Protecting Society from Typhoid Mary

Assuring Public Health Rights and Individual Rights

Aug 2, 2009 Marian Henderson

Typhoid Mary is a notable figure in the history of public health. Although the major events of Typhoid Mary's life occurred between 1907 and 1939, her story is still rele

Inside of her body Mary carried the pathogen (typhoid bacilli) that caused typhoid fever, yet she herself remained unaffected by the disease. Although harmless to her, the infection that she carried was fatal to many others, and the probability of her spreading contagion was increased as Mary Mallon was a cook by profession who worked in various households. Her capacity as a cook increased her odds of spreading the disease.

Eventually, her cooking duties and the resultant outbreaks of disease led to her apprehension. Because typhoid infections had occurred in each household where Mary Mallon worked, public healthcare officials suspected Mary Mallon was the source of the infections. Their suspicions aroused, officials began a relentless pursuit of Mary Mallon to confirm that she was responsible for outbreaks of the disease.

Finding Typhoid Mary and Stopping Her

The task of the public healthcare providers was complicated because Mary resisted restrictions and constraints imposed upon her to ensure public health. As the authors of Bioethics and Public Health Law observe, public healthcare providers and policy makers (then and now) must “attempt to balance the state’s interest in protecting the public at large with an individual’s right to freedom from coercion or constraint” (2005, Hall, Bobinski & Orentlicher, p. 521). During their pursuit of Mary Mallon in the early 20th century, healthcare officials wrestled with the dilemma of recognizing Mary Mallon’s right to freedom and the public’s right to safety without denying the rights of either.

Public Healthcare as the Enemy

The case of Mary Mallon, unfortunately, was not handled well. The authorities (especially George Soper) who were responsible for approaching Mallon, informing her of the characteristics of the disease, explaining to her how the disease progressed, and explaining why she needed to be tested and possibly isolated only inspired fear and mistrust in Mary.

Author, Judith Leavitt, describes Mary’s thoughts and apprehension, “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?” (p. 180) Mary didn’t understand how she could infect others with typhoid fever if she had never contracted the illness herself, and the public healthcare officials offered very little explanation to Mary. To compound Mary Mallon’s fears, public healthcare officials also didn’t address her concerns about where or how she would live.

The health care officials had approached Mallon asking for stool and urine samples to test for the presence of the typhoid bacilli in her body and warning Mary that she couldn’t work as a cook anymore if she had contracted typhoid. But they hadn’t offered reassurance, a means of financial support, solace, or understanding, and their tactless, insensitive approach frightened Mary.

Rebellion

Mary refused to cooperate. Eventually, after several events of resistance, avoidance, and rebellion on Mary’s part – public healthcare officials despite uncertainty about the legality of their actions, apprehended Mary and restricted her to a hospital island. “When health department officials forced Mary Mallon into the city ambulance and took her against her will into WiIlard Parker Hospital and then to her isolation on North Brother Island in March, 1907, they acted with uncertain legal authority” (p. 70, Leavitt). Nonetheless, Mary Mallon was restricted to North Brother Island.

Although she was provided with a cottage on North Brother Island, interacted with personnel at the island hospital, and performed various duties to occupy her time while residing there, Mary Mallon still resented her enforced residency. She appealed to the courts and won her freedom once in 1910, but she was forced to return to North Brother Island in 1915 when public healthcare officials discovered that she was had resumed her profession as a cook.

Dying in Exile

Mary Mallon died 11 November 1938 at Riverside Hospital on North Brother Island, and she protested until her end that she was not a carrier of typhoid. What is the lesson of her ordeal? In protecting the public from individuals infected with communicable diseases, public healthcare officials must also protect and consider the individual rights and psychological well-being of persons who harbor the disease. Despite their threat to public safety, the rights of such individuals need to be recognized by the public.

What the Story Means to You and Healthcare Providers

As the story of “Typhoid Mary” illustrates, a healthy (or unhealthy) carrier may be mistrustful, frightened, and uncooperative of authorities. Although “Typhoid Mary” is a historical figure, her plight is of modern-day relevance; a graphic illustration of present-day mistrust in public healthcare is former vice presidential candidate Sarah Palin’s pronouncement (2009, facebook entry) that government-funded healthcare will result in “death panels” which essentially determine who lives or dies.

The timeless lesson of Mary's plight is that public healthcare officials must consider the human reactions of their subjects. The present-day controversy about healthcare and the recent outbreak of maladies such as swine flu, bird flu, and antibiotic resistant strains of tuberculosis indicate that authorities must develop strategies for effectively communicating with the public, protecting the public from contagious disease, and preserving the public's individual rights. Accordingly, the lesson of Mary Mallon is important to individuals who may be infected, the public who must be protected, and the healthcare providers who must provide medical care.

Ultimately, the public healthcare community must develop a better strategy to deal with carriers than fear, coercion, or exile to an island hospital. As epidemiologist Susan Baker once asserted “…the state (has) the authority to limit individual liberty to protect the public’s health and the rights of others” (2008, Markowitz et. al. p. 118). But, would you want to live the last years of your life like Mary Mallon?

References

Colgrove, J., Markowitz, G., Rosner, D. (Ed.) (2008). The contested boundaries of American health. Rutgers University Press: New Jersey

Hall, M., Bobinski, M., Orentlicher, D. (2005). Bioethics and Public health law. Aspen

Publishers: NewYork, N.Y.

Leavitt, J. (1996). Typhoid Mary, captive to the public’s health. Beacon Press: Boston, MA.

Wooden Figure by photographer Marcus74id. Photo from: Free Digital Photos

The copyright of the article Protecting Society from Typhoid Mary in General Medicine is owned by Marian Henderson. Permission to republish Protecting Society from Typhoid Mary in print or online must be granted by the author in writing.

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