The life and work of Ellen N. La Motte (1873-1961) provides compelling food for thought as the world wrestles with the COVID-19 pandemic, one that is affecting racial and ethnic minorities in the United States at a rate five times that of non-Hispanic whites. When La Motte graduated from the Johns Hopkins Training School for Nurses in 1902, Baltimore, Maryland – like many other densely packed urban areas around the world – was struggling to contain the spread of tuberculosis. It affected all citizens but African Americans and the poor, packed into small living spaces and without access to sufficient food and healthcare, suffered at significantly higher rates.
Public health advocates like La Motte recognized these differences but typically attributed them to the failings and weaknesses of individuals instead of to the legacy of slavery, structural racism, and classism. For much of the eight years she spent as a tuberculosis nurse and then as the head of Baltimore’s Health Department from 1905-1913, she published articles in which she castigated African Americans and the poor for lacking the discipline to adhere to the strict protocols prescribed to curb the spread of tuberculosis, which often included following a diet patients could not afford and maintaining standards in the home that were impossible to follow because of overcrowding and poor housing conditions.
La Motte was typical of white middle-class practitioners in the way she filtered her understanding of the causes and treatment of disease through the lenses of race and class; however, she was unusual in her aggressive assertion of the primacy of the community over the rights of the individual. She relentlessly advocated for surveilling and if necessary isolating tubercular patients and removing advanced cases to sanitoria as the only ways to safeguard against the spread of the disease. Many of her contemporaries objected to these measures as extreme, particularly when they meant breaking up families. La Motte never relented however and argued her position formidably in her first book, The Tuberculosis Nurse (1915).
Since the start of the pandemic, I have frequently revisited La Motte’s strong stance, one articulated in statements such as the following, “The one objection… is the seeming interference with the personal liberty of the individual, but to curtail the liberty of the patient to transmit a communicable disease, is to increase the liberty of hundreds to escape it. There should be no question as to which has the superior claim.” In the United States, public health recommendations such as masking, have been politicized. Measures that should be unquestionably followed to protect the larger community have thereby been twisted into assaults on individual liberty, a grotesque mockery of the concept of freedom that public officials today are combatting as diligently as La Motte did over a hundred years ago.
As she matured as an executive after being named the Head of the Tuberculosis Division in 1910, she expanded her discussion of the best ways to prevent the disease by looking more closely at some of the structural issues at work that made it difficult to control tuberculosis: poverty and lack of access to high quality food, housing, and healthcare. This broader perspective is reflected in her observation that “the root cause of these conditions is our present economic system, which produces an excess of luxury and frivolity on the one hand, and on the other an army of people who must forego the barest necessities of life. One class is maintained at the expense of the other. Every movement which seeks to abolish this injustice, and to substantiate a fairer and more equitable system, is a movement which at the same time tends to raise the standard of public health.”
Although she tied economic inequality to the difficulty of safeguarding the community’s health, she never subjected racism to the same kind of examination, and the current pandemic has revealed that there are still dangerous inequities that persist in the essential area of public health. As my book examines, despite some of the shortcomings of her approach, La Motte used public health as her touchstone: forged by what she learned about safeguarding the interests and safety of the larger community through public health work, she went on to be an activist on behalf of the vote for women, wrote a searing condemnation of the First World War based on her experiences nursing at the front, The Backwash of War (1916), and spent three decades crusading against the opium trade, which she identified as a particular threat to colonized people. Through an examination of her life and work, we can appreciate the way approaches to public health policies intersect with race, class, politics, war, and drug policies, topics that are still of crucial importance today.
Lea M. Williams, Professor of English at Norwich University, Vermont, USA, specializes in the literature of war. She has written several articles and a book-length biography of La Motte, Ellen N. La Motte: Nurse, writer, activist, published in 2019.
 Ellen N. La Motte, The Tuberculosis Nurse, History of American Nursing (1915; reprint, New York: Garland, 1985), 272.
 Ibid., 283-284.