Thursday, 27 March 2014

Typhoid Mary

27th March 1915

This day in history...Typhoid Mary, the first ever healthy carrier of typhoid identified in the US, is put in quarantine for the rest of her life

The case of Mary Mallon was highly unusual and controversial in its day. We can now look back at poor old Typhoid Mary as a medical phenomenon of her time. But we also need to look back at the way she was treated by officials and the cruelty and sadness she experienced in her life. 

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Mary Mallon, aged 39
The beginning: Mary Mallon was born in 1869 in Cookstown, County Tyrone, Ireland (Northern Ireland now). She emigrated to the United States in 1884 when she was just 15, seeking for a better life across the pond. She first worked in housekeeping and was a big boned, tall and hard-working girl. Mary found that she excelled as a cook and from 1990-1907 she worked as a cook in the New York area. In 1900, she worked in Mamaroneck, NY, and within 2 weeks of her employment, the residents developed typhoid fever. She then moved in 1901 to Manhatten, where the members of the family whom she worked for also developed fevers and diarrhoea, and the laundress even died. Mallon again moved on and worked fro a lawyer, until 7-8 household members developed typhoid. In 1906, Mary took a position in Oyster Bay, Long Island, and within 2 weeks, 10-11 family members were hospitalised with typhoid. Coincidence? If a pattern hasn't already emerged; Mary chanced jobs again and similar occurrences happened in 3 more households. A particular family, that of wealthy NY banker Charles Henry Warren, experienced 6 people coming down with typhoid fever. It was an unusual disease in Oyster Bay at the time according to doctors. Basically, wherever Mary went, the typhoid outbreaks followed her. 

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Mary Mallon cooking
Investigations: In 1906 a family, The Thompson's, hired an investigator to find the cause of the spread of typhoid in their area. George Soper, the investigator, had experience with typhoid outbreaks and found that the family had changed cooks 3 weeks before the epidemic broke out. He wrote in the Journal of the American Medical Association that the new cook had:

 'remained in the family only a short time, leaving soon 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.'

Mary had left no forwarding address with any of her previous employers, so it took some time fro Soper to locate her. It wasn't until an active typhoid outbreak in a Park Avenue penthouse that Soper was able to find Mary. This particular case involved 2 servants being hospitalised and the daughter of the family dying. When Soper approached Mary about her possible role in spreading the disease, she obviously rejected his request for urine and stool samples and it is believed that she 'grabbed a carving fork and advanced towards Soper until he fled.' He decided to look into her 5 year history of employment and found 8 families who had hired Mary and had experienced typhoid. Soper then returned to visit Mary with another doctor, but was again refused by Mary. He offered to write a book about her and give her all the royalties. Mary angrily rejected the proposal and is believed to have locked herself in a bathroom until he left. 

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Dr. George Soper
Quarantine:  The New York City Health Department eventually sent Dr. Sara Josephine Baker to talk to Mary. Dr. Baker stated that she thought the law was persecuting Mary for no reason. However, a few days later, Baker returned to Mary's workplace with several police officers and took her into custody. The case attracted lots of media attention and the 1908 issue of the Journal of the American Medical Association nicknamed her 'Typhoid Mary.' Mary was questioned by the police and medical experts and admitted she rarely washed her hand when cooking and felt there was no need to do so. The results from her urine samples - taken forcibly - revealed that her gallbladder was teeming with typhoid salmonella. She refused to have her gallbladder extracted and did not want to give up her cooking occupation. She was adamant that she did not carry any disease. She was later determined as a healthy carrier and under section of the Greater New York Charter, Mary was held in isolation for 3 years at a clinic and cottage in North Brother Island. Eventually it was decided that carriers should no longer be kept in isolation and that Mary would be freed as long as she agreed to stop working as a cook and to take reasonable steps to prevent her spread of typhoid. In 1910, Mary agreed to these conditions and was released. 

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Anti-Mary poster from the 1900s
What happened next: Mary aquired a job as a laundress after her release. The job was menial and paid much less than a cook. She soon changed her name from Mary Mallon to Mary Brown and returned to cooking. For the next 5 years she worked in many kitchens, and just like before, typhoid outbreaks followed her everywhere. Soper was unable to find her as she changed jobs so frequently, kept below the radar, and went under a pseudonym. In 1915, however, a serious epidemic of typhoid erupted in NY's Sloane Hospital for Women, with 25 cases and 2 deaths. City Health investigated and found that an Irish-American woman matching Mary's description had suddenly disappeared from the kitchens. Police tracked her to Long Island. Public health then arrested Mary and returned her to the quarantine in North Brother Island on the 27th March 1915, where she stayed for the rest of her life. Mary became a minor celebrity and was interviewed by a whole range of journalists - they were forbidden to accept even a glass of water from her. She was eventually allowed to work as a technician in the Island's lab, washing bottles. 

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Will remove at owner's request.

Bacteriologist Emma Sherman and
 Mary Mallon (right) at
North Borther Island Clinic
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Mary Mallon in the forefront at North Brother Island

The end: The next 23 years of her life, Mary was confined to her isolation. In 1932 she was paralysed by a stroke and was moved to a bed in a children's ward, where she spent the last 6 years of her life, and in 1938, Mary died of pneumonia, aged 69. Autopsy evidence showed live typhoid bacteria in her gallbladder. Her body was cremated and her ashes buried at Saint Raymond's Cemetery in the Bronx.

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Mary Mallon's tombstone
Her Legacy: No one knows for sure how many people were infected or killed at 'the hands' of Mary Mallon. Most people at the time considered her a horrible, stubborn and selfish woman as she refused to cooperate with health authorities, withheld information about her past, and used different pseudonyms when changing cities. 3 deaths have been directly linked to Mary, but estimates are now running as high as 50. Some believe she was consciously aware of her situation but was scared and didn't want to believe it. She was the first healthy typhoid carrier to be identified by medical science and there was no policy for guidelines handling this situation. This sort of explains the difficulties of her case and why she was treated as a prisoner. There were other healthy typhoid carriers in the 20th Century including Tony Labella, an Italian immigrant and a man nicknamed Typhoid John. Today, Typhoid Mary is a colloquial term for anyone who, knowingly or not, spreads something undesirable. 

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An illustration of Typhoid Mary that appeared in
1909 in The New York American
Some Medical Science: (I'm no doctor so don't kill me if I'm wrong) In August 2013, researched at Stanford University School of Medicine announced they had made breakthroughs in understanding the science behind asymptomatic carriers like Mary. The bacteria that causes typhoid may hide in macrophages, a type of immune cell. Individuals can develop typhoid fever after ingesting food or water contaminated by a human carrier who had handled it. The human carrier may be healthy, but they most probably have survived a previous episode of the disease and continue to shed the bacteria. Washing hands with soap before touching or preparing food, washing dishes and utensils with soap and water, and only eating cooked foods are ways to reduce the risk of typhoid infection. 

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Typhoid Poster 1923
Current Media:There have been many books published on Mary's case and her life. She was even immortalised in Marvel comic books as 'Typhoid Mary', 'Walker', 'Mutant Zero' who was a supervillian, fictional character and enemy of Daredevil and Deadpool. Some films and documentaries have also been made; some academic, intellectual and interesting; others just...awful. For example; Paranormal Asylum: The Revenge of Typhoid Mary (2013). If you click on the title here it will take you to the me...its not scary...its ridiculous. But that's for film critics to decide!

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DVD cover 
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Marvel Comic: Typhoid Mary 1988 ish

What are you thoughts on Mary Mallon? Do you agree with the way she was treated or how she reacted? Keep in mind that when you look back in hindsight at this, you are looking back with knowledge of the 21st Century, so can you really judge fairly on legislation at that time?

Please leave your comments below
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