Typhoid Mary, the asymptomatic cook who infected patrons

Image of Mary Mallon (far left) in a hospital bed that published in the June 20, 1909 issue of The New York American. (Credit: Wikimedia Commons)

Toronto — The novel coronavirus pandemic may remind us of another deadly infectious disease: typhoid fever.

It has claimed the lives of hundreds of thousands of people and sickened millions more around the world – and it's almost impossible to talk about typhoid fever without discussing the woman most famously known for spreading it.

Her real name was Mary Mallon, but she is more commonly referred to as “Typhoid Mary,” the person most prominently known for infecting dozens of people with typhoid fever while she worked as a cook for wealthy families in New York City at the turn of the 20th century. At the time, medical knowledge and understanding of asymptomatic carriers of disease was essentially non-existent, which is part of what made Mallon’s story all the more intriguing to doctors and public health officials.

Her story was widely covered in the media, according to Katie Foss, a professor of journalism and media studies at Middle Tennessee State University in the U.S. Foss, who studied Mallon for an upcoming historical book called “Constructing the Outbreak: Epidemics in Media & Collective Memory,” says most of the press Mallon got was negative and often one-sided. “She was never interviewed in the media, she was never quoted,” Foss told CTVNews.ca in a phone interview from Gatlinburg, Tenn. on May 14.

“We talk about her, but we don’t really hear from her. We don’t give her agency,” Foss added.

WHO WAS MARY MALLON?

To better understand the story behind ‘Typhoid Mary,’ it helps to understand who Mary Mallon was before she got her famous nickname. Mallon was born in Cookstown, County Tyrone in Northern Ireland, in 1869 and emigrated as a teenager to the U.S., where she was eventually hired as a cook in New York City to prepare meals for some of Manhattan’s wealthiest families.

Mallon cooked for seven families between 1900 and 1907, unaware that she was a healthy carrier of typhoid fever. No one at the time, including Mallon, really understood that a person showing no signs or symptoms of typhoid, such as fever, cough, fatigue, or diarrhea, could still transmit the disease to others. Her signature dish of peach ice cream, according to this BBC piece, has also been theorized by experts as the conduit through which Mallon spread the contagious disease.

Judith Walzer Leavitt, an American historian and professor emerita at the University of Wisconsin-Madison who specializes in medical history and women’s studies, says Mallon’s story illustrates a unique and unprecedented period in medical history. “It’s a wrenching personal story. She was the first healthy carrier of typhoid fever to be discovered, so people had never seen it before and didn’t know what to do,” she told CTVNews.ca during a phone interview on Sunday from Madison, Wis. “It was completely unheard of. People in the medical community thought, ‘How could this be?’ There were a lot of skeptics,’ Leavitt added.

In 1906, a rash of outbreaks erupted in New York and involved the families Mallon worked for. In one particular household, six of the 11 people got sick. That family hired George Soper, a well-known epidemiologist, to find out why. After months of investigation that included following Mallon around for blood, urine and feces samples, Soper concluded that Mallon was the culprit. Some time passed before Soper had Mallon taken into police custody in 1907 and moved to Riverside Hospital on North Brother Island in New York’s East River, where she was forcibly kept in quarantine for three years.

Mallon hired a lawyer and sued for her release, even requesting a trial to prove her innocence on the accusations made against her. One of the few times the public heard from Mallon directly was in a handwritten note she wrote to her lawyer describing her time in isolation. But a judge found Mallon was still a public threat and ordered her to remain on North Brother Island. She was finally freed in 1910, but on the condition that she stop cooking and stay out of kitchens.

In 1915, Mallon was busted working under a suspected alias in a home kitchen in New York and was once again banished to a life of isolation on North Brother Island, where she remained until her death in November 1938 at the age of 69. In total, Mallon had spent 26 years of her life in quarantine there.

MALIGNED AND MISUNDERSTOOD

Talk of Mallon’s nickname and reputation as a virus “super-spreader” have resurfaced in light of the COVID-19 pandemic.

Leavitt, who researched and wrote extensively about Mallon in her 1996 book “Typhoid Mary, Captive to the Public’s Health,” says she was able to verify and trace 47 typhoid infections and three deaths to Mallon during her career as a cook – a large number, but not nearly as many as some earlier reports suggest.

When you consider all the other deadly disease outbreaks that rocked New York City before this, such as yellow fever, cholera and influenza, the use of the term super-spreader seems to be somewhat excessive. In Leavitt’s opinion, the epithet is plain wrong. “I don’t think she was a super-spreader. She gave the disease to people she cooked for, in small homes. That’s not a big number,” she said. According to Dr. Foss, there were an estimated 400 other asymptomatic carriers that were discovered in New York City after Mallon, but much less was said or known about those individuals.

And Foss also agrees with Leavitt that Mallon was misjudged, believing that the nickname ‘Typhoid Mary’ strips away all the context of who Mallon actually was, as suggested in this piece she wrote for The Conversation on April 24. Foss believes Mallon, as a young, poor and single immigrant, was unfairly characterized as a spreader of disease at a time when little was known or understood about typhoid fever in healthy carriers. And Foss thinks the same can be said about how people today are trying to make sense of the coronavirus. “It’s interesting to see how casually people use Typhoid Mary as a reference [to COVID-19],” Foss said. “Most people don’t understand what an asymptomatic carrier is. People don’t really understand what it means to feel fine and spread disease at the same time,” she added.

PARALLELS TO TODAY’S PANDEMIC

For more than a third of her life, Mallon was confined to living in quiet isolation over concerns and fears she would continue infecting people with typhoid fever if she was allowed to live freely. Those same fears resurfaced earlier this year as the coronavirus quickly spread and became a global health pandemic. Governments forced people to quarantine on cruise ships and entire countries were ordered to observe strict lockdown measures to help stop the virus.

Foss says the question about whether to sacrifice an individual’s civil liberties for the safety of a whole society in the early 1900s with Mallon’s story are resurfacing with the COVID-19 pandemic today. And she believes it’s important to look to the past to keep the present in perspective. “At any moment, this [pandemic] can happen. It’s arrogant to assume just because we have vaccines and advanced medicine that disease won’t find a way and we have to be ready,” Foss said. “We should also recognize that it’s selfish to not think about other countries where diseases are still affecting places, like polio and yellow fever,” she added. Foss said the rise of the anti-vaccination movement has played a pivotal role in allowing some of the diseases that were once eradicated to return.

Like Mallon and typhoid fever, Leavitt reiterates that there is still much we don’t know about how healthy carriers transmit COVID-19, and that what we learn seems to be changing from day to day. “People grasp the concept of asymptomatic carriers, but there is still so much unknown,” she added.

LESSONS TO BE LEARNED

Both Foss and Leavitt agree there is plenty for us to learn from the story of Typhoid Mary when taken into the context of how we navigate pandemics like COVID-19. How media and the public handle the stigmatization of carriers of disease is one of them. How Mallon was blamed for having spread typhoid fever, intentionally or not, and then was given the nickname Typhoid Mary, is another clear example, according to Leavitt. “She got the name Typhoid Mary and she felt the sting of it very badly. She was something to be loathed,” Leavitt said.

Society’s need to find a source of the virus, or to pin blame for its spread, has manifested in the racially-motivated attacks on Chinese people and anti-Asian rhetoric that have begun showing up in cities around the world since the first case was reported in late December 2019 at a seafood market in Wuhan, China. Leavitt thinks making that association is problematic, and says it doesn’t help when that kind of messaging is coming from her country’s commander-in-chief. “Our president called it ‘the China virus’,” Leavitt reiterated. “The way that the Chinese population is being stigmatized is the same as Mary Mallon.”

The importance of clear and honest messaging from governments and public health officials in addressing the coronavirus is another key lesson to be learned from Mallon’s story, according to Leavitt. “Mary Mallon understood there were different messages, and she thought she was treated unjustly,” Leavitt said.

As the story of Typhoid Mary serves as a cautionary tale of one person’s individual rights being infringed upon for the public good, Leavitt thinks the anti-lockdown protests that have sprung up across the U.S. and in cities around the world in recent weeks means the question of “freedom at what cost?” still remains. Quite simply, Leavitt believes that if governments and public health agencies are going to control disease, they’re going to have to infringe on people’s rights, in temporary or perhaps, more permanent ways. “In Mary’s case, it was unfair. Her rights were taken away cavalierly,” she said.

While she admits the decision-making political leaders and health officials are tasked with can become harder in the thick of managing a pandemic, she believes their efforts and intentions on protecting people are genuine. Mary Mallon may not have been afforded the opportunity to have it explained to her why she was being vilified, forced to quit her career in cooking, or why she had to be isolated on an island for years at a time. The lesson we can learn today, Leavitt believes, is in having an informed public that is willing to work together to eradicate COVID-19. “Co-operation is best achieved when you’re honest and open about what you’re doing and why you’re doing it,” she said.

Infographic: Mahima Singh