Questioning the Quantified Life   /   Summer 2020   /    Notes And Comments

Learning from Typhoid Mary

Genuine risks to public health are commingled with selective punishment and prejudice.

B.D. McClay

An illustration of “Typhoid Mary” that appeared in 1909 in The New York American. Via Wikimedia Commons.

When she arrived on North Brother Island in 1907, Mary Mallon knew it mainly as the site of a terrible disaster that took place just three years before. A steamboat, the General Slocum, caught fire and the resulting conflagration killed approximately one thousand German Americans, mostly women and children, as they were travelling to Eatons Neck, Long Island, for a church picnic. The tragic loss of human lives was increased not only by useless safety equipment—life preservers that had lost their buoyancy, lifeboats fixed in place and unmovable—but also the captain’s decision to steer straight into the wind, thus fanning the murderous flames. Bodies littered the shoreline.

Except for a brief five-year hiatus, Mallon would stay on North Brother Island for the rest of her life (twenty-six years in all) as a permanent ward of Riverside Hospital, which had been established in the 1880s to quarantine patients with contagious diseases. Today, even more than the General Slocum episode, Mallon is the most famous disaster associated with North Brother Island. You know her as Typhoid Mary.

In light of her employment history, and knowing what we know now, it is surprising that Mallon never believed she had spread typhoid herself. She worked as a home cook—one of the few professions in which it was possible for her to infect others—and was well-loved by her employers for a dish of ice cream and peaches—a dish which, being uncooked, was one of the few that could carry typhoid. Still, typhoid was not a rare disease, even though it was uncommon in wealthy households. So there was no real reason for Mallon to have associated herself with the disease. And as it turns out, she never did.

That connection was made by one George Soper, a civil engineer who had been called in to investigate an outbreak in a home in Oyster Bay, Long Island. The home was a rental property, and the owners feared that if they couldn’t assure potential renters the home was typhoid-free, they would no longer be able to rent it. Soper went about his work and determined that the cook, not the house, was the likely problem. Unwilling to believe she might have typhoid, Mallon refused to provide a stool sample and even threatened the investigator, who finally had her apprehended by authorities. As expected, the stool samples proved positive for typhoid, and Mallon was confined to North Brother Island for three years. Released on condition she would not cook again, she eventually violated the terms and was confined for good. So goes a compressed version of an unsettling story.

Mallon was the first known “healthy carrier” of typhoid in the United States, and one of the first in the world. As such, she would vindicate the still-new theory that disease was caused by bacteria. Although she maintained all her life that she had never contracted typhoid, Mallon was chronically infected with Salmonella typhi, which doctors at the time suspected lived in her gall bladder. To reduce chances of transmission, she was told she had to do only two things: wash her hands properly after going to the bathroom, and stop cooking. She found the first suggestion insulting and the second impossible.

I knew very little about Typhoid Mary—nor, to be honest, did I realize there was much to know—until I began to read about her at the beginning of the coronavirus lockdown here in New York City. At that point, both public health and the idea of haplessly spreading infection became subjects of immediate and pressing interest. I didn’t know that Mallon had spent so much of her life isolated from the general population, some of it quite alone; in her words, she had been “banished like a leper and compelled to live in solitary confinement with only a dog for a companion.” Until I did more research, I wasn’t even sure how the story of Typhoid Mary had ended. I suppose I thought she had died from the disease.

Mallon believed and complained bitterly that she was being singled out for unique punishment by the health department. “There were two kinds of justice in America,” one contemporary newspaper quoted Mallon as saying when she was first quarantined on North Brother Island. “All the water in the world wouldn’t clear me from this charge, in the eyes of the Health Department. They want to make a showing; they want to get credit for protecting the rich, and I am the victim.”

She wasn’t wrong. As Judith Leavitt carefully details in Typhoid Mary: Captive to the Public’s Health, Mallon might have been the first known healthy, asymptomatic carrier of typhoid in New York, but she was not the last and certainly not the only one to continue cooking after being forbidden to do so by the health department. But she was the only one of typhoid’s “healthy carriers” to be cast into permanent exile. While some of the others might temporarily join her on North Brother Island, they were all eventually released.

In Mallon we find a story in which genuine risks to public health are commingled with selective punishment and prejudice. It is entirely relevant that Mallon was an Irish immigrant and also a woman. It is equally relevant that she not only continued to spread typhoid when she returned to cooking; she did so at a maternity hospital—behavior that seems to combine her forgivable skepticism about her infectiousness with her quite unforgivable malice. “It’s a measure,” writes Anthony Bourdain in his sympathetic book Typhoid Mary, “of how little she cared about herself or anybody else that she would risk infecting pregnant women and newborn children.”

As both Leavitt and Bourdain draw out in their books, Mallon was viewed by the investigators—primarily Soper and Dr. S. Josephine Baker, who was sent to deal with Mallon after Soper failed—with a mixture of disgust and condescension. She walked strangely. She was described variously as enormous and masculine; Leavitt quotes Soper’s description of her as a “fearfully angry-looking person [with] a startling appearance.” And because she lived with a man outside of marriage, Soper classified her as homeless.

But then, Soper was a civil engineer, not a doctor; he might have investigated typhoid outbreaks for a living, but there would certainly have been cause for a reasonable person to think he was overstepping his expertise. What right did he have to show up at Mallon’s place of work, accuse her of being dirty, appear at her shared apartment unannounced, and set in motion the chain of events that would eventually lead to her imprisonment? His theory of disease was not, at the time, settled science. When Mallon had her own tests done on her stools, they were typhoid free. She had almost no reason to believe she was anything but a scapegoat. If anybody earnestly tried to persuade her after Soper and Baker failed, they came too late.

There isn’t a neat moral to this story, which is partly why I find myself dwelling on it these days. Soper was right about the bacteria; Mallon was right that she was being selectively punished. Had Mallon been released from North Brother Island a second time, she likely would have gone straight back to cooking. But as in the wreck of the General Slocum or today’s own outbreak of COVID-19, one thing that stands out in the story of Typhoid Mary is the extent to which natural disasters are never more than partly natural.

Almost certainly, there is no plausible alternative version of the General Slocum tragedy in which nobody dies. But there are scenarios in which the casualties could have been reduced: by the captain’s steering away from rather than into the wind; by the ship owner’s having checked and updated safety equipment; or by the crew’s believing the child who first reported the developing fire. Similarly, there is no version of the story of Mary Mallon that ends happily for everybody, but there are probably versions in which she is treated less like an animal and more like a person from the beginning. A version in which the city continued to pay her rent—as it did for other healthy carriers—while she established herself in a new career, for instance.

Riverside Hospital largely took in hopeless cases. When Mallon first arrived, it mostly housed tuberculosis patients, for whom “little could be done for those suffering from the disease,” wrote Bourdain. Still, he continues,

it employed doctors who were used to offering sympathy and kindness in place of as yet undiscovered medication. Dr. John Cahill, who ran the hospital during this final period of Mary Mallon’s life, was remembered by his son, Dr. Kevin Cahill, as saying, “What did you do before there were drugs? Before there were antibiotics? … You learned to sit on the bedside and hold the hand…every once in a while you gave the person a hug.”

This is not to suggest that overworked doctors in overwhelmed ICUs work on their bedside manners. They do the best that they can—and often far more. Still, I wonder if there is space for certain kinds of volunteers—people who might agree to live separately from the rest of society and one another—to visit the sick and make dying from COVID-19 and other contagious diseases a less lonely experience. Some Dominican friars in New York, for instance, have sealed themselves into a nursing home to take care of the elderly there. The New York City Council is also considering establishing a “Compassionate Helper” volunteer corps. If nobody should have to live in isolation, nobody should have to die that way either. (Mallon, who never suffered ill effects from typhoid, died at age 69, six years after a stroke that left her bedridden and alone, apart from visits by a handful of medical professionals she had come to know on the island.)

Another lesson from Mallon’s experience might simply be that while we want to cast stones at others for “thoughtlessness”—witness the very popular social media activity of denouncing people in pictures who appear to be crowded together—we may want to consider that those people make their decisions for many of the same reasons we do. People have livelihoods they fear for. People are lonely. They have friends and family they worry about and want to see as safely as possible. Maybe they’re doing the wrong thing. But they work from the same limited information we all work from. Energies might be better directed toward pressuring authorities to make it as easy as possible for people to stay at home through rent and mortgage freezes and other forms of social aid—or, just as important, to make sure that those who can’t or won’t stay at home have reasonably safe working conditions and guarantees of job security if they need time off for health reasons.

Mary Mallon was not a thoughtless woman. She simply couldn’t believe she could carry a disease without ever experiencing any of its symptoms. She made her decisions accordingly. They were reasonable decisions. Tragically, they were also wrong—though in the end no more so than those of an inflexible system prone to punishment and scapegoating.