
4. I brushed my teeth thoroughly after breakfast and after the evening meal today. I took ten or more slow, deep breaths of fresh air today. I was careful to protect others if I spit, coughed, or sneezed.
5. I played outdoors or with open windows more than thirty minutes today.
6. I was in bed ten hours or more last night and kept my windows open.
7. I drank four glasses of water, including a drink before each meal, and drank no tea, coffee, or other injurious drinks today.
8. I tried to eat only wholesome food and to eat slowly.
9. I went to toilet at my regular time.
10. I tried hard today to sit up and stand up straight; to keep neat, cheerful, and clean-minded; and to be helpful to others.
11. I took a full bath on each of the days of the week that are checked.

Children who complied with these standards were “promoted” from squire to knight, then to knight banneret, and finally to knight of the round table. By 1919 there were three million “crusaders” in the United States. Two years later, the National Education Association recommended the adoption of a Crusade-like health education system in every elementary school in the country.

Crusaders’ Song by Emily Nichols Hatch, ca.1920s

Hail! all ye gentle knights and squires and pages!
Crusaders’ band, for health we stand.
While all around life’s battle fiercely rages
We’ll do our part — clean hands and heart.
Our soldiers bravely there in France were fighting
Like knights of old, chivalrous, bold.
Like them we must some wrong each day be righting
With smiles of cheer, and know no fear.

With souls and bodies growing strong and stronger
Brave Knights we’ll be, our land to free.
From curse of dread disease which shall no longer
O’er it prevail, we shall not fail.
The holy war which we must still be waging
Is for good health, tis more than wealth.
The health of mind and body both engaging
Our efforts true in all we do.

Chorus

We’ll battle, we’ll conquer; disease and dirt we’ll slay!
We’ll scout them and rout them and drive them off each day!
With hands and bodies clean and hearts all brave and bold.
Prepared our country’s flag and honor to uphold.

Sources

[1] Edward O. Otis, The Great White Plague (New York: Crowell & Co., 1909), 245-47.
[2] Lawrence F. Flick, Consumption, a Curable and Preventable Disease, (Philadelphia: Flick, 1904), 172, 257.
[3] Flick, 254-56, 266-71.
[4] S. Adolphus Knopf, A History of the National Tuberculosis Association: The Anti-Tuberculosis Movement in the United States (New York: NTA, 1922), 43-44.
[5] Richard H. Shryock, National Tuberculosis Association, 1904-1954: A Study of the Voluntary Health Movement in the United States (New York: NTA, 1957), 170-73.

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Dr. Lawrence Flick (1856-1938)

Edward Livingston Trudeau’s work breathed new life into the fight against tuberculosis. In 1892, Dr. Lawrence Flick (1856-1938) of Philadelphia and a graduate of Jefferson Medical School founded the Pennsylvania Society for the Prevention of Tuberculosis, the first society in the world to concentrate all of its efforts into the control and cure of tuberculosis. The following year, Dr. Hermann Biggs of New York established the first TB diagnostic community laboratory. Biggs was a leader in determining effective control measures. Other state societies and research programs were organized, but there remained a need for a national organization that would raise money for research, for the building of sanatoriums, and, most importantly, for the education of the general public.

Offices of the NTA, ca. 1910

The scattered regional groups could not possibly reach all 82 million people living in the United States in 1904. To complicate matters, an increasing number of these were migrating into cities which were the primary danger zones for tuberculosis. Although the mortality rate for TB had declined by nearly 17 percent since 1890, the tuberculosis death rate in 1904 was still a frightening 188.1 per 100,000, compared to heart disease at 163.7, and cancer at only 71.5.[1]

Hermann Biggs (1859-1923)

William Osler (1849-1919)

William Welch (1850-1934)

The National Association for the Study and Prevention of Tuberculosis (NASPT) was formed in 1904 to unify and expand the country’s regional anti-TB programs. The co-founders of the NASPT were among the most prominent medical men in America: Drs. Trudeau and Flick; Hermann Biggs of New York, who established the first tuberculosis diagnostic community laboratory in 1893; William Osler; and William H. Welch; to name a few. They decided to use Flick’s Pennsylvania Society as a model: the NASPT would be a voluntary organization made up of physicians and laymen. Osler served as chairman at the first general meeting in Atlantic City, 6 June 1904. The group chose Trudeau to be the first president.

Sources

[1] Richard H. Shryock, National Tuberculosis Association, 1904-1954: A Study of the Voluntary Health Movement in the United States (New York: NTA, 1957), 62-63.

The post The Birth of the American Lung Association in the Early 20th Century to Fight Tuberculosis appeared first on American Lung Association Crusade.

Cartoon by Fred O. Seibel

The American Lung Association is dedicated to the cure and control of all lung diseases, but its formation in 1904 was in response to only one: tuberculosis. During the nineteenth and early twentieth centuries, tuberculosis (TB) was the leading cause of death in the United States, and one of the most feared diseases in the world.

Formerly called “consumption,” tuberculosis is characterized externally by fatigue, night sweats, and a general “wasting away” of the victim. Typically but not exclusively a disease of the lungs, TB is also marked by a persistent coughing-up of thick white phlegm, sometimes blood.

Cartoon by Fred O. Seibel

There was no reliable treatment for tuberculosis. Some physicians prescribed bleedings and purgings, but most often, doctors simply advised their patients to rest, eat well, and exercise outdoors.[1] Very few recovered. Those who survived their first bout with the disease were haunted by severe recurrences that destroyed any hope for an active life.

Kentucky TB Association Ad, ca. 1945

 

 

 

It was estimated that, at the turn of the century, 450 Americans died of tuberculosis every day, most between ages 15 and 44.[2] The disease was so common and so terrible that it was often equated with death itself.

Tuberculosis was primarily a disease of the city, where crowded and often filthy living conditions provided an ideal environment for the spread of the disease. The urban poor represented the vast majority of TB victims.

 

Villemin, Koch & Contagion

Jean-Antoine Villemin (1827-1892)

 

Science took its first real step toward the control of tuberculosis in 1868, when Frenchman Jean-Antoine Villemin proved that TB was in fact contagious. Before Villemin, many scientists believed that tuberculosis was hereditary. In fact, some stubbornly held on to this belief even after Villemin published his results.[3]

 

 

 

 

 

Robert Koch (1843-1910)

 

In 1882, German microbiologist Robert Koch converted most of the remaining skeptics when he isolated the causative agent of the disease, a rod-shaped bacterium now called Mycobacterium tuberculosis, or simply, the tubercle bacillus.

The work of Villemin and Koch did not immediately lead to a cure, but their discoveries helped revolutionize the popular view of the disease. They had demonstrated that the tubercle bacillus was present in the victim’s sputum. A single cough or sneeze might contain hundreds of bacilli. The message seemed clear: stay away from people with tuberculosis.

 

 

 

Cover Up!

 

This new rule of behavior was sensible, but it made the tubercular invalid an “untouchable,” a complete outcast. Many lost their jobs because of the panic they created among co-workers. Many landlords refused to house them. Hotel proprietors, forced to consider the safety of other guests, turned them away.[4] Rejected by society, tuberculosis victims gathered in secluded tuberculosis hospitals to die.

 

 

 

Trudeau & the Sanatorium

Edward Livingston Trudeau (1848-1915)

 

Dr. Edward Livingston Trudeau (1848-1915) was the first American to promote isolation as a means not only to spare the healthy, but to heal the sick. Trudeau believed that a period of rest and moderate exercise in the cool, fresh air of the mountains was a cure for tuberculosis. In 1885, he opened the Adirondack Cottage Sanatorium (often called “the Little Red Cottage”) at Saranac Lake, New York, the first rest home for tuberculosis patients in the United States.

 

 

 

 

“The Little Red Cottage” at Saranac Lake, NY. Image from An Autobiography by Edward Livingston Trudeau, 1916.

Dr. Trudeau’s sanatorium plan was based on personal experience. When he was nineteen, Trudeau watched his older brother die of TB, an experience that convinced him to become a physician. In 1872, just a year after leaving medical school, he, too, contracted tuberculosis. Faced with what he believed to be a sure and speedy death, Trudeau left his medical practice in New York City and set off for his favorite resort in the Adirondacks to die.[5] There, instead of wasting away, he steadily regained his strength, due entirely, he believed, to healthy diet and outdoor exercise. Experiments on tubercular rabbits in his lab at the cottage seemed to verify his belief. In February of 1885, Trudeau welcomed the first group of hopeful patients to his sanatorium in the woods.

 

 

Child Memorial Infirmary with open-air porches for tuberculosis patients at Adirondack Cottage Sanatorium, Saranac Lake, N.Y. Library of Congress.

Trudeau required his guests to follow a strict regimen of diet and exercise. They were given three meals every day, and a glass of milk every four hours. Trudeau and his staff encouraged their patients to spend as much time as possible outdoors. At first, this meant extended periods of sitting on the sanatorium veranda (the open-air porch was a standard feature of Trudeau-style sanatoriums). Gradually, patients spent more time walking than sitting, until they were able to spend 8 to 10 hours per day exercising outdoors, regardless of weather.[6] Trudeau made his rest home available to the poor by setting a very low rent and providing free medical service. By 1900, what started as a single red cottage was a small village, a 22-building complex that included a library, a chapel, and an infirmary.

Sources

1. Edward O. Otis, The Great White Plague (New York: Crowell & Co., 1909), 100-103.
2. Sheila M. Rothman, Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in American History (New York: BasicBooks, 1994), 190; Richard H. Shryock, National Tuberculosis Association, 1904-1954: A Study of the Voluntary Health Movement in the United States (New York: NTA, 1957), 63.
3. Shryock, 6.
4. Otis, 44-45.
5. Mark Caldwell, The Last Crusade: The War on Consumption, 1862-1954 (New York: Atheneum, 1988), 42-43.
6. Rothman, 203-204.

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The American Lung Association is the oldest voluntary public health agency in the United States. The original name of the ALA was the National Association for the Study and Prevention of Tuberculosis (NASPT), formed in 1904 to combat the deadliest disease of the time. The name was changed to the National Tuberculosis Association (NTA) in 1918, and finally, with the decline of tuberculosis and the rise of other serious lung diseases, to the American Lung Association (ALA) in 1973. The American Lung Association of Virginia (ALAV) had been similarly renamed since its formation in 1909 as the Virginia Anti-Tuberculosis Association. The ALAV was disbanded in 2009. Today the American Lung Association is dedicated to the prevention, cure, and control of all lung diseases.

The ALA is perhaps best known as “The Christmas Seal People.” Since 1907, the Christmas Seal Campaign has raised many millions of dollars toward the fight against lung disease. The fame of the Christmas Seal makes the holiday season the perfect time to honor the work of the ALA.

Dr. Carl Booberg and Linda Watson

This exhibit recounts the origin and early history of the American Lung Association. Pictured here is Dr. Carl Booberg (Director of the American Lung Association of Virginia in 1991) signing over the ALAV Collection to Ms. Linda Watson (Director of the CMHSL). The Collection contains personal and official correspondence, financial and legal papers, minute books, organizational and scientific reports, educational publicity, photographs, and artifacts. The Claude Moore Health Sciences Library wishes to gratefully acknowledge the contributions of the American Lung Association of Virginia, whose donation of the organization’s papers to the Library in 1990 and 1991 made this exhibit possible. The ALAV made an additional donation in 2009.

Copyright Notice

The materials in this exhibit are kept in the Wilhelm Moll Rare Book and Medical History Room of the University of Virginia Health Sciences Library. They are owned by the University of Virginia and are protected under U.S. Copyright Law. For permission to reproduce any of the text or images or to make comments or suggestions, please contact a member of Historical Collections. This exhibit was created by Donny Wright and Joby Topper. It was on display at the Health Sciences Library in early 1998 and converted to the Web in December of 1998. Redesign of the exhibit was completed in 2004 by Steve Stedman.

The post Introduction to the American Lung Association and the Fight against Tuberculosis appeared first on American Lung Association Crusade.

Dr. Selman A. Waksman (1888-1973)

With the support of the American Lung Association (ALA) and its international associates, scientists made considerable progress in tuberculosis research. By the 1930s, the BCG vaccine was being used in many parts of the world. Dr. Selman Abraham Waksman, a Rutgers University microbiology professor, isolated streptomycin in 1943 and proved its effectiveness against TB. He won the Nobel Prize in 1952. Other notable anti-tubercular drugs first used in the 1940s and 50s were isoniazid and para-aminosalicylic acid.  The new treatments made the TB sanatorium obsolete: in 1954, Edward Livingston Trudeau’s “Little Red Cottage” at Saranac Lake closed.

Despite the advances made since 1900, tuberculosis is still with us, along with other lung diseases that are equally devastating. Lung disease is the third leading cause of death in America. In Virginia alone, more than 600,000 people suffer from some form of lung disease.

Fortunately, of the leading causes of death in America, lung disease is the most preventable. The ALA sponsors public education programs to prevent people from beginning to smoke and to encourage smokers to quit. It campaigns against all forms of air pollution, both outdoors and in the workplace. In addition, the American Lung Association supports research and public education in lung cancer; emphysema; chronic bronchitis; asthma; respiratory distress syndrome (RDS) in both children and adults; Sudden Infant Death Syndrome (SIDS); chronic respiratory diseases like sinusitis and hay fever; and infectious diseases such as influenza and pneumonia. The ALA’s public health education and biomedical research programs are supported by donations to Christmas Seals and by other voluntary contributions.

Additional Links of Interest

• American Lung Association
• Christmas Seals

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