Heather Munro Prescott, Professor of History, Central Connecticut State University, is the author of "The Morning After: A History of Emergency Contraception in the United States" (Rutgers 2011).

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.

Heather Munro Prescott, Professor of History, Central Connecticut State University, is the author of "The Morning After: A History of Emergency Contraception in the United States" (Rutgers 2011). 

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 bedside.  In fact, no one deserves to be treated like Typhoid Mary, not even Mary Mallon herself.

Heather Munro Prescott is a Professor of History at Central Connecticut State University. She is the author of "The Morning After: A History of Emergency Contraception in the United States" (Rutgers 2011).

Estelle Griswold & Cornelia Jahncke, Planned Parenthood League

At this year’s annual meeting of the American Association for the History of Medicine I participated in a panel on Reproductive Rights after Griswold: A Fifty Year Retrospective.  Since the meeting was held in New Haven, Connecticut, it was a fitting venue for such a commemoration.

Here is the video of the panel and the question and answers that followed. For those who don’t have the time or inclination to watch the video, here are some highlights:

Barbara Sicherman, William R. Kenan, Jr., Professor Emerita, Trinity College, set the stage by briefly summing up the Connecticut law prohibiting the use of contraceptives and Planned Parenthood’s efforts to overturn it, which culminated in the landmark Griswold decision. Dr. Sicherman is currently doing research on the illegal birth control clinics established in Connecticut in the 1930s, a follow up to “’Let’s Do It’: Women Making History in the Land of Steady Habits,” Connecticut History (Spring 2012).

This introduction was followed by a first-hand account by Rosemary A. Stevens, DeWitt Wallace Distinguished Scholar in Social Medicine and Public Policy at Weill Cornell Medical College, Department of Psychiatry, and the Stanley I. Sheerr Professor Emeritus in Arts and Sciences at the University of Pennsylvania.  For Dr. Stevens, Griswold v. Connecticut is a personal history because she was the witness testifying against Griswold and the physician who gave her contraception, Dr. C. Lee Buxton, at the trial in New Haven. Dr. Stevens described the contentious atmosphere at the time, how she came to be involved and what happened; with brief comments on the case as history.

What is especially notable about Dr. Stevens’ talk is how access to birth control affected women’s educational opportunities.  Dr. Stevens was a graduate student at the Yale School of Public Health at this time.  Being able to delay having children was key to her ability to finish her degree.  As a recent immigrant from Great Britain, Dr. Stevens put herself at considerable risk of deportation by admitting to the crime of using contraception.

Next was a presentation by Professor Reva Siegel,  Nicholas deB. Katzenbach Professor of Law at Yale Law School.  She briefly discussed the debates that engendered Griswold and the cases that followed in its wake. She then considered how the culture wars of the 1980s shaped modern understandings of Griswold and its progeny, concluding with current conflicts over religious objections to contraception and over the right of same-sex couples to marry.  Her presentation is especially relevant to our understanding of Obergefell v. Hodges, the gay marriage case that is currently before the U.S. Supreme Court.

Linda Greenhouse, Joseph Goldstein Lecturer in Law at Yale Law School, talked more specifically about Roe v. Wade as Griswold's progeny. She showed how Griswold crucially informed Roe v. Wade at a time when the sex equality claim for a right to abortion was not a plausible option for a Supreme Court that had not yet established a jurisprudence of sexual equality.  

My presentation followed.  I started by discussing how I use the Griswold v. Connecticut case in the classroom.  Because I teach in Connecticut, the case has special resonance for my students, many of whom have relatives who lived through the era when the case was decided.

I like to use the Griswold case to bust my students’ misconceptions about the so-called sexual revolution of the 1960s. One key point I bring out when discussing the language of Griswold is the decision only protected the rights of married couples to use contraceptives in “the sacred precincts of marital bedrooms.” This opinion was very much in keeping with the family values of the postwar era and the belief that the middle-class home was a zone of privacy that should not be intruded upon by the state. The court’s emphasis on the sanctity of the marital bedroom made it difficult to extend the same line of argument to unmarried persons, except within the context of premarital religious counseling.

In my presentation, I drew on points I made in my book Student Bodies: The Influence of Student Health Services on American Society. I discussed how college students played a critical role in expanding access to birth control for unmarried persons. I examined the partnership between student organizations and Planned Parenthood's Program of Student Community Action to get birth control included in college and university health services. I also look at the relationship between college student activism and the work of contraceptive salesman turned reproductive rights activist Bill Baird who purposely violated Massachusetts law against distributing contraception to unmarried persons. Baird won the support of students throughout the nation, who picketed for his release.  Eventually, the U.S. Supreme Court reversed Baird’s conviction, stating in their ruling case Eisenstadt v. Baird (1972), “if the right of privacy means anything, it is the right of the individual, married or single, to be free from unwarranted governmental intrusion into matters so fundamentally affecting a person as the decision whether to bear or beget a child.”

I concluded by observing that recently, there have been repeated efforts to undermine access to birth control and abortion, especially for young, single women. It is important to remember earlier strategies used by campus groups so they can inform the work that students are continuing to do for reproductive rights today. The last presenter was Judy Tabar, President and CEO of Planned Parenthood of Southern New England (PPSNE). Ms. Tabar showed how access to contraceptives during the 50 years since Griswold has made a dramatic impact on the lives of women, men and families across our country. She spoke about the link between reducing unintended pregnancies and a whole host of positive effects for women and men, from improved health outcomes for women and their babies to expanded educational and career options for women and their partners when they use contraceptives to delay childbearing until the time is right for them. She also discussed the evolution of the contraceptive methods available to women over the years, and noted some of the challenges that we are still struggling to overcome, such as recent public policy debates to limit contraceptive access and the persistent racial and ethnic health disparities that exist in relation to reproductive health outcomes.

Our presentations were followed by a robust discussion of the issues raised by Griswold v. Connecticut and their relevance today.  Ellen More from the University of Massachusetts School of Medicine gave a personal story of when she was an undergraduate prior to the Eisenstadt v. Baird decision.  She was very grateful to Planned Parenthood who, while they officially only treated women over the age of 21, did not ask for proof of age.  So, if you could count back twenty-one years and give the clinic a birth date they could live with, you were home free.

Dr. More is currently writing about women physicians who were advocates for sex education, with a focus on Planned Parenthood Medical Director Mary Steichen Calderone. She asked when did conservative Republicans start using the politics of abortion to draw conservative Democrats into the Republican fold.  Linda Greenhouse and Reva Siegel said that this began during President Nixon’s administration.  In the lead up to the 1972 election, Nixon’s campaign advisor Pat Buchanan began exploring how to bring Northern voters into the Republican party.  Buchanan used opposition to birth control and abortion as a way to lure the “Silent Majority” of white, urban, predominantly Catholic voters who were dismayed at the decline of traditional “family values.” This was the Northern counterpart to Nixon’s “Southern Strategy” to attract Southern Democrats to the GOP.  President Reagan continued this tactic by convincing evangelical Protestants as well as Catholic voters to join his opposition to reproductive rights.

Lara Freidenfelds asked about the parallels between Griswold, Roe, and more recent Supreme Court cases involving gay rights.  She observed that reproductive rights and gay rights involve different notions of privacy: taking contraception and having an abortion are things done in private, while advocating for gay rights involves coming out in public about one’s sexual orientation. Reva Siegel said that the “coming out” stories of women who had abortions were central to abortion activism in the 1970s. Lawyers included women’s personal stories of their struggles to find safe abortion services in their legal briefs. Over the past few decades, with the growing restrictions on abortion rights, she has seen women be less public about their abortion decisions. While gay rights has come out of the closet, abortion rights have gone back in.  Today, the most prominent coming out stories in regards to abortion are abortion regret stories used by abortion opponents.

A first year student at Trinity College asked if the growing availability of birth control on campus contributed to some of the problems of sexual assaults we now see on campus.  I answered that when students were advocating for birth control the feminist approach to rape as a crime against women and activism against sexual assault was just beginning. This is an example of how the sexual revolution was uneven for women: gaining access to birth control created new freedoms but it also created new pressures as well.

Judy Tabar added that studies of teenage pregnancy and sexual behavior indicate that when young people have access to accurate sex education they are more likely to delay having sex.  They are also more likely to use contraception when they do become sexually active.

Another audience member asked about whether the right to privacy is relevant in the case of Purvi Patel, the young Indiana woman who was recently sentenced to twenty years in prison for feticide following a miscarriage, which prosecutors allege was a self-induced abortion. I answered that this is an example of how the rights of young women, women of color, and poor women are especially vulnerable in our current political climate.

The last question was from Leslie Reagan Professor of History at Illinois who has written extensively about the history of abortion.  She said it’s important to consider the perspective of those writing the Griswold decision, that is, white, privileged men who are horrified by the thought of the police invading their bedrooms.  She pointed out that in fact there were cases of police invading the bedrooms in this era, such as the “midnight raids” on female welfare recipients to see if they were violating rules against having a man in the house.  She asked whether welfare rights activists ever used the notion of a right to privacy to combat these instrusions. Reva Siegel said that the Griswold decision was issued before the Supreme Court could imagine our current notions of gender equality.  She mentioned that Cary Franklin at the University of Texas is currently working on how to understand Griswold in light of more recent understandings of equal citizenship.

In short, the discussion celebrated what Griswold v. Connecticut did for women’s reproductive rights while also pointing out its limitations. It was a wonderful way to commemorate the decision, if I do say so myself. Edited versions of our presentations will be published in Connecticut History Review later this year so keep an eye out for the Fall issue.