When the COVID-19 pandemic hit the world at the beginning of 2020, many of us were still largely oblivious to the fields of epidemiology, the ethics of medicine, patient rights, and words like “superspreader”. As a writer covering health at that point—and as a keen student and researcher of history—I quickly came across the curious case of Mary Mallon, known to many as “Typhoid Mary”.
Why does her story matter now? Because Mallon’s life has led to much introspection and the constant revaluation of medical ethics. Her story lays the foundation of the individual rights in society, especially while accessing health services, information and rights. Her example still has the power to spark discussions about how women, immigrants and the diseased are treated across the world. This is her story, but it also affects you, today.
Mary Mallon: The Irish Cook Who Made A Mark On New York
Born in 1869 in Ireland, Mallon migrated to the United States in 1883. She earned her livelihood as a household cook, and by all accounts, she was good at her job—after all, she did manage to secure a job in the household of one of New York’s wealthiest families in 1906. Charles Henry Warren was a New York banker who rented a plush summer house in Oyster Bay, Long Island. On August 27, 1906, Warren’s daughter came down with typhoid, and soon after, five more members of the household became infected. There was no other outbreak of typhoid in Oyster Bay at that time, which led medical experts to believe that the source of the contagion had to be in the Warren residence itself.
A 2013 study in the Annals of Gastroenterology describes what happened next. George Albert Soper, a sanitation engineer, was hired by the Warren family to find out and eliminate the source of the contagion. Soper’s entire investigation was published in the Journal of the American Medical Association in June 1907. It reveals that he soon began to suspect that Mallon may be a “healthy carrier” of the disease—meaning that while she could spread the bacteria responsible for typhoid, Salmonella typhi, she wouldn’t fall sick due to the bacteria herself and would remain asymptomatic!
But Soper needed concrete proof to establish his theory. So, from March 1907, he started stalking Mallon across New York, discovering that she had served as a cook in eight families. Seven of these families had seen cases of typhoid, 22 people had signs of the infection, and some had also died due to the disease. It’s important to note here that typhoid was a deadly contagion at that point in time. A vaccine against it hadn’t been developed until 1911, and antibiotic treatments for the disease weren’t available until 1948. This made Mallon, in the mind of doctors and public health officials of the time, a “danger to society”.
Soper enlisted the support of Dr Hermann Biggs of the New York State Department of Health, and Dr Sara Josephine Baker to apprehend Mallon. Dr Baker is celebrated as the one who finally convinced Mallon to allow the testing of her urine, faecal matter and blood; Soper had famously been chased away by her with a carving fork for requesting the same! However, reports reveal that Mallon had to be forced to provide her samples, and was arrested by the police.
She was then transferred to North Brother Island’s Riverside Hospital, where she was quarantined for two years and tested on repeatedly. Her stool samples were tested 163 times during this period, and the samples tested positive 120 times. She was treated by doctors with hexamethylenamin, laxatives, urotropin and brewer’s yeast, and still not cured. New York State’s new health commissioner released her in 1910 on the condition that she would not get employment as a cook. As an immigrant woman without any other source of livelihood, could she stick to this condition for long? Obviously, not.
Changing her name to Mary Brown, she got employed at Sloane Maternity Hospital in Manhattan, where she contaminated 25 people, including doctors, nurses and staff in 1915. It was after this that Dr Baker apprehended Mallon again, and sent her back into isolation on North Brother Island, where she suffered a stroke in 1932, and passed away in 1938 at the age of 69.
The Ethical Questions Raised By Typhoid Mary’s Story
In a world which has just started to emerge from the plight of COVID-19, the horrors endured by New York when Mallon was “at large” cannot be that difficult to imagine. And yet, Mallon’s story isn’t as straightforward as you might imagine. She was not, by most accounts, a woman who was intentionally infecting people or spreading a deadly disease to hold society hostage. Instead, she was a victim of multiple problems of her time.
Here are a few that throw new light on the life and experiences of Mary Mallon, vilified in public media as Typhoid Mary.
The lack of health education and awareness
Mallon lived in the US at a time when ideas of public health, contagions, germs, etc were still unknown to most people. Add to this the repeatedly reported fact that Mallon was never explained her condition, and you know she was not operating on any level playing field. She was the very picture of health, so how would she know, understand or believe that she was a healthy carrier of a deadly disease if none of the doctors explained it to her properly? Instead, Mallon was arrested without any warrant, kept isolated from the world, and repeatedly tested on like a lab rat until the day she died. This is not only morally and ethically wrong, but also raises the question of patient rights—which is why Mallon’s case is still taught to medical students around the world.
How gender, ethnicity and class played a role
For a working class immigrant woman living at the turn of the twentieth century, any sort of education was not on the cards that easily—let alone health education, which was in a nascent stage then. Further, working class women were not even afforded the few rights that gentile or “respectable” women enjoyed at that point in time, so there is no way Mallon would have been treated as a patient with any rights.
What’s even more intriguing is the fact that Mallon was an Irish immigrant. Social scientists show that at various points in US history, public sentiment was against certain groups of immigrants. Just like there was immense anti-Chinese immigrant sentiment in the 1860s—which also led to the horrendous Chinese Exclusion Act, 1884—the decades which Mallon lived through were noted for widespread anti-Irish bigotry. This also explains why Mallon was constantly apprehended and treated in an adversarial manner, and why she quickly became such a villain in the public’s imagination.
The ambition of doctors and administrators
Soper claimed fame in 1907 as the first American author to identify the first “healthy carrier” of Salmonella typhi in the continent. However, he needed concrete proof, and roped in public health administrators of New York in his hunt for Mallon. Being able to be a pathbreaker is challenging, but can you imagine what it might have been at a time like that, when the concepts of health awareness and individual rights, or even women’s rights, were not formed? Soper pursued Mallon doggedly, and was not only able to get her arrested without warrant, by force, twice, but was also allowed to try experimental treatments for typhoid on her. While the target of improving medical science, especially in a field as critical as epidemiology, is noble and can change lives of many, the methods used by the health experts in Mallon’s case have always been ethically suspicious and morally dicey.
Individual rights and consent
And that brings us to one of the key violations that Mallon endured. She never consented to being arrested, quarantined, tested again and again, living without a livelihood, or being held against her will in isolation for the rest of her life. Can you imagine anybody, no matter what their gender or ethnic identity, living with the violations she endured, today? Even during the height of the COVID-19 pandemic, most of us grew impatient when we were quarantined or stuck at home due to lockdowns—and this, despite having the access to health education that we do now. This really puts a big question mark on the behaviour of the authorities who handled Mallon and her case.
Hysteria about diseases and the media
Mallon’s case was highly publicised by public health authorities and the media of the time, and she was vilified in posters and advertisements as Typhoid Mary. This was also because, by the time of her recapture in 1915, the public believed that Mallon was guilty of knowingly and willingly spreading the disease across New York. The idea that she might herself be a victim of her circumstances was not known. The use of the derogatory pseudonym, Typhoid Mary, made the public believe even more that she was the guilty party here.
Mary Beth Keane, an Irish-American author who wrote Fever, A Novel Of Typhoid Mary, once described Mallon as “a contemporary character who happened to live a century ago”. This is not only apt, but also the reason why Mallon’s story should be more well-known today. We live in an era where lockdowns, quarantines, epidemics and pandemics have become as normal a part of the vocabulary as “superspreader”, antigens and vaccines. Mallon’s story is that of a woman who, because of her gender, class, ethnicity and, most importantly, lack of health education, suffered immense human rights violations in her lifetime—and notoriety beyond it. If that isn’t the encouragement you need to go and learn more about your own health and individual rights, right now, then I don’t know what is.