Typhoid fever is no longer a household word in America, but a century ago the disease frequently broke out in epidemic form. It created such enormous concern for public health officials that New York state authorities waged a lengthy campaign against one individual who spread the infection and whose nickname, "Typhoid Mary," became a widespread term of opprobrium.

The disease is characterized by a persistently high fever, rash, generalized pains, headache and severe abdominal discomfort that can lead to intestinal bleeding and even death. Ten percent of those who got the disease a century ago died.

The worst manifestations occur after two or three weeks. Thus, unlike the patient afflicted with cholera's similar symptoms, which rapidly progressed to a serious state, typhoid fever victims were disposed to think the malady less serious as time went by. But if the patient survived for four or five weeks after onset, recovery was likely.

Unsanitary conditions help spread typhoid fever. The bacillus Salmonella typhosa, part of the genus of organisms that causes food poisoning, is harbored in the urine and fecal matter of its unfortunate victim. If that person has unsanitary personal habits and holds a position as a cook or food attendant, the disease may quickly spread. It also can be diffused by healthy "carriers," who harbor the disease and practice poor personal hygiene but appear unaffected by its symptoms.

In addition to the bacteria entering the body through food, milk or water contaminated by a carrier, flies also can become a carrier.

Typhoid fever appears to be as old as man, with descriptions of the malady dating back to the Greece of Hippocrates. In England, King William the Conqueror (1027-1087) is believed to have died of typhoid fever, as did Albert the Prince Consort, husband of Queen Victoria, in 1861. But it took medical authorities a long time to identify unsanitary conditions with typhoid fever's prevalence.

Indeed, for years the disease was confused with typhus fever -- an insect-borne malady. In 1856, medical officials made the connection between fecal matter and infectiousness.

Still, ensuring safe water and food supplies was not a simple task, especially in wartime. Of the more than 186,000 northern troops who died from disease during the Civil War, about 81,000 were attributable to typhoid fever and dysentery.

In the Spanish-American War of 1898, a fifth of all soldiers -- about 4,000 -- serving in Cuba were stricken with typhoid fever.

Within 15 years, the development of a vaccine provided short-term protection, and troops engaged in military action in Mexico in 1913 were rarely affected. But in the interim, typhoid exacted a high death toll among Americans, responsible for 26.7 of every 100,000 deaths from 1900 to 1904. It exceeded the fatality rate of measles, scarlet fever, whooping cough or even influenza.

It was difficult in a democratic society to prevent citizens from engaging in activity that could spread typhoid fever. The most famous case was that of "Typhoid Mary" Mallon (1870-1938), an Irish-American cook whose body appeared to be a reservoir for typhoid germs and the source, authorities reckoned, of at least 10 outbreaks that involved 51 cases, three resulting in deaths.

Suspicion was aroused in 1904, when an unusual number of typhoid fever cases occurred in Oyster Bay, N.Y., and environs, all traced to homes where Mallon had worked as a cook. But the link to Mallon wasn't made until 1906, when a physician presented evidence that healthy carriers could be the source of outbreaks.

She refused medical treatment and confinement in a hospital, leading the New York Health Department in 1907 to isolate her on North Brother Island in New York City's harbor. She was released three years later.

In 1915, Mary Mallon was working at a cook at a Newfoundland, N.Y., sanitorium. When 25 of the institution's employees were stricken with typhoid fever, she was banished once again to North Brother Island, where she remained until her death in 1938 of a stroke.

Typhoid fever's ugly presence would continue beyond the early 20th century in nations with poor sanitary conditions, but it ebbed in this country.

The weapons here were legislation requiring medical inspection of food handlers, hospital personnel and water supplies; the acceptance of pasteurized milk and chlorinated water, and the improvement of sewage facilities. In the early 1950s, antibiotics were effective for the few existing cases. Inoculation of travelers also conferred short-term immunity.

Still, one of the main sources of contagion in developed countries today bears some relation to Typhoid Mary: the undetected and often asymptomatic carrier who holds a position as a food handler.

Even antibiotics are ineffective in ending the carrier state in such individuals.

Thomas V. DiBacco is a historian at American University.