Chances are that if you lived in the United States in early 1930’s you were concerned about numerous diseases that don’t have today’s media headlines. Typhoid Fever is one of those diseases which garnered much attention during that time in United Sates history, but today receives little or no attention. Although it lacks the marquee value of other diseases such as MRSA, smallpox, and anthrax, there are many lessons to be applied from the impact of Typhoid. One such lesson is that taught by Mary Mallon…better known as Typhoid Mary.
Mary Mallon (September 23, 1869 – November 11, 1938) has the dubious honor of being the first person in history to be a carrier of typhoid fever. Between 1901 and 1907 Mary Mallon held several positions with institutions and in private homes as cook. Many of the jobs were held here in New York State. During here working time she is alleged to have infected 22 people with typhoid fever and accused of the resulting single death. Typhoid illness and deaths spiked in her presence as she moved from city to city. The incidence of disease and deaths seemed to follow her from Mamaronek, NY to Manhattan to Long Island. It seems that within two weeks of Mary Mallon’s arrival, outbreaks of typhoid occurred.
Defending her innocence to the accusations of being a carrier of typhoid, Mallon refused to submit stool and urine samples in 1904, and in 1906 the possibility of a human carrier of typhoid was published in the June issue of the Journal of the American Medical Association. Later Mallon, now know by the popular Typhoid Mary name was taken into custody and held for three years. Her involuntary isolation came at her protests that the law was against her and claims of harassment because she was an Iris immigrant. She was eventually released on condition that not work with food, but took job as a hospital cook under an assumed name and infected twenty-five other people with typhoid. Two of those infected died. After this latest outbreak of typhoid, Mary “Brown” was discovered to actually be “Typhoid” Mary Mallon. She was arrested and re-admitted (involuntarily) for life-long isolation.
At the age of 69, on November 11, 1938, “Typhoid” Mary Mallon died of pneumonia. On postmortem exam, live typhoid bacteria was found in her gallbladder. Despite her overwhelming denial of her role in the typhoid cases and deaths, she in fact, produced the situations resulting in numerous cases and deaths from typhoid.
What relevance can we bring to today’s bio-security awareness society from Typhoid Mary? There are several historical points that should be considered. First, Mary’s situation was almost certainly unintentional. That is, Mary Mallon did not intend to harm anyone or spread disease. Would a change in the intent change the outcome or the circumstances of the situation? I think so. We have become accustomed to the “suicide bomber” scenarios played on the evening news. Consider the possibility of a “Biological Bomber”…a person who intentionally infects himself/herself with a disease in order to spread the disease and effect a bioterrorist event. Can you imagine the impact of one person infected with some disease walking into a hospital and contacting immunological suppressed patients, visitors, and health care workers?
And what if Mary was alive today and incarcerated on the suspicion of being a health carrier of a deadly disease; what would be said about her civil rights? Would public health authorities have the ability today to impose isolation? Think back to the media circus surrounding Mr. Speaker, the international traveler with extremely drug resistant tuberculosis. Can you imagine what would have happened had a fellow traveler contracted TB? Further, what will the effects be on society during an actual public health emergency? During a public health crisis I’m not convinced that the imposition of isolation or quarantine measures will be effective. During the Sever Acute Respiratory Syndrome (SARS) outbreak of 2003, the city of Toronto found that a majority of citizens voluntarily complied with social distancing. These high levels of compliance may be contributed to community education efforts and use of the modern media. With the SARS situation in mind, I am still skeptical that a similar outcome would be possible in the United States despite the Constitutional and legal ability to do so.
The Public Health Services Act (1944) provides for quarantine authority of the Federal government and authorizes “…apprehension, detention, and conditional release of individuals to prevent spread of communicable disease” This statute applies to persons infected with a communicable disease in a qualifying stage Title 42 U.S.C. Section 264 (Section 361 of the Public Health Service Act) gives the Secretary of Health and Human Services responsibility for preventing the introduction, transmission, and spread of communicable diseases from foreign countries into the U.S. and within the U.S. and its territories/possessions, and CDC has the authority to “detain, medically examine, or conditionally release individuals suspected of carrying a communicable disease” under regulations found at 42 C.F.R. Parts 70 and 71. Violation of a quarantine and isolation order is a federal criminal misdemeanor.
On April 4, 2003, at the request of the CDC, President Bush signed Executive Order 13295, adding SARS to the list of communicable diseases for which federal isolation and quarantine is authorized. And earlier in 2007, President Bush signed Homeland Security Presidential Directive 51 authorizing the Office of the President to declare and define “threats to continuity of government”.
The fact remains that during a public health crisis resources would be few and one has to wonder if quarantine would be possible at all.
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Critical Care Study Guide. Criner/D’Alonzo ISBN 0-387-95164-4
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About.com:20th Century History. “Typhoid Mary” http://history1900s.about.com/od/1900s/a/typhoidmary.htm accessed Nov. 30, 2007
Typhoid Mary: Villain or Victim? Judith Walzer Leavitt http://www.pbs.org/wgbh/nova/typhoid/mary.html accessed Dec. 2, 2007
The Most Dangerous Woman in America. NOVA http://www.pbs.org/wgbh/nova/typhoid/ accessed Dec. 01, 2007
Women’s Health, Prevention works for women. Centers for Disease Control and Prevention http://www.cdc.gov/women/owh/wominspire/baker.htm accessed Dec. 1, 2007