In the 1909 legal proceedings, the judge ruled that Mary Mallon’s liberty, like Henning Jacobson’s in 1905, could be taken away in the name of protecting the public’s health. He did not point to any limitations on the health department’s authority to protect the public in the instance of protecting the liberty of healthy carriers of typhoid fever. Indeed, S. Josephine Baker learned from the case, “what sweeping powers are vested in Public Health authorities. There is very little that a Board of Health cannot do,” Baker concluded, “in the way of interfering with personal and property rights for the protection of the public health.”53 Nonetheless, the health department did seem to recognize some limits to its authority. While it forced Mallon to stay on North Brother Island, it did not force her to undergo the surgical removal of her gallbladder (a procedure, as we have seen in chap. 1, often unsuccessful and dangerous in this period, that had the potential for alleviating her condition). The risks to her of surgical complications or even death were so high that officials, while suggesting the operation, did not insist upon it.54
We might speculate that if the New York City Health Department had tried to isolate against their will all the known healthy typhoid carriers—over 400 by the 1930s—the judicial rulings might have begun to go in the opposite direction. The court might have put limitations on health department use of its authority with regard to the isolation of large numbers of healthy people. But the judge seemed to have no problem with a single case, perhaps reasoning that because Mary Mallon was the first healthy carrier to be identified, she made a good example to deter potential future offenders. Whatever other reasons might have motivated him—and I will explore some possible ones in later chapters—the judge interpreted an ambiguous law as allowing him to accept the advice of the city physicians and permit long-term isolation.
Part of what Mary Mallon’s case reveals is the early-twentieth-century acceptance of the authority of scientific experts and of laboratory tests as legal measurers of truth and determiners of the abridgment of liberty.55 Significant parts of American society came to trust these new tools based on microscopic examination instead of relying only on experience. Even in a case of conflict, when a person said she was healthy and one laboratory agreed, but another claimed she was not, health policy seemed to rest with the point of view that favored the new science. Health law stood on the shoulders of bacteriological findings.
There is more at work here than the prominence of medical knowledge or the legal acceptance of new medical theories. Let us posit for a moment that all parties in Mallon’s case agreed that she carried and disseminated typhoid fever with her cooking. The question still remained about whether or not people who gave disease to others needed to be isolated. Was it not possible to stop Mary Mallon from cooking without placing her in strict isolation in a cottage on an island? After all, officials did not later isolate most other healthy carriers they found. If health officials and judges believed strict isolation was the only way to stop Mary Mallon’s potential dangers, why and how did they reach this conclusion? What differentiated her case from others?
The law was not always interpreted in such a way as to demand isolation. Compare the New York Supreme Court ruling in Mallon’s 1909 case with a report the following year of an Adirondack guide, Mallon’s “brother in affliction,” dubbed “Typhoid John” by one newspaper, who was identified as a typhoid fever carrier and the perpetrator of an epidemic among tourists that killed two and infected over thirty-six more (more in both categories than Mallon had been associated with at the time). The state health department in this case determined that “there was no State law by which a human carrier of typhoid bacilli could be kept from spreading contagion and disease,” and did not try to detain him, although it did offer him free medical care. The newspaper similarly concluded that “there is no law in this country restraining the movements of these human carriers of typhoid germs, although medical experts estimate that there are probably some 10,000 such afflicted and afflicting persons in the United States.”56 While comparing Mary Mallon to this man, the reporters and health officials did not, significantly, note the anomaly of her isolation.
In Mallon’s court case the health department did not bring up arguments to distinguish her from other carriers, in terms of her resistance or of her being the first carrier to be traced. Health officials presented to the court a situation in which a healthy woman needed to be isolated because the presence of pathogenic bacteria in her alimentary tract defined her as a danger to society. The legal proceedings indicate that the judge was convinced that the positive laboratory tests proved Mallon’s dangers and that similar laboratory tests in another case would bring the same conclusion. Science and medicine could adequately define a health menace.
Given the universality of the arguments raised in court, what happened to Mary Mallon as a healthy carrier should have been typical and precedent-setting. But we already know that when a similar case of Alphonse Cotils (a repeat healthy carrier, which Mary Mallon was not in 1907 or in 1909) came before the municipal court in 1924, the judge suspended his sentence (see chap. 2). In that case, the judge thought, “The only object in imposing a prison sentence would be to deter other typhoid germ carriers from handling foodstuffs.”57 He clearly did not see the specifics of Mallon’s isolation as precedent-setting or generalizable.
The judges in 1909 and in 1924 did not speak about the universal applicability of their rulings; and the health officials, who understood it, chose not to bring it up. They had no intention of isolating all carriers. O’Neill made some effort at generalizing in his sarcastic remarks about locking up all cooks, but did not effectively carry the argument to its conclusion. Mary Mallon’s habeas corpus hearing did not lead to a legal precedent about healthy carriers. Her case was not published in the legal journals, and it was not cited as precedent in other cases concerning typhoid carriers.58
In the early twentieth century the law spoke with a single voice and a simple guideline: public health authorities had the medical ability and the legal authority to define a public health menace, regardless of due process or the curtailment of an individual’s liberty and regardless of consistency. The judges were willing to give health departments the power to discriminate among carriers and decide which healthy people who carried pathogenic bacteria in their bodies were to go free and which were to be detained.
The public health laws that exist today are basically similar to the ones developed at the beginning of the twentieth century. The states’ obligation to protect the health of citizens cannot be abridged or obliterated, but that obligation is constantly open to interpretation as to how it should be carried out and whose expertise might be called upon to help. Legal questions like ones posed earlier in the century continue to face public health officials trying to prevent the spread of HIV infection and drug-resistant tuberculosis. There are public health workers who believe that infected people in both instances should be kept separate from the healthy population, possibly on the basis of laboratory screening tests before any symptoms develop, and others who think that while a few individuals may need to be singled out for such isolation, most do not. Evaluation of the danger of disease transmission is one criterion that remains important to the decision, but other factors enter into the equation today as in the past.
Current fears of living in a police state put limits on plans to isolate large numbers of people, even in the face of potential public health dangers. Mass isolation has been used in Cuba, where the state has created a community within the boundaries of which all AIDS sufferers must live, but such authoritarian behavior on the part of the government in the United States would not easily be met with cooperation.59 Charles Chapin knew, early in the century, that “there certainly would be most energetic opposition on the part of the public” to such policies. Besides, Rosenau had insisted, “It is unnecessary to place bacillus carriers incommunicado.“60 But that is just what health authorities did with Mary Mallon in 1907 and what the court reinforced in 1909
: they forced one woman to live in isolation in the name of protecting the public’s health. From the legal point of view, justice could be served in allowing such abridgment of individual liberty.
“She Walked More Like a Man than a Woman”
Social Expectations and Prejudice
CHAPTER FOUR
When the court ruled in July, 1909, that Mary Mallon had to stay on North Brother Island under health department-imposed isolation, many public health professionals sympathized with the healthy woman and were disturbed by her predicament. Charles Chapin, from his distance in Providence, Rhode Island, wrote about the issues that made her case compelling: “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. “There is now a good deal of sympathy for her, for she is simply one of thousands, perhaps an extreme case, but at the same time one of a class of which all the other members are still at liberty.” Chapin acknowledged that Mary Mallon should not be permitted to cook for other people, for in such a position she would be “in truth a dangerous focus of infection,” but, he went on, “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, and be shorn of her injurious powers.”1
In the mind of this national expert on public health policy, there were no medical or public health reasons to keep Mary Mallon isolated in a cottage on an island. The judge in Mallon’s case may have been convinced by the New York City Health Department that on scientific grounds isolating Mary Mallon was necessary to protect the health of New Yorkers, but many of those people who understood the public health issues best—and Chapin represented this point of view—believed that New Yorkers could be well protected without such extreme measures. Health Commissioner Darlington had voiced “considerable doubt” about whether the health department needed to detain the “germ woman.” In 1910, when Ernst J. Lederle took over as health commissioner, he, too, thought her isolation unnecessary and released her from her quarantine.
Despite the single-mindedness of their arguments in court in 1909, New York health officials in other venues did not limit themselves to bacteria counts and laboratory analyses when they described Mary Mallon and her potential dangers. In this chapter I explore some of the social expectations and prejudices shared by New York health officials that contributed to their perception that Mallon was different from other carriers and in turn affected what happened to her. The fact that Mary Mallon was a woman, a domestic servant, single, and Irish-born significantly influenced how health officials and the middle-class public thought about what should be done with her. Looking at Mary Mallon’s story from the perspective of the dominant social values of her times—as from the perspectives of medicine, public health, or the law—does not alone nor fully explain why health officials and the courts acted as they did, but this point of view adds an important dimension to her story.2
Health officials viewed women carriers of typhoid fever as more dangerous than men in part because cooking, an activity that provided one of the easiest routes of bacilli transmission, was a traditional female activity. Women more than men cooked for their families; women more than men were employed in domestic service; women more than men provided food at public functions like church suppers. The earliest statistics gathered on typhoid carriers revealed that many more women than men were listed on healthy carrier rosters.3 New York City’s own carrier statistics bore out the gender disparity: in 1923, of 106 identified carriers, 82 were women.4 Being a carrier was a gendered condition, one defined in part by socially sanctioned sex roles. Cultural expectations about who women were and what they did became part of the explanation of why more women seemed to be carriers and part of the response concerning how to control carrier-transmitted typhoid fever.
One striking example of how ideas about gender roles influenced thinking about the dangers of typhoid fever carriers came from George Soper. In a press interview after Mary Mallon’s 1915 capture, Soper made use of the opportunity to warn the public in the pages of a Sunday news magazine that, as food handlers, all women cooks were potentially dangerous to the public health, whether they were employed outside the home or within it. “The first lesson to be learned from the case of Mary Mallon,” Soper emphasized, “is in the matter of cooks. Who is your cook? Has she ever had typhoid? Has she ever nursed a typhoid patient?” Almost all women, Soper safely assumed, either cooked for their own families or hired other women to cook for them. Women of all classes, then, by virtue of their culturally defined gendered activities, were potentially dangerous in Soper’s eyes.
How does a lady engage a cook? She goes to an office, she has an interview with a number of candidates of whom she has never heard before, she is told they have good references as to character and ability, and she employs the one who makes the best personal impression. In five minutes she has satisfied herself concerning the person who is to perform the most important function in the household.
Soper indicted upper-class women who were careless in making important hiring decisions and urged them to make sure that they did not bring danger into their homes. In even stronger language, he targeted middle-class women, with whom “the danger of transmitting typhoid is increased tremendously,” because mothers tend sick children and bring germs directly from the sick room to the kitchen when they prepare the family’s meals. Mothers, in carrying out their traditional jobs of caring for their children and feeding their families, might carry disease to the ones they love. Most of all, Soper blamed working-class women domestics who entered the homes of others as cooks, spreading germs to unsuspecting people.5
While all women thus became suspect for spreading typhoid fever, health officials did not for a moment consider testing all women and locking up all those identified as typhoid carriers. It was not simply her sex that made Mary Mallon a candidate for incarceration. Mary Mallon was not isolated because she was female, but her womanhood was an important factor contributing to what happened to her. The gendered order of society, embodied in cultural expectations about men’s and women’s behavior and in language, influenced how women in general and Mary Mallon in particular were viewed.
By the 1930s in New York City, such gender considerations had become a stated component of health department rules for controlling typhoid carriers. As Charles Bolduan and Samuel Frant wrote, “A hard and fast rule has been set. Stools on all who prepare food in the family, as well as on all women over 40 in the household, and any grandmothers or mothers-in-law, are required, and also on all those giving a history of typhoid fever in the past” (emphasis added).6 Men (and young women) living in a household which was being investigated for the cause of a typhoid outbreak would be subject to scrutiny only if they gave a history of having handled food or having had the disease; women over the age of forty, regardless of their typhoid status or their stated connection to food preparation, were all required to undergo medical examination. The rules recognized a socially common sexual division of labor at the same time as they reinforced the expectation that even women who claimed no responsibility for food preparation could not be trusted not to cook.
Because Mary Mallon was a woman, middle-class American society had expectations about how she should act and what she should do that helped lead to her condemnation when she did not follow the acceptable norms. The gendered language evident in some tellings of her story reveals that appropriate “womanly” behavior was on the minds of health officials as they considered Mallon’s case. As the following discussion suggests, gender was one very important factor in Mary Mallon’s situation, and it interacted closely with class and ethnicity, both of which also carried strong cultural expectations that influenced the outcome of Mallon’s story. Mallon was not isolated for life because she was a Catholic, Irish-born, single, working woman. The evidence suggests, rather, that for the middle-c
lass professionals with whom she came in contact these social identifiers created a set of social expectations and evoked certain prejudices, which together helped lead to their perception of her as deviant and expendable.7
Gender, class, marital status, and foreign birth all help explain how it happened that Mary Mallon was cooking for the Charles Henry Warren family in their rented Long Island summer home in 1906. She was an Irish-born, working-class, single woman. These facts meant that she had few choices in her life. She did not have a family on which to rely for social or financial support. She had to work, and, like many other Irish-born women, she made her living by hiring out her domestic services to wealthy New Yorkers. She found most of her placements through an employment agency, a fact that later helped George Soper trace her typhoid history.8 Her career pattern was completely ordinary, following the limited opportunities available to single women of her ethnicity and class.9
From Soper’s identification of the families for whom Mary Mallon worked who reported cases of typhoid fever, it is possible to trace Mallon’s employment history, although she claimed that his list was incomplete. Between September, 1897, the first employment date we know, and March, 1907, when the health officials first apprehended her, Mary Mallon was fully employed 65.5 months, or 57 percent of the time. Mallon admitted that she was not always working. We can safely conclude that her life was not easy, that money was a problem, and that she, like other women of her marital status, occupation group, and ethnic background, sometimes did not have adequate support.
This, then, is the basic outline of Mallon’s situation when she became a public ward in 1907. The statements and attitudes of the health officials reflect that they saw her as a person representing a class lower than their own, as uneducated, and as unappealing in her appearance, her choice of a male companion, and her living spaces. Assessing the attitudes that underlay public officials’ thinking about Mallon will help us to understand the conscious and unconscious thought that determined how she was viewed and treated, as well as how Mary Mallon herself understood their words and actions.
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