It is very difficult for most healthy Americans to envision themselves as the ones whose liberty might be threatened in the effort to protect the health of the community. As a society, we have become masters of stigmatizing the sick and the contagious; we label them as separate from the mainstream. As we did so easily in the past, Americans are again considering isolating—locking up—those who threaten public health. But any complacency about this subject is grounded in illusion. The liberty not just of people who are now sick or infected but of each individual citizen is at stake; indeed, our cultural ethos itself may be threatened in this dilemma. Because these are such important issues for our own times, we must, as individuals and as a society, try to come up with some answers to these difficult questions.
The quandary posed is, of course, not hypothetical or merely theoretical, but as real in our end-of-the-century world as it was earlier in the century. Public health officers and the courts today must often decide whether to remand specific individuals to the hospital or to isolation because they threaten the health of those around them. As I write, headlines in a local newspaper read, “Woman with HIV Sought as a Threat to Public Health.” A Milwaukee woman, infected with the virus, “reportedly engaged in highly risky, unprotected sex,” and has become the “focus of unprecedented attention by state and city public health officials who are trying to figure out how to stop her potentially lethal activity.”3 Officials and the society they represent need help thinking about the issues involved in locking up, for example, a person with AIDS who persists in behaviors that place others at risk. They need help determining when and if isolation may be advisable for this woman or, for example, for another Wisconsin woman who suffers from a drug-resistant case of tuberculosis.4 Medicine cannot answer all of their questions, nor should we seek the answers in medical control alone. It is my hope that the historical example explored in this book, the case of Mary Mallon, can illuminate the issues that most concern us today and help us find present-day solutions to our present-day problems.
The book is organized in two ways. Readers will find a chronological narrative of Mary Mallon’s life and experiences woven throughout the text, with a full outline previewed in chapter 1. Each chapter unfolds more details about Mary Mallon’s experiences and moves the narrative forward. A second, and stronger, organizing principle is my attempt to immerse the reader at separate times in a number of different perspectives on Mary Mallon; that is, I have purposefully disentangled the strands of her history to force us to see, and to understand, that there are various ways to tell Mary Mallon’s story and that while they differ, they are all relevant. The physicians who cared for Mary Mallon made one set of observations about her, newspaper journalists brought quite another point of view to her story. Officials trying to determine public policy using her example approached her from yet another perspective. The interpretations are different; some exist comfortably alongside one another and some are in significant conflict. I will not make it easy for the reader to choose only one perspective as the best view on the past or to choose only one way in which to use these stories in the present. Instead, I encourage readers to engage, as I have, in the process of interpretation, and to find their own integrated meanings in these stories, meanings that I hope will help us as a society to come to terms with our health dilemmas and force us as individuals to remember and use all the pasts we can recover.
Memory about the past helps construct our present. But whose past, or which past, shall we remember? And who shall decide how we use the past in understanding our present? Our reading of the past is by necessity mediated through our present world. Because the road from and to the past is a two-way street, we must be alert to how the realities of the present have an impact on how we construct and reconstruct the past. Present-day experiences with new viruses and old diseases reappearing in drug-resistant forms influence us as we try to figure out what Mary Mallon’s experiences mean. If we are aware of our present sensitivities, they can help rather than hinder our understanding of history, just as history can help us comprehend our options in the present.
Remembering Mary Mallon helps us keep in mind the complexity of the past as it helps to shape our present-day ideas about people who are sick or who may carry sickness to others. In this book I retell Mary Mallon’s many stories and explore the perspectives and motives of Mary Mallon and the people who encountered her—the people who became ill because she exposed them to pathogenic microbes, the people who kept her isolated as a “special guest of the city of New York” for twenty-six years,5 the people who tried to set her free from her quarantine, the people who studied typhoid through the evidence she provided, the people with whom she personally interacted, the people who condemned her during her lifetime, and those who continue to use her memory into the present.
The first perspective on Mary Mallon’s story comes from medicine and the authority of the new science of bacteriology. The turn of the twentieth century represents one of the most exciting and dramatic periods in all of medical history. At the end of the nineteenth century, medical scientists had come to accept germ theory, a new theory of disease causation, brought to medicine through basic science research. Laboratory experiments established that microorganisms could cause disease, a realization that radically altered previous views that undifferentiated filth and air contaminated by rotting organic material (miasmas) caused disease. The optimism spurred by the study of microorganisms led public health physicians, who were in direct confrontation with infectious disease in the cities where death rates soared along with the population, to search out answers from the new science and from the laboratory whenever possible.
Typhoid fever was one of the nineteenth century’s worst killers. Though it abated somewhat with urban sanitation measures, it remained a significant public health problem. Turn-of-the-twentieth-century bacteriologists tried to understand how this bacterial infection continued to thrive in relatively clean city environments. The answer came through bacteriological studies in Europe and the United States that led to the realization that typhoid, along with a few other diseases, could be transmitted by healthy people.
Mary Mallon was the first healthy carrier of typhoid to be carefully traced in North America. She was the first of hundreds of New Yorkers whom the health department accused of sheltering typhoid bacilli in their gallbladders and of transmitting the germs to susceptible people through their urine and feces via unwashed hands. She was not sick herself, but the presence of the pathogenic bacilli in her body defined her as hazardous to others. “A bacteriological examination revealed the fact that fully thirty percent of the bacteria voided with the feces were of typhoid bacilli,” claimed the scientists during her habeas corpus hearing.6 They were identifying health dangers using a brand-new method, a bacteriological marker possible to establish only through the use of laboratory tests. The medical view of her life, which focused on this laboratory finding and its exciting implications, is thus characterized by optimism and faith in science: her capture demonstrated that it was possible for humankind to conquer disease.
The second narrative of Mary Mallon’s story comes from the point of view of public policy makers. This perspective built directly on the scientific one. The people responsible for devising health procedures that would truly protect the public in the early twentieth century saw the case of Mary Mallon as a very important turning point. Because of the new science, it was possible to find individuals who although healthy themselves put the general public at risk for disease. Having located such carriers, the health policy makers defined them as menaces to the public health. According to this viewpoint, it was necessary to keep Mary Mallon under lock and key for twenty-six years because she was responsible for three deaths and at least forty-seven cases of typhoid fever. To people like Hermann Biggs, the medical officer of the New York City Department of Health, Mary Mallon represented a clear-cut case of the necessity of infringing on individual rights in order to protect the public.
This pub
lic policy telling of the story portrays Mallon as a cog in a machine much larger than herself. Health officials used what they learned from Mallon, in the laboratory and in her isolation, to create rules and regulations that they could use to control other healthy carriers. She was the worst case who prepared health officers to cope with other healthy carriers and provided them with an argument to use to increase their authority. The story of Mary Mallon as a prelude to new public health policy is one in which she herself plays a relatively unimportant part, one that emphasizes her expendability to a greater good.
The third perspective on Mary Mallon’s case emanates from the law and the lawyers who defined and defended it. While following closely on the tails of public policy, the legal story provides a different arena in which the supremacy of the new medicine was tested. The police powers left with the states under the U.S. Constitution mandate that states must operate to protect the health and welfare of their citizens. This is not just a right of the states, but an obligation. Over the course of United States history, various governmental activities evolved to meet this obligation. One of them was for authorities to remove, whenever possible, the causes of fatal disease that were present in the environment. By the beginning of the twentieth century most Americans agreed that government should act to prevent disease even when that meant the occasional infringement on the liberty of those who might have stood in the way of such disease prevention. Most such infringements—for example, forcible quarantining of individuals sick with diseases such as smallpox, so that they could not easily infect their neighbors—were viewed as the cost of health for the majority. The questions Mary Mallon’s experiences raised involved whether forcible quarantines could be extended to healthy people and whether such people could be kept isolated indefinitely.
Mary Mallon’s lawyer, George Francis O’Neill, argued that Mary Mallon had never been sick with typhoid and was thus not a menace to the health of society. He also noted that she had been arrested without proper warrants or due process. O’Neill organized Mallon’s court hearing around the question of whether or not the health department had a legal right to banish a healthy person to lifetime isolation. The legal perspective focuses on individual rights and issues of justice. Ideas about these issues have changed over time—today they differ from earlier in the century especially with regard to interpretation of due process requirements—and the law can be two-sided: on the one hand is the commitment to protect the public’s health; on the other is the fear of arbitrary power and the loss of individual freedoms. When the lawyers tell Mary Mallon’s story, her long-term forced incarceration becomes a complex legal dilemma.
The fourth perspective on Mary Mallon’s experiences derives from the social expectations and prejudices of the period. We see them at work in the language a diverse group of people used to talk about her—language that went beyond factual scientific description to focus on Mallon’s appearance and behavior, for example. Clearly, who she was and what she represented significantly affected the story people told about Mary Mallon.
There were those who argued during the years of her incarceration that Mallon got what she deserved. Their point of view was based in part on judgments about her culpability for her actions, assuming that she knowingly transmitted typhoid fever and that she acted from free will. These assumptions about Mallon’s personal responsibility need to be analyzed in terms of the expectations people brought to their understanding about who Mary Mallon was and how she should act. Her lower class and immigrant status, at a time when so many Americans championed native-born, middle-class behavior patterns, seems to have influenced public as well as scientific opinion about her, especially since she did not seem to aspire to middle-class behavior patterns herself. Many people, including some of the bacteriologists and physicians in whose care she found herself, came to think of her as expendable in the fight to protect the public health of all New Yorkers. Influenced by social prejudices, they blamed Mallon for her own fate. The microbe was not at fault, its carrier was.
The fifth perspective on Mary Mallon is the one constructed by the media in newspaper and journal representations. These public descriptions first emphasized, for dramatic purpose, the personal misfortune of a woman who was forced to give up a productive life to languish on an island. But by 1915, when Mallon returned to cooking after having promised she would not, the press more often demonized and blamed her. Reporters presented Mary Mallon to the world as someone to be dreaded, a carrier of sickness and death, someone to be shunned, ridiculed, “as a fiend dropping human skulls into a skillet.”7 Their words and editorial cartoons stripped Mallon of her human qualities. “This human culture tube,” wrote one reporter, “has worked for prominent families in this city and communicated the disease to some of its members.”8 The news media accounts of the story dehumanized the carrier, using her life as a lesson to be learned and turning her into a uni-dimensional character.
Understanding how the media creation of Typhoid Mary gradually took the place of Mary Mallon is a crucial step in understanding the full dimensions of her story. Both the medical world and the American public have lived with Typhoid Mary for a long time, and although her meanings vary, she has not yet disappeared as a useful concept. Why did her medical story resonate in the public mind and in what ways was it purposely stylized? The public representation of a dangerous woman must be analyzed, especially in light of our recent exposure to yet another epidemic and new groups of stigmatized people who are labeled and sometimes treated as our generation’s Typhoid Marys. Going back to the roots of this particular creation of Typhoid Mary can illuminate its present-day meanings and help sensitize us to our experiences with HIV infection, AIDS, drug-resistant tuberculosis, and the people who suffer from these diseases.
The sixth perspective on Mary Mallon is her own. An Irish immigrant cook, with limited career opportunities, but with quite a good reputation among New York’s finest families, Mary Mallon deeply resented her incarceration from the beginning. From the day in 1907 when her employment came to an abrupt end, when the health officials knocked at her door and literally dragged her, kicking and screaming, into a city ambulance, and ultimately deposited her in a small cottage on an island on the grounds of an isolation hospital, Mallon claimed never to have understood the basis on which she, a healthy woman in mid-career, could be isolated and locked up for life. As she put it to a reporter, “I never had typhoid in my life, and have always been healthy. Why should I be banished like a leper and compelled to live in solitary confinement with only a dog for a companion?”9
Focusing on the woman and her life experiences, we come to understand the human dimension of public health policy, especially when it is based on still-new scientific propositions. Here was a woman who had never experienced any symptoms of typhoid and whose life was transformed for the worse because scientists insisted that microbes she could not see and in which she had no reason to believe had lodged in her gallbladder. Is it any wonder that she was incredulous and belligerent when first approached by health officials? Although possibly never convinced that she was in fact a public health danger, Mallon, after her second isolation, became resigned to her fate and died in captivity in 1938. From her own perspective, Mary Mallon’s story is one of oppression, isolation, and injustice, of state authority run amuck.
The seventh, and final, perspective on Mary Mallon’s story comes from its frequent retelling since her death. In what forms did her life continue to have cultural meaning after 1958? Why do we, to this day, see references to Typhoid Mary, a mark of her enduring meaning to our society? The post-1938 stories—in newspapers, journals, radio plays, novels, short stories, and theater—show compassion for Mallon’s personal misfortune at the same time that they separate the historical figure from what she has come to mean.
Reflecting the advantages of hindsight and the perspectives of a more modern era, many recent accounts give more agency to Mary Mallon than the media at the time mustered. In emphasizing a positive view of her
strength and feistiness, some modern-day writers depict a complex interaction between individual and society and a more analytical sense of what Mallon represents in our culture today. Paradoxically, even though these recent retellings seek to humanize Mary Mallon, they also make an explicit connection between Mallon and some of our current fears about AIDS and other “microbes into infinity.”10 In so doing they perpetuate the notion of Typhoid Mary as a metaphor for contagion and fear of contamination in some of the same ways the media used Mary Mallon’s story in the past.
The phrase “Typhoid Mary” has modern-day resonance beyond attempts to recapture Mary Mallon’s history. It has an independent life of its own, as a metaphor for contamination and the transmission of harm or death. Used now by people who have no memory or knowledge of Mary Mallon, the epithetical or metaphorical Typhoid Mary carries different implications at the end of the century than it did at the beginning. The process of the construction of meaning of Typhoid Mary, which began during Mary Mallon’s lifetime, continues after her death, transformed yet again in a specific historical context, by end-of-the-century experiences with new epidemics.
These multiple perspectives on Mary Mallon’s story lead to different conclusions about her significance and meaning. There are many ways in which to read the lives of people in the past and no one right way to tell the past’s stories, just as there is no one way to experience events in the present. The diversity with which humans interpret life’s meanings helps illuminate where we have been, where we are, and where we are going. I hope the stories presented here weave a tapestry that is both rich with past memory and useful in searching for today’s answers to our pressing public health problems.
Typhoid Mary Page 2