We have been hearing about “asymptomatic carrier” quite a lot in the past few months. It scares us to death that there are people carrying chronic diseases with no outward symptoms of the microbes within, spreading the deadly disease to unsuspecting, healthy individuals they come into contact with. But back in the early 1900s, the concept of “healthy carriers” of infection was entirely new to scientists, and this brings us to the story of Mary Mallon, the first known asymptomatic carrier of typhoid in the United States, who is believed to have infected more than fifty people with typhoid fever, three of whom died.
An illustration, published around 1909, depicting “Typhoid Mary” breaking skulls into a skillet.
Mary Mallon was born in 1869 in Cookstown, County Tyrone, in what is now Northern Ireland. At the age of 15, she immigrated to the United States, where she lived with her aunt and uncle. Like most Irish immigrant women, Mary found work as a domestic servant, initially in laundry and seamstress work, cleaning, or hauling coal. Later, she became a cook, working with affluent families in Manhattan. But things were not going as well as they seemed.
From 1900 to 1907, Mary worked in the homes of eight families, and in seven of these homes, people either fell sick with typhoid or died. In 1900, she worked in Mamaroneck, New York, where within two weeks of her employment, residents developed typhoid fever. In 1901, she moved to Manhattan, where members of the family for whom she worked developed fevers and diarrhea, and the laundress died. Mary then went to work for a lawyer and left after seven of the eight people in that household became ill.
In the summer of 1906, a New York banker Charles Henry Warren took his family on vacation to a rented house in Oyster Bay, Long Island, and hired Mary Mary to be their cook for the summer. Shortly after the family arrived, the youngest daughter became ill, followed by their two maids. Soon, Mrs. Warren became sick too, then another daughter, and finally the gardener.
This was highly unusual because no one else in Oyster Bay, except this family, was sick and this wasn't the sort of area that one would expect to see typhoid, which was often associated with crowded, poor neighborhoods. Typhoid is a bacterial infection that typically spread through food and water contaminated by salmonella typhi. The bacteria grow and reside in the intestinal tract and are expelled from the body with feces, which then contaminates drinking water. Patients who fall sick to typhoid experience high fever, headache, diarrhea and delirium. In the early 20th century, there were no antibiotics and one out of 10 died of the disease.
Typhoid bacteria (Salmonella typhi) under electron microscope. Photo: Sanofi Pasteur/Flickr
Fortunately, the Warren family recovered, but for George Thompson and his wife, who owned the rented property in Oyster Bay, the crises was far from over. The Thompsons regularly rented out their property to wealthy New York families, and the news of the outbreak had already botched their reputation. They knew that unless they are able to find the source of the infection, they might not be able to rent out the property again. The Thompsons hired several independent experts who checked the plumbing of the house to see whether it was contaminating the drinking water. They checked the local shellfish supply and the milk supply, but every source turned out to be free of the bacteria. The source of the outbreak remained a mystery.
Desperate to get to the bottom of the puzzle, Thompson hired George Soper, thirty-seven-year-old freelance civil engineer who had been investigating typhoid outbreaks in well-to-do families. After learning that the Warrens had hired a new cook, who no longer worked with them, Soper had his suspicions. Soper was able to trace Mary's employment history back to 1900. He found that typhoid outbreaks had followed Mary from job to job. From 1900 to 1907, Soper found that Mary had worked at seven jobs in which 22 people had become ill, including one young girl who died with typhoid fever shortly after Mary had come to work for them.
Soper tracked Mary down to her new place of employment, the family of Walter Bowens, who lived on Park Avenue. There was typhoid in the residence too. Soper found that two of the household's servants were hospitalized, and the daughter of the family had died of typhoid.
Soper confronted Mary in the kitchen of the Bowens, and asked her to give samples of her urine and stool. This infuriated Mary. Grabbing a carving fork from the table, Mary chased Soper out of the house. Sopher tried again, this time in the apartment of a man Mary was spending time with. Mary threw Sopher out again, swearing the whole way.
Sopher then went to New York City’s health officials and presented his theory, laying out the facts concerning Mary’s history and suggesting that the woman be taken into custody and her specimens examined. A public health inspector, Dr. Josephine Baker, was sent to see Mary about it, but she slammed the door in her face. The next morning, a Department of Health ambulance drew up quietly in front of Walter Bowens’s house and three policeman got out. Two placed themselves carefully so as to prevent Mary from escaping, and one was taken by Dr. Baker with her to the front door. As soon as Mary saw Baker, she ran back to the kitchen and escaped through a window.
After three hours searching the adjoining properties, one of the men caught sight of a tiny scrap of blue calico caught in a door in a back hallway. When they opened the door, they found Mary. It took five police officers to pull Mary out scratching and screaming and yelling. They lifted her into the ambulance, and Josephine Baker literally sat on her the whole way to Willard Parker Hospital. “It was like being in a cage with an angry lion,” Baker recalled.
At the hospital, Mary’s stool was examined. It was full of pure culture of the typhoid bacteria.
Mary Mallon in bed after having been institutionalized in a hospital on North Brother Island.
In 1907, Mary was confined to quarantine on North Brother Island, in the East River. It was the site of the City's largest quarantine facility, Riverside Hospital, where most of the patients were sick with infectious diseases, such as tuberculosis.
Mary suffered from a nervous breakdown after her arrest and forcible transportation. Mary, who believed she was unfairly persecuted, could not understand how she could have spread disease and caused a death when she, herself, seemed healthy.
"I never had typhoid in my life, and have always been healthy. Why should I be banished like a leper and compelled to live in solitary confinement with only a dog for a companion?"
Protesting her innocence, she added:
I have committed no crime, and I am treated like an outcast, a criminal. It is unjust, outrageous, uncivilized. And it is incredible that in a Christian community a defenseless woman can be treated in this manner.
In 1909, after having been isolated for two years on North Brother Island, Mary sued the health department. But the judge ruled in favor of the health officials and Mary, now popularly known as “Typhoid Mary,” went back to quarantine. Mary’s fortune changed on February of 1910, when the state’s new Commissioner of Health, decided that disease carriers should no longer be kept in isolation and that Mary could be freed on the condition that she no longer worked as a cook. After nearly three years, Mary was released from quarantine.
Upon release, Mary promptly disappeared. She assumed a new name and went cooking again. She found work in restaurants, hotels, and spa centers, and almost everywhere she went, a trail of typhoid outbreaks followed. Mary changed jobs frequently, which kept her one step ahead of health officials desperate to find her. In 1915, a typhoid outbreak sickened 25 people at Sloane Maternity Hospital, and George Soper was again called to investigate. Evidence soon pointed to a recently-hired cook, a certain Mrs. Brown, who was no other than Mary Mallon herself, under a pseudonym.
Mallon (fourth from right) with other quarantinees on North Brother Island.
Mary was arrested and returned to quarantine on North Brother Island. This time she made no struggle. She had become reconciled to a life of imprisonment. Mary remained on North Brother Island for 23 more years until her death in 1938. Mary might not have regained her liberty, but she did live a fairly comfortable life at North Brother Island. She was given a private cottage, where she was able to cook and sleep and read to her heart's content. Mary also became a technician at a laboratory in the island’s hospital, where she washed bottles, did recordings, and prepared glasses for pathologists.
Mary is believed to have infected at least 51 people, of which three died. The number of cases was probably much higher. According to one source Mary could have infected at least one hundred and twenty two people, including five dead.
By the time Mary died, New York health officials had identified more than 400 other healthy carriers of typhoid. But they were not punished the way Mary Mallon was. One of them, an Italian immigrant named Tony Labella, was presumed to have caused over 100 cases and five deaths. Another notorious super spreader was Belgian-born Alphonse Cotils, who owned a bakery in New York. Health officials warned Cotlis not to work in his bakery anymore, but he disregarded their warnings, leading to his arrest. Unlike Mary, Cotlis escaped confinement and was released when he promised to conduct his business over the phone.
References:
# The Most Dangerous Woman In America, PBS
# George A. Soper, The Curious Career Of Typhoid Mary, Bull N Y Acad Med
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