Monday, March 23, 2020

Typhoid Mary's Refusal To Change Killed Others

Dear Friends,

While all of us have to take measures to deal with the Coronavirus (COVID-19) epidemic, a few of you have written to ask if isolating is really needed to combat this crisis. A couple of you have told me about family members who refuse to take this seriously enough to change their social lifestyle and stay home. A couple of you have also said that you can't get through to some of your family member who don't realize that they can be carriers --knowingly or not.

So now, since a couple of you have asked about her, let's talk about a woman who went down in history for all of the right reasons as a notorious disease carrier. Many of us know her as "Typhoid Mary." What you may not know is that she was a very healthy carrier the whole time she was infecting others. It's true. As an "asymptomatic carrier," she was a very "healthy carrier" of typhoid fever.

Typhoid fever is a deadly communicable disease that kills over a hundred thousand people worldwide each year still today. Typhoid fever, also known simply as "typhoid, is a bacterial infection. It's actually a type of Salmonella and the symptoms vary from mild to severe, but usually starts about 6 to 30 days after exposure.

Symptoms are similar to those of many other infectious diseases. Typhoid fever starts out slow with the victim having a high fever, overall weakness, abdominal pain, constipation, headaches, and vomiting in the first few days. After that, those infected get a skin rash with rose colored spots. That's all just the beginning. 

By the second week, most patients become agitated, and experience confusion and delirium. The "muttering delirium" led doctors back in the day giving typhoid the nickname "nervous fever". And soon, the victim's spleen and liver becomes enlarged and tender. Liver enzymes become elevated. If the patient lasts into the third week, the patient will experience intestinal hemorrhaging due to gastrointestinal bleeding. Intestinal perforation can be fatal. Of course, this is all accompanied by respiratory diseases such as pneumonia and acute bronchitis. Without treatment, this can all go on for weeks to months.

Typhoid is spread by eating food or by drinking water that's been contaminated with the feces of an infected person. Yes, human feces. Keep in mind that sanitation conditions of congested cities of the late 1800's and early 1900s were horrible. Those living there at the time were at risk of all sorts of diseases just living in the squalor taking place back East. 

As for today, think about places like San Francisco where people are defecating on the streets. Risk factors include poor sanitation and lousy hygiene, or non-existent hygiene practices as seen in many big cities. Of course, travelers to Third World countries put themselves and others at risk. 

Then there are those people who may carry the bacterium, and are still able to spread the disease to others, but aren't affected. Mary Mallon became known in the newspapers as "Typhoid Mary" because she was one of those carriers who was never ill. 

Mary Mallon was born on September 23rd, 1869, in Cookstown, Ireland. She emigrated to the United States in either 1883 or 1884. Upon arriving in New York City, she lived with her aunt and uncle for a time before finding work as a cook for a few wealthy families. 

From 1900 to 1907, Mary Mallon worked as a live-in cook and servant for seven different families in New York City. Remember, typhoid is spread by eating contaminated food or by drinking contaminated water. 

Investigation later showed that in 1900, within two weeks of her starting a job as a cook, the residents where she was cooking all developed typhoid fever. Then in 1901, another who she cooked for started to develop the symptom of typhoid fever. In that home, one of the servants who hate what she cooked died a week later. When she went to work for another family, she was fired after seven out of the eight people living there came down with the fever. 

Again in 1906, while working in Long Island, it took only two weeks for 10 family members to come down with typhoid fever. Later, after getting another position as a cook with other families, the same thing happened. 

She was the common denominator when looking at what was making those families ill. Wherever Mary Mallon was hired to cook, those families came down with the fever. 

In late 1906, a typhoid researcher who was a sanitation engineer by trade, George Soper, was hired by an infected family to investigate what was taking place. It was Soper who said that Mary Mallon may have been the source of the outbreak. He said so in a paper published in the Journal of the American Medical Association in June of 1907.

According to George Soper in his paper: "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."

Soper discovered that Mary Mallon was the woman who matched the physical description of the Irish cook involved in every one of the typhoid outbreaks. Though she was known to have left their employment or was fired after an outbreak started, remarkably for the time, Soper found her after she was connected to a household where she was the cook. It was a household where the daughter of the family died of typhoid fever. 

In March of 1907, Soper met with then 37-year-old Mary Mallon who worked as a cook at a Park Avenue brownstone. When he demanded that she give him a sample of her blood, urine and feces, she became enraged. Soper later wrote: "It did not take Mary long to react to this suggestion. She seized a carving fork and advanced in my direction."

George Soper found her and immediately accused her of causing the illness and deaths. Of course Mary Mallon became angry and rejected the notion that she was the cause of the outbreaks, after all, she was healthy. Besides the distrust of authorities by immigrants fresh off the boat, at the time it was unheard of for a healthy person to be a "disease carrier." 

No one at the time realized that an individual can become infected from consuming contaminated food and drinks prepared by an infected individual who shows no symptoms of the disease. Of course not one at the time realized that someone who recovered can also be a carrier. Today, we know that the spread of many infectious diseases fall under the "80–20 rule" which says 80% of the disease transmission is conducted by only 20% of people in any given population. In the case of Mary Mallon, it's believed that most of Mary Mallon's transmissions which infected others were through her handling food.  

Besides George Soper, New York City's public health officials were also looking for a common denominator and found that she was it. When they got involved, they tried to restrict her from cooking as a way to make a living. Surprising for the times, they didn't want to quarantine her on a permanent basis. At least that was their plan initially. But frankly, that changed because she refused to comply with the city's request to stop handling food -- and the newspapers put pressure on the authorities to quarantine her. 

After newspaper got the story, they ran with it. They saddled her with that moniker "Typhoid Mary". Then in 1908, the Journal of the American Medical Association also labeled her "Typhoid Mary" after a news story which also pointed out how the city of New York refused to act.  

Because of her continued refusal to give up the only occupation that she believed she was able to do, and the pressure from the newspapers, New York City's public health officials ordered that she be quarantined as a prisoner on one of the islands that surround Manhattan. While in prison, she was forced to give stool and urine samples. And while she maintained that she was not the carrier, tests results for those samples showed that she carried the disease. 

Mary Mallon was freed from quarantine in prison after agreeing that she would stop working as a cook. On February 19, 1910, Mary 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." 

Upon her release from quarantine, she was given a job as a laundress. Since that position paid a lot less than cooking, she changed her name to Mary Brown and took jobs cooking. It is said that for the next five years, Mary Mallon was hired to cook in several restaurant kitchens. She even took a cooking job in a local hospital under an assumed name, and was working there when a typhoid outbreak took place. Of course, outbreaks of typhoid followed her wherever she worked.

By 1915, those who believed that "disease carriers" should not be kept in isolation started to change their minds. Helping to change their minds was the fact that Mary Mallon was responsible for other outbreaks. In those, people also died. Because of her failure to cooperate, she was found and arrested.

On March 27, 1915, under sections 1169 and 1170 of the Greater New York Charter, Mary Mallon was held in isolation quarantine at a clinic located on North Brother Island. She spent the rest of her life in quarantine at the Riverside Hospital. She remained there until she died of pneumonia at age 69 on November 11, 1938. Mary Mallon's body was cremated. 

I find it interesting that doctors believed that Mary Mallon likely passed along typhoid germs by failing to vigorously wash her hands before handling food. But there is something else, though it is believed that temperatures necessary to cook food would have killed the bacteria, some wonder just how did she transfer the germs? Well, it's believed that Mary Mallon did so through one of her more popular dessert dishes which was ice cream with peaches. After dishing the ice cream, she would cut up the raw peaches. 

Her not washing her hands and cutting up the peaches was the perfect transferable state for germs.  According to George Soper, "I suppose no better way could be found for a cook to cleanse her hands of microbes and infect a family."

New York saw thousands of cases of typhoid fever by 1910. It's believed that thousands of asymptomatic carriers probably walked the streets of New York. Of course, who knows how many were cooks and food handlers who didn't wash their hands? 

She lived in isolation for 26 years in large part due to public opinion which turned against her when she refused to change and stay out of the kitchen. Mary Mallon was linked to 47 people being infected and 3 deaths as a result of her negligence, poor sanitation habits, and stubbornness. But, because she used more than one alias while refusing to change her ways and give up cooking for a living, it's speculated that she may have infected hundreds and caused the death of at least 40 people. Frankly, as with all such speculation, we'll never know the honest truth about that.

When I first wrote this story, I left out one thing because I couldn't prove whether it was true or not. Supposedly, before there was a vaccine, doctors are said to have believed that the typhoid fever bacteria lived in the gallbladder of the host. Supposedly they wanted to remove her gallbladder to "cure" her, but she wouldn't let them do the surgery since the death rate during surgeries at the time was incredibly high. The rest of that story says that after her death, they did an autopsy and found the typhoid fever bacteria present in her gallbladder. There's no telling whether that story is true or no. It might simply be just myth.

While, I was contacted by my reader Vivian Schuler who researched this. Vivian sent me what she found. According to Science Today: Humans who harbor these bacterial communities in their gallbladders, even without symptoms, are able to infect others with active typhoid fever, especially in developing areas of the world with poor sanitation. The disease is transmitted through fecal-oral contact, such as through poor hand-washing by people who prepare food. Scientists and physicians have known for decades that these bacteria, Salmonella enterica serovar Typhi, accumulate in the gallbladder. In fact, the most widely accepted treatment of chronic typhoid infection is removal of the gallbladder.

Knowing this, thanks to Vivian Schuler and Science Today, I can report that it's a safe bet to say that the story about finding the typhoid fever bacteria present in Mary Mallon's gallbladder during her autopsy is probably true.  

As for Mary Mallon, the poor gal was a "healthy carrier" of the disease. Yes, no different than today where some who appear very healthy are carrying the bacteria for the Coronavirus. She was able to pass it onto others by handling food while exhibiting no symptoms herself. That too is happening today with the Coronavirus. As for her becoming the first known "asymptomatic carrier" of typhoid fever, it's only that way because she was linked to those outbreaks. It's said that there were probably others, but she was the one who was found and stopped before she could do more harm.

She needed to be isolated so that others would not become infected and die. That's why we are going through what we are today with the mandatory isolation taking place. Many today are carriers who may appear perfectly healthy right now. I can't help but wonder how many carriers out there are refusing to change their lifestyle and isolate to save others, especially those they say they love.

In the case of typhoid fever with the symptoms starting anywhere from 6 to 30 days after being exposed, a healthy carrier could be long gone after exposing others. So no, they might not even know they're the ones who are spreading the disease. Of course that goes to Mary Mallon's legacy as "Typhoid Mary," which as most know is a term used for anyone who spreads disease -- knowingly or not.

Tom Correa

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