Typhoid Mary Has Reappeared

views updated

Typhoid Mary Has Reappeared

Quarantine and Public Health

Newspaper article

By: Anonymous

Date: April 4, 1915

Source: "'Typhoid Mary' Has Reappeared: Human Culture Tube, Herself Immune, Spreads the Disease Wherever She Goes." New York Times (April 4, 1915): SM3.

About the Author: This unattributed article was written by a staff writer for the New York Times, a daily newspaper with a circulation of over one million readers worldwide.

INTRODUCTION

Mary Mallon, a known carrier of typhoid, refused to stop behaving in ways that risked spreading the disease and forced the government to jail her to protect the public health. The first person in North America to be identified as a healthy typhoid carrier, Mallon was an Irish-born cook who worked for wealthy New Yorkers. In 1906, she was employed in the rented summer home of banker Charles Henry Warren in Oyster Bay, Long Island, when typhoid fever struck six people in the household of eleven. The owners of the rental house hired investigators to determine the source of the epidemic. The detectives traced forty-seven cases of typhoid and three deaths to Mallon.

A contagious bacterial disease, typhoid had a fatality rate of 10 percent, although milder cases also occurred. Typhoid bacteria remain in the intestine, liver, and bile ducts until they are transmitted via urine and feces. Victims suffer fever, chills, headaches, malaise, severe cramping, and diarrhea or constipation. The symptoms often continue for over a month. While sick, persons with typhoid weaken and became susceptible to complications such as dehydration or intestinal bleeding.

As a single, working class woman, Mallon needed to work in order to support herself. She was reputedly an excellent cook, but was unaware of the germ theory of disease and of the simple measures, such as hand washing, necessary to prevent spreading disease. Investigators discovered that 30 percent of the bacteria excreted by Mallon in her urine were the bacteria that cause typhoid.

In March 1907, New York City health officials literally dragged Mallon kicking and screaming into a city ambulance. They deposited her in a small cottage on North Brother Island that formed part of the grounds of an isolation hospital. Although she was released for brief periods, Mallon died in captivity in 1938 at the age of sixty-nine, after spending twenty-six years in her island prison.

PRIMARY SOURCE

"TYPHOID MARY" has reappeared. With her has come the usual epidemic of the fever to which she is immune. This time she brought her apparently inexhaustible supply of typhoid bacilli to no less extended a field than the Sloane Maternity Hospital, where, under an assumed name, she had obtained a position as cook.

Here she was dispensing germs daily with the food served up to the patients, employees, doctors, and nurses of the hospital—a total of 281 persons. Twenty-five of this number were attacked by typhoid before the epidemic could be checked….

… At present she is back on North Brother Island, from which she was released nearly three years ago….

… Thanks to the untiring sleuthing of Dr. George A. Soper, sanitary expert of this city, Mary Mallon's case had been called to the attention of the health authorities and rapidly became famous the world over.

This "human culture tube," herself immune to typhoid, but a peripatetic breeding ground for the bacilli, was proved by Dr. Soper to have been responsible for at least seven typhoid epidemics and she has since produced some more. After considerable skirmishing, the authorities landed Mary in 1907 at North Brother Island, against which confinement she vigorously protested. She appealed to the courts and brought a suit for her release and another suit for $50,000, neither of which was successful.

She was finally released on parole. The conditions of her release were that she should report at frequent intervals to the Board of Health and should, under no circumstances, engage in her former profession as cook. For a short time she complied. But after about three months she returned with the complaint that her profession being taken from her, she had lost her chances of making a living for herself, and the city should be responsible. So a position was obtained for her as laundress, but it was only a short time before "Typhoid Mary" had vanished, parole notwithstanding.

This was over two years ago. The Department of Health had heard nothing of her until the investigation of the sudden epidemic in January at the Sloane Hospital … Dr. Soper was called in and soon had the disease under control….

[Soper says:] "Mary Mallon is said to feel that she is the victim of an unjust punishment. I think that if she could get rid of the idea that she is being persecuted and would answer some questions concerning her history, that I might be able to help her in various ways. As it is, I'm afraid that liberty is an impossible privilege to allow her. This, however, is a matter for the Board of Health to decide, and I have no desire to pass my view upon it."

"What is to be done about all the other carriers of whose existence we are for the most part unaware? Shut them up? Isolate them, as in the case of Mary Mallon? No, not if they will act intelligently. But something must be done if typhoid is to be stamped out in this country. And typhoid must be exterminated. It is the last of the filth diseases which formerly ran like wildfire through the civilized world."…

SIGNIFICANCE

The case of Mary Mallon raised serious constitutional questions. The Bill of Rights protects Americans from being seized by the government and held without a jury trial. Mallon's case never came to trial because she committed no crime according to the existing legal statutes. While it may have been morally wrong to transmit typhoid, no law made it illegal to do so. Additionally, no law allowed New York City to confine Mallon indefinitely.

Typhoid Mary also represented a clear-cut case of the necessity to sometimes infringe upon individual rights in order to protect the public. By the beginning of the twentieth century, most Americans agreed that the government should act to prevent disease even when such action occasionally infringed upon the liberty of those who might have stood in the way of such disease prevention. Quarantines were viewed as the price some individuals had to pay to ensure the health of the majority.

The case of Typhoid Mary also represented a turning point for the field of public health. The identification of Mallon gave support to the progressive idea of better living through science. Mallon's case demonstrated that it was possible for humans to conquer disease through the new process of testing for bacteria. Finding Mallon showed that science could identify ostensibly healthy people who could potentially spread disease to the general public.

After Mallon's case, authorities did indeed track down hundreds of New Yorkers who were accused of harboring typhoid bacilli and transmitting the germs to susceptible people. While not all of these typhoid carriers were cooperative with government officials, no other person suffered the treatment that Mallon experienced. Typhoid Mary is unique in American history as the only person to be quarantined indefinitely as a public health menace.

Federal quarantine legislation was first passed by Congress in 1878 in an effort to contain the yellow fever epidemics that occurred in the later nineteenth century. The Public Health Service Act of 1944 clearly defined federal control of quarantine. Traditionally, state health departments were charged with enacting quarantines and compliance by citizens was usually voluntary. Quarantines were used in the twentieth century to help stem the spread of diseases, including typhoid fever, measles, tuberculosis, influenza, and polio, within the United States. Diseases from abroad were held at bay by establishing quarantine stations at every major U.S. port, airport, and border crossing. The term quarantine was clarified to mean separation of a vehicle, person, animal, or material suspected of exposure or carrying a contagious disease, while the term isolation was clarified to mean exclusion of a person or animal who is ill with a disease.

When the Centers for Disease Control and Prevention (CDC) assumed responsibility for quarantine in 1967, the focus broadened to include surveillance of disease outbreaks worldwide. In the modern era, air travel and transport has the potential to spread communicable diseases rapidly. As a result, quarantine has again come to the forefront of scientific concern. In 2004, after the emergence of severe acute respiratory syndrome (SARS) in Asia, President George W. Bush added SARS to the list of diseases included in an executive order for which quarantine can be used. The list also includes include cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, and viral hemorrhagic fevers such as the disease caused by the Ebola virus. In 2005, public health officials considered the potential necessity for quarantine measures in the event of a pandemic of avian (H5N1) influenza.