If you’ve ever seen the television series The Knick (2014–present), you might also hesitate to have a doctor circa 1909 perform surgery on you, especially if you felt perfectly healthy. Mary went on: “I have been in fact a peep show for everybody. Even the interns had to come to see me and ask about the facts already known to the whole wide world. The tuberculosis men would say ‘There she is, the kidnapped woman.’ Dr. Park has had me illustrated in Chicago. I wonder how the said Dr. William H. Park would like to be insulted and put in the Journal and call him or his wife Typhoid William Park.”28
Despite their efforts and theories, there was actually very little anyone could do to stop Mary from potentially infecting others with typhoid. That theory that she’d be cured if only they removed her gallbladder? Not so accurate. By 1914 Dr. Park concluded: “Medicinal treatment or surgery seems so far to have yielded only slight results … Removal of the gall-bladder cannot be relied upon.”29 It was becoming increasingly obvious that isolating Mary for life was, at the very least, according to Dr. Park himself, impractical. As early as 1908 he had discussed Mary’s case at a meeting of the American Medical Association and had remarked:
It seems to me that any attempt to isolate and treat on bacteriologic examinations … is impracticable. When we consider that the presence of the bacilli in the feces of these persons is often only occasional, that numerous contact cases having never had typhoid fever would not come under suspicion, and finally, the impracticability of isolating for life so many persons, we are forced to consider isolation utterly impracticable, except as in the case of the cook already described, where conditions increase the danger to such a point that an attempt at some direct prevention becomes an essential.30
Dr. Park concluded his speech with a kind of “monsters are among us, trying to get to our water supply” sentiment, claiming: “We must, therefore, as before, turn to the more general methods of preventing infection, such as safeguarding our food and water, not only chiefly when typhoid fever is present, but at all times, for we now know that in every community, whether it be large or small, unsuspected typhoid bacilli carriers may always be present.”31 He could have phrased it in a less terrifying way, but it is a good idea to boil your water if it’s not sanitized.
After her story became known, Mary Mallon decided to go to court. Good for Mary! Since as long as she was not preparing food, she posed little risk to anyone, her imprisonment seemed unreasonable. She found an attorney, who some people claimed was financed by William Randolph Hearst, the owner of the New York American, which had shared her story. The newspaper claimed that “some welathy [sic] New Yorkers” supported Mary Mallon in her effort to seek release after reading of her plight on June 20, 1909, in an article that moved them to “pity for the lone woman who has not a relative or a friend to whom she can turn.”32 Maybe that was the case. Maybe Hearst was just being a really nice guy. Or maybe he wanted to maintain close ties to Mary because updates on her story sold papers.
Her lawyer, George Francis O’Neill, filed a writ of habeas corpus in June 1909. This constitutional right guarantees that when citizens are detained against their will, they are entitled to legal judgment about their situation. Mary’s case would be brought before the New York State Supreme Court. This doesn’t seem unreasonable. Mary was correct that she was stripped of her rights. It is not that hyperbolic to say that she was kidnapped. And during this time other asymptomatic carriers had been found who were not detained. Mary even submitted to a lawyer samples of her feces that tested negative for typhoid.
Yet many people were, also understandably, concerned about the risk that carriers like Mary might pose to the public’s health, and her release was a controversial topic at the time. This led to some exquisitely sarcastic solutions, such as the New Thought Student’s letter to the editor published in the New York Times:
If one unfortunate woman must be labeled “Typhoid Mary,” why not send her other companions? Start a colony on some unpleasant island, call it “Uncle Sam’s suspects,” there collect Measles Sammy, Tonsillitis Joseph, Scarlet Fever Sally, Mumps Matilda, and Meningitis Matthew. Add Typhoid Mary, request the sterilized prayers of all religionized germ fanatics, and then leave the United States to enjoy the glorious freedom of the American flag under a medical monarchy.33
Anyhow, that’s how the X-Men started.
If you are surprised that there was public outcry about an Irish immigrant (a member of a marginalized group at the time) being held against her will, well I’m with you. I didn’t expect the public to be on Mary’s side. This is an instance in history when people truly seemed to value “freedom for all” over “safety for some.”
Despite the public support, the initial ruling in Mary’s case did not improve her situation. In July 1909 it was decided that she was too dangerous to mingle with the public. The judge ruled that “the said petitioner, Mary Mallen [sic] be … hereby remanded to the custody of the Board of Health of the City of New York.”34
But she wouldn’t stay so for long. Almost immediately after the trial the newspaper coverage exploded, largely taking up Mary’s cause. The public health official Charles Chapin stated, most likely in the Boston Transcript: “It seems a hardship to keep her virtually in prison, to deprive her of her liberty, because she happens to be the type of a class now known to be numerous and well distributed.” He suggested instead: “There are many occupations in both city and country in which she could do little harm … there are hundreds of occupations in any one of which she might be free, but under a sort of medical probation.”35
When Ernst J. Lederle was made the new Board of Health commissioner, he seemed to agree with Chapin. Lederle released Mary in 1910 because, as he put it, “she has been shut up long enough to learn the precautions that she ought to take.”36
Here are the actions the Board of Health took with Mary while she was at North Brother Island:
• Obtained many samples of her feces
• Offered to remove her gallbladder
• Gave her pills
• Allowed her to hang out with a dog and write murder threats
Here is an action they did not take:
• Teaching her a new job
Apparently, the board did not consider teaching her hygiene precautions or new job skills at North Brother Island. Where is a government-sponsored reeducation program when you need one?
Lederle, perhaps having some inkling of how this situation would play out, wondered upon Mary’s release, “What will she do now? She is a good cook and until her detention had always made a comfortable living. I really do not know what she can do.”37 And then I imagine he exclaimed, “Well, I guess she’ll figure it out!” and wandered off, whistling and chortling, “Remember, you’re a good cook, Mary!”
I cannot stress enough how Mary should have been taught other job skills. Because, as I suspect everyone reading this chapter can guess, Mary went right on cooking. After 1912 she stopped reporting to the Board of Health. She began working under the pseudonym “Mrs. Brown.” By 1915 she took a job in a place populated by babies with weak little immune systems.
That is a monstrous thing to do.
Dr. Sara Josephine Baker explains it more eloquently: “Typhoid appeared in the Sloane Maternity Hospital in New York City, with two deaths out of twenty-five cases. Although I was no longer a roving inspector, I went up there one day and walked into the kitchen. Sure enough, there was Mary earning her living in the hospital kitchen and spreading typhoid germs among mothers and babies and doctors and nurses like a destroying angel.”38
Mary was quarantined once more on North Brother Island. This time the public was far less sympathetic. Soper claimed: “Most persons will agree that no amount of dullness, anywhere this side of downright feeble-mindedness, can excuse [her return to cooking], and Mary Mallon is not feeble, either in mind or body. She is an excellent cook and has shown considerable ability in various other ways.”39
On July 11, 1915, an article in the Richmon
d Times-Dispatch pondered the problem of “people who are fountains of germs, scattering disease and death all their lives—and the problem of what to do with them.”40 The article included an illustration depicting a cook casually tossing some skulls into a pan. The piece, written by John B. Huber, M.D., did an impressive job of fearmongering. People Huber claimed could be asymptomatic carriers of typhoid included your cook, dishwashers in hotels or restaurants or on ships, and any worker in a dairy. Pretty much anybody, really. However, he ended on a very sensible note: “It would not be necessary to confine typhoid carriers if they would only understand and observe the simple precautions they should take in order that the health and lives of others shall not be endangered by them. The activities of typhoid carriers must be so restricted that they shall never infect food nor their surroundings. In essence, all they have to do is be careful about their cleanliness.”41 He believed that the problem could be handled if people would simply “keep [their] hands clean … especially before handling food that others would have to eat.”42
If you have ever wondered why you see those “Employees Must Wash Hands” signs in restaurant bathrooms, well, here you go. Those signs are there so no one can Typhoid-Mary you.
But here’s the thing people didn’t understand at the time: Mary could not get her hands clean enough to prevent infecting anyone. If someone is shedding typhoid germs as Mary was, in order to have “clean” hands they have to wash them with soap for thirty seconds in 140-degree water. Water that hot causes third-degree burns within five seconds. You really just couldn’t eat anything Mary prepared.43
Okay, she could have worn gloves. If all of this is making you very nervous, check that the guys preparing your burrito at Chipotle are wearing gloves. They almost invariably are, and also, they don’t have typhoid fever.
The anxieties Mary Mallon induced linger on, even when people have forgotten their source. Most people today have no fear that individuals handling their food will give them typhoid. Most people today probably cannot describe exactly what typhoid entails. But a lot of them will still recoil at the thought of someone on a preparation line making their food without wearing gloves or restaurant employees failing to wash their hands.
One hundred years ago Huber’s suggested protocols did not result in everyone just calmly washing their hands and practicing cleanliness. The idea that there were seemingly perfectly healthy people infecting others with deadly diseases simply by going about their daily business was sensational tabloid fodder. Journalists responded to outbreaks with a tone that bordered upon giddy delight. By August 22, 1920, the Richmond Times-Dispatch ran an article with the lengthy headline: “Mystery of the Poison Guest at Wealthy Mrs. Case’s Party—Who Is the New ‘Typhoid Mary’ Who Haunted This Fashionable Society Function Like an Angel of Death, Scattering the Disease Germs That Made Thirty-Nine Women Seriously Ill and Have Already Killed Two Victims?”44 The article was accompanied by a picture of a skeleton wearing what appears to be a very pretty hat.
Stories like these would go on for years. In 1924 the baker Alphonse Cotils, an asymptomatic carrier, was “found preparing a strawberry pancake.”45 Then the confectioner Frederick Moersch infected twenty-eight people with his ice cream in 1928. People seemed as hungry for stories about these people as they had once been for the delicacies these men prepared. Unlike Mary, though, these people were treated more leniently and given suspended sentences in Cotils’s case or allowed to stay at home in Moersch’s.
Mary Mallon was confined for the rest of her life at North Brother Island. She began working at the Riverside Hospital as a helper. She supposedly enjoyed working in the laboratory, so it’s a shame that those weren’t skills she was taught earlier in life. She died of complications following a stroke at age seventy, on November 11, 1938.
Of Mary, Dr. Baker wrote:
From my brief acquaintance with Mary, I learned to like her and to respect her point of view. After all, she has been of great service to humanity. There have been many typhoid carriers recognized since her time but she was the first charted case and for that distinction she paid in a life-long imprisonment. Today, typhoid carriers are usually allowed their freedom after they have pledged themselves not to handle other people’s food. And, so far as we have been able to discover, they have kept their word. It was Mary’s tragedy that she could not trust us.46
The government and the afflicted came to a place in this outbreak of disease where they both behaved sensibly and compassionately, and, at least by Dr. Baker’s account, with some exceptions, that approach worked. Of course, on both sides, cooperation requires a sizable degree of trust. People have to be able to trust officials to see them as individuals, not just as a transport system for a disease. They also have to trust that officials will not lie to them when told they are ill, even if they don’t feel sick. The government, in turn, has to trust that people will not go out of their way to harm their fellow citizens. All of that trust seems very much a matter of faith, but it’s not impossible to achieve. It just requires everyone not being the absolute worst.
Spanish Flu
Influenza, labeled Spanish, came and beat
me to my knees;
Even doctors couldn’t banish from
my form that punk disease.
—WALT MASON
The purpose of this book is not to scare you. Instead, like all good books, it is intended to distract you from the screaming baby one aisle over from the airplane seat where you are currently trapped for the next five hours. So I apologize that I have to tell you to smile at the frazzled parent, put on your earphones, and brace yourself, because about one hundred years ago, in 1918, 50 million people worldwide died of the Spanish flu, and we still don’t know what caused it or how to treat it, how to eradicate it, or if it will ever return. Sorry!
We do know that this disease wasn’t Spanish. In all likelihood, the Spanish flu was an all-American plague hailing from Haskell, Kansas. There is still research that attempts to pin the biggest plague in the twentieth century on anyplace else (guesses range from China to Great Britain), probably because “America’s bread-basket” is a much nicer way to refer to the Midwest than “the planet’s flu bin.”
In spite of our First World desire to believe that diseases are fundamentally exotic imports, the first case of the Spanish flu epidemic was reported to the weekly journal Public Health Reports by Dr. Loring Miner of Haskell, Kansas, in March 1918. Since the early winter, Dr. Miner had been shocked to see dozens of his patients become sick with what seemed to be “influenza of a severe type” and die. They weren’t even older, less robust patients. The deceased were people who seemed to be extremely healthy and in the prime of life. When Dr. Miner called the U.S. Public Health Service to describe his unusual findings, it wasn’t able to offer any help. Despite his notice in Public Health Reports, people didn’t seem to take the outbreak all that seriously.1
This might be a good time to mention that if you learn about an airborne virus that seems to be killing otherwise healthy young people in your area from a reputable medical journal, you are reading very bad news. Go to the grocery store and start stocking up on supplies immediately. If you have someplace relatively isolated to live, go there. Doing so might feel a bit silly or paranoid, but, honestly, neither of those responses would be overreactions.
Of course, at the time, no one followed Loring’s sage advice. People may have been cavalier because almost everyone has had the flu once and survived. During the early 1900s there was even a jokey doctor’s saying about influenza that went, “Quite a godsend! Everybody ill, nobody dying.”2 Even today, if you mention Spanish flu, most will think that maybe some people had to take a week or two off work in Spain because they were throwing up a whole lot. Because, sure, the flu is inconvenient, but it’s something most people are able to survive.
This wasn’t that sort of flu. Dr. Miner was describing a disease that was deadliest in the healthiest people, adults between the ages of twenty-five and twenty-nine.3 T
he historian Dr. Alfred Crosby explained this phenomenon on the PBS TV series American Experience: “One of the factors that made this so particularly frightening was that everybody had a preconception of what the flu was: it’s a miserable cold and, after a few days, you’re up and around. This was a flu that put people into bed as if they’d been hit with a two-by-four. That turned into pneumonia, that turned people blue and black and killed them. It was a flu out of some sort of a horror story.”4
One of the good things about flu, however, is that it burns out pretty fast. Haskell was a relatively isolated town. At any other time—other than now, obviously, when people probably catch a plane to New York from Kansas without thinking about it—the illness might have stopped right there. But in 1918 large numbers of young men from the area were traveling to a military camp to train for battle in World War I.5
Camp Funston, also in Kansas (it was an encampment of Fort Riley), housed twenty-six thousand young soldiers, making it the second-largest training camp in the country. So it was the second-worst place for a young man sick with a superdeadly strain of young-people-killing flu to go. Especially because that winter the “barracks and tents were overcrowded,” which meant that men hung out in close, cramped proximity to one another.6 March 4 brought the first report of someone at Funston becoming sick with what seemed to be a severe type of influenza. Within three weeks, 1,100 men at the camp had the flu and 38 had died.7
That’s not a shocking percentage, unless you consider the fact that no one expected healthy twenty-year-olds to die of the flu at all. A table in Dr. Crosby’s book America’s Forgotten Pandemic: The Influenza of 1918 shows that in 1917 flu deaths were highest—around 30 to 35 percent of those contracting the disease—among babies and those over age sixty. (Don’t worry, older readers. Age sixty then is probably like being over age ninety today.) People outside of those age groups died of flu less than 10 percent of the time. So the chart of age and flu death usually looks like a U. Meanwhile, the chart of influenza deaths in 1918 looked like a crazy, badly drawn N. Around 20 percent of affected babies seemed to die, followed by a drop down to the standard less than 10 percent, followed by a spike in deaths beginning at age nineteen, and returning to normal levels by around middle age. By 1918, 35 percent of people dying from influenza were in their twenties.
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