Mary Mallon

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Mary Mallon
Mary Mallon (Typhoid Mary).jpg
Mallon in isolation
Born(1869-09-23)September 23, 1869
DiedNovember 11, 1938(1938-11-11) (aged 69)
Resting place Saint Raymond's Cemetery
ResidenceUnited States
NationalityBritish subject by birth; American citizen by naturalization after immigration; Assumed Irish post-1921
Other namesMary Brown
OccupationCook
Known for Asymptomatic carrier of typhoid fever

Mary Mallon (September 23, 1869 – November 11, 1938), also known as Typhoid Mary, was an Irish cook. She was the first person in the United States identified as an asymptomatic carrier of the pathogen associated with typhoid fever. She was presumed to have infected 51 people, three of whom died, over the course of her career as a cook. [1] She was twice forcibly isolated by public health authorities and died after a total of nearly three decades in isolation. [2] [3]

Irish people Ethnic group, native to the island of Ireland, with shared history and culture

The Irish are a nation and ethnic group native to the island of Ireland, who share a common Irish ancestry, identity and culture. Ireland has been inhabited for about 12,500 years according to archaeological studies. For most of Ireland's recorded history, the Irish have been primarily a Gaelic people. From the 9th century, small numbers of Vikings settled in Ireland, becoming the Norse-Gaels. Anglo-Normans conquered parts of Ireland in the 12th century, while England's 16th/17th-century (re)conquest and colonisation of Ireland brought many English and Lowland Scots people to parts of the island, especially the north. Today, Ireland is made up of the Republic of Ireland and the smaller Northern Ireland. The people of Northern Ireland hold various national identities including British, Irish, Northern Irish or some combination thereof.

Asymptomatic carrier pathogen carrier without symptoms

An asymptomatic carrier is a person or other organism that has become infected with a pathogen, but that displays no signs or symptoms.

Typhoid fever Bacterial infection cuased by Salmonella enterica subsp. enterica

Typhoid fever, also known simply as typhoid, is a bacterial infection due to a specific type of Salmonella that causes symptoms. Symptoms may vary from mild to severe, and usually begin 6 to 30 days after exposure. Often there is a gradual onset of a high fever over several days. This is commonly accompanied by weakness, abdominal pain, constipation, headaches, and mild vomiting. Some people develop a skin rash with rose colored spots. In severe cases, people may experience confusion. Without treatment, symptoms may last weeks or months. Diarrhea is uncommon. Other people may carry the bacterium without being affected; however, they are still able to spread the disease to others. Typhoid fever is a type of enteric fever, along with paratyphoid fever.

Contents

Early life

Mary Mallon was born in 1869 in Cookstown, County Tyrone, in what is now Northern Ireland. She migrated to the United States in 1883 or 1884. [4] [5] She lived with her aunt and uncle for a time and later found work as a cook for affluent families. [6]

Cookstown Town in County Tyrone, Northern Ireland

Cookstown is a town in County Tyrone, Northern Ireland. It is the fourth largest town in the county and had a population of 11,599 in the 2011 census. It is one of the main towns in the area of Mid-Ulster. It was founded around 1620 when the townlands in the area were leased by an English ecclesiastical lawyer, Dr. Alan Cooke, from the Archbishop of Armagh, who had been granted the lands after the Flight of the Earls during the Plantation of Ulster. It was one of the main centres of the linen industry west of the River Bann, and until 1956, the processes of flax spinning, weaving, bleaching and beetling were carried out in the town.

County Tyrone Place

County Tyrone is one of the six counties of Northern Ireland and one of the thirty-two counties on the island of Ireland. It is no longer used as an administrative division for local government but retains a strong identity in popular culture.

Northern Ireland Part of the United Kingdom lying in the north-east of the island of Ireland, created 1921

Northern Ireland is variously described as a country, province or region which is part of the United Kingdom. Located in the northeast of the island of Ireland, Northern Ireland shares a border to the south and west with the Republic of Ireland. In 2011, its population was 1,810,863, constituting about 30% of the island's total population and about 3% of the UK's population. Established by the Northern Ireland Act 1998 as part of the Good Friday Agreement, the Northern Ireland Assembly holds responsibility for a range of devolved policy matters, while other areas are reserved for the British government. Northern Ireland co-operates with the Republic of Ireland in several areas, and the Agreement granted the Republic the ability to "put forward views and proposals" with "determined efforts to resolve disagreements between the two governments".

Career

From 1900 to 1908, Mallon worked as a cook in the New York City area for seven families. [7] 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. Mallon then went to work for a lawyer and left after seven of the eight people in that household became ill. [8]

New York City Largest city in the United States

The City of New York, usually called either New York City (NYC) or simply New York (NY), is the most populous city in the United States. With an estimated 2018 population of 8,398,748 distributed over a land area of about 302.6 square miles (784 km2), New York is also the most densely populated major city in the United States. Located at the southern tip of the state of New York, the city is the center of the New York metropolitan area, the largest metropolitan area in the world by urban landmass and one of the world's most populous megacities, with an estimated 19,979,477 people in its 2018 Metropolitan Statistical Area and 22,679,948 residents in its Combined Statistical Area. A global power city, New York City has been described as the cultural, financial, and media capital of the world, and exerts a significant impact upon commerce, entertainment, research, technology, education, politics, tourism, art, fashion, and sports. The city's fast pace has inspired the term New York minute. Home to the headquarters of the United Nations, New York is an important center for international diplomacy.

Manhattan Borough in New York City and county in New York, United States

Manhattan, , is the most densely populated of the five boroughs of New York City, and coextensive with the County of New York, one of the original counties of the U.S. state of New York. Manhattan serves as the city's economic and administrative center, cultural identifier, and historical birthplace. The borough consists mostly of Manhattan Island, bounded by the Hudson, East, and Harlem rivers; several small adjacent islands; and Marble Hill, a small neighborhood now on the U.S. mainland, physically connected to the Bronx and separated from the rest of Manhattan by the Harlem River. Manhattan Island is divided into three informally bounded components, each aligned with the borough's long axis: Lower, Midtown, and Upper Manhattan.

Diarrhea Loose or liquid bowel movements

Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are exclusively breastfed, however, are normal.

In the year 1906, Mary took a position in Oyster Bay, Long Island, and within two weeks 10 of the 11 family members were hospitalized with typhoid. She changed jobs again, and similar occurrences happened in three more households. [8] She worked as a cook for the family of a wealthy New York banker, Charles Henry Warren. When the Warrens rented a house in Oyster Bay for the summer of 1906, Mallon went along, too. From August 27 to September 3, six of the 11 people in the family came down with typhoid fever. The disease at that time was "unusual" in Oyster Bay, according to three medical doctors who practiced there.[ citation needed ] Mallon was subsequently hired by other families, and outbreaks followed her. [8]

Bank financial institution

A bank is a financial institution that accepts deposits from the public and creates credit. Lending activities can be performed either directly or indirectly through capital markets. Due to their importance in the financial stability of a country, banks are highly regulated in most countries. Most nations have institutionalized a system known as fractional reserve banking under which banks hold liquid assets equal to only a portion of their current liabilities. In addition to other regulations intended to ensure liquidity, banks are generally subject to minimum capital requirements based on an international set of capital standards, known as the Basel Accords.

Oyster Bay (town), New York Town in New York, United States

The Town of Oyster Bay is the easternmost of the three towns which make up Nassau County, New York, in the United States. Part of the New York metropolitan area, it is the only town in Nassau County to extend from the North Shore to the South Shore of Long Island. As of the 2010 census, it had a population of 293,214.

Investigation

In late 1906, one family hired a typhoid researcher named George Soper to investigate. Soper published the results on June 15, 1907, in the Journal of the American Medical Association . He believed Mallon might be the source of the outbreak. [9] He wrote:

George A. Soper was a sanitation engineer. He was best known for discovering Mary Mallon, or Typhoid Mary, a carrier of Typhoid who had no symptoms.

It was found that the family changed cooks on August 4. This was about three weeks before the typhoid epidemic broke out. The new cook, Mallon, remained in the family only a short time, and left about three weeks after the outbreak occurred. Mallon was described as an Irish woman about 40 years of age, tall, heavy, single. She seemed to be in perfect health. [10]

Soper discovered that a female Irish cook, who fit the physical description he was given, was involved in all of the outbreaks. He was unable to locate her because she generally left after an outbreak began, without giving a forwarding address. Soper learned of an active outbreak in a penthouse on Park Avenue and discovered Mallon was the cook. Two of the household's servants were hospitalized, and the daughter of the family died of typhoid. [8]

When Soper approached Mallon about her possible role in spreading typhoid, she adamantly rejected his request for urine and stool samples. [11] Since Mallon refused to give samples, he decided to compile a five-year history of Mallon's employment. Soper found that of the eight families that hired Mallon as a cook, members of seven claimed to have contracted typhoid fever. [12] On his next visit, he brought another doctor with him but again was turned away. During a later encounter when Mallon was herself hospitalized, he told her he would write a book and give her all the royalties. She angrily rejected his proposal and locked herself in the bathroom until he left. [13]

First quarantine (1907–1910)

Mary Mallon (foreground) in a hospital bed during her first quarantine Mary Mallon in hospital.jpg
Mary Mallon (foreground) in a hospital bed during her first quarantine

The New York City Health Department finally sent physician Sara Josephine Baker to talk to Mallon. Baker stated "by that time she was convinced that the law was only persecuting her when she had done nothing wrong." A few days later, Baker arrived at Mallon's workplace with several police officers, who took her into custody.[ citation needed ]

Mallon attracted so much media attention that she was called "Typhoid Mary" in a 1908 issue of the Journal of the American Medical Association . Later, in a textbook that defined typhoid fever, she was again called "Typhoid Mary". [14]

Mallon admitted she did not understand the purpose of hand-washing because she did not pose a risk.[ citation needed ] In prison, she was forced to give stool and urine samples. Authorities suggested removing her gallbladder because they believed typhoid bacteria resided there. [15] However, she refused as she did not believe she carried the disease. She was also unwilling to cease working as a cook. [8]

The New York City Health Inspector determined she was a carrier. Under sections 1169 and 1170 of the Greater New York Charter, Mallon was held in isolation for three years at a clinic located on North Brother Island. [8]

Eventually, Eugene H. Porter, the New York State Commissioner of Health, decided that disease carriers should no longer be kept in isolation and that Mallon could be freed if she agreed to stop working as a cook and take reasonable steps to prevent transmitting typhoid to others. On February 19, 1910, Mallon agreed that she was "prepared to change her occupation (that of a cook), and would give assurance by affidavit that she would upon her release take such hygienic precautions as would protect those with whom she came in contact, from infection." She was released from quarantine and returned to the mainland. [16]

Release and second quarantine (1915–1938)

Upon her release, Mallon was given a job as a laundress, which paid less than cooking. After several unsuccessful years of working as a laundress, she changed her name to Mary Brown and returned to her former occupation despite having been explicitly instructed not to. For the next five years, she worked in a number of kitchens; wherever she worked, there were outbreaks of typhoid. However, she changed jobs frequently, and Soper was unable to find her. [8]

In 1915, Mallon started another major outbreak, this time at Sloane Hospital for Women in New York City. 25 people were infected, and two died. She again left, but the police were able to find and arrest her when she brought food to a friend on Long Island. [8] [16] After arresting her, public health authorities returned her to quarantine on North Brother Island on March 27, 1915. She was still unwilling to have her gallbladder removed. [16]

Mallon remained confined for the remainder of her life. She became a minor celebrity and was occasionally interviewed by the media. They were told not to accept even water from her. [8] Later, she was allowed to work as a technician in the island's laboratory, washing bottles. [9]

Death

A historical poster warning against acting like Typhoid Mary Typhoid carrier polluting food - a poster.jpg
A historical poster warning against acting like Typhoid Mary

Mallon spent the rest of her life in quarantine at the Riverside Hospital. Six years before her death, she was paralyzed by a stroke. On November 11, 1938, she died of pneumonia at age 69. [1] A post-mortem found evidence of live typhoid bacteria in her gallbladder. [17] Other researchers have cited George Soper who wrote, "There was no autopsy" to assert a conspiracy to calm public opinion after her death. [18] Mallon's body was cremated, and her ashes were buried at Saint Raymond's Cemetery in the Bronx. [19]

Legacy

Among the infections Mallon caused, at least three deaths were attributed to her; however, because of her use of aliases and refusal to cooperate, the exact number is not known. Some have estimated that she may have caused 50 fatalities. [8]

Mallon was the first asymptomatic typhoid carrier to be identified by medical science, and there was no policy providing guidelines for handling the situation. Some difficulties surrounding her case stemmed from Mallon's vehement denial of her possible role, as she refused to acknowledge any connection between her working as a cook and the typhoid cases. Mallon maintained that she was perfectly healthy, had never had typhoid fever, and could not be the source. Public-health authorities determined that permanent quarantine was the only way to prevent Mallon from causing significant future typhoid outbreaks.

Other healthy typhoid carriers identified in the first quarter of the 20th century include Tony Labella, an Italian immigrant, presumed to have caused over 100 cases (with five deaths); an Adirondack guide dubbed "Typhoid John", presumed to have infected 36 people (with two deaths); and Alphonse Cotils, a restaurateur and bakery owner. [20]

Today, "Typhoid Mary" is a colloquial term for anyone who, knowingly or not, spreads disease or some other undesirable thing. [21]

Actress Elisabeth Moss is reported to be developing a TV miniseries in which "Typhoid Mary" is a central character, based on the 2013 novel Fever by Mary Beth Keane. [22]

Modern medical understanding of Mallon's case

In August 2013, researchers at the Stanford University School of Medicine announced they were making breakthroughs in understanding the exact science behind asymptomatic carriers such as Mallon. The bacteria that cause typhoid may hide in macrophages, a type of immune cell. [23] [24]

Individuals can develop typhoid fever after ingesting food or water contaminated during handling by a human carrier. The human carrier may be a healthy person who has survived a previous episode of typhoid fever yet continues to shed the associated bacteria, Salmonella typhi , in feces and urine. Washing hands with soap before touching or preparing food, washing dishes and utensils with soap and water, and eating only cooked food are all ways to reduce the risk of typhoid infection. [25]

See also

Related Research Articles

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Quarantine Epidemiological intervention to prevent disease transmission

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Further reading