There’s a saying in our language: “Don’t judge someone until you’ve walked a mile in their shoes.” Generally speaking, it’s a good principle to live by, as it promotes empathy for our fellow humans. When faced with the ugly reality of death and disease, however, few people can resist the urge to form opinions about those who are less healthy than themselves—especially when these people threaten the well-being of the healthy. In the history of public health, few people have received as much negative press as Mary Mallon, better known to the general masses as Typhoid Mary.
Mary Mallon was born in Cookstown, Ireland, in 1869 and immigrated to the US in 1884, at the age of 15. She found work in domestic service, serving wealthy families in New York as a cook, and probably would’ve lived an unremarkable life had she not been identified as the first healthy carrier of typhoid to be discovered in the US in 1907. What brings her from fame to infamy is not just her contribution to our knowledge of disease remission and transmission mechanics; rather, it’s the fact that Mary herself lived in vehement denial of her carrier status. In 1907, she was forcibly captured and made to live in quarantine on North Brother Island in New York. Feeling as though her rights as a law-abiding citizen had been grossly and unjustly violated, she petitioned for release. In 1910, a newly-elected health commissioner, taking pity on her case, granted her release on the conditions that she abstain from the cooking profession and report regularly to the health department. Mallon promptly disappeared upon her release, and was discovered five years later, when a mysterious typhoid outbreak occurred at the Sloan Maternity Hospital in New York, to have been cooking under a pseudonym. Mallon was recaptured and brought back to North Brother Island, where she lived the remainder of her life until she died of pneumonia, in 1938. In the newspapers, she was painted—in words and in pictures—as a witch-like harbinger of death. Though some were initially sympathetic to her protests of unjust imprisonment, arguing that she was an unwitting victim of biological circumstances beyond her control, all support vanished upon her recapture, when she was found out to have deliberately endangered the welfare of others by continuing to cook when she was told not to.
Indeed, what kind of person would knowingly pass diseases onto other people? How can Mallon claim to be a faithful Christian when she deliberately evaded the law in order to engage in behavior that she knew would endanger others? Why didn’t she believe that she could be a carrier?
Let us go back to 1936. Late in her life, Mallon had already been the recipient of a huge amount of negative attention from the press. As a result, she had been constantly poked, prodded, and interviewed by a variety of professionals, journalists, and medical students. Unsurprisingly, she was reluctant to consent to my interview, but I insisted that I was genuinely interested in her point of view, and backed up my position with the suggestion of talking over a meal. I prepared the meal myself, of course, and brought it to her cottage on North Brother Island, along two sets of disposable dishware and utensils.
“So what is it you want to know that hasn’t already been in the papers?” She asked.
Why did you endanger so many people? I wanted to ask her. But in an effort to be diplomatic—I had to make sure the interview wouldn’t be prematurely terminated, after all—I asked about her background. Did she have siblings? Yes, six brothers, all older than her. What did her parents do? Her mother died when she was very young and her father worked in the cotton factories in Cookstown. Did she attend school? Until she was twelve. Why did she come to the US? Because it was hard to find work that would pay enough to live on, and everyone she knew was leaving. And they were right—cooking for the upper classes in New York paid good money. She lived comfortably here.
This led up to my first real question: “How was your relationship with the families you worked for?” In other words, did they ever suspect you?
“I’m a very good cook, and I work hard.” She replied, hinting that my culinary skills were no match for hers. In general, she didn’t like what she called “those high and mighty bookish people”—the educated intellectuals that she usually worked for. “I fed my six brothers and my pa, and it was just us. These people need six servants for the four of them, and they can barely take care of themselves!” But she liked the children. Whenever one of the children in the family got sick, she went to extra lengths to take care of them. “I’m not any nurse,” she said, “but I know how to care for people.”
“Did many of the families you worked for get sick from typhoid?” I asked. About half, she replied. Did she think that was unusual? No. A lot of people were sick in the cities, and it had been in the papers that typhoid was spreading in New York. But it wasn’t any more common in New York, she thought, than it was in Ireland. Besides, she’d been with a few families more than two years, and they never had reason to link her to any of the illnesses. Then why did she change families so frequently? “Do you think I was the only cook in New York who worked in a different house each season?” She asked me, disbelievingly. Did she much about typhoid? Yes, actually. She knew when someone got sick, they had to be washed carefully, and their bathroom business had to be disposed of properly and quickly. She also knew that once you survived, you wouldn’t get it again. Was she ever sick with typhoid? Never. She was never a sickly person; that’s why she could get work with wealthy families, because they didn’t want to hire sickly servants.
I decided to enquire about 1907 and the encounter with Dr. George Soper, a civil engineer with the who had first linked her to a series of typhoid outbreaks in wealthy families. “Bah!” She cried. The mention of Dr. Soper clearly upset her. Why? He said she was the common link in “a plague of typhoid”—an unfortunate choice of words. He insulted her, then requested samples of her stools. “It’s not right to ask that of a woman!” By his own accounts, he was “as diplomatic as possible” and had presented to her the evidence which led him to her. Was the evidence unconvincing? “He presented no evidence!” She said, with conviction, “They all think the Irish are dirty, so just because I’m Irish, I must have disease.” A few of her Irish friends had also been accused by the families they worked for of a number of things, from stealing to poisoning food, and she was convinced that Dr. Soper, who approached her at her place of work, was the same person who’d gotten one of her friends sacked just a few weeks before. The fact that he then followed her to her home only cemented her belief that he was an indecent man.
None of her subsequent dealings with any heath department official or hospital doctor would allay her mistrust of the government. She was passed from lab to lab and doctor to doctor, none of whom would believe her claim that she had never been sick with typhoid in her life. When she was finally taken to North Brother Island, she was “so prostrated with grief” that she developed a problem in her eye. Repeated requests for medication went ignored. Nurses would talk about her, doctors treated her like an exhibit (“I was a peep show for these doctors!”), and she was put on several medications were not right for her condition. “They gave me a pill for kidney trouble! Me, a healthy woman!” Not all of her stool tests were positive for the typhoid bacteria, and as a result, the doctors, who did not know all of the mechanisms associated with typhoid transmission, kept changing their minds about where it was coming from. She was asked to undergo a gall bladder removal. “No knife would be put in me.” She declared firmly. She did not trust them.
I turned our conversation to her release and subsequent recapture. “What I and everyone else want to know is, why didn’t you keep your promise that you made in court, not to cook for others again?” “I tried not to,” she said. “I got a job washing clothes, but it hurt my back and my hands, and I wasn’t paid enough to buy my sweat.” In the hierarchy of domestic service, in-house positions offered much better pay and amenities. But Mallon, who had been cooking since the age of 16, did not have any other skills. “What was I to do? With no husband and everyone calling me Typhoid Mary when they found out who I was?”
I finally asked her if she regrets anything she did. She did not. She felt, even after having lived on North Brother Island for thirteen years, that she acted in the way she could have, under the circumstances. I decided to try something; I began to explain to her, in simplified terms, some of the mechanisms of disease transmission via a carrier, and how it’s known that people can carry a disease but not manifest the symptoms. “You’re a strong woman,” I said, “That’s why it wouldn’t hurt you.” I don’t think she was convinced, but she at least appeared to think it over. I asked her to indulge me and pretend that she did for the last couple of questions. “Knowing that now, and thinking back, what do you think Dr. Soper should have done differently?” She thought for a moment. “He shouldn’t have said anything about a plague. And me being Irish—what did that have to do with any of this?” What about the other doctors and the officials at the health department? “I’m not a crazy woman. If they’d treated me like a person and listened to me, I would’ve listened to them. I’m a good Christian and I’d done no wrong. They had no cause to treat me like a peep show.” And with that, dinner concluded.
In the field of public health, it’s probably easy to make the mistake that Dr. Soper and the New York Department of Health did. As officials, it is easy to assume that we know better than the general populace, and that we who think in terms of the well-being of the masses must take precedence over the individual’s concerns over their own liberty. But it must be remembered that, in order for public health policies to be effective, they must obtain the cooperation of the people. The officials who dealt with Mary Mallon contributed to the subsequent conflict with her in several ways. First, they assumed that she would view things from the same perspective that they did. The fact is, they were a part of a group of well-educated intellectuals who believed in germ theory, while she was a part of the less-educated masses who based their beliefs on tradition and observations made from experience. And Mallon had observed that not everyone she came into contact with had fallen ill. The health community had utterly failed to convince her of the validity of their arguments, in part because they used arguments well above her level of comprehension, and in part because what they did say often conflicted with each other. And this is the second point, that the doctors themselves were, at the time, engaged in a kind of debate over what exactly the mechanisms of typhoid transmission were. Thus, Mallon received conflicting bits of information from different sources, that all that the common effect of convincing her not to believe any of it. Finally, the officials failed to consider the social and economic circumstances that heavily influenced Mallon’s decisions. An immigrant woman with no family and no support network can rely only on her skills to sustain a living. Mallon’s skills were limited to cooking. Once barred from that, she would not have been able to sustain herself for very long. In such desperate circumstances, it’s no surprise that she put her own survival and well-being over that of the people she came into contact with. Furthermore, the anti-Irish sentiments of the community at the time made themselves felt quite acutely. Irish, Italian, and Jewish immigrants were often blamed for outbreaks of disease in major cities, and the negative attention of the press would have only exacerbated Mallon’s feelings of hostility.
In other words, this case of Mary Mallon is a classic study in “What not to do when confronted with a possible human source of an epidemic.”
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