Image found at: https://www.history.com/news/10-things-you-may-not-know-about-typhoid-mary
When we left off last time, Mary Mallon, a suspected carrier of typhoid fever, had been tracked down by investigator George Soper, who requested fecal and urine samples from her. She promptly refused to comply. (Let’s be honest, if some guy shows up and asks you to give him some of your pee and poop, wouldn’t you refuse?)
Undeterred, Soper resumed his investigation and discovered that Mallon had worked as a cook for eight families, seven of members of which had developed typhoid fever. That was enough. Soper went to law enforcement and presented the evidence. Shortly thereafter, he showed up at Mallon’s workplace with five policemen. Although Mary attempted to elude them, she was captured and escorted to Riverside Hospital.
At the hospital, Mallon tested positive as a carrier of typhoid bacteria. Follow-up tests confirmed the original diagnosis and she was sent into quarantine in small house on the grounds of the hospital, which was situated on North Brother Island. There was no way for her to escape. Mallon was stuck.
Soper’s dogged pursuit of Mary Mallon may be the first incidence of locating a “healthy carrier,” or as we know it today an “asymptomatic carrier.” What Soper learned was groundbreaking and on June 15, 1907, the Journal of the American Medical Association (JAMA) published his article about the investigation.
That said, there is a tragic element to this medical investigation story that involves communication. Mallon never believed that she was a carrier of typhoid fever nor that she could infect others. The doctors around her either did not or would not adequately communicate the why’s and wherefores of her situation to her. As a result, Mallon continued to insist that she was not sick. It is no surprise then that when physicians offered to remove her gallbladder, which they claimed would also remove the Salmonella typhi from her body, Mallon flatly refused. Her refusal was interpreted by the medical community as stubbornness or foolishness.
To add insult to injury, in 1909, The New York American gave her a nickname, “Typhoid Mary,” which took off like one of today’s Facebook memes.
At that point, Mallon had had enough and sued the New York City Department of Health to be released from the Riverside. Her case went all the way to the Supreme Court, but the court ruled against releasing her. However, in 1910, a new city health commissioner took over and decided that Mallon could be discharged. There was only one caveat: she must never take another job as a cook again. Mallon agreed and went on her way.
However, since she still did not believe that she was ill and did not believe that she could make others ill, Mallon ignored her agreement with the city and found work as a cook in the New York-New Jersey area.
Five years later, when a new outbreak of typhoid fever made 25 people sick at Sloane Maternity Hospital, Soper found himself on the job again. This time he traced the epidemic to a woman by the name of “Mrs. Brown,” and was surprised to discover that “Mrs. Brown” was in fact Mary Mallon.
Once again, Mallon was packed up and sent to Riverside Hospital, where stayed for the rest of her life, dying on North Brother Island in 1938. Records indicate that she passed to the disease to 51 people, three of whom died, although, Nina Strochlic notes, the “number of cases was probably much higher.”
The truly tragic part of the story was how Mallon was perceived and portrayed by the medical community and the press. The nickname, “Typhoid Mary,” was insulting. The doctors did not appear interested in explaining to Mary how she could give a disease to others and not feel ill herself. Strochlic suggests that Mallon most likely was not an educated woman and did not understand why she needed to be quarantined and give up her career as a cook. If that was the case, then the physicians should have exercised some patience and compassion for her.
The Marinelli, et. al. paper in Annals of Gastroenterology expands on Mallon’s situation: “Instead of working with her, to make her realize she was a risk factor, the state quarantined her twice, making her a laboratory pet. Mary endured test after test and was only thinking of how she could cook again. She had become a victim of the health laws, of the press and above all of the cynical physicians, who had plenty of time to test but never had time to talk with the patient.”
Even Soper noticed the issue. Strochlic quotes him as saying, “The story of Typhoid Mary indicates how difficult it is to teach infected people to guard against infecting others.”
Fortunately, though, the situation with Mary Mallon did have a positive effect for future carriers. Strochlic adds, “But the authorities had already changed the way they responded to such threats. At the time of Mallon’s death, more than 400 healthy carriers of typhoid… had been identified by New York officials, and none had been forced into confinement.”
Educating a population about disease, locating asymptomatic carriers, and encouraging citizens to take efforts to protect themselves and others is not easy, as we know today. The situation is best summed up by the Annals of Gastroenterology paper:
Mary’s case is a perfect example of how the Health Care system provokes social attitudes towards disease carriers, often associated with prejudice. This case highlighted the problematic nature of the subject and the need for an enhanced medical and legal-social treatment model aimed at improving the status of disease carriers and limiting their impact on society. Probably the answer to the rhetorical question “was Mary Mallon a symbol of the threat to individual liberty or a necessary sacrifice to public health?” is a single word, “balance”. After all what Mary ever wanted was to be a good plain cook.
In short, the sad tale of Mary Mallon can teach us something. Managing an epidemic or pandemic is akin to walking a tightrope without a net. While we all may have differing opinions on what needs to be done and when, I think we also need to be careful to communicate well and not allow our differences to shake that tightrope. Because if we shake it enough, we just might fall off.
Janet R. Stafford
Filio Marineli, Gregory Tsoucalas, Marianna Karamanou, George Androutsos, “Mary Mallon (1869-1938) and the history of typhoid fever,” History in Gastroenterology, Annals of Gastroenterology (2013) 26, 132-134. The History of Vaccines (from the College of Physicians of Philadelphia)
Nina Strochlic, “Typhoid Mary's tragic tale exposed the health impacts of 'super-spreaders',” Coronavirus Coverage, History, National Geographic, 27 March 2020.
Janet Stafford, Squeaking Pips Founder