Americas,  ER,  United States

Typhoid Mary

Typhoid Mary in a 1909 newspaper illustration
Photo Credit

There were many ways to die in the overcrowded disease ridden cities of the late 19th century and early 20th century.  Typhoid was one the most terrifying ones simply because of the speed it could spread through a household.   It’s initial symptoms could be anything- fever and some abdominal cramping.  Then the fever got higher and blood clots formed under the skin.  The patient becomes delirious and the brain and the intestines hemorrhage.  The death rate was recorded anywhere from one in ten to three in ten.  It was frightening.  Doctors were building on the advances in the young science of epidemiology led by pioneers like Dr. John Snow.  (For more on him, please see this post: ) By the 1900s, they had found the cause of the disease was much like cholera in that it was cause by bacteria found in infected feces.  They were able to trace the cause of outbreaks more accurately, however, outbreaks still happened.

Typhoid broke out in the quiet community of Oyster Bay, Long Island.  One of the families affected was the Warren family where six of the eleven people in the rented vacation home became ill.  The patriarch, Charles Henry Warren, hired civil engineer, George Soper, to determine the cause of the outbreak.  Soper checked out the usual suspects- the food and water supply- and came up empty.  Then he began interviewing the servants.  His suspicions fell on Mary Mallon, a cook for the family who had arrived at the vacation home shortly before the outbreak began.  It was strange though because Mary wasn’t sick.  She was an immigrant in her thirties from Ireland who took pride in her cooking.  When asked if she washed her hands before she cooked, she indignantly replied “Of course not.”  When Soper asked her for samples of her blood, urine and feces, she brandished a meat fork at him and called him indecent.  However, Mary was his best lead.

Soper did more research and found that typhoid seemed to follow Mary wherever she went.  Between 1900 and 1907, Mallon worked as a cook in the New York City area for seven families.  In all of these families, someone became ill with typhoid.  He tried again to get her tested, this time visiting her in the hospital when she was ill with an unrelated ailment.  She locked herself in the bathroom until he left.  Mary was convinced she was being persecuted unjustly.  Finally, Sara Josephine Baker from the New York City Health Department went to Mary’s place of employment with five police officers and she was taken into custody.  The samples were forcibly taken, and it was found Mary had a gallbladder teaming with typhoid bacteria.  They suggested she get her gallbladder removed.  Mary refused.  They told her she could not work as a cook.  Mary refused that as well.  She was put into quarantine on North Brother Island in the East River.  There she stayed for three years.  Mary paid a private lab to run tests and they found she was not a typhoid carrier and sued for her freedom.  She lost.

In 1910, a new health inspector deemed the Mary was no longer a danger to the public.  He released her from quarantine as long as she promised not to be a cook.  Mary duly promised and then promptly disappeared.  Then a new outbreak of typhoid broke out at the Sloane Maternity Hospital in 1915.  It was mostly found in the staff, and there were twenty-three people who became ill and two who died.  They found that a Mary Brown was working in the kitchen.  This Mary Brown soon disappeared when people became sick and matched the description of Mary Mallon.  The authorities soon caught up with her in her Queens apartment, sneaking in through a second story window.  Mary was once again sent to the hospital on North Brother Island.

The public had become fascinated with the case, dubbing her “Typhoid Mary.”  The New York Times reported, she was “a veritable peripatetic breeding ground for the bacilli”.  Any public support she had dwindled once it came out that she went back to cooking and endangered people.  However, Mary did not have many options once she was out in the world.  Cooking was the only skill she had.  Plus, she never truly believed she was a carrier of typhoid so didn’t believe she was putting anyone in danger.  

Scientists from Stanford figured out only recently how Mary could be a carrier and not get sick.  Part of the immune system are macrophages, which “eat” foreign bodies.  When someone becomes sick, the macrophages go into high gear to fight the infection.  However, after a few days the macrophages become less aggressive and the typhoid bacteria actually penetrate and live in the cells meant to kill them.  Even now, that is difficult to treat let alone a hundred years ago.  

Mary was not always well treated in quarantine, and it was not an easy life.  She suffered a stroke and died from its effects six years later. She was still living on North Brother Island, and her New York Times obituary attributed 41 cases of typhoid and 3 deaths to her.