Typhoid Mary
Author: Judith Walzer Leavitt

Overview

This book eminently succeeds in conveying the history of ‘one of the nineteenth century’s worst killers‘, and it does so by exploring ‘the many stories of Mary Mallon‘ – the Irish immigrant cook who became infamous for spreading typhoid fever in early 1900s New York. Referring to the book as ‘the stories of the human side of disease and its control’, the author used the intriguing case of Mallon to skilfully unravel the complex intersection of individual liberty and public health. As it objectively dispelled the myths that mushroomed around Mallon, the book cast her as the casualty of a biased and discriminatory public health system, proposing that understanding the different sides of her story may ‘help us find present-day solutions to our present-day problems’. In this regard, the book turned out to be a masterclass on how to create fair public health policies which engender people’s confidence even when their beliefs about the disease differ from those of public health officials. And at the heart of the book are its recommendations to public health authorities which have contemporary relevance, and these range from avoiding ‘the use of labels that stigmatize and separate’, and treating infected people ‘with respect and empathy for their personal stories’ (pages xvii-xviii, 1-9, 12, 176 and 237-238).

Synopsis

The book’s portrayal of typhoid fever, a disease it characterised as ‘one of nineteenth-century America’s most serious health problems‘, was in the context of the science of bacteriology which was just emerging at the time, and of the importance of sanitation in controlling infectious diseases. The book therefore reviewed the biology of the causative organism, Salmonella typhi, and it explored the distinctive clinical manifestations of typhoid such as headache, malaise, diarrhoea, abdominal cramps, and a ‘characteristic rash…which lasted a few days’. The author also pointed out that typhoid manifests with a ‘sustained fever‘ which ‘could remain high for two weeks’, and it follows a clinical course that takes ‘over a month’ during which ‘the patient weakened and became susceptible to complications‘ – the basis for its ‘case fatality rate of about 10 percent’. Relevant to Mary’s case, the author also helpfully defined the typhoid fever carrier state, attributing this to faecal excretion of persisting bacteria in the gallbladder, and pointing out that this could develop on the background of mild, subclinical or acute infections (pages 22-30).

Whilst Mary was involved in several typhoid spreading situations, the most prominent the book explored was ‘when typhoid struck six people in the household of eleven’. The author narrated how George Soper, a civil engineer hired by the homeowners, traced the source of the epidemic to Mallon by discovering that typhoid fever had broken out in seven of the eight previous families she had worked for. The author also chronicled Mallon’s countless confrontations with the New York Health Department and the police who forcefully arrested her, noting that she repeatedly reneged on her promises to abandon her cooking career – the reason she was eventually permanently confined for more than twenty six years. Perhaps the most touching theme of the book is its portrayal of Mallon’s own perspective of the whole saga, one that the author said goes ‘beyond the caricature‘ to reveal someone different from ‘her public definition‘. Arguing that Mallon saw her case as a story ‘of oppression, isolation, and injustice, of state authority run amok’, the author asserted that Mallon found the concept of a healthy carrier to be something ‘beyond the realm of thoughtful possibility’ – the reason she never believed she was a danger to the public (pages 11-21, 31, 36, 163, 163-173 and 190-192).

A relevant point the book makes is that the public health authorities deliberately treated Mary differently from hundreds of other healthy carriers, including those who were food handlers. Insisting that the authorities ‘wanted Mary Mallon isolated‘ even though they knew she wasn’t a risk to the general population, the author maintained that it was ‘possible to stop Mary Mallon from cooking without placing her in strict isolation in a cottage on an island’. To support this contention, the author compared Mallon’s treatment to that of similar cases, for example Typhoid John, the Adirondack guide who the health authorities ‘did not try to detain‘ even after he was ‘the perpetrator of an epidemic amongst tourists that killed two and infected over thirty-six more’; Tony Labella who ‘reportedly caused an outbreak of eighty-seven cases and two deaths’, who was never isolated for life even though he was ‘as dangerous to the health of others as was Mallon’; and Alphonse Cotils who ‘violated the terms of his agreement’ and ‘defied health department rules’ and ‘continued his work’ as a baker. Furthermore, unlike other carriers who were given stipends to cover their loss of earnings, the author said ‘health officials did nor offer Mary Mallon similar aid and understanding‘. In explaining Mallon’s exceptional treatment, the author contended that it was because she ‘was a woman, a domestic servant, single, and Irish-born‘, and adding that the ‘expectations and prejudices about Mary Mallon’s social position…all contributed to defining her as dangerous in the eyes of those who pursued her’ (page 57, 60-61, 66, 88-89, 93, 97, 99, 102-119 and 125).

The creation of the negative public image of Mallon was another theme the book explored in which the author reviewed the media’s duplicitous role. For example, the book showed that the pejorative terms and cartoons which the lay and medical press used to depict Mallon created a form of ‘social stereotyping‘ which ‘gave support to her long-term isolation‘. The author argued that these reports conveyed ‘surprisingly little‘ about her as a person, and this explained why the real Mallon ‘receded in historical memory‘. Arguing further that ‘the popular portrayals of her uniqueness‘ helped to stoke ‘deep social prejudices and powerful emotions‘, the author said it also ‘helped to turn public opinion from sympathy and curiosity to anger and fear‘, and to transform her into ‘a villain who could not be trusted, who had to be locked away in order to protect innocent people’. The author also established a timeline of subsequent public depictions of Mary which remained unsympathetic until the 1980s when ‘newer renditions of Mallon’s story’ were written by those who have ‘increasingly shown sensitivity to the personal sadness in Mallon’s story’ and tried ‘to understand Mallon’s own position’ (pages 10, 126-136, 146, 151-158 and 214).

The book acknowledged that ‘there is no single truth‘ about Mallon, and the strident argument it made was that appreciating the contrasting perspectives of her story should ‘remind us of important approaches to consider and pitfalls to avoid as we seek answers to similar health dilemmas today’. Arguing that Mallon’s story ‘underscores the necessity of looking at public health problems from different stances‘, the book explored the question of how to strike the right balance between personal liberty and public safety. In doing this, the author argued that it is rarely legal nor necessary ‘to restrain even one person’s individual liberty in order to achieve health‘, pointing out that at the time of Mary’s incarceration, the law did not allow for the isolation of healthy typhoid carriers – just as it did not forcibly enforce vaccination. Indeed she pointed out that Mary was the first healthy person the public health authorities had ever forcefully isolated, adding that prior to her case, ‘public health officials had not implicated healthy people in causing outbreaks of typhoid fever’. Acknowledging that Mallon herself was not ‘blameless in historical judgment’ as she ‘overreacted‘, and conceding that ‘there might remain a few individuals who would need to be forcibly separated from society’, the author nevertheless maintained that ‘we can work toward developing public health guidelines that recognize and respect the situation and point of view of individual sufferers‘ (pages 42, 69-70, 78-80, 231-232, 244-245 and 254).

Opinion

This book shines an enlightening light on a historical figure whose public profile has been twisted to fit a denigrating stereotype. By exploring the various layers of complexity that Mallon symbolised, the author extracted critical lessons on integrating fairness and civil liberties in the development of public health policies. Whilst the book’s sympathies were clearly with Mallon, the author nevertheless maintained a balanced perspective, recognising the justifiable concerns of health authorities and the public. The book stuck to its outlined goals although although it had a tendency to be repetitive on certain themes.

Overall assessment

This book has given a voice to the disease, and to its most famous victim. With a forensic and methodical approach, it succeeded in painting a balanced portrait of Mary Mallon – one that includes her own previously under-appreciated views that counters the popular one that casts her as a villain. The book portrays Mallon as the victim of a complex system that was biased in its attitude to all that she symbolised. The author’s discussion of the history of typhoid is fascinating on its own merit, and the added personal dimension makes it even more instructive. Its contents are of both historical and present-day relevance, and I recommend it to all doctors.

Book details

Publisher, Place, Year:  Beacon Press, Boston, 1996
Number of chapters: 7
Number of pages: 331
ISBN: 978-0-8070-2103-3
Star rating: 5
Price: £17.93