Typhoid Mary PDF: A Historical Case Study

# Patient Zero (Revised Edition): Solving the Mystery of Typhoid Mary ## A Warm Summer Evening "Oh, cook, I just had to come and talk to you about this evening's dinner." Mrs. Warren was rarely seen in the kitchen of the family's grand rented summer house at Oyster Bay, Long Island, and when she...

# Patient Zero (Revised Edition): Solving the Mystery of Typhoid Mary ## A Warm Summer Evening "Oh, cook, I just had to come and talk to you about this evening's dinner." Mrs. Warren was rarely seen in the kitchen of the family's grand rented summer house at Oyster Bay, Long Island, and when she did appear, the cook noticed that it always caused a commotion among the staff. Not surprising, really. Mary had worked for many wealthy families over the years, and in her experience the lady of the house generally came to the kitchen only to complain. She'd been cooking for the Warren family in this fashionable summer resort town for almost three weeks now, so she was probably overdue for a scolding. The clams she'd served tonight-had they smelled a little off? Rich New York City folks could be terribly sensitive, she knew that. Mary hoped she wasn't going to be fired-it had been hard enough finding this job, and she didn't look forward to the thought of pounding the pavement to look for work again so soon. But to her relief, she realized Mrs. Warren had come to the kitchen to praise her: “The clams were so tender-sublime! And the dessert! So refreshing, just the thing for a warm summer evening. My daughters were in heaven. What do you call that dessert?" "It's Peach Melba, ma'am. Very fashionable just now. All the best New York restaurants are serving it, they say." "Peach Melba. How wonderful! You must make it for us again. I am very pleased with you, cook, and I intend to keep you on in the fall. I imagine that suits you?" "Yes, ma'am. Thank you, ma'am.” “Fine. Good evening, Mary." ## A Shameful Disease The Warrens' cook, Mary Mallon, went to bed that night glad to have a steady job for the fall. She would happily please her employers with more special desserts. A peach pie, perhaps? But there would be no more elaborate meals cooked for the Warren family that summer. A few days later, on August 27, 1906, the household awoke to turmoil: Margaret, one of the Warrens' daughters, was seriously ill. Margaret had gone to bed early complaining of a bad headache. By morning it was worse, and soon she was doubled over with stomach cramps. As the day wore on, Margaret developed a violent cough, and her mother noticed that the girl's skin was hot and dry, almost burning to the touch. That afternoon, one of the maids collapsed and had to be sent to bed. Then the gardener drooped over his rake, and he too had to be helped into bed. By the evening, the Warrens' second daughter had joined her sister in the sickroom. Finally, Mrs. Warren herself was stricken. More than half the members of the household were now fighting for their lives. Doctors were called in, first from the nearby town, then specialists from New York City. Private nurses in white uniforms whisked down the corridors, carrying cups of broth on silver trays. There were grave faces, and whispered conferences between the medical men. Finally, the diagnosis was delivered. ## Typhoid Fever Typhoid! It was unthinkable. Wealthy New York bankers' wives and daughters were not supposed to get typhoid, not in 1906. Not in fashionable resort towns like Oyster Bay, Long Island. Typhoid was a disease of the poor. It meant you didn't have proper standards of hygiene in your home. Immigrants, laborers, servants-those were the people who fell ill with typhoid, not the rich and privileged. Outraged, Charles Warren demanded an explanation from the owner of the summer house, George Thompson. Thompson was worried: If he couldn't find the source of the disease, his luxury summer house might get a bad reputation, and then how would he rent it out next year? If people in New York heard that typhoid was running rampant in Oyster Bay, it could hurt the whole town. And he had four other houses to rent each summer. This mystery needed to be cleared up, quickly and discreetly. Thompson started asking around for an investigator with a scientific or medical background. A few weeks later, Thompson found just the man for the job: George Soper. ## Tracking the Suspect George designed and managed sewer systems for a living, so he knew a lot about how disease could be spread through water contaminated by human waste. He had made a name for himself as an investigator by tracking down the source of a typhoid epidemic in Ithaca, New York, a few years earlier. Now, he packed his bags for Oyster Bay. The first thing George did was check the house's plumbing. He put colored dye in the Warrens' toilet and flushed it, to see if it would show up in the home's drinking water. The water from the taps remained clear and colorless. Next, he looked for leaks in the home's cesspool, where the waste collected: it was fine. Contaminated milk was a frequent source of typhoid, yet the dairy that supplied the Warren family was spotlessly clean. One by one, George eliminated the usual suspects for a typhoid outbreak. Finding the source wasn't going to be as easy as he had hoped. George interviewed all the family members, trying to sniff out something unusual that might have happened in the days leading up to the outbreak. Someone recalled that they'd all eaten clams bought from a local woman on the beach. George checked, but none of the clam seller's other customers had gotten sick—it wasn't a case of contaminated shellfish. Still, it made George wonder if something the family had eaten might have picked up contamination in the kitchen. He went to talk to the kitchen staff, and he heard something that made his ears perk up. The family's cook, hired just three weeks before everyone got sick, had recently quit. He asked more about the cook, an Irish woman whose specialty was a dessert of peaches and ice cream called Peach Melba. Listening to the family sing the cook's praises, George realized that she could have passed microbes to them when she handled the uncooked fruit. New cook hired. Family gets ill. New cook leaves suddenly without any explanation. It was highly suspicious behavior, in George's opinion. He asked for the cook's name. "It's Mary. Mary Mallon." ## The Doctor's Plague Today, every kid learns about the importance of handwashing. Clean hands are one of the most effective ways of preventing the transmission of communicable diseases. But not too long ago, even doctors didn't bother washing their hands. When one doctor pointed out that clean hands seemed to help keep patients from dying, his colleagues felt so insulted that they ran him out of the profession. In 1847, Ignaz Semmelweis was working at the maternity clinic of the Vienna General Hospital in Austria. At that time, 10 percent of women who came to the hospital to give birth died from a bacterial infection called puerperal fever. Dr. Semmelweis suspected the doctors were passing the infection from woman to woman, and he asked them to try washing their hands in water and bleach before each delivery. When they did, rates of puerperal fever at the hospital dropped to less than 2 percent. Handwashing worked, but Semmelweis couldn't explain why. When he presented his findings and argued that all doctors should wash their hands, the hospital fired him. He was forced to leave Vienna, and he had difficulty finding work as a doctor ever again. Twenty years later, Louis Pasteur proved that microscopic organisms cause disease, and suddenly Semmelweis's insistence on handwashing began to seem more reasonable. In the 1880s, when a British surgeon called Joseph Lister started sterilizing surgical instruments, many more people survived operations. Doctors were cleaning up their act. ## Putting Disease Under the Microscope When George Soper barged into Mary Mallon's kitchen demanding samples of her blood, urine and feces, she must have thought he was out of his mind. In 1907, laboratory tests to identify bacteria in human body fluids were still very new, and the idea that a doctor could diagnose a disease by looking at a tiny blood sample under a microscope sounded ridiculous to most people. But George Soper's unusual request showed that he was familiar with the most cutting-edge medical developments of his time. Thirty years earlier, the bacteria that causes typhoid, Salmonella typhi, had been identified. ## Round Two Unfortunately for Mary, that wasn't the end of it. Very soon, George returned, bringing backup with him. Dr. Josephine Baker was a medical officer with the New York City Health Department. As one of the city's only female doctors, it was her job to get urine and feces samples from Mary to prove whether or not she was a typhoid carrier. As George Soper had already discovered, it wasn't an easy assignment. When Dr. Baker and two burly New York City policemen showed up, Mary Mallon was suddenly nowhere to be found -and none of the other kitchen staff would tell them where she'd gone. Josephine and the police hunted through every closet and cupboard in the house, searching for the fugitive. They were ready to give up when the doctor noticed a bit of colored cloth caught in a closed door. It was the edge of Mary Mallon's long skirt, revealing her hiding spot in a tiny cupboard under the stairs. The doctor and the police had to haul the angry, fighting woman out of the house and into a waiting ambulance. They ignored her when she shouted that she wasn't sick, that she didn't have typhoid, that she'd never been so insulted in her life. Afterward, Josephine remembered how "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." Fecal, blood, and urine samples taken in the hospital confirmed what George Soper had suspected: Mary was a typhoid carrier. In the early 1900s, 350,000 people in the United States became ill with typhoid every year. In New York City alone, there were more than 4,000 cases a year, and the city was trying to clean up its act and reduce the rates of infectious diseases such as typhoid. There were campaigns to clear the streets of garbage, manure, and sewage, and the city was working to establish safe drinking water supplies and sanitation for all its inhabitants. ## Dr. Josephine Baker: Public Health Pioneer Mary Mallon and her captor, Dr. Josephine Baker, had quite a bit in common. They were both single women struggling against the odds to make lives for themselves in New York City. Dr. Baker—or Dr. Joe, as she preferred to be called—had the advantage of an education and a medical license, but that doesn't mean she had it easy. In her first year as a doctor, she made just $185—and she had to split that with another doctor who shared her office. To earn more money, she went to work part-time as a medical inspector. That's how she ended up searching for Mary Mallon. Dr. Joe made many contributions to public health during her long medical career. She was especially interested in the connection between poverty and ill health. In 1907, Dr. Joe was put in charge of the city's new bureau of child hygiene, the first in the country. There, she developed programs that were later picked up in 35 other states: she made sure all children were vaccinated, that free milk was available for children from low-income families, and that people looking after young children got training in the basics of infant care. By 1923, New York City had the lowest child mortality rate of any major city in the U.S., thanks to Dr. Joe. Epidemiologists continue to explore the question of what makes some people healthier than others, and what policymakers and governments can do to ensure that all people remain as healthy as possible. ## Round Three Mary fought back—writing letters, demanding her civil rights, and pleading for help to get her released from quarantine. Three years later, the New York Supreme Court agreed to hear her case. While Mary was on North Brother Island, a surprising thing had happened: 50 other healthy typhoid carriers had been identified, just in the state of New York. Not one of them had been sent to North Brother Island. Health department officials admitted that perhaps they had overreacted. Mary won her case, and her freedom, on the condition that she agree not to work as a cook again. In 1910, after three years as a prisoner of the New York City Health Department, she was allowed to cross the river back to New York City. The health department didn't see it as their responsibility to train Mary for new work. Instead, they gave her a job as a laundress—one of the hardest, worst-paid jobs for a woman at that time. At first, they checked in with her frequently—then, as the weeks and months passed, less and less regularly. Finally, they lost contact with Mary altogether. What was she doing? Where was she living? It seemed no one cared any longer about the healthy carrier who had caused such a stir only a few years before. Then, in 1915, a New York City maternity hospital had an outbreak of typhoid. Twenty-five doctors and nurses got sick. Two died. The hospital employment records showed that a new cook had been hired just weeks before the outbreak. The head of the hospital brought in George Soper and showed him a sample of the cook's handwriting. George knew it right away: “I saw at once that it was indeed Mary Mallon." Just to be sure, George called Josephine Baker to the hospital. "Sure enough," Josephine wrote, “there was Mary, earning her living in the hospital kitchen, spreading typhoid germs among mothers and babies and doctors and nurses, like a destroying angel." The health department sent Mary back to North Brother Island, where she stayed for the next 23 years. Mary died in quarantine in 1938. ## Villain Or Victim? From the beginning, newspapers had a field day reporting on Mary Mallon's case. When an article in the Journal of the American Medical Association in 1908 called her “Typhoid Mary," the tabloids starting using it too. Before long, Typhoid Mary was a household name. Today, we call anyone who spreads disease, intentionally or not, a Typhoid Mary. Mary Mallon's story still fascinates people. Articles and books and plays and movies have been written, looking for answers to the many questions we still have about her. Did she suspect, before George Soper first approached her, that she might have had something to do with the typhoid that struck all the families she worked for? Why did she risk going back to cooking after she'd finally won her freedom from North Brother Island? Was she a villain? Or was she just an ordinary person whose life was ruined by an uncaring system? Mary was a woman, a servant, an Irish immigrant to the United States, unmarried, and with little education. All those things meant she had very little power in the society in which she lived. Yet she wasn't afraid to chase officials away, elude doctors, fight the police, swear, argue, and write angry letters until the courts were forced to take notice of her. Doctors and officials were no doubt surprised to see Mary standing up for herself so fiercely, and her behavior may have branded her as a problem case in their eyes. There's another reason Typhoid Mary's story continues to interest people: it raises questions about how far governments should go when trying to protect the public from epidemics. Was it fair to keep Mary Mallon in isolation for so long? During the SARS epidemic in 2003, the Ebola epidemic in 2014, and again when COVID-19 struck in 2020, people returning from affected areas were ordered into quarantine. Putting people into quarantine, even temporarily, means they may lose their jobs and be unable to provide for their families. Public health officials have to try to balance individuals' rights with the need to protect the public from disease. ## The Irish Potato Epidemic Mary Mallon was one of many Irish people who came to North America in the 1800s and early 1900s. It all started in 1845 when Irish potato farmers discovered their crops were infected with an epidemic of mold: *Phytophthora infestans*. The potato was the farmers' main source of food, and they couldn't eat the rotten, diseased tubers. A million people starved to death during the potato epidemic. Millions more boarded ships and came to North America to start new lives. In New York, landlords rented cheap apartments with no running water or sanitation to the new arrivals. Diseases spread quickly in the crowded buildings. Newspaper articles blamed the outbreaks on the new immigrants, and some people said the United States should close its borders. No one pointed their fingers at the landlords or the city government, who were responsible for the living conditions in the buildings. When Mary Mallon, an Irish immigrant, was identified as the spreader of typhoid, it seemed to confirm the idea that new immigrants were sources of disease. When epidemics strike, people still look for someone to blame. Immigrants, LGBTQ+ people, Jewish people, Muslim people, people of Chinese heritage—they've all become targets. The reality is that the pathogens that cause disease don't look for people of a particular race, belief, or sexuality—all they need is a human body to infect. ## A Vaccine and a World War Typhoid had killed thousands of troops in the Spanish-American War of 1898. So in 1911, when a ist named Almroth Wright developed the disease, army doctors were eager e. They got their chance during World War I. The vaccine became mandatory for all soldiers in the U.S. army, and the results were impressive. During the Spanish-American War, typhoid infected 142 out of every 1,000 soldiers, but in World War I the number fell to less than 1 infection per 1,000. ## Tool of the Trade: Quarantine Quarantines have been used for centuries to contain epidemics, by keeping people who have been exposed to a disease separated from the rest of the population, to see if they get sick. The word “quarantine” comes from the Italian for 40 days: *quaranta giorni*. During the plague pandemic of the 1300s, that's how long the city of Venice made ships wait in the harbor before docking, to be sure no one on board had plague. As the Black Death raced through Europe, other cities began using quarantines. Sometimes entire neighborhoods or towns were sealed off to prevent plague from spreading. But quarantines could backfire. If people in infected cities suspected that a quarantine order was coming, thousands would flee, hoping to get out before they were shut in with the sick and dying. Inevitably, some of the people running away from the quarantine would develop plague, spreading it far and wide. Quarantine is one of the social distancing measures we still use today to control the spread of disease. In 2020, many countries began requiring anyone returning from an area affected by COVID-19 to self-quarantine for at least two weeks. New Zealand instituted a rule that all travelers must report to a quarantine station and stay there for two weeks, returning to their homes only when they tested negative for the COVID-19 virus ## The Cure of Typhoid It is lucky enough to live in a city with a sewer system and a reliable supply of drinking water, chances are you've never had typhoid fever. In most of North America, typhoid is a disease of the "bad places." Before engineers, public health doctors and city planners figured out how to safely handle the human waste generated by cities, typhoid was a common disease, especially in places where large numbers of people lived packed together in unsanitary housing. <start_of_image> It’s important to note that Typhoid fever, which can be fatal, is no longer a major problem in countries like the United States and Canada. However, it is still a serious disease in some countries, particularly in developing nations, and it can cause significant illness and death.