x- post HIstory News Network

Like other bloggers, as I’ve watched the story of Kaci Hickox, the Doctors Without Frontiers nurse who was forcibly confined to a tent in a hospital parking garage in New Jersey following a trip to West Africa to treat Ebola patients, I’ve been struck by the similarity between her situation and that of the infamous “Typhoid” Mary Mallon at the turn of the twentieth century.  Like Mallon, Hickox is a fiery redhead with working class roots who defied excessive infringements on personal liberty for the sake of public health.   As Hickox told reporters last week,  “So many states have started enacting these policies that I think are just completely not evidence-based. They don’t do a good job of balancing the risks and benefits when thinking about taking away an individual’s rights.” “I understand how fear spreads,” she said. “But if I’m a nurse and I have a patient in the hospital, it’s our responsibility as medical professionals to advocate for our patients. Now, it’s the medical professionals who are being stigmatized. Even if there is popular public opinion, we still have to advocate for what’s right.”

Last week, Maine Judge Charles LaVerdiere sided with Hickox, declaring the nurse “currently does not show symptoms of Ebola and is therefore not infectious,” confirming what Hickox and her supporters have been saying all along. The judge also decried “the misconceptions, misinformation, bad science, and bad information being spread from shore to shore in our country with respect to Ebola . .  . The court is fully aware that people are acting out of fear and that this fear is not entirely rational.” Hickox has agreed to inform public health officials of her movements and submit to daily monitoring of her condition, requirements that are consistent with the Centers for Disease Control guidelines for non-symptomatic medical personnel returning from West Africa.

Unlike Hickox, Mary Mallon did not have science on her side. In her book Typhoid Mary: Captive to the Public’s Health, historian Judith Walzer Leavitt describes the “shoe leather” public health detective work that traced several outbreaks of typhoid fever in early nineteenth-century New York to the infamous Irish cook.  Key to their success was the new concept of a health carrier — a person who showed no signs of typhoid fever yet carried the bacteria that caused the disease in their feces and urine and could transmit it to others via unwashed hands. Leavitt describes how Mallon was “the first person in North America to be identified, charted, and reported in the literature as a healthy typhoid carrier.”  Once public health officials tracked her down in 1907, Mallon was arrested and confined to an isolation cottage on the grounds of Riverside Hospital on North Brother Island in New York for two years until she successfully sued for her release in 1909.  Mallon disappeared from public view until 1915, when city public health workers traced another outbreak of typhoid fever to her work as a cook in a private home.  Again she was arrested and confined to North Brother Island, this time for over twenty years until her death in 1938.

Gender and class bias played a prominent role in treatment of Mallon. As an Irish-born domestic servant, Mallon was already an object of scorn since most “respectable” women of this time did not work outside the home.  Although Irish Americans were more assimilated and tolerated than more recent arrivals from central and southern Europe, recent Irish immigrants like Mallon “who were not well integrated into middle-class New York City life and did not meet American standards,” still felt the sting of anti-Irish prejudice (for example in the acronym “NINA” for “No Irish Need Apply” attached to job announcements). The civil engineer who helped track her down, George Soper, said “Mary walked more like a man than a woman and . . . her mind had a distinctly masculine character also.”  He described the home Mallon shared with a “disreputable looking man” as “a place of dirt and disorder” and Mallon as “careless in her personal habits.” Although there were other healthy carriers in this era — 400 in New York alone by the 1930s — Mallon was the only one who was, as Mary put it, “banished like a leper” and confined for over two decades.

Ideas about “appropriate” female behavior play a role in public discussions of Kaci Hickox as well.  Because nursing grew out of women’s traditional obligations towards the sick in their families, nurses are expected to be subservient and self-sacrificing.  Hickox crossed the line from selfless “Florence Nightingale” to “selfish brat” by daring to assert her authority as a health care professional and her rights as a human being. As Joe Niemczura observes in an article for the Daily Kos, Hickox’s fate is “a huge ‘teachable moment’ ” for the nursing profession and the USA.” In defying Governors Christie and LaPage, Hickox “was doing what we, as faculty of nursing, hope that every nurse will do. Nurses do not simply take orders from doctors.  Rather, “a nurse is responsible to apply their own knowledge and judgment and not do anything blindly.” Niemczura and other nursing faculty tell their students that they must advocate for both themselves and their patients. “In every school of nursing, this is an ethical principle we hammer into the students, both in the classroom and at clinical. You Must Speak up. This goes all the way to Florence Nightingale in Scutari during the Crimean War. Being silent is worse than being over-ruled.”

Unfortunately, our society still tends to frown on women who speak truth to power.  Hickox should not be treated like Typhoid Mary because she refused to be a silent angel at the beside.  In fact, no one deserves to be treated like Typhoid Mary, not even Mary Mallon herself.

x-post History News Network

At a recent meeting of the World Bank and International Monetary Fund, Centers for Disease Control (CDC) Director Tom Frieden likened the current Ebola outbreak to the early years of the AIDS epidemic.  “I’ve been working in public health for 30 years,” said Friedan. “The only thing like this has been AIDS. And we have to work now so that this is not the world’s next AIDS,” Frieden said.

Since I’m a historian of medicine, I have been thinking the same thing as I’ve watched the Ebola epidemic unfold over the past few months.  I first read about the Ebola virus in journalist Randy Shilts’s book And the Band Played On: Politics, People, and the AIDS Epidemic (1987).  Although the book was meant to raise awareness about the AIDS crisis, it begins in 1976 with a “virulent outbreak of a horrifying new disease” in a town along the Ebola river on the Zaire-Sudan border, which “had demonstrated the dangers of primitive medicine and new viruses.” The outbreak started when a trader from a nearby village came to the teaching hospital for nurses in Maridi with fevers and profuse, uncontrollable bleeding. Within days 40 percent of their student nurses were infected.

Alarmed local leaders called the World Health Organization, who sent doctors from American Centers for Disease Control. By the time the CDC workers arrived, thirty-nine nurses and two doctors had died from what was now called Ebola hemorrhagic fever.  CDC doctors quickly isolated those with fevers and the epidemic was quickly contained.  Still the toll was high:  53% of those who contracted the disease died from it.  “Years later,” Shilts wrote, “a tenuous relief would fill the voices of doctors who talked of how fortunate it was for humankind that this new killer had awakened in this most remote corner of the world and been stamped out so quickly.  A site just a bit closer to regional crossroads could have released a horrible plague.”

Ebola epidemics have occurred periodically in rural parts of West and Central Africa but until this year have been quickly contained.  In contrast, the current epidemic first emerged in a major urban area and spread rapidly before an effective containment strategy could be put in place. From there, it has spread to other heavily populated areas, and now, because of air travel, to the United States and Europe.  The fact that the virus has until now been confined to isolated rural areas explains, but does not excuse, why public health officials were caught off-guard.  As Shilts reminded us back in 1987, “With  modern roads and jet travel, no corner of the world was very remote anymore; never again could diseases linger undetected for centuries among a distant people without finding some route to fan out across the planet.”

Calls by Texas Governor Rick Perry and members of Congress to ban flights from countries in West Africa where the epidemic is raging, while understandable, also risk creating the kind of ignorance and xenophobia we saw during the early years of the AIDs epidemic.  In his book When Germs Travel: Six Major Epidemics that Have Invaded America and the Fears They Have Unleashed, Howard Markel observes that the discovery of AIDS among homosexuals, heroin users, Haitians, and Haitian immigrants living in New York and South Florida “helped to create a powerful association of sexuality, substance abuse, ‘bad blood,’ black skin, voodoo rituals, and prejudice.” Haitian refugees who were HIV positive were held at “Confinement Camps” in Guantanamo Bay.  Although these refugees were eventually allowed to settle in the United States, discrimination against Haitians continued. Haitians in the U.S. were the only immigrant group that the FDA prohibited from donating blood, even though the percentage of Haitians infected with HIV was much lower than residents of San Francisco, New York, Boston, or San Juan, Puerto Rico. After nationwide protests by the Haitian immigrant community and their supporters, “the FDA formally removed Haitians from its list of banned blood donors.”

We are already seeing this type of racism in the news coverage of the current Ebola epidemic.  For example, Andrea Tantaros of Fox warned that people who travel to the country and show symptoms of Ebola will “seek treatment from a witch doctor” instead of going to the hospital. Immigrants and visitors from Liberia, Guinea, and Sierra Leone are being shunned and asked to leave work out of fears they will spread disease, and Navarro College near Dallas is refusing to accept international students from countries with confirmed Ebola cases. Conservative radio hosts Rush Limbaugh and Michael Savage have even suggested that President Obama and other liberals deliberately want to spread Ebola in the United States as punishment for slavery. Randy Shilts died in 1994, but hopefully his message that prejudice is no way to fight a plague will live on.

via Our Bodies, Our Blog, where Melanie Holmes describes how her mother gave her older sister a copy of Our Bodies, Ourselves to her oldest sister, and then “instructed each sister to hand down the book to the next.”  When Holmes’ daughter turned 10, Holmes bought an updated copy of “Our Bodies, Ourselves” to read together “We covered the basics; I wanted her to know what her forthcoming menses would mean.”

Since I study the history of adolescent health, I know that one of the founders of the Boston Women’s Health Book Collective, Ruth Davidson Bell Alexander,  published a guide for teens called Changing Bodies, Changing Lives: A Book for Teens on Sex and Relationships.  The first edition was published in 1980. Although the title emphasizes teenage sexuality the book also describes “the many physical and emotional changes that occur during adolescence.”  The book has been updated several times, and the most recent edition was released in 2008. 

So, I’m wondering why mothers choose to give their daughters the adult version of Our Bodies, Ourselves instead of Changing Bodies, Changing Lives.  Are they unaware of the teen version?  Or do they find the information in OBOS better?

Earlier today Philly.com posted my column on last year’s FDA ruling that Plan B One-Step could be sold over-the-counter without age restrictions.  The column was already in progress when yesterday’s Supreme Court decision in Burwell v. Hobby Lobby Stores, Inc. was handed down. Even though the column discusses a non-prescription drug, which isn’t covered by the Affordable Care Act,  Philly.com thought it timely enough to publish it today.

There are a number of excellent columns and blog posts about the implications of this decision not just for contraception but health care in general (for example, see this one at Nursing Clio), so my observations will come from my expertise as a historian of childhood and youth.  One of my Facebook friends mentioned the case of Commonwealth v. Twitchell. The case involved parents who were  were convicted of involuntary manslaughter because their son died of a bowel obstruction when they relied on the Christian Science practice spiritual healing rather than seeking medical care.  (there were several other similar cases involving Christian Scientists during the 1980s and 1990s involving parents were prosecuted for murder, manslaughter, or child neglect).  Although the Twitchell’s conviction was overturned on a technicality, the prosecutors’ office observed, “the law is now clear: parents cannot sacrifice the lives of their children in the name of religious freedom.”

In her dissent from the majority opinion in Burwell v. Hobby Lobby, Justice Ruth Bader Ginsburg wrote, “Would the [religious] exemption…extend to employers with religiously grounded objections to blood transfusions (Jehovah’s Witnesses); antidepressants (Scientologists); medications derived from pigs, including anesthesia, intravenous fluids, and pills coated with gelatin (certain Muslims, Jews, and Hindus); and vaccinations[?]…Not much help there for the lower courts bound by today’s decision.”

Children are covered either by their parents’ health insurance or the state (Medicaid).  The state has a duty in loco parentis to care for child health and welfare.  Now that corporations (or at least certain kinds of corporations) have the same religious freedoms as individuals, what happens in the case of a child or adolescent who dies because their parents’ employer objects to their treatment on religious grounds?  Will a corporation’s religious freedoms trump the health needs of the child? Or will the law eventually decide that, like parents, corporations can’t sacrifice the lives of children in the name of religious freedom either?  Just wondering.