Coughing, kissing, and the spread of tuberculosis

As winter draws in and coughs start spreading, our Project Cataloguing Archivist Rebecca looks at how a cough could be both a symptom and a cause of tuberculosis.

Just as nowadays we are told to seek medical advice if we have a cough for more than 3 weeks, patients would often report to the Royal Victoria Dispensary with a troubling cough. A productive cough could often be a symptom of tuberculosis along with haemoptysis, or coughing up blood. Patients would be tested for exposure to tuberculosis bacteria and have their chest x-rayed to see if any of the characteristic signs of tuberculosis were present in the lungs. For many patients, no signs of disease were found and they were sent home with instructions to return in a few months to check for changes in the lungs.

A cough was a characteristic sign of tuberculosis (think of the ominous cough developed by many a period drama character), but it was also a key vector in the transmission of the disease. The bacteria could be present in any phlegm coughed up, and therefore be spread through airborne transmission the same as any other infectious chest disease. Studies in the 1920s showed that tuberculosis bacteria could live outside the body and intermingled with dust for several days. This is why patients were encouraged to sparsely decorate their homes, and why twentieth century sanatoriums were built with far less decorative flourishes than their nineteenth century predecessors.

A WWII-era poster informing the British public of the dangers of coughs and sneezes. © IWM (Art.IWM PST 14154)

Coughing into a handkerchief could prevent the bacteria spreading in the air, but the handkerchief would need to be fully sterilised after each use in order to stop the tuberculosis bacteria from lingering, difficult to achieve in a domestic setting. It was widely acknowledged that the best solution in a domestic setting was to kill the bacteria with fire. Patients at home were told either to cough into disposable paper handkerchiefs or into disposable paper flasks, which could be burnt in a closed stove. Patients would also have been given sterile 'sputum flasks' to cough into. These could have disposable liners, or in hospitals they could be collected and sterilised on site.

 

The Royal Victoria Dispensary handed out informational leaflets to patients including this and other advice. The images below are some examples, and they really convey the strict rules which patients were expected to follow in order to prevent the spread of tuberculosis. Instructions to keep windows open, avoid kissing, and for the patient to sleep alone in a large, airy room all seem unfeasible in different ways, particularly in a cold Edinburgh winter, so it is likely that they weren't always followed; they do, however, represent the ideal behaviour of the tuberculous patient to do their part in not spreading the disease.


A card handed out to patients at the Royal Victoria Dispensary, with strict rules on hygienic living. (LHSA slide collection)

Advice for Royal Victoria Dispensary patients on living well. (LHSA Slide Collection)