Nurse Kaci Hickox is not Typhoid Mary

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.