Courtrooms were considered no place for proper women in the late 1800s. Crowded with men who smoked and spat, they were places where women usually appeared as victims or witnesses, during their divorces, or when accused of committing a crime themselves.

“The female spectacle would be the prostitute, the dancer, the actress, all that was tinged with not being reputable,” says Felice Batlan , a law professor and legal historian at the Chicago-Kent College of Law. “A fine woman did not appear in court.”

But in late 1884, newspapers reported that a group of middle-class woman from Manhattan delivered written documentation, wrapped in a "lovely bow," to a grand jury, according to a paper by Batlan in the Akron Law Review . The members of the Ladies’ Health Protective Association (LHPA), a group from Beekman Place in the borough's East Side, brought a suit against a man named Michael Kane, the owner of a giant manure dump in their neighborhood.

Of Poop and Politics

The manure pile covered two city blocks and stood 30 feet tall. For Kane, it was a cash cow—he employed 150 workers to gather the manure from stables and sell it as fertilizer to farmers outside the city. His manure pile supposedly earned about $300,000 per year , worth about $8 million today.

According to a New York Times article on December 20, 1884, ten members of the LHPA, including president Mathilda Wendt, testified to the grand jury. They said that the smell was “very disagreeable,” “perfectly frightful,” and “simply unendurable.” They couldn’t open their windows and enjoy the fresh air. They worried it posed a danger to their children’s health. Altogether, they argued, it was a public nuisance and ought to be removed.

By calling the manure a nuisance, the LHPA placed the case in legal terms. A nuisance case argues that the offending activity ruins others’ ability to enjoy their property. Such lawsuits were common at the turn of the 20th century, when industrialization brought factories, railroads, and all of their sounds and smells right up to the edges of residential neighborhoods.

Kane had faced accusations of maintaining a nuisance for the manure pit before , but his brother-in-law was a New York state senator , so it was widely suspected at the time that New York City’s Board of Health let him off the hook, according to Batlan. The women’s fight was therefore twofold: They fought literal filth in the city’s streets as well as the dirt of political corruption. By pairing a clever public campaign with their legal argument, the LHPA’s numbers grew from fewer than a dozen to almost 300 members between the grand jury and Kane’s trial.

“The power of the association was that it was done in a group,” Batlan says. “Others really tried to dismiss them as crazy, dainty, picky; all the types of language associated with the irrational or unreasonable woman. Doing it as a group was a way to conquer that.”

Not only did they get the manure pile removed, the LHPA went a step further. They pressured the Board of Health to deny all permits for manure dumps in the city.

Thus the association found their stride in fighting the city’s public health nuisances. They took the traditional expectation of women as housekeepers and expanded it to the entire city: They were trusted as “ municipal housekeepers ,” and the LHPA soon looked to other threats to their community’s public health.

Beware the Careless Spitter

In 1882, two years before the manure fight, the German bacteriologist Robert Koch had identified the world’s most-wanted germ: Mycobacterium tuberculosis . Tuberculosis killed one in seven people in the U.S. and Europe during the late 1800s, making it the deadliest infectious disease at the time. By linking tuberculosis to a bacterium, Koch opened the door for public health campaigns that aimed to prevent its spread.

For six years, the LHPA lobbied the city’s Board of Health, along with groups like Brooklyn’s Anti-Tuberculosis Committee and the National Tuberculosis Association, for protective measures. And in 1896 , they got an unusual ordinance: The city made expectoration, or spitting, illegal in public.

At first, the city put up signs in street cars reminding people not to spit and encouraged citizens to remind each other not spew their saliva on the streets. But in 1909 , a new health commissioner decided to enforce the ordinance more forcefully. On random nights, he instructed the health officers to arrest anyone they saw spitting on subway platforms. The Sanitary Squad, as the officers were called, would round up hundreds of alleged spitters. They were brought to court together and subjected to fines of up to two dollars. When that proved ineffective, the health department also began to hand out informational pamphlets about the purported dangers of spitting.

The spitting ban, “probably would have been partially helpful [in limiting the spread of TB],” says Ruvandhi Nathavitharana , an infectious disease specialist at Harvard’s Beth Israel Deaconess Medical Center. “The question with spitting is if you're really likely to be generating something that can be aerosolized.”

The details of how tuberculosis spread weren’t known at the time. But now, experts know that the bacteria live in thick mucus called sputum in a person’s lower respiratory system—the lower throat and lungs.

Tuberculosis spreads in droplets of sputum that become aerosolized “when a person coughs or sneezes or sings or even talks loudly,” says Nathavitharana, who also works with the South Africa-based advocacy group TB Proof . “TB can be suspended in these droplets and, depending on the kind of environment that you're in, can be in the air for a couple of hours.”

Along with chest pain, fever and night sweats, a tuberculosis infection causes a person to cough up the bacteria-infected sputum from deep in their lungs and frequently spit it out. The creation and enforcement of the anti-spitting ordinance in New York City, and eventually 150 other cities around the U.S., highlighted the threat that tuberculosis posed. The LHPA was concerned that spit on the sidewalk that got caught in the hems of long dresses, a common problem at the time, could facilitate the spread of the disease. But it would take a pretty messy spitter to create the sort of droplets required to transmit tuberculosis. If a loogy of TB-infested sputum landed flat on the ground, it would likely offend the sensibilities of witnesses, but it probably wouldn’t become aerosolized again.

Even if the ban on spitting didn’t directly reduce transmission of the disease, it may have helped prevent the spread of others—expectorators were arrested again during the 1918-19 influenza pandemic. The flu virus spreads via aerosolized droplets , but it can also be transmitted on contaminated clothing and lives longer on non-porous surfaces like the ground. The ban likely also had an indirect effect to help prevent the spread of disease broadly, Nathavitharana says, by bringing attention to public hygiene.

The Ladies’ Health Protective Association accomplished a lot for public health, but members also engaged in the same prejudices as many upper-class people of the time. At the group’s inception in 1884, the Beekman Place neighborhood could be described as a gentrifying area, and when it came to the anti-spitting law, “It was also meant to regulate what were often working-class peoples’ behavior,” Batlan says. “So there’s this other side to the campaign.”

Municipal Housekeeping

For decades, the LHPA worked on a series of projects that improved sanitation in New York City. Perhaps most importantly, according to Batlan, they fought for sanitary slaughterhouses in the city, and eventually for the removal of slaughterhouses from the city altogether. According to an 1895 report from the Ohio State Board of Health, which viewed the LHPA's work as exemplary, the association also investigated “the water supply, gas houses, school hygiene, street cleaning, garbage disposal, sewer system, sanitation of prisons and tenements, and in several instances influenced the legislature to pass sanitary laws.”

All of these improvements to sanitation in public infrastructure likely contributed to the decline in disease in New York City during the early 1900s. In 2015, researchers compared the rates of tuberculosis in New York, London and Cape Town, South Africa, beginning in 1900, and found that while New York and London’s tuberculosis rates fell significantly before the first treatment was discovered in the 1940s, the same wasn’t true for Cape Town, where public sanitation measures didn’t advance at the same rate.

“What they're saying is, it's not just about treatment, it's also about the socioeconomic aspect of TB,” Nathavitharana says. “Actually reducing overcrowding and improving ventilation means it's more likely that you're going to decrease TB transmission.”

The Ladies’ Health Protective Association also started some fights that are still going on today. Their fight for better slaughterhouse conditions continues with campaigns for animal welfare in factory farming, and their anti-spitting pamphlets evolved into informational posters decorating today’s public restrooms that describe how to cough, sneeze and properly wash hands.

The association’s decades of work highlight the “importance of local, community action being done in the name of citizens who want to have and create a larger public good,” Batlan says. “They opened up the space for other women’s groups to come in and do a whole host of things.”