Typhoid Mary: Captive to the Public's Health.

By Judith Walzer Leavitt (Boston: Beacon Press, 1996. xviii plus 331pp. $25.00).

In Typhoid Mary: Captive to the Public's Health, a very readable, informative and well-written monograph, Judith Leavitt analyzes the meanings of Mary Mallon's (Typhoid Mary's) experiences by examining the perceptions of the medical profession, public health officials, the legal profession, the public, the media and Mary herself. More importantly, Leavitt explores how those impressions reflected cultural values of the period, which, in turn, influenced official policy. Her intention is to inform current policy debate in an age when victims of AIDS and drug resistant tuberculosis are stigmatized. Several themes are woven throughout the book. A key issue today, as in the past, is the controversy over individual rights versus those of the public. Americans prize individual liberty, but also value scientific achievement and its potential for preserving the health of the public, resulting in sometimes unresolvable conflict and controversy over the state's power to resolve these dilemmas. Leavitt also provides an enlightening analysis of the relationship between science and culture, clearly demonstrating how cultural values affect the way science's capabilities may be accepted and absorbed into American society.

Although the book is very comprehensive, some topics remain unexplored. Leavitt sees the new faith in science on the part of medical professionals, public health officials and legal professionals as a major driving force behind their actions. The first two chapters deal with the perceptions of the medical profession and public health officials regarding the conquest of infectious disease. Exploring the viewpoints of physicians in an age when science was becoming revered by the lay public, Leavitt argues that scientists in the business of diagnosing and preventing disease focused more narrowly on the pathogenic bacilli, reducing the scope of health-related work. Mary Mallon's isolation, in fact, represented the scientific optimism and pervasive "faith that science would serve humanity by curbing disease" in the early twentieth century.(p. 38) But during this time period, American physicians, some of whom were public health officials, were struggling to professionalize and gain credibility for their profession and their individual specialties. Many doctors saw science as the avenue to that credibility and delved into laboratory science and bacteriological research partially to increase their status. Discussion of the professionalization of physicians would have helped to explain their narrow focus. In addition, public health policies and the courts are often guided by other unseen outside forces such as political pressure. Leavitt suggests that the courts relied on scientific evidence to make their decisions, but they, like public health officials, may also have been reacting to other pressures. The analysis would have benefited by attempting to ascertain whether political demands affected the decision-making process.

Leavitt does address other significant factors in one of the most interesting chapters titled "Social Expectations and Prejudice," clearly demonstrating how social views and biases shared by the public, health professionals and members of the legal community influenced policy. Widely accepted ideology regarding class, ethnicity, marital status and gender had a major impact on the decision-making process. Mary did not conform to the cultural expectations and, therefore, was considered deviant and expendable. Mary was stigmatized because she reflected inappropriate gender roles and brought out prejudices regarding class and ethnicity.(p. 124) As Leavitt notes, socially constructed views, and not just scientific criteria, affected decisions made about her situation. In the following chapter, Leavitt examines how this shared ideology was portrayed by the media over time, illuminating how the press helped to shape events. These two chapters would have been better placed at the beginning of the book so as to minimize the impression that medical, legal and public health officials were ruled solely by science.

Mary Mallon's experience serves to inform current policy debate. Clearly, public health officials were influenced by the image constructed by the press which reflected ideas entrenched in American culture. Today's policy makers need to be cognizant of prevailing ideology so they can make informed decisions which are not based on cultural values. Leavitt discusses three issues, all of which emphasize the interdependence of medicine and society, and revolve around the conflict between public health and individual rights. The first is the identification of new categories of people who challenge the public's health. Identification carries powerful social meaning and should be guarded against. Labels, and the stigma associated with them, inhibit public health measures because when people are labeled as deviant they automatically resist public health measures and keep their illnesses secret. Secondly, Leavitt discusses the ramifications of isolation and its inhibition of personal liberty in favor of the public's health, arguing that the public health system should put greater emphasis on educating disease carriers on how to refrain from activities that put others at risk, making isolation a last resort. Leavitt urges officials to give civil liberty a dominant priority, thereby encouraging Americans to have more confidence in public health agencies. Her third issue is that of blame and responsibility. If individuals are asked to alter their behavior in order to protect others, providing financial compensation might ensure their compliance. The conflict between protecting the public and protecting individual rights cannot be easily solved. But when public health policy respects individual sufferers, those sufferers will be more cooperative, thereby serving the needs of the public at large.

Although this monograph explores a particular event in medical history, it can serve as a general textbook in history of medicine survey courses. Considering the appalling dearth of good American medical history surveys, this book serves as a wonderful teaching tool. Leavitt uses Mallon's experiences as a window through which to visualize changes in health care practices, and the book can function as a starting point for discussions on medical care, professionalization, public health, hospitalization, scientific discoveries and the germ theory and the relationships between society and medical practice.

I highly recommend this monograph for historians of medicine as well as policy makers. Not surprisingly, it is enlightening as well as enjoyable.

Carolyn Leonard Carson University of Pittsburgh