Christine L. Case, Ed.D.
Biology Professor
Skyline College

In the 19th century spittoons were useful for people suffering from tuberculosis who would cough up phlegm. Public spittoons would sometimes contain a solution of an antiseptic such as carbolic acid with the aim of limiting transmission of disease. Beginning in 1896 in New York, towns and cities throughout America passed anti-spitting legislation. With the start of the 20th century medical doctors urged tuberculosis sufferers to use personal pocket spittoons instead of public ones; these were jars with tight lids which people could carry with them to spit into. Similar devices are still used by some with tuberculosis. In the U.S., Dr, Samual Crumbine's public health crusade argued for pure food and drugs, elimination of houseflies and rats, water and sewage sanitary control, and the prevention of tuberculosis. He succeeded in abolishing the common drinking cup, the common or "roller" towel, and spitting in public places. After the 1918 flu epidemic, both hygiene and etiquette advocates began to disparage public use of the spittoon, and use began to decline.

In 2012, in most places in the United States, spitting in public is considered a minor crime. In Battle Creek, Mich., it is a disorderly conduct offense. In Prescott Valley, Ariz., spitting on sidewalks or in public buildings could bring a $500 fine. "Expectorating on a public surface" in Virginia is a violation of state law. And in New York City, letting phlegm fly is a quality-of-life crime that is rarely enforced, the police say, unless the offender is caught in the subway. Many towns and public transit systems have rules against spitting. New York subway riders are routinely fined for spitting. San Francisco bus riders cannot do it, either. In Beijing, spitters are berated in public, fined 18 cents and forced to clean up the mess. In Sonoma, the fine for spitting in the plaza is $100 to $300. In Burlingame, you cannot spit, unless you are spitting on a baseball diamond; the fine for spitting is $270.


TB Death Rate, 1840-1960. Thomas McKeown’s epidemiological research on the decline of respiratory tuberculosis in England and Wales revealed a stunning fact: Although medicine was credited with defeating the disease, more than 90 percent of the decline in mortality rates had taken place before a antibiotics or a vaccine became available, suggesting that social and economic change had done most of the work. (Source: American Scientist, Nov-Dec 2001)


TB Incidence, 1948-2010. Data source: CDC


TB Trends, This graph illustrates the increase in the percentage of cases occurring in foreign-born persons during this period, from 29% in 1993 to 60% in 2010. Overall, the number of cases in foreign-born persons remained virtually level, with approximately 7,000–8,000 cases each year before 2009, until 2009 when the number dropped to 6,854. That trend continued in 2010 with the number of foreign-born cases dropping to 6,720. The number in U.S.-born persons decreased from more than 17,000 in 1993 to 4,393 in 2010. Data source: CDC