PBS NOVA: Typhoid Mary

Judith Walzer Leavitt, Ph.D.,
Author and professor of Medical History and Women's Studies, University of Wisconsin
Wednesday, October 13, 2004 3:00 PM

NOVA explores the legacy of one of history's most infamous disease carriers, Mary Mallon also known as "Typhoid Mary." Mallon, an Irish immigrant cook, became a notorious symbol of a public health menace. Typhoid fever is a bacterial disease spread by poor sanitation. At the turn of the 20th century, it was associated with slums and poverty and about 10 percent of those infected died.

NOVA's "The Most Dangerous Woman in America" opens with a mysterious cluster of typhoid fever cases in August 1906 at a summer house in Oyster Bay, Long Island. Mallon's ordeal took place at a time when the new science of bacteriology was shaping public health policies in America for the first time. Her case continues to hold lessons amid today's heightened concerns about communicable diseases.

Judith Walzer Leavitt, Ph.D., author of "Typhoid Mary: Captive to the Public's Health" (1996) was online Wednesday, Oct. 13, at 3 p.m. ET, to discuss the program and her book.

"The Most Dangerous Woman in America" airs on PBS Tuesday, Oct. 12, 2004, at 8 p.m. ET. (Check local listings).

Leavitt is a Ruth Bleier WARF Professor of Medical History and Women's Studies at the University of Wisconsin. Her field specialties include the history of medicine and public health, history of women's health, and history of childbirth. Throughout her career, Leavitt has authored numerous books including "The Healthiest City" (1982), "Women and Health in America" (1984) and "Sickness and Health in America" (1978). She is currently working on a sequel to her book, "Brought to Bed" (1986), focusing mainly on 20th century childbirth and the role of fathers in labor and delivery in the hospital setting.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

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Judith Walzer Leavitt, Ph.D.: Hello everyone. Thanks so much for watching NOVA last night and joining our conversation today. I'm looking forward to your questions and comments!

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Arlington, Va.: How would Typhoid Mary's case likely be handled today? Current civil rights law would probably prevent her from being confined for life, wouldn't it? What protections could the public invoke if a "healthy carrier" of Ebola or hantavirus were to emerge?

Judith Walzer Leavitt, Ph.D.: Today's public health officials who work with people deamed "dangerous" to the public's helth start with our due process protections. If public health officials thought it was important to isolate someone immediately, they can do so under the laws of most states, but they need to inform people of the process and of their rights and be sure that each individual has access to legal recourse. They also have to demonstrate that they are applying their health judgment equally.

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San Franscisco, Calif.: Was there any Tx that would have worked?
Was there any "safe" occupation she could have worked in?
When was penicillian first used?
What is (are) most common vector for Typhoid?

Judith Walzer Leavitt, Ph.D.: The New York pubic health officials in 1907 could have trained Mary Mallon for any work that did not involve food handling. When the French were faced with this problem in the same period, they trained the carrier as a librarian. Penicillan was was first available in the post second world war period; treatment for typhoid fever today is usually chloramphenicol or amoxicillian. Typhoid is transmitted through food and water contaminated by feces and/or urine of patients and carriers. This includes, for example, shellfish taken from sewage-contaminated beds, raw fruits and vegetables fertilized by nightsoil, contaminated milk.

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Raleigh, N.C.: What did you think of J. F. Federspiel's novel about the case, THE BALLAD OF TYPHOID MARY?

Judith Walzer Leavitt, Ph.D.: It was a good read in many ways, but I thought it distorted too much of what actually happened historically for my liking. Its been a while since I read it, but my memory is that the author even changed the ethnicity of Mary, and as an historian, its hard for me to understand the need for that. This is such a dramatic story on itsown, I don't think there isn't such a need for embellishment. But I do think that fiction can offer an opportunity for expand our understanding of history.

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Mt. Vernon Square, Washington, D.C.: I found the documentary very interesting -- I can't wait to read your book.

My question: Was Mary Mallon really guilty? Did she deserve the confinement?

Judith Walzer Leavitt, Ph.D.: Thanks very much for your kind comments about the documentary. I will pass them on to the filmmaker and others involved with the production. I wrote the book upon which the film was based, and in tht book I try to answer your question about the extent of Mary Mallon's guilt. It is a complex issue for me, and I think it is extremely important today to all of us who think about the potential dangers of infectious diseases now. My short answer is that, yes, I think Mary Mallon shoulders some of the blame in this case because she shut her mind to listening to the health authorities. But I guess I believe that the health department has more to answer for, because they did not present the case in a way she could hear it. When science offers something very new, if often takes a while for people to understand it and come to appreciate it.

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Palm Springs, Calif.: Were any of the other 49 healthy carriers mentioned in the show ever quarantined at all?

Other than for her "recalcitrance", wby was Mallon so aggressively singled out for long-term quarantine?

Why was Mallon quarantined for nearly 3 decades? Did not the Health Department during that time ever come to realize why it was that she had gone back to the only decent-paying work she'd ever known?

Did no one in that nearly 30 year period, no lawyer, no immigrant aid group, ever try to get her released? Or was she simply forgotten?

Judith Walzer Leavitt, Ph.D.: A few other healthy carriers were quarantined, but none for life as Mary Mallon was. The health department did track carriers and try to make sure they didn't cook again, but many others did and were not isolated. I trace some of the other ones in my book. The question about why Mary Mallon was singled out is a complex one. Some of it is related to the fact that she was the first in the English speaking world to be identified as a healthy carrier. Then I think her resistant behavior was a factor. I also think that some thought that as a single immigrant woman without a family, she was an easy example and expendable in some respects.
Remember that the health department did release Mary Mallon in 1910, after almost three years, and then isolate her again in 1915 after they found her cooking. In 1910 she did have a lawyer and finally had her day in court. But the court was more impressed with the health department argument and sent her back into health department custody.

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Healdsburg, Calif.:
I am a grandson of George Soper, whom we called "Topy", and I wonder if Mr. Bourdain consulted with you on your findings about Topy when he was developing his book.

JMS

Judith Walzer Leavitt, Ph.D.: Delighted to know of your connection to George Soper!!
Yes, Anthony Bourdain read my book as he was developing his own; I did not meet him until after his book was published.

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New Britain, Conn.: I don't understand why the health department was so bent on capturing her. Why didn't they retrain her for another career that paid a decent wage?

Judith Walzer Leavitt, Ph.D.: Yes, they did seem "bent on" keeping her! I'm not sure it occurred to them to retrain her until Ernst Lederle became health commissioner in 1910, and then he did release her and helped her find a job in a laundry. The trouble was that washing and ironing was not such rewarding work as cooking could be, didn't pay as much, and wasn't what Mary Mallon wanted. She tried it, though, for quite a while, and perhaps some other domestic work too, for four years before finally going back to cooking. I did find other examples of typhoid fever carriers for whom the health department found more rewarding work and even provided some extra compensation. So in the end, I think the health officials' treatment of her was related to their views about single, Irish immigrant women, and perhaps especially those who did not see the wisdom of the health department actions.

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Chapel Hill, North Carolina: Do people still get typhoid fever in the United States today?

Judith Walzer Leavitt, Ph.D.: Yes, there are still reports of typhoid fever in the United States today. They are usually small outbreaks connected to people eating raw shellfish from contaminated waters, or imported from endemic areas in other parts of the world. They are contained through antibiotics and sanitation regulations.

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San Antonio, Tex.: In the way last night's program depicted George Soper and his detective sleuthing, Soper could be a member of a CSI investigative team. In so many ways, Soper's work closley parallels the work done over the past 50 years or so by the epidemiological team of the CDC, the "disease cowboys(girls). My question: Are you aware of examples of earlier epidemiological work in the United States much like the investigative tracking done by Soper in pursuit of the typhus carrier Mallon?

Judith Walzer Leavitt, Ph.D.: Yes, I agree that much about Soper's sleuthing is familiar today! Indeed, there were earlier examples of public health people tracing epidemic outbreaks in similar ways, although the process does get much more sophisticated in the 20th century. One very famous example is Dr. John Snow, who figured out that cholera was spread through contaminated water (long before any bacteriological understanding) and in 1854 mapped out the cholera cases in London that could be traced to the Broad Street pump. Dr. Charles V. Chapin, the health commissioner in Rhode Island for about forty years at the end of the 19th century was also known for his careful investigations of outbreaks of infectious diseases. Once there were permanent boards of health established in the United States, which dates to the 1860s and 1870s, most health departments had investigators doing this kind of work.

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San Antonio, Tex.: I was mesmerized by your program, not only because it told the 1906/7 of Mary Mallon so well, but because it raises so many ethical and legal public health questions some 98 years later: level of infectiousness/lethality, role of public health in public safety, legality of quarantine (I think too of the Carville, Ala. leprosorium), patients' rights, legal representation and redress, search/seizure, and conscientious objector status for certain medical interventions.

My question: Of all the issues that Mallon and George Soper had to deal with in their day, which one do you feel is the most relevant for us all a century later?

Judith Walzer Leavitt, Ph.D.: Thank you for your interest and comment! I agree that the story raises important issues that are still with us; indeed, that is one reason that I got interested in studying it myself. You have a good list of relevant issues. I think I would pick the dilemma between protecting the rights of the individual at the same time as protecting the public's health. There are so many examples of when these two can come into conflict, as they did in Mallon's situation, and the health department has to walk a tight rope trying to balance them. They are obligated to work to protect the healthy, but sometimes it is hard to do this without stepping on the toes of individual liberty. The balancing act has to be equal treatment fairly applied; in the face of rapidly developing medical emergencies, it might be hard to keep all the balls in the air (to mix my metaphors!).

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Norwich, CT: I enjoyed the documentary; my mother immigrated
from Ireland when she was 17, and it reminded
me of some of the prejudices that existed into the
20th century.

How did the Irish-American community react to
Mallon's case? It seems it would have made
sense for an Irish-American to call on Tammany
Hall for support.

Judith Walzer Leavitt, Ph.D.: I'm glad the documentary resonated with your own family experiences! I was surprised to learn that Mary Mallon had little contact with the Irish community in New York, at least in far as the written record can tell us. There were many instances of Irish cooks being called "Typhoid Mary," and one of the things I had to sort out in my research was which one was the Mary Mallon I was studying! There was a story, but one I could never verify, that Mary Mallon contacted an Irish newspaper for help. I'm sure she had a lot of sympathy among the Irish!

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Shaw, WDC: Where did you originally get the idea to write a book on Mary Mallon? Was public health policy directly affected because of her retainment, or did it take years for public health officials to realize that they had mistreated her?

Judith Walzer Leavitt, Ph.D.: I got interested in Mary Mallon's story because I teach a course in the history of public health at the University of Wisconsin, and I would teach her story. Historians had not written very much about it, and so I set out to tell the story myself!

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San Antonio, Tex.: On Oct. 1, the Washington State Nurses Association--representing the 600 nurses employed at Seattle's Virginia Mason Medical Center--filed a petition in federal court seeking an injunction to stop implementation of the hopital's new policy of mandatory flu shots for all employees.

Should patients--in this case the staff--be free to assess the risks and benefits of their own medical care, and decide what is injected into their bodies, without being threatened? (The problems with the Chiron flu vaccine may make this question moot, but I would appreciate your answer.) Do you see any parallels with the Mallon situation?

Judith Walzer Leavitt, Ph.D.: You raise an important issue. Let me just say that it has often been the case historically that those who have direct patient contact have been required to be protected themselves so as not to spread diseases. This has been the case in the past with smallpox vaccinations and tuberculin testing, among others. The parallel with Mallon would be the health department right to stop her from cooking, not for isolating her for life. Mallon was dangerous to others when she cooked food that they ate, but not when she walked the streets of New York.

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Judith Walzer Leavitt, Ph.D.: Thank you all for your wonderful questions and comments. I hope the documentary helps us all think through questions that remain so important for our society.

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