Hello lovely people,
Now I know, I know, you’re getting pretty sick of being told about Coronavirus and how
you should be washing your hands and blah blah blah and oh my god it’s so oversaturated
in your daily content consumption but at the same time you’re morbidly fascinated and
still eating up every single thing you see about it
- clearly. Since you clicked on this video.
Well I’m feeling much the same. And I’m feeling pretty out of control. And when I
feel out of control, I turn to the history books, because knowing that massive, global
pandemics have happened before but the world kept turning and life continued on and clearly
it wasn’t so Earth-shattering in the end because here I am: alive, existing and talking,
and here you are: alive, existing and watching…? Well, that makes me feel a whole lot better.
What DOESN’T make me feel better, as someone who has an underlying health condition and
is therefore ‘vulnerable’ when it comes to the coronavirus is people not understanding
the importance of how symptom-free carriers can spread sickness.
- and thus maybe you’re watching this video because it was sent to you as you’re a bit
of a wally who won’t STAY HOME.
Social distancing. It works. Do it.
[calming sigh]
And that’s why today we’re going to be learning about poor, tragic Mary Mallon, otherwise
known as ‘Typhoid Mary’, one of the first identified ‘super-spreaders’ of disease.
Mary’s case demonstrates how an unwitting carrier can be the root of a disease outbreak,
but also sparks debate about how far personal autonomy can go when it’s pitted against
public health.
This video is part of my historical profiles series, in which we learn the fun history
we should have been taught in school through the lives of queer and/or disabled people.
You’ll find all of the previous episodes in a playlist in the card above. If you have
a suggestion of who I should cover next, please leave it in the comments below and subscribe
to make sure you don’t miss future episodes!
Mary was a breakthrough in our learning of how disease can spread
and how unwitting asymptomatic
carriers can harm others even if they aren’t themselves at risk. A century later and we’re
still learning about how quarantine can save lives. But before we can think about what
it means in current times, let’s learn about her story…
Mary Mallon was born in 1868 in Cookstown, County Tyrone, in what is now Northern Ireland.
She migrated with a sister to the United States of America in around 1883 to live with her
aunt and uncle and work as cooks for affluent families in New York City.
In 1900 she began working in Mamaroneck, New York, where within two weeks of her employment,
residents developed typhoid fever and she thus had to move on. In 1901 she worked for
a family in Manhattan where, again, members of the family for whom she worked developed
fevers and diarrhea, and their laundress died. She switched to working for the family of
a lawyer but left when seven of the eight people in the household took ill. In August
1906, Mary took a position with a wealthy family in Oyster Bay, Long Island, but within
two weeks 10 of the 11 family members were hospitalized with typhoid.
We might look at that history and think:
- “gosh, seems fishy…”
But typhoid fever is a bacterial infection typically spread through food and water contaminated
by salmonella. Patients fall ill with high fever, diarrhoea—and, before antibiotics
were developed to treat it, sometimes delirium and death. This was the early 1900s however
and since there were no regulated sanitation practices in place, the disease was fairly
common and New York had battled multiple outbreaks. This wasn’t particularly strange to Mary
and, because she was completely oblivious, she just kept moving on.
Mary went back to New York City and changed jobs three more times. Unsurprisingly, the
same thing kept happening.
But the wealthy family who lived in Oyster Bay hired a typhoid researcher and civil engineer
named George Soper to investigate, expecting perhaps to find a contaminated water source.
Through a process of elimination he realised however that it was the family’s cook who
had been the missing link.
Soper began tracing other outbreaks in the local area and realised that in a number of
cases an Irish cook, who fit the same physical description, had worked for the families.
At first he was unable to locate her because she generally left immediately after an outbreak
began and without leaving a forwarding address.
All he could do was wait.
As the months turned warm again Soper learnt of an active outbreak in a penthouse on Park
Avenue: two of the servants had been hospitalised and the family’s daughter had died. When
Soper arrived, he discovered that Mary had not only been their cook... but was also still
there. However, when confronted with his evidence and a request for urine and faeces samples,
she surged at Soper with a carving fork.
- the word ‘confronted’ probably explains that, to be fair.
He sought the help of the authorities but Mary evaded them for five hours before being
betrayed by a scrap of her dress, caught in the door of her hiding place.
George Soper was a civil engineer by training and had become an expert in sanitation, but
he was not a doctor. Despite this, he had deduced that typhoid could be spread by one
person serving as a carrier, whether or not they had any symptoms. With Mary refusing
to give samples, Soper instead compiled a five-year history of Mallon's employment.
He found that of the eight families that hired Mary as a cook, members of seven had contracted
typhoid fever- 22 infected people in total.
It hadn’t raised red flags at first because in 1906, the year Soper began his investigation,
a reported 639 people had died of typhoid in New York. But never before had an outbreak
been traced to a single carrier—and definitely not one without any symptoms themselves.
In fact it wasn’t even common knowledge that someone could HAVE typhoid without symptoms.
Finally, Mary was escorted by five policemen to a hospital where—after a nearly
successful escape attempt—she tested positive as a carrier for Salmonella typhi, a bacteria
that causes typhoid. The key was in the fresh fruit dishes Mary served on Sundays in the
summer months. Whilst cooking the food she had touched killed the bacteria transferred
from Mary’s hands, uncooked foods were the perfect way to spread the disease.
The New York City Health Inspector determined she was a carrier and thus was quarantined
in a small house on the grounds of Riverside Hospital, an isolated facility on North Brother
Island just off the Bronx…
for three years!
- so stop complaining about social distancing for three months!
In prison, she was forced to give regular stool and urine samples. Despite never developing
symptoms (or receiving treatment) she tested positive every time. Authorities suggested
removing her gallbladder because they believed typhoid bacteria resided there but stopped
just short of doing it against her will as she attracted a lot of media attention. Mary
continued to believe that it was impossible for her to actually have the disease: She’d
seen people die from typhoid! They looked ill! She felt fine!
A 1908 issue of the Journal of the American Medical Association named her “Typhoid Mary”
and the public ran with it. Mary’s resentment and distrust grew.
In 1909, she sued the New York City Department of Health and the case was brought to the
Supreme Court. Mary’s case stirred a debate over individual autonomy and the state’s
responsibility in a public health crisis. America was then, as it is today, a culture
founded on personal liberty, that takes the rights of the individual very seriously. Her
lawyer argued that she had been imprisoned without due process and the court of public
opinion was on her side. Despite the judge declining to release her, on the grounds that
the court “must protect the community against a recurrence of spreading the disease”...
she was freed the following year by the city’s new health commissioner
who wanted some good press, so...
On the grounds that she stopped cooking.
- Which, why would she do that? She didn’t have symptoms so she didn’t have typhoid.
Right? Riiight?
February 19, 1920, Mallon agreed that she was "prepared to change her occupation, 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."
Good luck with that.
Oh sure, sure, to start with Mary tried… on her release she was given a job as a laundress
but it paid SO much less than cooking and it wasn’t good for her hands to be in hot
water all day…
- except, it WAS good for her hands because the heat killed the disease shed from them,
but oh well!
After a few years she changed her name to Mary Brown and returned to cooking, despite
the explicit instructions not to.
For the next five years she worked in a number of
kitchens, again followed by outbreaks of typhoid. She changed jobs frequently, always trying
to outrun George Soper and his detective team!
BUT in 1915, Mary started a MAJOR outbreak, this time at Sloane Hospital for Women in
New York City, infecting twenty-five people. She left after the first two deaths but this
time the police managed to outpace her and she was arrested, still protesting that the
outbreak had nothing to do with her-
- She was healthy! Healthy people didn’t have typhoid!
Except they did. They were just less likely to die from it…
She was returned to quarantine on North Border Island on March 27, 1915 and, because she
refused to believe she was a danger, remained confined for the next 23 years.
- Twenty Three Years! Are you paying attention?
Mary remained confined for the remainder of her life, despite becoming a minor celebrity.
People were told not to accept even a glass of water from her and, although she was later
allowed to work in the hospital laboratory, washing glass bottles, it must have been an
incredibly lonely existence.
Although doctors frequently tested her and told her she was still positive, they left
her largely ignorant about her condition, failing to explain HOW she could carry the
virus and kill those weaker than her without feeling any symptoms herself.
- So aren’t we lucky that today we have doctors on the news trying to explain things
for us?
Mary died from pneumonia in 1938 at age 69, vilified in folk memory as “the most dangerous
woman in America”, a patient zero who had to be locked up and isolated until her death
because she refused to work for the public good.
History has been unkind to Mary and today the colloquial term “Typhoid Mary” is
used for anyone who, knowingly or not, spreads evil or disease.
- There is even a Marvel comic book villain named after her: a female assassin who has
a cruel temper
But by her second capture and quarantine there were a number of other healthy typhoid carriers
identified, but they were not treated as harshly as Mary. Having said that, due to her use
of aliases and refusal to cooperate, the exact number of deaths attributable to Mary is not
known. Some have estimated that she may have unwittingly caused as many as 50 fatalities.
Scholars believe however that as a poor, unmarried Irish immigrant, and a woman, she suffered
prejudice not shown to other asymptomatic typhoid carriers, including some who infected
more people than Mallon but were quarantined for only a few weeks.
Today we see workers in service industries and gig work across the world facing a choice
about whether to isolate and stop working as a precaution against coronavirus, possibly
forfeiting pay and health insurance, or to continue on.
In a 2001 the late television chef Anthony Bourdain defended Mallon as a kindred spirit
who worked because she needed to work: “Cooks work sick. They always have. Most jobs, you
don’t work, you don’t get paid. You wake up with a sniffle and a runny nose, a sore
throat? You soldier on … it’s a point of pride, working through pain and illness.”
Mary’s legacy as an asymptomatic vessel for disease led to the theory of “superspreaders”,
which has helped end disease outbreaks faster ever since. The problem of carriers in relation
to infectious diseases is now justly recognised as immensely important to effective public
health work.
Today we know that being a carrier of disease is not that unusual: Up to 6 percent of people
who’ve had typhoid, which is still common in the developing world, can spread it long
after they’ve recovered, even if they experienced few or no symptoms.
Dr Denise Monack, a microbiologist
at Stanford has shown that genetic mutations might allow bacteria to climb unnoticed into
immune cells, where they can take up long-term residence, meaning the carrier can go on infecting
people for years.
For years medical scholars have used Mary’s case in debates over when the government is
justified in depriving someone of their freedom for a perceived greater good. Mary’s refusing
to isolate and practice social distancing killed others and ruined her own life.
- just as it might ruin the life of a healthy COVID-19 carrier to accidentally infect and
kill someone else.
I know if you’ve watched this far into the video you’ve probably already got the point
I’m making but it doesn’t hurt to be on the nose occasionally.
In 2015, a super-spreading event led to 82 people being infected by a single hospital
patient with Middle East respiratory syndrome (Mers), a coronavirus distantly related to
COVID-19. And in the Ebola epidemic in West Africa, 61% of cases were spread from just
3% of patients.
Today we face social distancing and self-isolation, travel restrictions, bans on public gatherings
and strict surveillance. In some parts of China there are rewards for informing on sick
neighbours and their drastic measures DO seem to be working as (at time of filming this)
they are now only reporting a handful of internally transmitted coronavirus cases a day, rather
than the hundreds we were seeing just a few weeks ago.
The debate about how far to curb individual liberty in order to protect public health
rages on and whilst Mary is certainly a cautionary tale in how the government can get the balance
wrong… it also shows that we DO have a personal responsibility to NOT infect other people-
- especially after a doctor tells us we’re infectious!
It is our duty to educate ourselves on what being a carrier means and how to reduce the
spread of infection.
If you are having symptoms or have come into contact with someone who has PLEASE isolate
yourself and seek medical attention as soon as possible if your symptoms worsen. For the
rest of us, both those with and without underlying health conditions, it’s our responsibility
to take care of ourselves: practice social distancing to slow the spread of the disease,
DO NOT do anything stupid that may land you in the hospital-
- especially not if it’s just to make a TikTok video!
even if it’s a hilarious one...
And please, please take care of others in your community, especially vulnerable people
including the elderly or those with disabilities who may have trouble accessing
food right now and the medicine they need.
Lastly, as much as I’ve spent this segment of the video nagging you not to spread
disease… we need to be careful with the language we use when it comes to infected
people, particularly superspreaders. They’ve picked something up through no fault of their
own and (as long as they’re not spreading infection for the fun and licking public property)
they need our support.
Lecture over! Congrats! You made it to the end of the video. I promise to berate you
less in the next one.
See you soon.
[kiss]