Annals of Gastroenterology (2013) 26, 132-134
HISTORY IN GASTROENTEROLOGY
Mary Mallon (1869-1938) and the history of typhoid fever
Filio Marineli, Gregory Tsoucalas, Marianna Karamanou, George Androutsos
Medical School, University of Athens, Athens, Greece
Abstract
Mary Mallon was born in 1869 in Ireland and emigrated to the US in 1884. She had worked
in a variety of domestic positions for wealthy families prior to settling into her career as a
cook. As a healthy carrier of Salmonella typhi her nickname of Typhoid Mary had become
synonymous with the spread of disease, as many were infected due to her denial of being ill.
She was forced into quarantine on two separate occasions on North Brother Island for a total
of 26 years and died alone without friends, having evidently found consolation in her religion
to which she gave her faith and loyalty.
Keywords Typhoid fever, salmonella, Mary Mallon, carrier, New York
Ann Gastroenterol 2013; 26 (2): 132-134
Isolating Salmonella
Long before the bacillus responsible for the disease was
discovered in 1880, Karl Liebermeister had already assumed that
the condition was due to a microorganism. He also tried, with his
colleagues, to demonstrate that the spread of epidemic was related
to drinking water contaminated by the excrement of patients
with typhoid fever [1]. William Budd, a doctor in Bristol who
was interested in cholera and in intestinal fevers, demonstrated in
1873, that typhoid fever could be transmitted by a specific toxin
present in excrement and that the contamination of water by the
feces of patients was responsible for that propagation. According
to Budd, every case was related to another anterior case. A
great number of doctors and scientists had tried to discover the
nature of the microorganism responsible for the disease and had
encountered great difficulty in isolating the bacillus. It was Karl
Joseph Eberth, doctor and student of Rudolf Virchow, who in
1879 discovered the bacillus in the abdominal lymph nodes
and the spleen. He had published his observations in 1880
and 1881. His discovery was then verified and confirmed by
German and English bacteriologists, including Robert Koch
[2]. The genus Salmonella was named after Daniel Elmer
Salmon, an American veterinary pathologist, who was the
administrator of the USDA research program, and thus the
organism was named after him, despite the fact that a variety
of scientists had contributed to the quest [3].
History of Medicine Department, Medical School, University of
Athens, Athens, Greece
Conflict of Interest: None
Correspondence to: Filio Marineli, MD, History of Medicine
Department, Medical School, University of Athens, Athens, Greece,
Erehthiou 59, Alimos, Attiki, Greece, Tel.: +30 6972 331848,
e-mail: [email protected]
Received 29 September 2012; accepted 19 November 2012
2013 Hellenic Society of Gastroenterology
Salmonella thus became new scientific knowledge and
therefore the contagion mechanisms, as well as the existence
of healthy carriers were relatively in status nascendi [4].
The contagion
Mary Mallon was born in Ireland in 1869 and emigrated
to the United States in 1883 or 1884. She was engaged in
1906 as a cook by Charles Henry Warren, a wealthy New
York banker, who rented a residence to Oyster Bay on the
north coast of Long Island for the summer. From 27 August
to 3 September, 6 of the 11 people present in the house were
suffering from typhoid fever. At this time, typhoid fever was
still fatal in 10% of cases and mainly affected deprived people
from large cities [5,6].
The sanitary engineer, committed by the Warren family,
George Sober, published the results of his investigation on
the 15th of June 1907, in JAMA. Having believed initially that
freshwater clams could be involved in these infections, he had
hastily conducted his interrogation of the sick people and also
of Mary who had presented a moderate form of typhoid [7].
Mary continued to host the bacteria, contaminating everything
around her, a real threat for the surrounding environment.
Although Sober initially feared that the soft clams were the
culprits, this proved to be incorrect as not all of those stricken
had eaten them. Finally Sober had solved the mystery and
became the first author to describe a healthy carrier of
Salmonella typhi in the United States. From March 1907, Sober
started stalking Mary Mallon in Manhattan and he revealed
that she was transmitting disease and death by her activity.
His attempts to obtain samples of Marys feces, urine and
blood, earned him nothing but being chased by her. Sober
reconstituted the puzzle by discovering that previously the cook
had served in 8 families. Seven of them had experienced cases
www.annalsgastro.gr
Mary Mallon (1869-1938) and the history of typhoid fever
Figure 1 Mary Mallon as Typhoid Mary in the local newspaper
of the era
of typhoid. Twenty-two people presented signs of infection
and some died [5,6].
That year, about 3,000 New Yorkers had been infected by
Salmonella typhi, and probably Mary was the main reason
for the outbreak. Immunization against Salmonella typhi was
not developed until 1911, and antibiotic treatment was not
available until 1948 [4]. Thus, a dangerous source like Mary
had to be restrained. Mary was then frequently accused of
being the source of contact for hundreds of the ill. Sober, after
enlisting the support of Dr. Biggs of the N.Y. Department of
Health, persuaded Dr. Josephine Baker, who along with the
police, was sent to bring Mary Mallon in for testing. Baker
and the police were met by an uncooperative Mary, who
eluded them for five hours. At the end she was forced to give
samples. Marys stool was positive for Salmonella typhi and
thus she was transferred to North Brother Island to Riverside
Hospital, where she was quarantined in a cottage [5].
In 1909, Mary unsuccessfully sued the health department.
During her two-year period of confinement, she had 120/163
stool samples test positive. No one ever attempted to explain
to Mary the significance of being a carrier, instead they had
offered to remove her gallbladder, something she had denied.
She was unsuccessfully treated with Hexamethylenamin,
laxatives, Urotropin, and brewers yeast. In 1910, a new health
commissioner vowed to free Mary and assist her with finding
suitable employment as a domestic but not as a cook. Mary
was released but never intended to abide by the agreement.
She started working again in the cuisines of her unsuspecting
employers, threatening public health once more [4].
As a cook of Sloane Maternity in Manhattan, she
contaminated, in three months, at least 25 people, doctors,
nurses and staff. Two of them died. She had managed to be
hired as Mary Brown [8]. Since then she was stigmatized
as Typhoid Mary (Fig. 1) and she was the butt of jokes,
cartoons, and eventually Typhoid Mary appeared in medical
dictionaries, as a disease carrier. Mary was placed back on
North Brother Island where she remained until her death.
On Christmas morning, 1932, a man who came to deliver
something to her found Mary on the floor of her bungalow,
paralyzed. She had had a stroke of apoplexy and never walked
133
again. Thereafter, for six years, she was taken care of in the
Riverside Hospital (Fig. 2). She died in November 1938. Her
body was hurried away and buried in a grave bought for the
purpose at St. Raymonds Cemetery in Bronx. A post mortem
revealed that she shed Salmonella typhi bacteria from her
gallstones raising the issue of what would have happened if she
had accepted the proposed operation. Some other researchers
insisted that there was no autopsy and that this was another
urban legend, whispered by the Health Center of Oyster Bay,
in order to calm ethical reactions [5].
Mary Mallon, the first known case of a healthy carrier in the
United States, was proven responsible for the contamination
of at least one hundred and twenty two people, including
five dead [5].
Ethical issues
Much speculation remains regarding the treatment that
Mary received at the hands of the Department of Health, City
of New York. She was never fined, let alone confined. Instead
of working with her, to make her realize she was a risk factor,
the state quarantined her twice, making her a laboratory pet.
Mary endured test after test and was only thinking of how
she could cook again. She had become a victim of the health
laws, of the press and above all of the cynical physicians, who
had plenty of time to test but never had time to talk with the
patient [9,10].
Marys case is a perfect example of how the Health Care
system provokes social attitudes towards disease carriers,
often associated with prejudice. This case highlighted the
problematic nature of the subject and the need for an enhanced
medical and legal-social treatment model aimed at improving
the status of disease carriers and limiting their impact on
society [9,10]. Probably the answer to the rhetorical question
was Mary Mallon a symbol of the threat to individual liberty
or a necessary sacrifice to public health? is a single word,
balance. After all what Mary ever wanted was to be a good
plain cook [11].
Figure 2 Mary Mallon in the Riverside Hospital
Annals of Gastroenterology 26
134 F. Marineli et al
Concluding remarks
References
The history of Mary Mallon, declared unclean like a
leper, may give us some moral lessons on how to protect
the ill and how we can be protected from illness. Mary had
refused the one operation which might have cured her. In
later years she lost much of her bitterness and lived a fairly
contented if necessarily restricted life. She evidently found
consolation in her religion and she was then at perfect
peace in the bosom of the church to which she gave the last
years her faith and loyalty. By the time she died New York
health officials had identified more than 400 other healthy
carriers of Salmonella typhi, but no one else was forcibly
confined or victimized as an unwanted ill. Mary Mallon is
always a reference when mentioning the compliance of the
laws concerning public health issues. The states pursuance
and Marys stubbornness gave her an awkward place in the
history of Medicine.
1. Liebermeister KV. Cholera Asiatica und Cholera Nostras. Alfred
Hlder, Vienna; 1896:132.
2. Moorhead R. William Budd and typhoid fever. J R Soc Med
2002;95:561-564.
3. Oldenkamp EP. Predecessors: veterinarians from earlier times,
Daniel Elmer Salmon (1850-1914). Tijdschr Diergeneeskd
2004;129:554-555.
4. Fanning WL. Typhim Vitrade mark Vaccine. J Travel Med
1997;4:32-37.
5. Soper GA. The curious career of Typhoid Mary. Bull N Y Acad
Med 1939;15:698-712.
6. Brooks J. The sad and tragic life of Typhoid Mary. CMAJ
1996;154:915-916.
7. Marr JS. Typhoid Mary. Lancet 1999;353:1714.
8. Walton MK, Connolly CA. A look back: nursing care of typhoid
fever: the pivotal role of nurses at the Childrens Hospital of
Philadelphia between 1895 and 1910: how the past informs the
present. Am J Nurs 2005;105:74-78.
9. Aronson SM. The civil rights of Mary Mallon. R I Med 1995;78:311312.
10. Rimar Y, Shaoul R. Mary Mallon, Mr. N and Mr. Koch as well.
Harefuah 2005;144:216-218, 229.
11. Finkbeiner AK. Quite contrary: was Typhoid Mary Mallon a
symbol of the threats to individual liberty or a necessary sacrifice
to public health? Sciences (New York) 1996;36:38-43.
Annals of Gastroenterology 26
