Typhoid Mary

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Mary Mallon
Mary Mallon (Typhoid Mary).jpg
Mallon in isolation
Born(1869-09-23)September 23, 1869
Cookstown, County Tyrone, Ireland (present-day Northern Ireland)
DiedNovember 11, 1938(1938-11-11) (aged 69)
North Brother Island, East River, New York
ResidenceUnited States
NationalityBritish subject by birth; American citizen by naturalization after immigration
Other namesMary Brown
EthnicityIrish
Known forHealthy carrier of typhoid fever
 
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Mary Mallon
Mary Mallon (Typhoid Mary).jpg
Mallon in isolation
Born(1869-09-23)September 23, 1869
Cookstown, County Tyrone, Ireland (present-day Northern Ireland)
DiedNovember 11, 1938(1938-11-11) (aged 69)
North Brother Island, East River, New York
ResidenceUnited States
NationalityBritish subject by birth; American citizen by naturalization after immigration
Other namesMary Brown
EthnicityIrish
Known forHealthy carrier of typhoid fever

Mary Mallon (September 23, 1869 – November 11, 1938), better known as Typhoid Mary, was the first person in the United States identified as an asymptomatic carrier of the pathogen associated with typhoid fever. She was presumed to have infected some 49 people, three of whom died, over the course of her career as a cook.[1] She was forcibly isolated twice by public health authorities and died after a total of nearly three decades in isolation.

Early life[edit]

Mary Mallon was born in 1869 in Cookstown, County Tyrone, Ireland (now Northern Ireland). She emigrated from Ireland to the United States in 1884.[citation needed]

Career[edit]

From 1900 to 1907 she worked as a cook in the New York City area.[citation needed] In 1900, Mary worked in Mamaroneck, New York, where, within two weeks of her employment, residents developed typhoid fever. In 1901 she moved to Manhattan, where members of the family for whom she worked developed fevers and diarrhea, and the laundress died. Mallon then went to work for a lawyer, until seven of the eight household members developed typhoid.[2]

In 1906, she took a position in Oyster Bay, Long Island, and within two weeks ten of eleven family members were hospitalized with typhoid. She changed jobs again, and similar occurrences happened in three more households.[citation needed] She worked as a cook for the family of a wealthy New York banker, Charles Henry Warren. When the Warrens rented a house in Oyster Bay for the summer of 1906, Mallon came along. From August 27 to September 3, six of the eleven people in the family came down with typhoid fever. The disease at that time was "unusual" in Oyster Bay, according to three medical doctors who practiced there.[citation needed] Mary was subsequently hired by other families, and outbreaks followed her.[2]

Investigation[edit]

In late 1906, one family hired a typhoid researcher named George Soper to investigate. Soper published the results on June 15, 1907 in the Journal of the American Medical Association. He believed Mary Mallon might be the source of the outbreak.[3] He wrote:

"It was found that the family changed cooks on August 4. This was about three weeks before the typhoid epidemic broke out. She remained in the family only a short time, leaving about three weeks after the outbreak occurred. The cook was described as an Irish woman about 40 years of age, tall, heavy, single. She seemed to be in perfect health."

Soper discovered the common element in the outbreaks was an unmarried, heavyset Irish cook, about forty years old. No one knew her whereabouts. After each case she left and gave no forwarding address. Soper traced her to an active outbreak in a Park Avenue penthouse — two servants were hospitalized and the daughter of the family died.[2]

When Soper approached Mallon about her possible role in spreading typhoid, she adamantly rejected his request for urine and stool samples.[4] Since Mary refused to give urine and stool samples, he decided to compile a five-year history of Mary's employment. Soper found that of the eight families that hired Mallon as a cook, seven claimed to have gotten typhoid fever.[5] On his next visit, he brought another doctor with him but again was turned away. During a later encounter when Mary was herself hospitalized, he told her he would write a book and give her all the royalties. She angrily rejected his proposal and locked herself in the bathroom until he left.[citation needed]

First quarantine (1907–1910)[edit]

Mary Mallon (foreground) in a hospital bed during her first quarantine.

The New York City Health Department finally sent Dr. Sara Josephine Baker to talk to Mary Mallon. Baker stated "by that time she was convinced that the law was only persecuting her when she had done nothing wrong." A few days later, Baker arrived at Mary's workplace with several police officers, who took her into custody.[citation needed]

Mary attracted so much media attention that in a 1908 issue of the Journal of the American Medical Association she was called "typhoid Mary". Later, in a textbook that defined typhoid fever, she was called "Typhoid Mary" with a capital "T".[5]

Under questioning, Mallon said she rarely washed her hands when cooking and felt there was no need to do so. Cultures of Mary's urine and stools, taken forcibly with the help of prison matrons, revealed that her gallbladder was teeming with typhoid salmonella. She refused to have her gallbladder extracted or to give up her occupation as a cook, maintaining stubbornly that she did not carry any disease.[2]

The New York City Health Inspector determined her to be a carrier. Under sections 1169 and 1170 of the Greater New York Charter, Mallon was held in isolation for three years at a clinic located on North Brother Island.[2]

Eventually, Dr. Eugene H. Porter, the New York State Commissioner of Health, decided that disease carriers should no longer be kept in isolation. Mallon could be freed if she agreed to stop working as a cook and take reasonable steps to prevent transmitting typhoid to others. On February 19, 1910, Mary agreed that she "[was] prepared to change her occupation (that of a cook), and would give assurance by affidavit that she would upon her release take such hygienic precautions as would protect those with whom she came in contact, from infection". She was released from quarantine and returned to the mainland.[6]

Release, name-change and second quarantine (1915–1938)[edit]

Upon her release, Mallon was given a job as a laundress, which paid less than cooking. She soon changed her name to Mary Brown, and returned to her old occupation. For the next five years, she worked in a number of kitchens; wherever she worked, there were outbreaks of typhoid. However, she changed jobs frequently, and Dr. Soper was unable to find her.[2]

In 1915, a serious epidemic of typhoid erupted among the staff of New York's Sloane Hospital for Women, with twenty-five cases and two fatalities. City health authorities investigated and discovered that an Irish-American woman matching Mallon's description had suddenly disappeared from the kitchen. The police tracked her to an estate on Long Island.[2][6]

Public health authorities arrested Typhoid Mary, returning her to quarantine on North Brother Island on March 27, 1915.[6] She was confined there for the remainder of her life. Mallon became a minor celebrity, and was interviewed by journalists, who were forbidden to accept even a glass of water from her.[2] Later, she was allowed to work as a technician in the island's laboratory, washing bottles.[3]

Death[edit]

A historical poster warning against acting like Typhoid Mary

Mallon spent the rest of her life in quarantine. Six years before her death, she was paralyzed by a stroke. On November 11, 1938, she died of pneumonia at age 69.[1] An autopsy found evidence of live typhoid bacteria in her gallbladder.[2] Mallon's body was cremated, and her ashes were buried at Saint Raymond's Cemetery in the Bronx.[7]

Legacy[edit]

Exactly how many people were infected or killed by her is not known. She refused to cooperate with health authorities, withheld information about her past, and used different pseudonyms when she changed cities. Three deaths have been definitively attributed to her, with estimates running as high as 50.[2]

Mallon was the first healthy typhoid carrier to be identified by medical science, and there was no policy providing guidelines for handling the situation. Some difficulties surrounding her case stemmed from Mallon's vehement denial of her possible role, as she refused to acknowledge any connection between her working as a cook and the typhoid cases. Mallon maintained that she was perfectly healthy, had never had typhoid fever, and could not be the source. Public-health authorities determined that permanent quarantine was the only way to prevent Mallon from causing significant future typhoid outbreaks.[citation needed]

Other healthy typhoid carriers identified in the first quarter of the 20th century include Tony Labella, an Italian immigrant, presumed to have caused over 100 cases (with five deaths); an Adirondack guide dubbed Typhoid John, presumed to have infected 36 people (with two deaths); and Alphonse Cotils, a restaurateur and bakery owner.[citation needed]

Today, Typhoid Mary is a colloquial term for anyone who, knowingly or not, spreads something undesirable.[8]

In August 2013, researchers at the Stanford University School of Medicine announced they were making breakthroughs in understanding the exact science behind asymptomatic carriers such as Mary. The bacteria that causes typhoid may hide in macrophages, a type of immune cell.[9][10]

Individuals can develop typhoid fever after ingesting food or water contaminated during handling by a human carrier. The human carrier may be a healthy person who has survived a previous episode of typhoid fever yet who continues to shed the associated bacteria, Salmonella typhi, in feces and urine. Washing hands with soap before touching or preparing food, washing dishes and utensils with soap and water, and only eating cooked food are all ways to reduce the risk of typhoid infection.[11]

References[edit]

  1. ^ a b "'Typhoid Mary' Dies Of A Stroke At 69. Carrier of Disease, Blamed for 69 Cases and 3 Deaths, but She Was Held Immune". The New York Times. November 12, 1938. Retrieved February 28, 2010. "Mary Mallon, the first carrier of typhoid bacilli identified in America and consequently known as Typhoid Mary, died yesterday in Riverside Hospital on North Brother Island." 
  2. ^ a b c d e f g h i j Dex and McCaff, "Who was Typhoid Mary?" The Straight Dope. Aug 14, 2000
  3. ^ a b Ochs, Ridgely (2007). "Dinner with Typhoid Mary". Newsday. 
  4. ^ Soper, George A. (June 15, 1907). "The work of a chronic typhoid germ distributor". J Am Med Assoc 48: 2019–22. 
  5. ^ a b Satin, Morton (2007). Death in the Pot. New York: Prometheus Books. p. 169. 
  6. ^ a b c "Food Science Curriculum" (PDF). Illinois State Board of Education. p. 118. Retrieved February 9, 2011. 
  7. ^ "Mary Mallon". Find a Grave. Retrieved 3 Dec 2013. 
  8. ^ "Dictionary Reference Website: Typhoid Mary". Dictionary.reference.com. Retrieved 2013-03-29. 
  9. ^ Goldman, Bruce (August 14, 2013). "Scientists get a handle on what made Typhoid Mary’s infectious microbes tick". Stanford School of Medicine.
  10. ^ "'Typhoid Mary' Mystery May Have Been Solved At Last, Scientists Say". The Huffington Post. August 17, 2013.
  11. ^ "Hygiene helps you prevent Typhoid fever". KwaZulu-Natal Department of Health, Government of South Africa. 2001. Retrieved September 19, 2013. 

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