Mary Mallon
Mary Mallon, commonly known as Typhoid Mary, was an Irish-born American cook who is believed to have infected up to fifty-seven people with the bacteria that cause typhoid fever. The infections caused three confirmed deaths. She was the first person in the United States to be identified as an asymptomatic carrier of Salmonella 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 by George Soper, an epidemiologist at the New York Department of Health, identified Mallon as the potential disease vector. In 1907, she was forcibly quarantined at the Riverside Hospital, an institution for those with quarantinable diseases, on North Brother Island in New York City's East 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 the Sloane 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 of public 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 of HIV/AIDS, tuberculosis, and COVID-19.
Biography
Early life, 1869–1897
Mary Mallon was born on September 23, 1869, in Cookstown, County Tyrone, Ireland, 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 steamship Ethiopia. In New York City, she first lived with an aunt. 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. Her biographer, Judith Walzer Leavitt, described Mallon's career pattern as "completely ordinary, following the limited opportunities available to single women of her ethnicity and class".Early career, 1897–1907
Between 1897 and 1906, Mallon worked as a cook for several families, members of four of which contracted typhoid fever. From 1897 to 1900, she cooked for a family in Mamaroneck, 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. He had previously been in East Hampton, where there had been an outbreak. 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.In 1902, Mallon worked for lawyer and socialite J. Coleman Drayton while he and his family spent the summer in Dark 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. Two doctors, Edwin Daniels of Boston and Louis Starr of Philadelphia, investigated the matter and came to the conclusion that the footman—a household servant who served meals—was the person who carried the typhoid.
In mid-1904, Mallon was cooking for Henry Gilsey and his family at their summer house in Sands Point. Four members of the staff—who lived separately from the family—became ill with typhoid, but none of the family did. 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.
In 1906, Mallon worked as a cook for Charles Henry Warren, a New York banker. He and his family spent the summer that year at Oyster Bay on the North Shore of Long Island, where they had rented a house from George Thompson. 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.
Identified as a typhoid carrier, 1907–1909
Thompson was concerned that he would not be able to rent out his property again, and he hired George Soper, a sanitation engineer and epidemiologist for the New York Department of Health, to investigate the source of the problem. Soper was a renowned investigator and was referred to as an "epidemic fighter", according to microbiologist Richard Adler and epidemiologist Elise Mara. 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 would 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".Mrs. Warren told Soper that Mallon had been hired from Mrs. Stricker's employment agency. The agency described Mallon as "an Irish woman about 40 years of age, tall, heavy, single. She seemed to be in perfect health." 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. 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". Soper was aware of the existence of asymptomatic carriers—carriers that are infected with a pathogen, but show no signs or symptoms—as he was well versed in much of the European literature on the subject. He developed the hypothesis that Mallon was a healthy carrier of typhoid and wished to gain samples from her to test his idea.
While Soper was conducting his investigation, Mallon continued working. In September and October 1906, she cooked for the family of George Kessler in their Tuxedo Park home. Two weeks after her arrival, the laundress contracted typhoid. There had been no cases of the disease in Tuxedo Park and all the other staff had worked for the family for a long period. In November or December 1907, Mallon started cooking at the Park Avenue residence of Walter Bowen. On January 23, 1907, a chambermaid 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.
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. 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.
Soper—with his colleague B. Raymond Hoobler—then visited Mallon at her rooming house on Third Avenue that she shared with Briehof. Soper recalled, "Mary was angry at the unexpected sight of me". He tried again to explain the situation but he had no success in persuading her. When the two men left, they were "followed by a volley of imprecations from the head of the stairs". Mallon's refusal was based on her belief that she was not infected.
Soper reported to his superiors and recommended Mallon's arrest to obtain samples of her stool from which tests could be made. 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." She was found in the shed and again resisted: Baker reported that "Once the door was opened she wasted no time. She came out fighting and swearing, both of which she could do with appalling efficiency and vigor." She was placed in an ambulance and taken to Willard Parker Hospital. To stop her struggles, Baker had to sit on her chest for the journey.
Mallon was kept at Willard Parker for several months. Her stools were tested three times a week and showed the presence of Bacillus typhosus. The condition proved resistant to different drug treatments and Mallon refused to consider allowing the removal of her gallbladder, the organ where the typhoid bacillus is held in the body. It was enough proof for the Health Department to transfer her to the Riverside Hospital, an institution for those with quarantinable diseases, on North 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.
Release from North Brother Island, 1909–1915
In 1909, Mallon challenged in court her extended captivity. Leavitt believes that William Randolph Hearst's newspaper, the New York American, provided the funds to pay for her lawyer, George Francis O'Neill. He filed a writ of habeas corpus in an attempt to free her. Mallon came to public notice because of the case and the exposure she received in the New York American, which covered the case. 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. In an article published on June 30, in the New York American, they called for "pity for the lone woman who has not a relative or friend to whom she can turn". Mallon's case was heard in late June and early July 1909 in front of judges Mitchell Erlanger and Leonard Giegerich. The decision was handed down in mid-July: Mallon continued to be confined to the hospital. Their decision was based on the 1905 U.S. Supreme Court decision in Jacobson v. Massachusetts, in which the court supported the authority of states to enforce compulsory vaccination laws to protect the public.In 1910, Ernst J. Lederle was appointed as the new commissioner 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. 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.
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 a New Jersey inn in 1913 and 1914; Soper claimed she had been cooking for families, including one in Newfoundland, New Jersey, over the same years, and that six more typhoid cases were connected to this, but he provided no evidence. 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 in Marblehead, Massachusetts. 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 the Sloane Maternity Hospital. In January and February 1915, the hospital was the center of a typhoid outbreak with twenty-five cases; two people died.