"Spitting is dangerous, indecent, and against the law!" legislating health behavior during the American tuberculosis crusade.

Tuberculosis was the leading cause of death in early twentieth-century America. Reducing the sputum vector of contagion by changing public behavior initially focused on anti-spitting campaigns. According to most Progressive Era health experts, "promiscuous" spitting was a prime culprit in spreading the disease. Beginning in 1896 in New York, towns and cities throughout America passed anti-spitting legislation, sometimes creating tensions between individual liberty and the need to protect public health, and often highlighting class issues. Progressives viewed anti-spitting legislation in a favorable light because they advocated improving the health and well-being of Americans using state-of-the-art medical knowledge and because they often advocated the use of law and the coercive power of the state to impose order on society.