The recent coronavirus pandemic is a reminder of how vulnerable we all are to germs and disease, despite the huge advances in medicine in the past hundred years. As we’ve seen with Covid-19, it is not only the virus that is dangerous, but also misinformation and a lack of understanding about how disease is spread from one person to another. One of the most tragic examples is the case of Mary Mallon (1869 - 1938), a.k.a. Typhoid Mary, an Irish immigrant to America who became notorious for being an asymptomatic carrier of the deadly disease typhoid fever. Ultimately, she spread the disease to dozens of unsuspecting people, some of whom died. While the disease never caused illness in Mary herself, her status as a carrier defined her difficult life and her story remains a sobering cautionary tale about typhoid and disease, but also about the rights of medical patients and civil liberties in general.
Mary Mallon was born in Cookstone, County Tyrone, Northern Ireland in 1869 and, like thousands of her countrymen, immigrated to the United States in search of economic opportunity. Mary left at the young age of 15, arriving in New York City with only two real skills, cleaning and cooking. Initially Mary (her surname changed several times during her life, so we are referring to her mainly by her first name in this article, for clarity) lived with Irish relatives who had immigrated before her and she worked, like many Irish women immigrants at the time, as a maid. Eventually she found that the wealthy families employing her enjoyed her cooking. Since it paid twice as much as housework, Mary adapted and pursued a career as a private chef for wealthy families. It was a good job for an otherwise unskilled immigrant.
Mary began cooking professionally in 1900 in New York City and its wealthy suburbs. While working as a cook for a family in Westchester County, New York, several family members contracted typhoid fever. The following year, Mary moved to Manhattan. In the first home in which she worked, several members of the family came down with symptoms of typhoid fever: chills, vomiting, and fever. After leaving there, she worked for another family in the city. In this house, seven of the eight family members experienced similar health problems. Were Mary’s employers--or Mary herself--suspicious that she might be infecting others? Maybe not, at least not yet. Outbreaks among the wealthy were less common than those occurring in crowded tenements, but they were not unheard of.
Typhoid fever has been a part of human history since the dawn of agriculture, the first time large groups of humans began living together in villages and cities. Typhoid is caused by Salmonella serotype Typhi bacteria, which is only found--and passed on-- in humans. The disease is spread through water sources and food that has been contaminated with the feces of a typhoid carrier (the carrier may be symptomatic or asymptomatic). Communities are most at risk of typhoid when their sanitation systems and water supplies are unclean or inadequate.
One of the earliest historical incidents of typhoid dates back to the Plague of Athens (430 BCE), during the Peloponnesian War between Athens and Sparta. During the siege of Athens, the entire population was forced into close quarters, overtaxing the water and sewage systems. Once typhus had entered the walled city, it exploded in the population, ultimately killing 25 percent of the population, which amounted to 75,000 to 100,000 people. Recent medical analysis revealed the DNA of typhus in the remains found in mass graves in ancient Athens, and contemporary descriptions of the outbreak and its symptoms, such Thucydides’ History of the Peloponnesian War, support this theory. (Thucydides himself contracted the illness but recovered).
Outbreaks of typhoid fever were not uncommon after that. In the nineteenth century scientists in Europe began to identify the path of the disease, linking it to unclean drinking water. As cities in Europe and America began to implement better sanitation systems, incidents of typhoid dropped, but it still appeared from time to time. The families for whom Mary Mallon cooked may not have immediately thought of the cook as a possible source of infection; in one house the doctor was convinced the laundress was the cause of the outbreak, but it was later discovered to be Mary.
Mary Mallon may have been exposed to the pathogen while still in her mother’s womb, or she may have been infected at an earlier date and survived. Whatever her history, she became a “superspreader” of the disease, a healthy person with no symptoms of illness whose body harbors the pathogen and regularly sheds the germs (about 6 percent of those infected with typhoid may become asymptomatic carriers afterward, some temporarily and some, like Mary, for life). At the time, the concept of an asymptomatic carrier was a new and, understandably, bizarre idea. As Mary herself wondered, how could a healthy person make others sick? It was sanitation engineer George Soper who first made the connection in Mary’s case.
After an outbreak of typhoid fever in a mansion in Oyster Bay, New York in 1907, Soper was hired to solve the mystery of its origins. At first he examined the water pipes in the house, testing them for the typhoid bacillus, which had been identified in 1880 by the German biologist Karl Joseph Eberth. The plumbing was not the problem. In an early version of what we now call contact tracing, George Soper followed the cases of several wealthy families with unexplained typhoid outbreaks and discovered that Mary Mallon had worked as a cook for all of them. When she prepared dishes that were cooked at high temperatures, the bacterium would be killed and the food was safe to eat. Her specialty, however, was peach ice cream. Without heat to destroy the germs, the ice cream became a powerful vector for disease.
This was the beginning of the struggle that would define Mary Mallon for the rest of her life. When Soper confronted Mary and accused her of sickening her employers, she reportedly denied it and threatened Soper with a carving fork. After further contact tracing, Soper discovered even more cases of typhoid amongst Mary’s former employers, and he went to her home to demand stool and urine samples for testing. Mary again refused, insisting she was perfectly healthy and there was no evidence in medical history of healthy people infecting others. She wasn’t wrong; it was a new idea and virtually no one had ever considered the possibility of an asymptomatic carrier.
“No one will blame Mary Mallon for insisting on her constitutional rights,” wrote the San Francisco Call. “But if it is true, as doctors declare, that she carries pestilence among the people, there may be legal warrant for suspending the right of habeas corpus in her case.” Soper alerted the New York City Health Department and Mary was declared a public health threat and arrested, forcibly, by five police officers and a doctor who had to sit on her to hold her down. While held against her will in the hospital, she was tested for typhoid and found to be a carrier. She was ordered into quarantine and sent to live alone, under medical supervision, to North Brother Island, in the middle of the East River, just off Manhattan. While being held there, Mary had a nervous breakdown and continued to dispute Soper’s findings, insisting that she had committed no crime. For the next three years she was held in isolation on the island, undergoing numerous experimental treatments for typhoid infection, none of which had any effect.
Mary was allowed to return to society in 1910 after promising she would no longer seek employment as a cook, and would take all reasonable precautions to avoid infecting others. She began working as a laundress. But this job paid less than half the salary she’d made as a cook. After an injury that left her temporarily disabled, Mary was penniless and alone and returned to the one occupation in which she had ever been able to support herself, and returned to work as a cook. She began working under assumed names to avoid detection, and worked in larger kitchens such as those in hotels and hospitals in order to avoid the scrutiny of providing references to a private family.
In 1915 an outbreak of typhoid fever in New York City’s Sloane Hospital for Women was investigated, and all signs pointed to the cook. Twenty-five people were infected and two died of the disease; Soper arrived to investigate and believed Mary, who was working at the hospital under a pseudonym, was to blame. Although she tried to escape, she was tracked down by police, arrested, and sent back to North Brother Island. By now, Mary was notorious, known as “Typhoid Mary,” and vilified by the press. “Witch in NY,” the headline of the Tacoma Times read in 1915. “This twentieth century witch does not weave black incantations and scatter awful curses over the community. No! She scatters GERMS--typhoid germs!”
Mary Mallon spent the rest of her life, 23 years, on the island, virtually alone. She died there in 1938 at the age of 69, after suffering a stroke. Mary never accepted the medical explanations nor the judicial justifications for her imprisonment, arguing that her civil rights were illegally violated by the imprisonment. Although by 1915 thousands of other people around the country had also been identified as asymptomatic typhoid carriers who had unwittingly infected others, only Mary Mallon was confined to almost total isolation for life.
“The Lord only knows what we can do with the woman,” said one doctor at the time of her second arrest. Mary might have been offered training for a job which wouldn’t require her to handle food or anything that might endanger others; work as a secretary, perhaps. Or she could possibly have received financial assistance from the state in return for not working as a cook. But neither option was offered, nor did she have the family connections or finances to mount a meaningful legal defense. Instead, she was sent away to die within sight of New York City, where she had tried to make a life for herself. Although it is not known exactly how many people she inadvertently killed, the estimates range from three to fifty, with over a hundred infected over the course of her career. Today the case of Typhoid Mary remains an important example of the difficulty of balancing public health with the rights of individuals. According to Mary, her nurses and doctors sometimes referred to her as “the kidnapped woman.” She never escaped.
We all know George Washington as the formidable and persevering soul that led the way to American independence, becoming the first president of a new nation. His life leading up to the presidency was full of life-threatening events, including contracting smallpox in Barbados. His survival of the deadly disease provided him with a life-long immunity that would prove to be of great benefit to the military leader during an epidemic which occurred amidst the American Revolution. Later, as commander of the Virginia militia, Washington led an attack that was instrumental in starting the French and Indian War and eventually led the Continental Army in the quest for freedom from Britain. These and similar stories of his bravery and greatness abound and are common knowledge to many Americans, but what is lesser known is the fact that a simple illness, by modern-day standards, took the life of a man who had faced so many seemingly more dangerous obstacles during his lifetime.
Washington spent several hours on 12 December 1799 as he had many other days, overseeing the farm activities on horseback. Inclement weather found him back at home in soaking wet clothes at the dinner hour. Known for his punctuality, Washington opted to forego changing into dry attire for the meal. The next morning brought with it snow and the onset of what was termed at the time as quinsy. Though the exact cause of death is sometimes debated by modern-day theorists, most agree that the details of the reported treatments may just have been more brutal than the illness and could have contributed to his death.
On 14 December 1799, two days after receiving a soaking in the cold winter air, Washington awoke with increasing pain and difficulty breathing. Throughout the course of the day he was attended by three different doctors, who tried various treatments to “cure” the ailing man. At least two of the treatments included swallowing or gargling concoctions they believed would alleviate some of the symptoms, one of which was a molasses, butter, and vinegar that was so difficult to swallow that he began to convulse and nearly suffocated. The most egregious of the treatments was the blood letting, the practice of lancing the patient and withdrawing blood for the purpose of alleviating illness or disease. Washington was reportedly a proponent of blood letting, but the doctors may have taken things a bit too far, as over the course of 16 hours and four sessions, an estimated five to seven pints, or 40% of the total blood in his body was evacuated. This is believed by many to have contributed to his demise before night’s end, merely a day and half after waking up with a sore throat - quinsy had taken the life of one the most revered men in America’s history.
Quinsy is one of the many historic medical terms that are no longer in use. During the course of research you may find reference to these obsolete terms in death records, obituaries, military records and personal correspondence, among others.
Following is a list of some of the more commonly found historic medical terms:
Ague: malarial fever
Apoplexy: paralysis due to stroke
Bad Blood: syphilis
Black Plague: bubonic plague
Bilious Fever: typhoid, malaria, hepatitis
Brain Fever: meningitis, typhus
Bright’s Disease: nephritis, inflammatory disease of kidneys
Cerebritis: inflammation of cerebrum or lead poisoning
Delirium Tremens: hallucinations due to alcoholism
Dropsy: edema, often caused by congestive heart failure or swelling caused by kidney disease
Falling Sickness: epilepsy
French Pox: syphilis
Gravel: kidney stones
Lock Jaw: tetanus
Pott’s Disease: tuberculosis of spine
Puerperal Exhaustion: death due to childbirth
Scurvy: lack of vitamin C manifesting in symptoms of weakness, spongy gums and hemorrhages under the skin
Septicemia: blood poisoning
Ship Fever: typhus
Softening of Brain: result of stroke or hemorrhage in the brain
For additional assistance with deciphering those old terminologies, try the article Outdated Terms for Diseases and Conditions and in publications, such as A Medical Miscellany for Genealogists by Dr. Jeannette L. Jerger One of the most useful sources in the tool box of a researcher for interpreting the penmanship on historic death records is the Internal Classification of Diseases (ICD), a coding system which has been in widespread use since the late-19th century and provides a collective way to convey cause of death. These representative numbers are sometimes written in odd locations on the record and can be overlooked, but are normally included on death certificates in the general area of the cause of death. A cautionary note - ensure that you are reviewing the year applicable to the record in question, as the list has been updated about once every decade or so, making certain that you are viewing the pertinent cause of death.
Understanding the terminologies for illnesses, conditions and diseases, as well as the treatments of the time period, can provide a more in-depth understanding of the lives and trials of your ancestors and make you even more thankful for the miracles of modern medicine.
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