Brief History of Public Health:
The Age of Bacteria
lConnection made between bacteria and viruses and disease
lPasteurization U.S. adopts the Pure Food and Drug Act
lImportant species of bacteria are isolated and identified including Escherichia coli and staphylococcus
lIdentification of vectors helps battle communicable disease.
lElements of the immune system are identified creating regional laboratories devoted to disease research
lDrinking water and sewage treatment plants causes a decline in typhoid
Connection made between bacteria and viruses and disease
Pasteurization in milk is also applied to “canning” foods, enabling long-term storage of foods
U.S. adopts the Pure Food and Drug Act
Important species of bacteria are isolated and identified including Escherichia coli and staphylococcus. These pathogens continue to be a major cause of diseases today.
Vectors are identified for many diseases. This was an important discovery because controlling vectors meant controlling the spread of disease.
The case of Typhoid Mary.
Mary Mallon seemed a healthy woman when a health inspector knocked on her door in 1907, yet she was the cause of several typhoid outbreaks. Since Mary was the first "healthy carrier" of typhoid fever in the United States, she did not understand how someone not sick could spread disease - so she tried to fight back. After a trial and then a short run from health officials, Mary was recaptured and forced to live in relative seclusion upon North Brother Island. Who was Mary Mallon and how did she spread typhoid fever?
An Investigation
For the summer of 1906, New York banker Charles Henry Warren wanted to take his family on vacation. They rented a summer home from George Thompson and his wife in Oyster Bay, Long Island. Also for the summer, the Warrens hired Marry Mallon to be their cook. On August 27, one of the Warren's daughters became ill with typhoid fever. Soon, Mrs. Warren and two maids became ill; followed by the gardener and another Warren daughter. In total, six of the eleven people in the house came down with typhoid.
Since the common ways typhoid spread was through water or food sources, the owners of the home feared they would not be able to rent the property again without first discovering the source of the outbreak. Thus, the Thompsons hired investigators to find the cause.
Unfortunately, the investigators were unable to determine the cause so the Thompsons hired George Soper, a civil engineer with experience in typhoid fever outbreaks. It was Soper who believed the recently hired cook, Mary Mallon, was the cause. Mallon had left the Warren's approximately three weeks after the outbreak. Soper began to research her employment history for more clues.
Mary Mallon was born on September 23, 1869 in Cookstown, Ireland. According to what she told friends, Mallon emigrated to America around the age of 15. Like most Irish immigrant women, Mallon found a job as a domestic servant. Finding she had a talent for cooking, Mallon became a cook, which paid better wages than many other domestic service positions.
Soper was able to trace Mallon's employment history back to 1900. He found that typhoid outbreaks had followed Mallon from job to job. From 1900 to 1907, Soper found Mallon had worked at seven jobs in which 22 people had become ill, including one young girl who died, with typhoid fever shortly after Mallon had come to work for them.1
Soper was satisfied that this was much more than a coincidence; yet, he still needed proof to scientifically determine that Mallon was the cause. Soper needed stool and blood samples from Mallon.
In March 1907, Soper found Mallon working as a cook in the home of Walter Bowen and his family. To get samples from Mallon, he approached her at her place of work. Having a strange man come up to you, to accuse you (who seems completely healthy) of spreading disease and of killing people and then be asked for some of your blood and excrement, well, it does seem it would make just about anybody skeptical.
I had my first talk with Mary in the kitchen of this house. . . . I was as diplomatic as possible, but I had to say I suspected her of making people sick and that I wanted specimens of her urine, feces and blood. It did not take Mary long to react to this suggestion. She seized a carving fork and advanced in my direction. I passed rapidly down the long narrow hall, through the tall iron gate, . . . and so to the sidewalk. I felt rather lucky to escape.2 This violent reaction from Mallon did not stop Soper. Soper tracked Mallon to her home. He tried to approach her again, but this time, he brought an assistant (Dr. Bert Raymond Hoobler) for support. Again, Mallon became enraged, made clear they were unwelcome and shouted expletives at them as they made a hurried departure. Realizing it was going to take more persuasiveness than he was able to offer, Soper handed his research and hypothesis over to Hermann Biggs at the New York City Health Department. Biggs agreed with Soper's hypothesis. Biggs sent Dr. S. Josephine Baker to talk to Mallon.
Mallon, who was now extremely suspicious of these health officials, refused to listen to Baker, Baker returned with the aid of five police officers and an ambulance. Mallon was prepared this time. Baker describes the scene:
Mary was on the lookout and peered out, a long kitchen fork in her hand like a rapier. As she lunged at me with the fork, I stepped back, recoiled on the policeman and so confused matters that, by the time we got through the door, Mary had disappeared. 'Disappear' is too matter-of-fact a word; she had completely vanished.3 Baker and the police searched the house. The servants claimed ignorance as to Mallon's whereabouts. Eventually, footprints were spotted leading from the house to a chair placed next to a fence. Over the fence was a neighbor's property. They spent five hours searching both properties, until, finally, they found "a tiny scrap of blue calico caught in the door of the areaway closet under the high outside stairway leading to the front door."4 Since the closet was covered by a dozen ash cans, it had escaped searching thus far (meaning that another servant must have helped Mallon hide).
Baker describes the emergence of Mallon from the closet:
She came out fighting and swearing, both of which she could do with appalling efficiency and vigor. I made another effort to talk to her sensibly and asked her again to let me have the specimens, but it was of no use. By that time she was convinced that the law was wantonly persecuting her, when she had done nothing wrong. She knew she had never had typhoid fever; she was maniacal in her integrity. There was nothing I could do but take her with us. The policemen lifted her into the ambulance and I literally sat on her all the way to the hospital; it was like being in a cage with an angry lion.5 Mallon was taken to the Willard Parker Hospital in New York. There, samples were taken and examined in a laboratory. Typhoid bacilli were found in her stool. The health department then transferred Mallon to an isolated cottage (part of the Riverside Hospital) on North Brother Island (in the East River near the Bronx).
Mary Mallon was taken by force and against her will and was held without a trial. She had not broken any laws. So how could the government lock her up in isolation indefinitely? That's not easy to answer. The health officials were basing their power on sections 1169 and 1170 of the Greater New York Charter:
The board of health shall use all reasonable means for ascertaining the existence and cause of disease or peril to life or health, and for averting the same, throughout the city. [Section 1169] Said board may remove or cause to be removed to [a] proper place to be by it designated, any person sick with any contagious, pestilential or infectious disease; shall have exclusive charge and control of the hospitals for the treatment of such cases. [Section 1170]6
This charter was written before anyone knew of "healthy carriers" - people who seemed healthy but carried a contagious form of a disease that could infect others. Health officials believed healthy carriers to be more dangerous than those sick with the disease because there is no way to visually identify a healthy carrier in order to avoid them. But to many, locking up a healthy person seemed wrong. Where should the line between an individual's rights and the protection of society be drawn?
Freedom
Mary Mallon believed she was being unfairly persecuted. Wasn't she healthy? She could not understand how she could have spread disease and caused a death when she, herself, was healthy. I never had typhoid in my life, and have always been healthy. Why should I be banished like a leper and compelled to live in solitary confinement with only a dog for a companion?7 In 1909, after having been isolated for two years on North Brother Island, Mallon sued the health department. During Mallon's confinement, health officials had taken and analyzed stool samples from Mallon approximately once a week. The samples came back intermittently positive with typhoid, but mostly positive (120 of 163 samples tested positive).8 For nearly a year preceding the trial, Mallon also sent samples of her stool to a private lab where all her samples tested negative for typhoid. Feeling healthy and with her own lab results, Mallon believed she was being unfairly held.
This contention that I am a perpetual menace in the spread of typhoid germs is not true. My own doctors say I have no typhoid germs. I am an innocent human being. I have committed no crime and I am treated like an outcast - a criminal. It is unjust, outrageous, uncivilized. It seems incredible that in a Christian community a defenseless woman can be treated in this manner.9 Mallon did not understand a lot about typhoid fever and, unfortunately, no one tried to explain it to her. Not all people have a strong bout of typhoid fever; some people can have such a weak case that they only experience flu-like symptoms. Thus, Mallon could have had typhoid fever but never known it. Though commonly known at the time that typhoid could be spread by water or food products, people who are infected by the tyhpoid bacillus could also pass the disease from their infected stool onto food via unwashed hands. For this reason, infected persons who were cooks (like Mallon) or food handlers had the most likelihood of spreading the disease. The judge ruled in favor of the health officials and Mallon, now popularly known as "Typhoid Mary," "is remanded to the custody of the Board of Health of the City of New York."10 Mallon went back to the isolated cottage on North Brother Island with little hope of being released.
In February of 1910, a new health commissioner decided that Mallon could go free as long as she agreed never to work as a cook again. Anxious to regain her freedom, Mallon accepted the conditions. On February 19, 1910, Mary Mallon agreed that she "is prepared to change her occupation (that of cook), and will give assurance by affidavit that she will upon her release take such hygienic precautions as will protect those with whom she comes in contact, from infection."11 As part of the agreement, Mallon was also responsible for regularly showing up for more fecal samples and if she changed her address, she was supposed to notify the health department.
Recapture
Some people believe that Mallon never had any intention of following the health officials' rules; thus they believe Mallon had a malicious intent with her cooking. But not working as a cook pushed Mallon into service in other domestic positions which did not pay as well. Feeling healthy, Mallon still did not really believe that she could spread typhoid. Though in the beginning Mallon tried to be a laundress as well as worked at other jobs, for a reason that has not been left in any documents, Mallon eventually went back to working as a cook. In January of 1915 (nearly five years after Mallon's release), the Sloane Maternity Hospital in Manhattan suffered a typhoid fever outbreak. Twenty-five people became ill and two of them died.
Soon, evidence pointed to a recently-hired cook, Mrs. Brown, who turned out to be Mary Mallon using a pseudonym.
If the public had shown Mary Mallon some sympathy during her first period of confinement because she was an unwitting typhoid carrier, all of the sympathy disappeared after her recapture. This time, Typhoid Mary knew of her healthy carrier status - even it she didn't believe it - thus she willingly and knowingly caused pain and death to her victims. Using a pseudonym made even more people feel that Mallon knew she was guilty.
Mallon was again sent to North Brother Island to live in the same isolated cottage that she had inhabited during her last confinement. For twenty-three more years, Mary Mallon remained imprisoned on the island.
The exact life she led on the island is unclear, but it is known that she helped around the hospital, gaining the title "nurse" in 1922 and then "hospital helper" sometime later. In 1925, Mallon began to help in the hospital's lab.
In December 1932, Mary Mallon suffered a large stroke that left her paralyzed. She was then transferred from her cottage to a bed in the children's ward of the hospital on the island, where she stayed until her death six years later, on November 11, 1938.
Typhoid Mary Lives On
Since Mary Mallon's death, the name "Typhoid Mary" has grown into a term disassociated from the person. Anyone who has a contagious illness can be termed, sometimes jokingly, a "Typhoid Mary." If someone changes their jobs frequently, they are sometimes referred to as a "Typhoid Mary." (Mary Mallon changed jobs frequently. Some people believed it to be because she knew she was guilty, but most probably it was because domestic jobs during the time were not long lasting service jobs.) But why does everyone know about Typhoid Mary? Though Mallon was the first carrier found, she was not the only healthy carrier of typhoid during that time. An estimated 3,000 to 4,500 new cases of typhoid fever were reported in New York City alone and it was estimated that about three percent of those who had typhoid fever become carriers, creating 90-135 new carriers a year.
Mallon was also not the most deadly. Forty-seven illnesses and three deaths were attributed to Mallon while Tony Labella (another healthy carrier) caused 122 people to become ill and five deaths. Labella was isolated for two weeks and then released.
Mallon was not the only healthy carrier who broke the health officials' rules after being told of their contagious status. Alphonse Cotils, a restaurant and bakery owner, was told not to prepare food for other people. When health officials found him back at work, they agreed to let go free when he promised to conduct his business over the phone.
So why is Mary Mallon so infamously remembered as "Typhoid Mary"? Why was she the only healthy carrier isolated for life? These are hard to answer. Judith Leavitt, author of Typhoid Mary, believes that her personal identity contributed to the extreme treatment she received from health officials. Leavitt claims that there was prejudice against Mallon not only for being Irish and a woman, but also for being a domestic servant, not having a family, not being considered a "bread earner," having a temper, and not believing in her carrier status.12
During her life, Mary Mallon experienced extreme punishment for something in which she had no control and, for whatever reason, has gone down in history as the evasive and malicious "Typhoid Mary."