The Board of Health’s Exile of Mary Mallon:
Was It Justifiable?
Mary Mallon was born in Cookstown, County Tyrone, Ireland in 1869. Fifteen years later, she immigrated to the United States to work as a cook. In 1906, a typhoid outbreak occurred in a household on Oyster Bay in Long Island where Mary Mallon had recently worked. The owner of the house hired Dr. George Soper, a famed sanitary engineer, to investigate the domestic epidemic. Soper discovered that a recently hired cook had disappeared soon after the outbreak. Further research of Mary’s career records showed that seven out of eight houses she had worked in had contracted typhoid fever. All of Soper’s evidence showed that although Mary was healthy, she was spreading typhoid, reminding Soper of a German study on typhoid carriers, healthy people carrying a deadly disease. Soper tracked Mary relentlessly for months, determined to discover the truth. Seven months later, he heard of a typhoid outbreak on Park Avenue and immediately attempted to talk with the cook, Mary. When she did not comply with his efforts, Dr. Soper reported her to the health officials. The next day, the Board of Health sent a woman doctor, Josephine Baker, to speak with Mary. Although Dr. Baker’s first attempt was unsuccessful, her second succeeded in bringing a furious Mary Mallon to Willard Parker Hospital. The medical staff tested Mary for typhoid bacteria; the results showed her as positive for typhoid bacilli. Mary Mallon stayed in Willard Parker Hospital until the Board of Health exiled her to North Brother Island soon after, in 1907. The Board of Health acted reasonably because it needed to protect the public and further its knowledge of healthy carriers.
The Board’s original reason to isolate Mary Mallon was to protect the public against the menace of typhoid fever. Typhoid was a greatly feared disease because before the mid 1900s, there was no cure. The symptoms of typhoid fever include weakness, chills, stomach pains, and in ten percent of cases, even death (Leavitt 27). Typhoid is spread by the consumption of contaminated food or water, and stays in the system until either the person dies or the bacilli is disposed of through waste material (Leavitt 27). It is important to note that the Board of Health only exiled Mary Mallon after the tests proved she was a carrier of typhoid. During Mary’s time in Riverside Hospital on North Brother Island, the resident physician Dr. Fred Westmoreland stated that, “The Department of Health concluded… to place her in a contagious hospital and isolate her from the general public” (Leavitt 33). In 1909, Westmoreland further declared, “A bacteriological examination revealed the fact that fully thirty percent of the bacteria voided with the feces were of typhoid bacilli” (Leavitt 33). Mary was isolated because the Board of Health believed her to be a threat to society being that she was a carrier and had the ability to transfer the typhoid bacillus to anyone who ate the food she prepared.
The Board of Health was justified in isolating Mary Mallon because she was the first known healthy carrier and there were no cases to refer to which made relying on semi-precise laws a necessity. One of the laws used to apprehend Mary was Section 1170 of the Greater New York Charter, which said, “Said board may remove… any person sick with any contagious, pestilential or infectious disease” (Leavitt 71). Many people disagree with the validity of the law because they believe Mary was not sick because she showed no symptoms of typhoid fever. However, I believe the law would still apply to Mary because although she did not show any symptoms of typhoid, she was still harboring the disease that made her an “infectious” hazard. Additionally, even though Mary had no symptoms of typhoid fever—therefore not sick—she was extremely “contagious” and was more dangerous because of her occupation as a cook. The risk of infection Mary posed was another important component in the Board of Health’s decision to exile her to North Brother Island. A later study showed that carriers caused more than 40% of all typhoid fever cases, and 8.5% of all carriers worked in the food business (Leavitt 50). In 1909, there were approximately 3,500 cases of which roughly 1,400 cases were caused by food carriers (Leavitt 50). Despite the risk of typhoid and the many cases in New York, because Mary was the first discovered carrier the Board believed the danger she posed was greater than that of the average typhoid infected person. This is in part due to Mary’s healthy appearance. No one would suspect her of carrying a deadly disease, and as such, would not know the dangers of eating the food Mary prepared. In the right environment, the combined factors could cause an epidemic (Bourdain 36). The Board of Health was not willing to assume the responsibility of a possible epidemic, favoring the act of isolating Mary.
However, fear of an epidemic was not the only reason the Board officials had for exiling Mary Mallon; they also did not believe Mary would willingly kowtow to their will because she was in denial and severely headstrong. For at least eight years, she had worked as a cook mostly in wealthy houses. She made a comfortable living, had a boyfriend, and knew she was a good cook. Mary had no reason to give up the life she had worked so hard to build for a typhoid study that would ruin both her life and her career. When Dr. Soper and Dr. Baker approached Mary, she reacted angrily, denying their accusations. How she continually denied their accusations is odd, seeing that she usually left the households soon after the epidemic occurred. Seven out of the eight houses she had worked in from 1897 to 1907 had contracted typhoid fever, usually within a month after her arrival. In the houses where several months passed before anyone became ill is due to Mary being an intermittent carrier (Leavitt 33)—sometimes she was infected and sometimes she was not. When the Board of Health approached her to explain her intermittent healthy carrier situation, she reacted with obstinate aggressiveness, making it another incentive to exile her.
Mary’s exile was partially due to her initial headstrong behavior. After Mary was isolated in Riverside Hospital, Dr. Baker stated, “[Mary’s] bad behavior… inevitably led to her doom” (Leavitt 68). It is most likely that because Mary’s initial reaction to the health officials’ communication attempts was violence and anger, they were convinced that Mary was a threat in more than one way. Rosenau declared, “The price of liberty is good behavior” (Leavitt 61). If Mary had reacted rationally, and given the Board samples of urine and feces, she probably would have been able to live a free life. The knowledge of the danger she posed to the public and a warning of what would happen if she did not abide by the set rules of probation would have applied to her in the same way as most of the other carriers discovered later. The consequence of her violence, misbehavior, and unwillingness to comply combined with the risk of an epidemic and the Board of Health’s belief that she would not willingly follow its guidelines and stop cooking, convinced the officials that their best alternative was to exile her on North Brother Island.
However, when new carriers began appearing, the Board of Health was unable to deal with them in the same manner as Mary Mallon. A study showed that roughly two to five percent of people infected with typhoid became permanent carriers (Leavitt 48). If the Board had seen fit to house every carrier, there would roughly have been another one hundred carriers added per year in New York alone. Since the carrier’s death rate would have been close to nil, save natural ailments, the islands in New York that were dedicated for extreme health risks—diphtheria, tuberculosis, typhus, etc.—would have been filled with fairly healthy people, defeating the purpose of isolation islands. Dr. William Park of the Board of Health stated, “The impracticability of isolating for life so many persons, we are forced to consider isolation utterly impracticable” (Leavitt 47). Charles Chapin came to the same conclusion in his 1910 publication suggesting that the exiling of healthy carriers was impossible and unjust (Leavitt 63). Isolation was found not to be necessary if certain sanitary precautions were taken, as Rosenau’s textbook states, “It is not necessary to imprison the bacillus carrier; it is sufficient to restrict the activities of such an individual” (Leavitt 65). By just isolating Mary, the Board of Health was able to make an important statement to the public—although they did not want to use the isolation islands, they could if the situation evolved—while keeping the isolation islands void of typhoid carriers.
However, some people argue that it was inhumane to exile Mary and use her as a paradigm of what not to do, especially because of what transpired in the later cases of Alphonse Cotils, Tony Labella, and “Typhoid John” (Leavitt 93). Alphonse Cotils, a restaurant and bakery owner, who also was a healthy carrier, had a court hearing in 1924 because he had violated the restrictions that applied to all carriers (Leavitt 57); he had begun to cook again. Even though Alphonse violated the restriction placed upon him, he was not exiled. Tony Labella was an Italian immigrant who caused over one hundred cases and five deaths (Leavitt 57), significantly more than Mary was ever accused. After the Board of Health approached Labella and informed him about his unfortunate situation—that he was a typhoid carrier—he sought refuge in New Jersey (Leavitt 61). Even after the Board officials found him and saw how many more cases he had caused, they still did not see fit to isolate him. Yet another case of leniency by the Board of Health is that of “Typhoid John”, an Adirondack guide (Leavitt 93). John infected over thirty-six people, resulting in two deaths, more than Mary had by 1909 (Leavitt 93). However, like the others, John was not isolated.
Although all of these examples seem to be unfair in all respects relating to a likeness with Mary Mallon’s case, the Board saw several differences: Alphonse was a businessman, Tony, although an Italian immigrant, was a breadwinner, and “Typhoid John” (Leavitt 93) was a guide for tourists and was not considered a drain on the economy. The Board of Health knew that Alphonse in particular had more to lose than Mary did; he was a man of the middle-class, owned two businesses, and had a family. Although the first reason appears chauvinistic, the Board did not reach their final decision of exiling Mary because she was a woman. However, that may have been a minor incentive, along with her being a lower class Irish immigrant. The reason the judge provided for allowing Cotils’ his freedom was, “The only object in imposing a prison sentence would be to deter other typhoid germ carriers from handling foodstuffs” (Leavitt 94). As Mary was already being used as a case point, the Board of Health had no reason to isolate all the typhoid carriers. Mary Mallon and her situation was the paradigm of what not to do and what the consequence would be for breaking the law.
The Board of Health’s actions were justifiable because as Mary was the first known healthy typhoid carrier in the United States there were no policies in place defining particular rules or regulations for dealing with a healthy carrier. She was considered more dangerous because of her healthy appearance, and thus was exiled because of the epidemic hazard she posed to the public.
Bourdain, Anthony. Typhoid Mary: An Urban Historical. New York: Bloomsbury, 2001.
Leavitt, Judith Walzer. Typhoid Mary: Captive to the Public’s Health. Boston: Beacon P, 1996.