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Typhoid Mary: Captive to the Public's Health.

Driving to work one day, I listened to a radio segment about a prostitute with AIDS. After an arrest and brief period of confinement she was released with an order to give up her work. She didn't, and officials rearrested her and were considering incarcerating her to "protect the public." Had this been a public radio story, there might have been interviews with legal experts about her rights and with public health officials about the threat she posed to others. But this was an all-news station, and so the brief segment was followed by a commercial and a traffic report.

The dilemma confronting the small community named in the radio clip is an old one. How can we preserve individual liberties while simultaneously protecting public health? And are the poor, women and members of minority groups more likely to be singled out, labeled as dangerous and confined? Should individuals be forced to abandon their livelihoods without compensation? Is quarantining a few people an effective means of protecting society when there are so many others who are contagious? These are the questions posed in Judith Walzer Leavitt's eloquent and troubling history Typhoid Mary: Captive to the Public's Health.

The tale of Mary Mallon, the woman popularly known as Typhoid Mary, is relatively straightforward. In 1906, a family hired civil engineer George Soper to find the cause of the six cases of typhoid fever in their household. Soper suspected that the immigrant Irish cook, Mallon, had caused the outbreak. A review of her employment history revealed typhoid fever outbreaks in eight of her previous places of employment.

To prove that Mallon was the carrier, Soper needed samples of her blood, stool and urine examined for evidence of bacteriological contamination. He asked; she refused, violently. Soper then arranged for the New York City Health Department to send a health inspector to collect the evidence. Mallon again refused. Finally, the police seized and escorted her to the hospital, where tests confirmed her status as a healthy carrier of typhoid fever. Public health authorities then confined her at an isolation cottage at the Riverside Hospital on New York City's North Brother Island.

Three years later, the court granted Mallon's plea to be released. Her lawyer had argued that her incarceration was illegal and that there was scientific evidence of her innocence (reports from an independent laboratory did demonstrate an absence of bacteria in her feces; in fact, healthy carriers like Mallon excrete bacteria intermittently, not all the time). Mallon promised the court not to work as a cook again, but for unknown reasons, perhaps because she could find no other work, perhaps because she was proud of her skills, perhaps because she did not fully understand the risk she posed to others, she returned to the kitchen.

Under the name Mrs. Brown, Mallon obtained a job cooking at the Sloane Maternity Hospital - the site of 25 new typhoid fever cases. In 1915 authorities took her into custody for the last time. Mallon spent the remaining 23 years of her life on North Brother Island. Throughout her exile she fought to preserve her identity as Mary Mallon. But even the doctors and nurses on the Island, people with whom she worked and lived, referred to her as Typhoid Mary (a name first used in a medical report to conceal her identity).

Typhoid Mary presents Mallon's life not as a single narrative, but in a kaleidoscopic fashion, shifting the focus within each chapter so that the elements of her history are continually rearranged. Leavitt first details how the developing science of bacteriology made the identification of healthy carriers such as Mallon possible. She then demonstrates how the rise of a public health infrastructure made these carriers appear to be a growing menace. Once contaminated water supplies - the major cause of typhoid fever outbreaks - were eliminated, chronic carders who handled food accounted for a growing percentage of cases.

Leavitt also examines the legal issues, and explores what the public learned about Mallon by surveying the popular press of the time. Awakened to her plight only when she sued for her freedom, the newspapers initially portrayed her as a citizen wronged by the state, valiantly fighting for her liberty. The second time around, after she was captured cooking and using an alias, the roles were reversed. Mallon was the cook who killed, and the press called for new laws to protect citizens from menaces like her.

Leavitt must convince readers that Mallon was incarcerated for so long neither because she was the first known healthy typhoid fever carder in North America nor because she returned to cooking after being given her freedom. This is easy. There were, Leavitt demonstrates, many individuals who cooked, caused serious outbreaks of typhoid fever and escaped lifetime confinement. Tony Labella, for example, a food-handling carrier blamed for 87 cases of typhoid fever, including two deaths, was placed on a New York City registry. He disappeared to New Jersey, where he reportedly caused another 35 cases resulting in three more deaths. Despite his defiance and his trail of death and disease, he remained free. One possible reason, Leavitt notes, was his status as a family breadwinner.

In other cases, healthy carriers endured only a brief detention if they refused to stop handling food. In some jurisdictions, they received compensation for the loss of their trade or assistance in finding other work. Only Mallon endured a lifetime of incarceration.

Leavitt avoids the temptation to see Mallon's experiences as entirely the result of her gender, class and outsider status, while arguing that these elements were significant. A poor Irish woman who had lived out of wedlock with a man for several years, resisted authority and exhibited traits deemed unladylike, Mallon embodied much that society, and medical authorities, feared and loathed.

Yet reducing her life to one of victimhood would deny the suffering of the individuals who caught and sometimes died of typhoid fever, and it would overshadow what Leavitt sees as the greater significance of Mallon's encounters with the public health authorities: namely the difficulty of balancing individual and community rights. Leavitt does not tell readers directly what she thinks should have been done with Mary Mallon; instead, she asks us to draw our own connections with similar situations today.

While Mallon's experience was unique, her plight and the problem she posed for others remain all too common. The term "Typhoid Mary" is still in use, reflecting our uneasiness with individuals capable of spreading disease or other calamities. The dictionary defines "Typhoid Mary" as "one that is by force of circumstances a center or focus from which something undesirable spreads." In fact, we use the term in a far more pejorative fashion, emphasizing not the accidental but the deliberate spreading of ill. Consider that when the Chicago Bulls signed Dennis Rodman, one columnist wrote, "Here's the short list of who would be better news than Dennis Rodman for the Bulls: Typhoid Mary, Moammar Gadhafi, Charles Manson, Lizzie Borden, Jeffrey Dahmer." This is hardly a list of people who caused misfortune by "force of circumstances."

Leavitt segues from Mallon's story to contemporary issues, discussing the quarantining of HIV-positive individuals in Cuba and touching on the question of isolating those with drug-resistant tuberculosis in the United States. She argues that an effective response to our current public health dilemmas begins with an understanding that stigmatization is no substitute for reason and that the state must responsibly protect and care for the sick in order to protect the healthy. Treat people with dignity to gain their cooperation, she urges, or treat them as deviant and foster resistance. Use isolation as a last resort and focus instead on alternatives, from education to economic assistance.

Finally, she reminds us that a public health safety net begins with the provision of needed medical services to all. Her arguments are persuasive, supported by both Mallon's example and contemporary cases demonstrating that personal liberty and community well-being cannot be exchanged, but are inextricably bound together.

But while I'm convinced by Leavitt's arguments, fascinated by the way she tells this story and urge everyone to read her book, I must confess that I remain a pessimist. The cruel provisions of so-called welfare reform, the rising tide of nativism and the failure of even a limited attempt to provide all citizens with universal access to health care lead me to conclude that modern Mary Mallons - prostitutes with AIDS, homeless people with tuberculosis, food-handlers with hepatitis - will receive no greater understanding than she did. We will watch as they and others are exiled to our modern equivalents of North Brother Island. I hope I am wrong.
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Author:Golden, Janet
Publication:The Women's Review of Books
Article Type:Book Review
Date:Nov 1, 1996
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