Typhoid Mary

by Judith Walzer Leavitt

  “The Rigorous Spirit of Science”

  The Triumph of Bacteriology

  CHAPTER ONE

  Mary Mallon, born in 1869, had the distinction, at the age of thirty-seven, of being the first person in North America to be identified, charted, and reported in the literature as a healthy typhoid fever carrier.1 An Irish-born cook who immigrated to the United States as a teenager, she found work as a cook for wealthy New Yorkers and during the summer of 1906 was working in the rented summer home of a New York banker, Charles Henry Warren, in Oyster Bay, Long Island. When typhoid fever struck six people in the household of eleven, the owners of the home, Mr. and Mrs. George Thompson of New York City, hired investigators to determine the source of the epidemic.

  It was not unusual for cities, states, or private citizens to seek such an inquiry into household typhoid fever outbreaks. The common sources of the infection included water or food supplies, and homeowners could correct the defects and assure themselves and their families safety against further infection. In this case, however, the studies proved inconclusive. Thinking they would be unable to rent the property again unless the mystery of these cases could be solved, the Thompsons hired George Soper, a civil engineer they heard about through social connections, to investigate the outbreak further. Soper was known for his epidemiological analyses of typhoid fever epidemics.2

  George Soper had been born and raised in New York City. He attended the Rensselaer Polytechnic Institute in Troy, New York (B.S. 1895), and returned to the city to attend Columbia University (A.M., 1898; Ph.D., 1899) in sanitary engineering. He was well launched on a successful engineering career by the time the Thompsons hired him to investigate the Oyster Bay outbreak. He had already worked for the Boston Water Works and had successfully investigated typhoid fever outbreaks in Ithaca, New York, and other U.S. cities.3

  Soper began his investigation by reviewing the facts already known. The outbreak’s first case had been discovered on August 27 when one of the Warrens’ daughters became ill. Next, two maids and Mrs. Warren were affected, followed by another daughter and the gardener. Soper studied the records and ruled out the common causes of such typhoid fever outbreaks, contaminated water and milk. He systematically discarded other possible sources of infection, including clams from the bay and other foodstuffs consumed in the house and any contacts between family members and people outside who might have had the disease. When none of these alternative explanations proved viable, Soper pressed family members to remember any other distinctive events that might have taken place during the summer weeks when some members contracted typhoid. Through close scrutiny, Soper found his clue: he learned that the family had changed cooks shortly preceding the weeks in question.

  Believing the cook, named Mary Mallon, who had left the family three weeks after the outbreak, to be a prime suspect, Soper turned his attention to tracking her down. Although the family claimed the woman had been in perfect health, Soper, who undoubtedly knew about healthy carriers of other diseases and might have been reading (as he later claimed) literature from Germany and elsewhere in Europe about healthy typhoid fever carriers, expressed confidence that such a person was most likely to have caused this particular household outbreak. Soper was encouraged in his theory about the cook when he learned that she often prepared for the family an ice-cream dessert served with fresh sliced peaches, which would have been an excellent medium for typhoid infection.4

  Soper gathered his strongest evidence of the cook’s involvement by tracing her job history before her arrival in Oyster Bay in August, 1906. This kind of “shoe leather” epidemiological study, tracking down cases and patterns, was not new in the twentieth century. When he made the rounds and followed leads to find his target, Soper was following traditional methods dating to prebacteriological days.5 Relying heavily on information provided by Mary Mallon’s employment agencies, he found eight families who had previously employed her, the earliest beginning in 1897. In seven of these families typhoid fever had developed.6 The following is an expansion of the chronology Soper uncovered.

  1. Summer, 1900, Mamaroneck, New York. Mary Mallon had worked for a New York family with a summer home on Long Island for three years when one case of typhoid fever developed in a young male visitor about ten days after his arrival. There were no other reported cases during her tenure with this family, and, Soper reported, “It was believed at the time that the young man had contracted his typhoid before he came to visit the family.”7

  2. Winter, 1901–1902, New York City. Mary Mallon cooked for a New York City family for eleven months. One month after her arrival, the family’s laundress came down with typhoid fever. At the time there was no investigation of this case.

  3. Summer, 1902, Dark Harbor, Maine. In the early summer of 1902 the family of New York lawyer J. Coleman Drayton suffered a severe outbreak of typhoid fever. The Draytons had hired Mary Mallon to accompany them to their summer residence in Dark Harbor, Maine, just before leaving New York City in June. Beginning with the footman, seven of the nine (family of four and five servants) became infected.8 Only Coleman Drayton and Mary Mallon escaped the disease. The cook stayed on to help nurse the sick, for which Mr. Drayton was so grateful that he gave her a bonus for her trouble. The outbreak had been investigated by Dr. E. A. Daniels of Boston and Dr. Louis Starr of Philadelphia, who had concluded that the footman had brought the illness into the house.9

  4. Summer, 1904, Sands Point, New York. Nine months following Mary Mallon’s employment, an outbreak of typhoid fever affected four newly employed servants in the Long Island summer household of Henry Gilsey. The servants lived in a house apart from the family, and the family members were not infected. The episode was investigated by Dr. R. J. Wilson, superintendent of hospitals for communicable diseases in New York City, who believed that the laundress (the first infected) brought the fever to the servants’ quarters.10

  5. Summer, 1906, Oyster Bay, New York. Six persons in the Charles Henry Warren household of eleven were infected with typhoid fever. They included three family members—Warren’s wife and two daughters—and three servants—two maid servants and the gardener. Before Soper began his investigation of this outbreak, two other experts, E. E. Smith and D. D. Jackson, had concluded that the water supply “must have been contaminated,” possibly by the cleaners of the tank who “perhaps carried typhoid excreta on their boots.”11

  6. Autumn, 1906, Tuxedo Park, New York. Two weeks following Mary Mallon’s arrival as cook to the George Kessler family, a laundress was taken ill. The cause of her illness remained unclear.

  7. Winter, 1907, New York City. The Walter Bowen family of 688 Park Avenue hired Mary Mallon during the winter of 1906–1907. Two months after her initial employment, a chambermaid in the household became sick with typhoid fever, and soon after the daughter of the family became ill and died. It was within this house that George Soper conducted his first meeting with Mary Mallon.12

  About his findings, Soper noted, “There is a remarkable resemblance between these seven fragments. In each instance one or more cases of typhoid have occurred in households from ten days to a few weeks after the cook has arrived or among people who have, within that period, come to live near her and eaten the food which she has prepared.”13 Soper identified twenty-two cases of typhoid in his search of Mary Mallon’s employment between 1900 and 1907, although his enumeration, which is the one quoted by all those who used his evidence, was twenty-six. 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 by virtue of having recovered from the disease. During these same years, between 3,000 and 4,500 new cases of typhoid fever were reported each year in New York City, and most of these people would have been exposed to the disease through contaminated water supplies or other sources more common than an individual healthy carrier. (Immunization became available after 1911.)14

  Fourteen of the initial twenty-two infected people traced to Mary Mallon were
domestic servants and eight were members of the families who employed them. Soper called attention to the class of those infected in his first paper and later repeated his observation: “The social position of the persons attacked differed decidedly.” Soper’s audience at the Biological Society of Washington, D.C., when he first publicly presented his evidence on April 6, 1907, emphasized the servants’ susceptibility. Some believed with Dr. C. W. Stiles that more servants got sick because “personal cleanliness has an important bearing,” implying that servants were dirtier than their employers. In the discussion, Soper muddied the water somewhat by explaining that more servants became ill because cooks handled their salads, fruits, and other raw food items more often than they did for family members and thus had greater opportunity to infect other servants, an observation that was not necessarily true.15 The resultant perception that servants were uniquely sensitive to typhoid infection from healthy carriers has lasted in the literature to the present.16

  Although almost all of the outbreaks with which Soper linked Mary Mallon’s name had been investigated and other sources identified as their cause, Soper remained unpersuaded by the previous reports.17 The twenty-two cases in families with which he could connect Mary Mallon convinced Soper that it was the cook who constituted the danger. We have no independent source through which to verify Soper’s accounting of Mallon’s employment history, and internally, his tellings of the story disagree on small details. The account, nonetheless, was consistent in connecting Mary Mallon and typhoid fever. Being himself so skeptical of others’ investigations, Soper knew that in order to convince others of his own arguments about Mallon’s involvement, his epidemiological conclusions had to be thorough and backed with laboratory proof. This need for laboratory certainty explains why Soper was so persistent in his investigation and, once he found her, insistent on obtaining specimens of urine and feces from Mary Mallon.

  Mary Mallon’s apprehension in March, 1907, in the Park Avenue home in which she was then employed, was dramatic. George Soper appeared without warning and explained to her that she was spreading disease and death through her cooking. He wanted samples of her feces, urine, and blood to test them in the laboratory. The story seemed preposterous to the healthy Mallon, who promptly threw him out of the house. Mallon’s response was not unreasonable in an era before the idea of a “healthy carrier” was known to the general public and even before many in the medical profession understood it. Soper persevered. He took a medical colleague and visited Mary Mallon in her home, where, again, she evicted him.18

  When he could not obtain the necessary samples for laboratory testing himself, on March 11, 1907, Soper presented his evidence to Hermann Biggs, medical officer of the New York City Health Department, so that he could pursue the case. As an independent investigator, Soper did not have the authority to demand compliance. Biggs and his health department colleagues found Soper’s epidemiological evidence sufficiently compelling to follow through on his suggestions. Soper’s evidence convinced them that if Mary Mallon could be found, and her feces and urine tested, the laboratory would prove what Soper’s epidemiological study had already shown—that Mary Mallon, although healthy, had transmitted typhoid fever to those who had eaten the food she prepared.

  When approached by the official city health inspector, Dr. S. Josephine Baker, Mallon still did not understand the demands for laboratory specimens and refused to provide the evidence. Dr. Baker called in the police to help and the officers took Mallon by force and against her will to the Willard Parker Hospital, New York’s receiving unit for those suffering from contagious diseases. There they subjected her excreta to careful laboratory analysis.19 Finding high concentrations of typhoid bacilli in her feces, authorities kept Mallon in health department custody, moving her to an isolation cottage on the grounds of the Riverside Hospital on North Brother Island in New York.

  The city kept Mallon in her isolation retreat for two years before she sued the health department for release in 1909. Her lawyers argued before the New York Supreme Court that she had never been sick and could not be the “menace” to society that the health department claimed. The judge, while voicing sympathy, sided with the health department and sent Mary Mallon back to her island cottage.20 After another year of isolation, a new health commissioner released her on the promise that she would not cook again. Ultimately she reneged on this agreement, and in 1915 the health authorities found her cooking at the Sloane Maternity Hospital, the site of an outbreak of twenty-five new cases of typhoid fever. This time they sent her back to her island isolation for the rest of her life. On November 11, 1938, Mary Mallon died, having been “a special guest of the City of New York” for more than twenty-six years.

  The details of Mallon’s experiences beginning with her 1907 detention are further explored in the other chapters of this book. For the remainder of this chapter, I want to examine how and why it came to be that health officials in 1907 were eager and able to locate healthy carriers of typhoid fever and what Mary Mallon, as the first such carrier to be carefully traced, represented to the followers of the new science of bacteriology. The perspective of the bacteriologists, which emphasizes the triumph of scientific and laboratory methodology and has become the commonplace narrative in the medical literature, is but the first of multiple viewpoints on Mary Mallon that this book analyzes.

  Throughout the nineteenth century, epidemics of infectious diseases, many of which already had threatened and scourged America in the colonial period, increased in their destructive powers. As the population in major cities exploded through immigration, epidemics of cholera, smallpox, and yellow fever took increasing numbers of lives. Today at the end of the twentieth century, even while epidemics of HIV infection and drug-resistant tuberculosis threaten hundreds of thousands, even millions, of Americans, we cannot easily comprehend the high threat of disease with which nineteenth-century urbanites lived.

  On top of the ever-present childhood diseases that may have accounted for 60 percent of total urban deaths and carried away more than one in ten infants before their first birthdays, as well as various other endemic problems affecting adults, fatal epidemics periodically swept through America’s cities. These outbreaks—for example, cholera, which left an emaciated shell of a person if it did not kill, or the permanently scarring smallpox, which sometimes carried a high death rate—left behind extraordinary debility, and, often, complete civic disarray. Urbanites who could afford it fled their homes for the hoped-for safety of the less crowded rural areas. The exodus sometimes included government officials who abandoned the city to fend for itself at the height of the crisis.21 Too familiar was the sight of the horse-drawn ambulance or the disinfecting van, and the hearse.

  In response to the devastation from disease, especially epidemic disease, cities and states organized health departments whose functions included planning programs to obviate the worst of the disasters.22 Before the nineteenth century, health work remained haphazard and usually limited to epidemic emergencies: when an epidemic ended, health boards would be disbanded until the next one threatened. In the nineteenth century, however, urbanites, faced with increasing sanitation crises and devastating epidemics, began demanding a more systematic approach to disease control. Much of the work early in the century rested on the prevailing medical theory that dirt caused disease and emphasized keeping the city environment clean. The so-called “filth” theory of disease posited in a very general sense that undifferentiated urban pollution—deriving from waste material from the horses, cows, and pigs that roamed freely around America’s burgeoning cities and other rotting organic refuse and garbage left uncollected on city streets—caused bad air, or “miasmas,” which could lead to disease. In response to this perceived health reason to clean up the environment, health officers developed large-scale sanitation projects to bring clean water into the cities and allow efficient sewage disposal and garbage collection and disposal. In addition, nineteenth-century health departments operated vaccination programs, is
olation hospitals, and dispensaries to help bring health to urban residents.

  The results of some of these nineteenth-century responses to the threat of disease are with us still today. The city of Chicago, for example, built upon low-lying flatlands, literally raised its buildings above the water table in order to provide for sanitary sewerage and clean water.23 New York and Boston sought clean water miles from the city and spent considerable sums constructing pipes and aqueducts to transport it. All major cities engineered massive waterworks and intricate networks of pipes to carry clean water to city-dwellers. Creative solutions to the garbage disposal problems evolved as public works and public health departments cooperated to diminish the dangers from disease. Local governments spent large proportions of their budgets on these infrastructure necessities in response to the public demand for aid against the risks to health abounding in the city environment.

  By the last decades of the century, the experimental work from the laboratories of Louis Pasteur in France and Robert Koch in Germany had revolutionized medical theory about the causes of epidemic disease, substituting microorganisms for undifferentiated filth as the culprit. Narrowing the etiology of disease from the whole urban environment to microscopic germs seemed to pinpoint the public health activity needed to eliminate the problems. Medical scientists, some of whom completely abandoned the old theories, were convinced that the identification of microorganisms as a single cause of infectious diseases would allow them to target specific public health activity to find and eliminate those germs.24 The new science promised to eliminate some of the worst scourges of urban life and bring health to all who followed its precepts.