Mary Mallon | |
|---|---|
 Mallon,c. 1909 | |
| Born | (1869-09-23)September 23, 1869 Cookstown, County Tyrone, UK |
| Died | November 11, 1938(1938-11-11) (aged 69) North Brother Island, New York, US |
| Resting place | Saint Raymond's Cemetery, New York, US |
| Other names | Typhoid Mary |
| Occupation | Cook |
Mary Mallon (September 23, 1869 – November 11, 1938), commonly known asTyphoid Mary, was an Irish-born cook who lived in the United States from a young age and is believed to have infected up to fifty-seven people with thebacteria that causetyphoid fever. The infections caused three confirmed deaths. She was the first person in the U.S. to be identified as anasymptomatic carrier ofSalmonella typhi bacteria.
Between 1897 and 1907, Mallon worked at the houses of several New York-based families; members of four of the households contracted typhoid. An investigation byGeorge Soper, anepidemiologist at theNew York Department of Health, identified Mallon as the potentialdisease vector. In 1907, she was forciblyquarantined at the Riverside Hospital, an institution for those with quarantinable diseases, onNorth Brother Island in New York City'sEast River. She was released in 1910 after she swore to report to the health department every quarter and not return to cooking as a career.
A further typhoid outbreak at theSloane Maternity Hospital in early 1915 resulted in twenty-five cases and two deaths. Mallon was identified as the responsible party and was returned to North Brother Island. She remained there until her death in 1938. Her nickname, coined by officials at the health department, became a colloquial term for anyone who spreads disease.
Mallon's case raises ethical questions about the balance between protection of individual liberty and the requirements ofpublic health. She was treated differently from the four hundred other asymptomatic typhoid carriers identified during her confinement. Others who worked in the food industry were given jobs and had their rents paid for by the state, and none were confined for the same length of time as she was. Her story has been reexamined and reevaluated during outbreaks ofHIV/AIDS,tuberculosis, andCOVID-19.
Mary Mallon was born on September 23, 1869, inCookstown, County Tyrone, UK, to John Mallon and Catherine Igo. The level of Mary's education is not known, although she had some schooling. In 1883, when she was about fifteen, she emigrated to the United States aboard the steamshipEthiopia. In New York City, she first lived with an aunt.[1][2][a] Mallon was soon employed as a private cook with a series of wealthy New York families; she gained a favorable reputation for her work and earned good wages. Some of her positions were as live-in staff; for others she lived with friends, including a Mr. A. Briehof.[1][3] Her biographer,Judith Walzer Leavitt, observed that Mallon's career pattern reflected the restricted range of employment opportunities available to unmarried women of her ethnic background and socioeconomic status.[4]
Between 1897 and 1906, Mallon worked as a cook for several families, members of four of which contractedtyphoid fever.[5][b] From 1897 to 1900, she cooked for a family inMamaroneck, New York; no one in the family or among the staff contracted typhoid during that time. In September 1900 a guest became ill with typhoid ten days after he arrived to stay with the family.[c] He had previously been inEast Hampton, where there had been an outbreak.[9] From 1901 to 1902, Mallon worked for a family in New York for eleven months. On December 9, 1901, the family's laundress checked in to the hospital with typhoid.[5]
In 1902, Mallon worked for lawyer and socialiteJ. Coleman Drayton while he and his family spent the summer inDark Harbor, Maine. Four family members and five staff members became ill; only Drayton and Mallon were unaffected. She stayed with the family to help nurse the sick, for which Drayton paid her a bonus of $50.[d] Two doctors, Edwin Daniels of Boston and Louis Starr of Philadelphia, investigated the matter and came to the conclusion that the footman—a householdservant who served meals—was the person who carried the typhoid.[11][12]
In mid-1904, Mallon was cooking for Henry Gilsey and his family at their summer house inSands Point. Four members of the staff—who lived separately from the family—became ill with typhoid, but none of the family did.[e] Robert Wilson, the superintendent of hospitals for communicable diseases for the New York City Department of Health, investigated. He believed the laundress was the source of the outbreak but could not prove it.[13][14]
In 1906, Mallon worked as a cook for Charles Henry Warren, a New York banker. He and his family spent the summer that year atOyster Bay on theNorth Shore ofLong Island, where they had rented a house from George Thompson.[6] On August 27, one of Warren's daughters was incapacitated with typhoid, and five other family members out of eleven also became sick. All recovered.[2][15]
Thompson was concerned that he would not be able to rent out his property again, and he hiredGeorge Soper, asanitation engineer andepidemiologist for theNew York Department of Health, to investigate the source of the problem.[7] Soper was a renowned investigator and was referred to as an "epidemic fighter", according tomicrobiologist Richard Adler and epidemiologist Elise Mara.[2] In the first phase of his investigation, Soper eliminated the standard causes of typhoid: contact with infected people and contamination of the food, water, and milk supplies. Questioning the household, he found that Mallon joined the staff on August 4 and left three weeks after the outbreak. At first, he was unsure whether a cook could be the source, since cooking would kill the bacteria; he became more convinced, however, when he learned that Mallon prepared an ice cream dessert with fresh peaches. According to Leavitt, this dish "would have been an excellent medium for typhoid infection".[5][16][17]
Mrs. Warren told Soper that Mallon had been hired from Mrs. Stricker's employment agency.[9][f] The agency described Mallon as "an Irish woman about 40 years of age, tall, heavy, single. She seemed to be in perfect health."[18] They provided Soper with a copy of Mallon's employment history and he mapped this to known typhoid cases. He saw she had worked for eight families, seven of whom had suffered typhoid outbreaks.[19][9] He identified twenty-six cases of typhoid that were connected to Mallon. Leavitt writes: "This number is actually quite small and indicates that many of the people for whom Mallon cooked during these years may have been already immune to typhoid".[20] Soper was aware of the existence ofasymptomatic carriers—carriers that areinfected with apathogen, but show no signs orsymptoms—as he was well versed in much of the European literature on the subject.[21][22] He developed the hypothesis that Mallon was a healthy carrier of typhoid and wished to gain samples from her to test his idea.[23]
While Soper was conducting his investigation, Mallon continued working. In September and October 1906, she cooked for the family of George Kessler in theirTuxedo Park home. Two weeks after her arrival, the laundress contracted typhoid. There had been no cases of the disease in Tuxedo Park around that time and all the other staff had worked for the family for a long period.[24] In November or December 1907, Mallon started cooking at thePark Avenue residence of Walter Bowen. On January 23, 1907, achambermaid contracted typhoid. Bowen's daughter also fell ill with the disease and died; she was the first person connected to Mallon who was known to have died.[14][25]
Soper visited Mallon in March 1907 at the Kessler house. He explained the situation to her and told her that he needed samples of her blood, urine, and feces.[19][25] According to Soper:
It did not take Mary long to react to this suggestion. She seized a carving fork and advanced in my direction. I passed rapidly down the long narrow hall, through the tall iron gate, out through the area and so to the sidewalk. I felt rather lucky to escape.[26]
Soper—with his colleague B. Raymond Hoobler—then visited Mallon at her rooming house onThird Avenue that she shared with Briehof.[1][27] Soper recalled, "Mary was angry at the unexpected sight of me".[28] He tried again to explain the situation but he had no success in persuading her.[29] When the two men left, they were "followed by a volley of imprecations from the head of the stairs".[28] Mallon's refusal was based on her belief that she was not infected.[30]
Soper reported to his superiors and recommended that Mallon be arrested to facilitate sampling of her stool for testing. A female doctor and an inspector from the health department,Sara Josephine Baker, were sent to try and persuade Mallon. This also ended in failure, so Baker returned the following day, March 20, 1907, accompanied by the police. Mallon answered the door with a long serving fork in her hand; she lunged towards the visitors then ran out of the back of the house, hiding in a garden shed. Baker described the attempt: "Mary was on the lookout and peered out, a long kitchen fork in her hand like a rapier."[31][32] She was found in the shed and again resisted: Baker reported that "She came out fighting and swearing, both of which she could do with appalling efficiency and vigor."[33] She was placed in an ambulance and taken toWillard Parker Hospital. To stop her struggles, Baker had to sit on her chest for the journey.[34]
Mallon was kept at Willard Parker for several months. Her stools were tested three times a week and showed the presence ofBacillus typhosus. The condition proved resistant to different drug treatments and Mallon refused to consider allowing the removal of hergallbladder, the primary organ where the typhoid bacillus is held in the body.[34][29][g] It was enough proof for the Health Department to transfer her to the Riverside Hospital, an institution for those with quarantinable diseases, onNorth Brother Island. She remained there for three years, living on her own in a small cottage next to the hospital; she was allowed to walk around the island and had access to many of the facilities including the chapel.[34][37][38]
In 1909, Mallon challenged in court her extended captivity. Leavitt believes thatWilliam Randolph Hearst's newspaper, theNew York American, provided the funds to pay for her lawyer, George Francis O'Neill.[39] He filed awrit ofhabeas corpus in an attempt to free her. Mallon came to public notice because of the case and the exposure she received in theNew York American. The newspaper published a story about her on June 20, 1909, in which they called her "'Typhoid Mary', most harmless and yet the most dangerous woman in America"; her nickname had been given to her by officials at the health department and was then used by journalists.[25][40][h] In an article published on June 30, in theNew York American, they called for "pity for the lone woman who has not a relative or friend to whom she can turn".[42] Mallon's case was heard in late June and early July 1909 in front of judgesMitchell Erlanger andLeonard Giegerich. The decision was handed down in mid-July: Mallon continued to be confined to the hospital.[43] Their decision was based on the 1905U.S. Supreme Court decision inJacobson v. Massachusetts, in which the court supported the authority of states to enforce compulsory vaccination laws to protect the public.[38][44]
In 1910, Ernst J. Lederle was appointed as the newcommissioner for health for New York. On February 19, he released her from her enforced stay on North Brother Island. She signed an agreement to report to the health department every quarter and that she would not return to cooking as a career, which the department felt was sufficient to ensure she would not spread typhoid to others.[44][45][46] Lederle explained:
She has been released because she has been shut up long enough to learn the precautions that she ought to take. As long she observes them I have little fear that she will be a danger to her neighbors. The chief points that she must observe are personal cleanliness and the keeping away from the preparation of other persons' food. ... She has promised to report to me regularly and not to take another position as a cook.[47]
Lederle found Mallon a job in a laundry once she left. According to Leavitt, Mallon avoided cooking as a career until at least December 1911 and possibly to September 1912. By November 1914, the Department of Health had lost track of her whereabouts. The health department thought she had cooked at aNew Jersey inn in 1913 and 1914; Soper claimed she had been cooking for families, including one inNewfoundland, New Jersey, over the same years, and that six more typhoid cases were connected to this, but he provided no evidence.[48] Historian Alan M. Kraut writes she was "definitely linked" to an outbreak in New Jersey and that there is a possibility she was connected to more cases inMarblehead, Massachusetts.[49] Leavitt states the earliest confirmed instance of Mallon being employed as a cook after her release from North Brother Island was in October 1914, when she was hired under the name Mary Brown by theSloane Maternity Hospital. In January and February 1915, the hospital was the center of a typhoid outbreak with twenty-five cases; two people died.[48][50]
Soper was called in to investigate the hospital's outbreak and, by comparing the handwriting of "Mary Brown" with that of Mallon, realized she was responsible. She had left the hospital's employment by that time and it was not until March 1915 that she was apprehended and returned to North Brother Island.[49][50][51]
On her return to the island, Mallon spent her time baking cakes and making jewelry from beads, both of which she would sell to other patients and staff. In 1918, she got a job in the hospital, and by 1925 she was assisting in the hospital laboratory. In 1925, physician Alexandra Plavska came to the island for an internship and hired Mallon as an assistant. Mallon's duties included general cleaning, washing bottles, recording results, and assisting with the analysis. The two became friends, according to Plavska's daughter; after Mallon was allowed to leave the island on day passes, she visited the Plavskas' home.[i] Plavska left the hospital in 1927 and was replaced in 1929 by Emma Rose Goldberg. Goldberg set up a laboratory on an upper story of an unused chapel and Mallon continued there with her duties; Goldberg described her as a dependable worker who was always on time.[53]
In later life, Mallon had several smallstrokes. On December 4, 1932, she suffered a major one. She was transferred to a ward at the hospital and remained there paralyzed and bedridden; Plavska and her daughter were among her visitors. Mallon died on November 11, 1938. Her funeral was held atSt. Luke's Church, and she was buried atSaint Raymond's Cemetery on November 13.[54][55][56]
Medical historians Filio Marineliet al. report that anautopsy was conducted on Mallon, which showed she hadSalmonella typhi bacteria in her gallstones. They also observe that other writers state no such procedure took place and that this was "anotherurban legend, whispered by the Health Center of Oyster Bay, in order to calm ethical reactions".[57]
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Mallon was the first asymptomatic carrier of typhoid identified in the US.[58][59] Up to fifty-seven cases of typhoid and three deaths from the disease were connected to her.[60][j] She was not the only asymptomatic carrier identified in early twentieth century New York, but she was the only one confined indefinitely. One other carrier, Frederick Moersch, a German immigrant who worked as a confectioner, was sent to North Brother Island in 1915, but he was allowed to leave in 1944 and was given a job at aBrooklyn hospital. He lived in Brooklyn, and his rent was paid for by the state.[62][63] A second case involved Alphonse Cotils, a Belgian immigrant who owned a bakery in New York; his typhoid led to a ban from working in his bakery. In 1924, he was given a suspended sentence for breaching the ban; the judge stated that Cotils could not legally be imprisoned "on account of his health".[64] Another asymptomatic carrier, Tony Labella, was responsible for eighty-seven cases of typhoid and two deaths; after he evaded the Department of Health's restrictions on his activities he caused an additional thirty-five cases and three deaths. Officials helped him find work unconnected with the food industry.[65] By the time of Mallon's death, there were over four hundred recorded cases of asymptomatic typhoid carriers; none of them were detained or quarantined for as long as she was.[66][57]
Mallon was treated differently from the other carriers who evaded their restrictions. She was described as a "menace to public health"; her gender, class and Irish background were all factors that weighed against her.[67][68] Soper wrote that she lacked femininity, a characterization that was repeated in the press.[69][70] He wrote:
Nothing was so distinctive about her as her walk, unless it was her mind. The two had a peculiarity in common. Those who knew her best in the long years of her custody said Mary walked more like a man than a woman and that her mind had a distinctly masculine character, also.[71]
Much of the medical literature about Mallon containedvalue judgments about her.[66] According to Leavitt, Mallon's status as a working-class immigrant "seems to have influenced public as well as scientific opinion about her".[72] Mallon's confinement on Brother Island was affected by the recent campaign againsttuberculosis, which was aimed at low-wage immigrants; Foss hypothesizes that had Mallon been born twenty years earlier or later, she would not have been imprisoned.[69]
In 1908,William Park, a bacteriologist with the New York City Department of Health, published a paper inJAMA which described Mallon's case. He stated: "The case of this woman brings up many interesting problems. Has the city a right to deprive her of her liberty for perhaps her whole life?"[73] According to journalism historian Katherine A. Foss, Mallon's case "raise[s] legal questions abouthabeas corpus, civil liberties, and due process".[74] Marineliet al argue that she was "a victim of the health laws, of the press and above all of the cynical physicians, who had plenty of time to test but never had time to talk with the patient". Mallon's case exemplifies the tension between the protection of individual liberty and the requirements of public health.[57][75]
According to Leavitt, while the early uses of her nickname were as "typhoid Mary"—using the disease as a descriptor—it soon changed to "Typhoid Mary", constructing a representation of Mallon as a diseased social pariah, rather than as a person.[76] Wald describes the name "Typhoid Mary" as a "dehumanizing epithet".[77] Early press coverage referred to Mallon as a bacterial agent, rather than a human being; terms included "a walking typhoid factory", "a human typhoid germ", "a living human culture tube", "Woman 'typhoid factory'", and "Human typhoid germ".[78]
The reporting of Mallon's history has changed since her death. Between 1938 and the advent ofHIV/AIDS in the 1980s, stories about Mallon focused on a human interest angle and, according to Leavitt, aimed to show how advances in medical science had improved modern life. After AIDS became a problem, writers took a more practical viewpoint, examining the risks an individual can pose to others and how to balance the rights of the individual with protecting public health.[79] Marouf A. Hasian Jr., a professor of communications, observed: "the advent of HIV and the return of tuberculosis outbreaks has heralded a newfound respect for the trials and tribulations of Mary Mallon".[80] WhenCOVID-19 began spreading in 2019, several academics looked at Mallon's case in the light of the spread ofsocial distancing laws.[k]
The phraseTyphoid Mary is now a colloquial term for anyone who spreads disease. It can also mean "A person who or thing which spreads or is the source of undesirable opinions, emotions, etc."[88][89] Foss states that the name was so used as early as 1909, whenThe Washington Times used the name to describe a milk dealer; use continued, and by mid-1910 the name was commonly applied to seemingly healthy individuals who passed disease to others.[90]
Mallon has been fictionalized in several works, including Steve Beeferman'sTyphoid Mary, Poz McBeefy, which is described by Foss as "a fictional story about HIV-positive heroes in the midst of a pandemic".[91][92] There is also a one-woman play byCarolyn Gage about Mallon's life,Cookin' with Typhoid Mary, andTyphoid Mary: The Musical by Geoff Page.[91] Mallon's nickname has also been used fora supervillain inMarvel Comics. She first appeared in issue 254, May 1988, as an enemy ofDaredevil.[91]
Several films and television series in twentieth and twenty-first century culture have used the name "Typhoid Mary" as a passing reference to illness or asymptomatic carriers. In these cases, "they further cement ... [Mallon's] place in popular culture as nothing more than a malicious distributor of disease", according to Foss.[93][l]
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