“Typhoid” Mary Mallon

“Typhoid” Mary Mallon Kelly Burkholder-Allen Paul Rega

Typhoid Facts: • Typhoid Fever is caused by salmonella typhi • Characterized by: high fever, diarrhea, GI irritation, malaise, and headache • Water and food were the sources of contamination • In the early 1900’s Typhoid Fever had a mortality rate of about 10% • Immunization not developed until 1911 • Antibiotics treatment was not available until 1948, mortality rate remained 10% in developing countries • Today’s mortality rate in developing countries is approximately 1% • In 1906, there were 3,000 cases in the State of NY • 3% “carrier rate” was estimated to be the “norm” during Mary’s time

Mary Mallon • Born 9-23-1869 in Cookstown, Ireland • Emigrated to the US 1884, like many other Irish women of her generation • Worked in a variety of domestic positions prior to settling into her career as a cook • Worked for many wealthy families of Manhattan • Carried the distinction of being the first “healthy carrier” of Typhoid Fever discovered in the US • Spent 26 years in forced quarantine by the Department of Health, City of New York • Lived in isolation in a cabin on North Brother Island, near the Bronx and Rykers Island

Typhoid Mary • Known to have infected 47 people (including 3 deaths) • Mary Mallon’s nickname of “Typhoid Mary” has become synonymous with the spread of disease—it became such legend that she was “credited” with having infected hundreds, maybe thousands • Was forced into quarantined on two separate occasions on North Brother Island for a total of 26 years---without ever having been tried or convicted of any crime • Died—11-11-1938

Mary’s Story • Worked as a cook for many affluent families in the NYC area during the early 1900’s • In 1906, investment banker, Charles Henry Warren and family rented the summer home on Oyster Bay, Long Island from George Thompson and his family • In August, one of Warren’s children became ill with Typhoid Fever • Within a short period of time six of the eleven household members were ill

As Typhoid Fever was a disease common to the Oyster Bay crowd, Mr. Thompson hired a Sanitarian, George Soper to investigate the cause of the outbreak Although he initially feared that the soft clams were the culprit, that was proven to be incorrect as not all of those stricken had eaten them After a brief investigation, Soper began to suspect the Irish cook as the culprit He obtained her employment history (most cooks and domestic help at that time registered with a handful of agencies) from 1900-1906 From 7 of her past jobs, 22 had been infected with Typhoid Fever and one had died

In March of 1907, Mr. Soper arrived at the home of Mary’s employer in Manhattan requesting stool and blood samples----Mary waived a meat fork at him and denied ever having been ill with Typhoid He then unsuccessfully tracked her home and made similar requests Mary was frequently accused of being the source of contact for hundreds of the ill After enlisting the support of Dr. Biggs of the NYC Department of Health, Dr. Josephine Baker was sent to bring Mary Mallon in for testing Upon arrival at her employer’s home, Dr. Baker and the police were met by an uncooperative Mary who eluded them for 5 hours—finally being apprehended in a closet

Mary once again denied having ever been ill with Typhoid After an uncooperative Mary was forcibly restrained, she was transported to Willard Parker Hospital for blood and stool testing for typhoid Mary’s stool was positive for salmonella typhi Mary was then transferred to North Brother Island to Riverside Hospital—where she was quarantined in a cottage

Health officials based their power to quarantine Mary Mallon on sections 1169 and 1170 of the Greater New York Charter

According to Section 1169: “Board of Health shall use all reasonable means for ascertaining the existence and cause of a disease or peril to life or health and for averting the same throughout the city”

Section 1170: “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 hospital for the treatment of such cases”

In 1909, Mary unsuccessfully sued the health department • During her two year period of confinement, she had120/163 stool samples test positive • Her own independent laboratory tests were however; negative • NO ONE ever attempted to explain to Mary the significance of being a “carrier”, instead they offered to remove her gall bladder • She was unsuccessfully treated with Hexamethylenamin, laxatives, Urotropin, and brewer’s yeast • A post mortem revealed that she shed the salmonella typhi bacteria from her gall stones

In 1910, a new health commissioner vowed to free Mary and assist her with finding suitable employment as a domestic • Mary agreed to the terms of the health commissioner and signed an affadavit stating that she would no longer seek employment as a cook, would register any changes of addresses, and would submit to stool testing • Mary NEVER intended to abide by the agreement, she felt fine and was not sick!

Mary was demonized by public health and the media • She was the butt of jokes, cartoons, and eventually “Typhoid Mary” appeared in medical dictionaries, as a disease carrier

For the next 5 years, Mary worked as a cook in a variety of venues • In 1915, there was a Typhoid Fever outbreak at the Sloane Maternity Hospital in Manhattan---25 ill and 2 dead • The recently hired cook---Mary “Brown” was found to be the source • The public was no longer sympathetic to Mary, as she was now perceived as being malicious in her intent • Mary was placed back on North Brother Island where she remained until her death

During her second period of forced quarantine, she held a variety of jobs at Riverside Hospital, working first as a nurse, an assistant, and finally in the laboratory • Mary sold homemade baked goods to hospital employees from her isolated cottage

Why Mary? • Tony Labella was also a carrier who is responsible for infecting 122 people (including 5 deaths) • Other Typhoid Fever carriers broke public health agreements to “no longer work in the food service industry” and were not so much as fined, let alone CONFINED! • Much speculation remains regarding the treatment that Mary received at the hands of the Department of Health City of New York

Could we become victims to public health laws like Mary? • Do you know what powers your state and local public health departments possess?

References: Anthony Bourdain: Typhoid Mary: An Urban Historical. New York: Bloomsbury, 2001. The following websites: http://www.history1900s.about.com/library/weekly/99062900a.htm http://www.newsday.com/extras/lihistory/7/hs702a.htm http://www.snopes.com/medical/disease/typhoid.htm

“Typhoid” Mary Mallon