For Lewis
SONG OF SONGS 5:16
Contents
List of Illustrations
Acknowledgments
Prologue
INTRODUCTION
“A Special Guest of the City of New York”
CHAPTER ONE
“The Rigorous Spirit of Science”
The Triumph of Bacteriology
CHAPTER TWO
“Extraordinary and Even Arbitrary Powers”
Public Health Policy
CHAPTER THREE
“A Menace to the Community”
Law and the Limits of Liberty
CHAPTER FOUR
“She Walked More Like a Man than a Woman”
Social Expectations and Prejudice
CHAPTER FIVE
“This Human Culture Tube”
Media and the Cultural Construction of “Typhoid Mary”
CHAPTER SIX
“Banished Like a Leper”
Loss of Liberty and Personal Misfortune
CHAPTER SEVEN
“Misbegotten Mary”
The Stories Continue
CONCLUSION
A “Square Deal” for Public Health
Events in Mary Mallon’s Life
Notes
Credits
Index
Illustrations
1.1 Water Filtration and Typhoid Fever Death Rates, 1900–1913
2.1 S. Josephine Baker, 1922
4.1 George Soper, 1915
4.2 Mary Mallon in Willard Parker Hospital, 1909
4.3 Close-up of Mary Mallon in Willard Parker Hospital, 1909
5.1 “Typhoid Mary,” drawing, New York American, June 20, 1909
5.2 “Typhoid Mary,” article, New York American, June 20, 1909
5.3 Panoramic view of North Brother Island
5.4 Mary Mallon with other patients on North Brother Island
5.5 Patient Dining Room, North Brother Island
5.6 Mary Mallon, portrait with cartoons, 1909
5.7 Mary Mallon, drawing, 1933
5.8 Mary Mallon at stove, drawing, 1935
6.1 Riverside Hospital, North Brother Island
6.2 Mary Mallon’s cottage, North Brother Island
6.3 North Brother Island Plot Plan, 1943
6.4 View from North Brother Island
6.5 Excerpt from Mary Mallon letter, 1909
6.6 Emma Sherman and Mary Mallon, North Brother Island
6.7 Mary Mallon’s tombstone
7.1 Mary Mallon, “Innocent Killer,” drawing, 1957
7.2 Mary Mallon in kitchen, drawing, 1966
7.3 Mary Mallon advances on George Soper, drawing, 1970
7.4 Police arrest Mary Mallon, drawing, 1970
7.5 Mary Mallon followed by health officers, drawing, 1970
7.6 “Typhoid Mary,” drawing, 1979
7.7 Mary Mallon, drawing, 1984
Acknowledgments
IT IS ALWAYS A GREAT PLEASURE, UPON
completing a project such as this one, to remember all the people whose efforts helped make it possible and to have an opportunity to thank them publicly. In this case there were many, and their efforts mighty.
I begin with the students in my course, The Development of Public Health in America, at the University of Wisconsin, Madison. Since 1976, undergraduate and graduate students alike have demonstrated their fascination with Mary Mallon and the ways they could use her story to illuminate continuing issues in the field. I cannot name all of the students whose excitement with this subject finally ignited my own to the point that I began this project, but I understand my debt to them. Like all professors, I learn much from my students.
I would like to thank many graduate students in the history of medicine at the University of Wisconsin for the role they played, first in the classroom, and continuing beyond, in helping to shape my ideas and to sharpen my thinking. To Jon Harkness I owe a special thanks. Over the years, Rima Apple, Bob Bartz, Beth Black, Charlotte Borst, Marc Dawson, Diane Edwards, Eve Fine, Liz Hachten, Patty Harris, Judith A. Houck, Mary V. H. Jones, Susan Eyrich Lederer, Lian Partlow, Leslie Reagan, David Sandmire, Lisa Saywell, Rennie Schoepflin, Susan L. Smith, Diana R. Springall, Karen Walloch, John Harley Warner, and Tom Wolfe have pushed me even as I tried to push them. I am grateful to them all.
My colleagues at the University of Wisconsin have been equally important in helping me develop and continuing to challenge my ideas about what meanings we can derive from Mary Mallon’s experiences. I would like to thank, in the history of medicine, Thomas Broman, Harold J. Cook, Vanessa Northington Gamble, and Ronald L. Numbers for putting up with this project and, more significant, for putting up with me as I obsessed about it. I would also like to thank all the graduate students and fellow faculty in the history of science and in women’s studies for their considerable interest in this project.
My family, of course, has had to put up with more than anyone else. I am ever grateful to my children, Sarah A. Leavitt and David I. Leavitt, who, now adults, offer a special blend of intellectual and familial encouragement. Both of them provided practical help to this specific project as well as general goodwill about difficult schedules and delayed activities. My mother, Sally H. Walzer, who moved to Madison in the middle of this undertaking, has been ever-eager and supportive of my work on Mary Mallon as she has been of each of my career steps since I was too young to notice. Without her encouragement, and that of my father, Joseph P. Walzer, which I continue to feel through her, I would not be in a position to write this book. To Lewis A. Leavitt I owe more than can ever be written on the page. For his loving support over thirty years, and in anticipation of many more ahead, I dedicate this book.
This project benefited greatly from the research assistance of a number of people. I would like to thank Dawn Corley, Irving Ishado, Sarah A. Leavitt, Jennifer Munger, Lian Partlow, and Sarah Pfatteicher, all of whom were creative and resourceful—and persistent—in tracking down sources. For special contributions and consultations, I am happy to acknowledge the help of Nina Ackerberg, Peter Ackerberg, John Q. Barrett, Joan Jacobs Brumberg, Ann Carmichael, Bob Conlin, Gerard Fergerson, Vanessa Northington Gamble, Bert Hansen, Dirk Hartog, Greg Higby, Saul Jarcho, Robert J. T. Joy, David I. Leavitt, Barron H. Lerner, Gerda Lerner, Stephanie Mathy, John Parascondola, Sarah Potts, Carolyn Shapiro, Robert Skloot, and Rebecca Walzer. These people were willing to put aside their own work to offer help at very important moments in the project, and I am extremely grateful to them all.
I am grateful for the responses of many people to my Author’s Query in the New York Times Sunday Book Review section and the Irish Echo. These letters not only answered many of my questions, they also provided the comfort of knowing there were people out there who might be interested in reading this book.
I am in great debt to my colleagues who took the time to read a draft of the complete manuscript and offer detailed and informed opinions about what they read. I want to thank Thomas D. Brock, Susan Stanford Friedman, Linda Gordon, R. David Myers, and Ronald L. Numbers. While I know I did not answer all their concerns, I benefited from their insights, and I tried to do justice to their comments. I know some of their collective wisdom is reflected in the pages that follow, but these wonderful scholars are in no way responsible for the mistakes and shortcomings that remain.
I am happy to acknowledge the financial support that allowed this project to come to fruition. Foremost, I am grateful to the National Endowment for the Humanities, and to project officer Daniel Jones, for generous grant support, and to the University of Wisconsin Foundation for its matching grant. The University of Wisconsin, Madison, sabbatical program provided one semester free of teaching duties. The Institute for Research in the Humanities at the Uni
versity made a home for me for one semester, and I benefited from the experience there of trying out my ideas in an interdisciplinary group. My tenure as Evjue-Bascom Professor of Women’s Studies (1990–1995) provided added support for this project. Without all of this help, this book would not have become a reality.
I especially want to thank three people whom I have come to know quite recently. They have made it possible for me to have access to materials otherwise hidden, and their cooperation and enthusiasm for my project have been of ultimate importance. I am ever grateful to John S. Marr, M.D., M.P.H., now of the State Department of Health in New York; Ida Peters Hoffman, now retired from the City Health Department; and Emma Rose Sherman, also retired from her work first in bacteriology and then in education for the City of New York. These people were generous with their time and their knowledge; they opened their homes and their archives to me and shared their research, experiences, and memories. Only scholars and writers who have received similar help in their research from such personal and open communications can understand my debt and my gratitude to these three people. I only hope they get some pleasure out of the completed project.
Parts of chapter 1 and chapter 4 are reprinted and used here with permission: “ ‘Typhoid Mary’ Strikes Back: Bacteriological Theory and Practice in Early Twentieth-Century Public Health,” Isis 83 (1992): 608–29; “Gendered Expectations: Women and Early Twentieth-Century Public Health,” in U.S. History as Women’s History: New Feminist Essays, ed. Linda K. Kerber, Alice Kessler-Harris, and Kathryn Kish Sklar (Chapel Hill: University of North Carolina Press, 1995), pp. 147–69.
I also am pleased to acknowledge the help of a team of editors at Beacon Press. First and foremost is Lauren Bryant, no longer at the Press, who convinced me to sign and who gave the full manuscript her close attention in her capacity as free-lance editor even while her brand-new twins demanded her time and energy. I am grateful for her contributions. Marya Van’t Hul took over the project graciously and with enormous enthusiasm. I am particularly grateful for her insistence on certain changes that I only over time came to appreciate. Beacon has been small enough to be welcoming and generous with attention and big enough to do a super job, and I thank all the people there who helped this book emerge.
October 1995
Madison, Wisconsin
Prologue
SHE WAS AN IMMIGRANT WOMAN WHO
made her way as a cook. Born in Ireland, she boarded a boat for America when she was a teenager. She lived with an aunt for a time, but as an adult she settled down in domestic service in New York City. She cooked in the homes of the city’s elite, in their Park Avenue brownstones and in their summer estates on Long Island or the Jersey shore.
She was by repute an excellent cook and did not go unemployed for long periods. Sometimes she boarded with her employers, sometimes she lived with friends in the city—often with one particular male friend. We do not know how happy she was in her personal life, but in her work she was said to demonstrate a certain pride and satisfaction. Some families who employed her praised her accomplishments in the kitchen and her care of the children.
We do not know when she contracted typhoid fever, except that it must have been during or before 1900. She denied ever having been sick with the disease, and it is likely she never knew she had it, suffering only a mild flu-like episode. But between 1900 and 1907, she infected some twenty-two people with typhoid fever through her puddings and cakes. They suffered more serious disease symptoms; one of them died from the illness.
The authorities decided she was too dangerous to be allowed to continue to earn her living by cooking. In fact, they decided she should not even be allowed to walk the streets of the city. They put her in a small bungalow on the grounds of a large isolation hospital on North Brother Island in the East River. She was thirty-seven years old. She lived alone in the cottage for more than two years and then came before a judge to plead for release from her banishment. The judge was sympathetic, but did not want to be responsible for letting the Irish woman return to New York City and continue infecting people through her cooking, so he declared her a menace to the public’s health and sent her back to the small island.
Another lonely year passed. Finally a health department official decided it was not right to keep her isolated any longer, and he allowed her to go free. She worked in a laundry for a while, but she could not make a living away from her profession.
Eventually, she returned to cooking. When the health authorities found her the next time, it was estimated she had spread typhoid fever through her cooking to at least twenty-five more people, another two of whom died from the exposure. This time officials isolated her back on North Brother Island for the rest of her life. She lived twenty-three more years, in the one-room cottage on the small island, alone. She worked in the island’s bacteriology laboratory for a while. She died on November 11, 1938.
Mary Mallon was her name. This book tells her story—rather, her stories, for there are many, depending on the teller’s perspective and stance—to illuminate the many dimensions of sickness and sickness control that confronted Americans early in this century and continue to challenge us at the century’s end. There will be no easy answers here to our country’s present dilemmas with AIDS and tuberculosis. There will be, I hope, some insights that give meaning to our present concerns about controlling epidemics and force us to focus on the social dimensions of our efforts to combat the devastation sent our way by microbes. The many stories of Mary Mallon are the stories of the sufferers, of those who try to help the sufferers, of those who demonize the sufferers, and of those who try to prevent the suffering. They are the stories of the human side of disease and its control.
“A Special Guest of the City of New York”
INTRODUCTION
Many, perhaps most, American adults have heard of “Typhoid Mary.” The phrase connotes a polluted woman, someone who carries and gives disease to others. But although many people have heard of “Typhoid Mary,” most are vague about who she actually was, and almost no one knows her name. Some may conjure up the image of an Irish immigrant woman, heavy and ugly, who spread typhoid fever through her cooking. Many people cannot pinpoint the period in history in which she lived, and some believe her to be fictitious.
This book centers on Mary Mallon, the woman known as “Typhoid Mary,”1 not only because of her familiarity and meaning in American culture, but also because of the important issues raised by the stories of her capture and captivity, which have not been examined previously in any depth.2 The dilemma Mary Mallon posed for health officials in the early twentieth century—namely, how to protect the health of the public when it is threatened by an individual carrier of disease and at the same time preserve that individual’s civil liberties—is one that is very much still with us. Moreover, Mallon’s case illustrates the intertwining of science and culture. Through the lens of Mary Mallon’s experiences, we can view how the values of American public health during the first third of the twentieth century interacted with scientific activity. Knowledge of those values and events can enhance our understanding of and responses to the HIV epidemic and the resurgence of tuberculosis at the end of the century. One individual introduces us to a world of the past and offers a vital perspective on our own world of the present.
How far have Americans been willing to go to protect the public’s health? Mary Mallon’s experiences indicate the lengths to which officials in the past carried their obligation. Because they believed she threatened the health of those around her, New York City officials tracked Mary Mallon down and arrested her on two separate occasions, and forcibly isolated her for a total of twenty-six years of her adult life, beginning when she herself had no disease symptoms and was only thirty-seven years old. Her example reveals that the United States indeed holds the value of health dear. Americans want to be healthy and want to be protected from any neighbors who might threaten their health. Over the course of the nation’s history, people have searched for health,
have instructed the government to protect health, and have asked scientists to solve health problems when they arise. The government has used immigration policy to set United States residents apart from those of other nations in attempts to keep Americans free from disease. Elected officials have spent enormous amounts of money in the cause of a healthy citizenry. As I write, our nation’s “health care crisis” remains unresolved and recurs at the center of political debate.
In addition to a strong commitment to preserving health and preventing disease, Americans also hold dear the value of individual liberty, and our constitution and laws reflect this commitment. Americans see themselves as defenders of liberty, at home and sometimes abroad. The laws of the United States and the nation’s articulated values demand that government protect citizen liberty even while representatives carry out their duties to watch over citizen health and welfare. Thus, our laws guarantee the rights and immunities of all citizens against interference with the rights and privileges of citizenship. There are, of course, situations under which the nation agrees to abridge citizens’ liberty: for murder, crimes against persons and property, and some civil infringements. Is sickness or carrying disease one of the situations in which most Americans can accept depriving people of their liberty?
In exploring the meanings of Mary Mallon’s experiences early in the twentieth century with this question in mind, I examine in this book how American society, as a nation and as individuals, has approached taking away the liberty of someone who is sick or a carrier of sickness in the name of protecting the public’s health. In so doing, I pose the question of how we have weighted the two values of health and liberty when they come into conflict and address what might be at risk in the balancing.
If science could always be depended upon to find cures and preventive vaccines for all our ills, we still would not be able to avoid this dilemma. There is a cure for syphilis, to cite but one example, yet syphilis continues to plague Americans. A medical magic bullet cannot, as much as we might wish it, solve our medical problems. No single factor can address our difficult health concerns. Because health and disease are deeply embedded within the social and changing world, it is imperative that we learn to consider the full range of contexts in which disease ravages. The challenge before us today, as in the past, is to determine how to protect the individual liberties of the sick or those identified as carriers of sickness and at the same time actively protect the public’s health.
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