A “Menace” or a Martyr to the Public’s Health?

Abstract

Previous articleNext article FreeA “Menace” or a Martyr to the Public’s Health?Jacob Steere-WilliamsJacob Steere-WilliamsCollege of Charleston Search for more articles by this author PDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinked InRedditEmailQR Code SectionsMoreAs a historian of public health, it strikes me that the concept of uncertainty is key to understanding pandemics. Much like past pandemics, our current public health crisis, COVID-19, is surrounded by uncertainty. Transmission rates, reinfection probabilities, testing modalities, and—perhaps topping the list right now—the role played by asymptomatic carriers are all shifting scientific questions. And as in the past, scientific uncertainty has led to the questioning of scientific expertise by the broader science-consuming public.It is no surprise, then, that in our own pandemic moment of uncertainty we have turned to past pandemics to help us navigate the present. I have been most interested in seeing the expression “Typhoid Mary” reappear in news headlines, the hashtag #TyphoidMary trend on Twitter. Given that the causative organism for the novel coronavirus can spread through asymptomatic carriers, even if we do not quite yet know the extent, a renewed interest in Typhoid Mary makes sense. The name still provokes stirring images about an inherent dichotomy in modern public health: how governments are at once charged with preserving individual civil liberties and with stopping the spread of infectious disease in the community. Not knowing who is healthy and who is sick is worrying enough; knowing that seemingly healthy individuals can unknowingly spread an infectious disease is quite another matter and has produced palpable anxiety.Judith Walzer Leavitt’s 1996 Typhoid Mary: Captive to the Public’s Health was a milestone scholarly exploration of the most notorious asymptomatic carrier in the past, Mary Mallon.1 The basic details of Mallon’s life are well known. Born in County Tyrone, Ireland, she immigrated to America in 1883 and became a cook for several prominent New York families. At some point around 1900 Mallon contracted typhoid fever, a food- and water-borne bacterial infection and one of the leading causes of death at the time. A civil engineer, George Soper, independently investigating the cause of a violent outbreak of typhoid in 1907, traced the epidemic back to the cook, Mary Mallon. He implored New York City’s health officer, Hermann Biggs, to apprehend Mallon, obtain stool, urine, and blood samples, and—if they were found positive for typhoid—isolate her. Although Mallon showed no symptoms of the disease, bacteriological tests for Salmonella typhi were positive and Mary was quarantined on North Brother Island for two years. Despite signing a legal affidavit that she would not handle food upon her release, she was discovered—again by Soper—to be the cause of a subsequent outbreak of typhoid at Sloane Maternity Hospital in 1915. Mallon was thereafter demonized by health officials and the media, constructed as a “menace to the public’s health” (p. 69) and “the most dangerous woman in America” (p. 132). She was sent back to North Brother Island, where she died in 1938.The brilliance of Leavitt’s Typhoid Mary is what today we would call its intersectional approach. Mary Mallon’s fate was shaped, Leavitt argues, at the intersections of gender, class, race, and ethnicity. In Leavitt’s hands the story twists around like a Rubik’s Cube, each chapter turning, complicating, and nuancing. The journey takes us into the perspectives of bacteriologists, public policy makers, lawyers, the media, the broader public, and Mary herself.Rereading Leavitt’s book in the time of COVID-19 reinforces the power of studying epidemics using an intersectional approach. In our own moment of uncertainty about transmission and reinfection, long-standing structures of systemic racism and health inequalities have exposed racial and ethnic minorities to much higher rates of infection and death from COVID-19. The same forces worked on Mary Mallon in the early twentieth century, first in exposing her to typhoid fever and later in American public health officials designating her—a single, female, Irish, immigrant cook—a threat to the nation’s health.Origin Stories: Why Mary? and Why Bacteriology?Uncertainty is at the heart of Leavitt’s Typhoid Mary, which seeks to understand why Mary Mallon was singled out and quarantined for over twenty years while thousands of healthy typhoid carriers roamed American streets. In the first three decades of the twentieth century, the healthy carrier presented a serious public health risk. It was the newest fad in public health, a kind of canary in the coal mine. Deaths from typhoid fever were decreasing as a result of the implementation of municipal water and sewerage projects and the safeguarding of milk supplies, but sporadic outbreaks continued. With the discovery of the healthy carrier, and the highly publicized case of Mary Mallon, public health authorities had a new way to explain ongoing outbreaks and to teach domestic sanitation and personal hygiene—what Nancy Tomes has called “the gospel of germs”—to everyday Americans, particularly immigrants.2But in practice public health officials were unsure how to solve the healthy carrier problem. What rights could be infringed upon, and what powers did local authorities have? Seeing hundreds of heavily armed protesters recently storm the capitol building in Lansing, Michigan, demanding an end to quarantine and stay-at-home orders, reminds us that government authorities are still unsure. In early twentieth-century America, health officers across the country identified and surveilled lists of healthy typhoid carriers. Some of these individuals were isolated for a short period, but most fell through the cracks and escaped oversight. Virtually none were treated like Mary Mallon. Her ethnicity, her work, and her gender served to single her out, marking her as an important case, but Leavitt argues that another reason for the attention she received is that she was the “first” healthy carrier identified in America. Recent scholarship, particularly by Christoph Gradmann and Richard McKay, has underscored how such origin stories can turn toxic and serve class-based and race-based agendas.3To address the uncertainty of the healthy carrier—for typhoid in the early twentieth century and for COVID-19 today—we have turned to laboratory testing. And here too Leavitt’s account can help us understand our current pandemic: how conflicts of scientific expertise shape pandemic responses and how laboratory practices reveal deeper social structures. Take just one example from the book: the 1909 court decision that kept Mary medically imprisoned on North Brother Island. From March 1907 to June 1909, the New York City health department collected and analyzed 163 fecal specimens from her—more than one per week. But their bacteriological results were inconclusive. So often were the tests for Salmonella typhi negative, and so bent was Mallon on disproving the expertise of the city laboratory, that she sought out an independent laboratory, Ferguson Laboratories, to analyze her urine and feces. In all of his bacteriological tests George Ferguson found no positive typhoid cultures. Despite the conflicting evidence, in 1909 the judge ruled in favor of the city health officials, responding to what I have termed a “conflict of analysis”: in a moment when scientific experts disagree on methodology or results, factors of race, class, and gender shape how courts decide routine cases. Given Christopher Hamlin’s recent work on fin-de-siècle bacteriology, I am left wanting more on the differing bacteriological analyses and wondering how representative Mary’s case was within bacteriological circles at the time.4 In my own research on debates over late nineteenth-century legal cases pertaining to typhoid and food adulteration, such conflicts in scientific practice were the norm, not the exception. In the time of COVID-19, conflicts over testing, and reports of inaccurate tests, are shaping how we experience the pandemic and how our governments respond to it. Both for Mary Mallon’s time and now, the material culture of surveillance through testing is critical and deserves closer scrutiny.In important ways, though, scholarship on the germ theory and laboratory bacteriology has shifted since Leavitt wrote Typhoid Mary. Baked into Leavitt’s account is the idea that the bacteriological revolution represented a sharp epistemological break from older theories of disease causation and public health practice.5 A new faith in the laboratory fueled a “new” public health bent on identifying and isolating individuals, not cleansing environments. Leavitt writes that “bacteriological laboratories with their microbe-identifying capabilities became the single most crucial tool in identifying the people and the problems to which health departments should attend” (p. 26).Scholarship that followed Leavitt’s book, such as the work of Michael Worboys, has shown that debates about germs raged into the early twentieth century.6 Skepticism about the authority and expertise of laboratory bacteriology continued, we now know, well after the German hygienist Max von Pettenkofer, in the ultimate act of defiance of Robert Koch’s laboratory discovery of Vibrio cholerae, swallowed a cholera broth in 1892. Decentering the power of the bacteriological laboratory opens up at least two important ways to rethink the story of Typhoid Mary in the time of COVID-19. The first is to see conflicts in laboratory testing as key sites of knowledge production and powerful tools to politicize the science of pandemics. Today, for example, decentering the COVID-19 laboratory might help us better see preexisting health-care disparities as a driver of differential morbidity and mortality and encourage us to redouble public health efforts focused on preventable deaths that result from social determinants of health. The second is to see the field-based practices of epidemiology as deeply related to the laboratory-based practices of bacteriology.Recent research suggests that we might view the story of Typhoid Mary and the asymptomatic carrier not solely through the lens of laboratory bacteriology but also through the lens of epidemiology. In my own work, I have found that epidemiological approaches dominated thinking about typhoid through the first two decades of the twentieth century. Epidemiological practices were spatial, statistical, and environmental, but epidemiologists also were philosophically committed to the idea that typhoid was a specific disease spread via media such as food, water, and people. Experiences with healthy carriers like Mary Mallon were part of a longer gestation of epidemiological practice. Often epidemiologists claimed that they did not need the expertise of the laboratory to provide proof or to shoulder the burden of identifying an index case, and laboratory evidence was often seen instead as back-end scientific proof. We might, for example, see George Soper’s identification of Mary Mallon as the cause of two typhoid outbreaks within the longer history of epidemiological practice. Soper self-identified as a “thoroughly trained and experienced epidemic fighter who had seen service in the laboratory and the field” (p. 103). Leavitt calls him an “engineer epidemiologist” (p. 109), but I wonder how that label stacked up against contemporary Anglo-American actor categories. While Soper may have practiced epidemiological methods, did he identify as an epidemiologist? Was he part of what Thomas Gieryn calls disciplinary “boundary-work”? In other words, how representative was Soper’s brand of epidemiological practice? My book The Filth Disease, on epidemiological practice related to typhoid in Britain, sheds some important light on this question, but we still don’t have a comparable American work.7 Such a reframing of the story forces us to ask different questions about the history of epidemiology and bacteriology and reminds us today, in the middle of a pandemic, to think through the reliability of COVID-19 tests alongside the reliability of epidemiological maps and statistics.One criticism I have of Leavitt’s book that helps us think about COVID-19 today is how stable typhoid itself appears throughout Typhoid Mary. I have long struggled to make sense of the epistemological problem that what we today call typhoid fever does not neatly map onto the way late nineteenth- and early twentieth-century observers used the word “typhoid.” Anne Hardy’s 2015 Salmonella Infections, Networks of Power, and Public Health in Britain, 1880–1975, goes some way in clarifying how, in the early twentieth century, what had long been called typhoid was split into a number of distinct subcategories. “Typhoid” came to mean a single disease caused by Salmonella typhi, but bacteriologists also learned that there were subcategories of similar diseases in the Salmonella family, such as paratyphoid A and B.8 Typhoid was a disease in motion, in other words, not a stable target. There is a kind of epistemological certainty in Typhoid Mary about the stability of disease categories that looms particularly large as we confront COVID-19. Early in the pandemic there were reports of ongoing mutations, and the novel coronavirus that causes COVID-19 is—maybe not unlike typhoid in the early twentieth century—a disease in motion.I have been teaching the story of Mary Mallon for over a decade, largely through the lens of Leavitt’s multiple frameworks and intersectional approach. Students often comment in their course evaluations that this was the topic that resonated with them the most all semester. I suspect that, going forward, because of COVID-19 Typhoid Mary will become even more important in our classroom discussions about the complexities of public health, about naming and blaming as part of the fabric of epidemics, and, above all, about how science functions in moments of uncertainty.NotesJacob Steere-Williams is Associate Professor of History at the College of Charleston. His research focuses on the history of infectious disease, public health, and biomedicine. He is the author of The Filth Disease: Typhoid Fever and the Practices of Epidemiology in Victorian England (Rochester, 2020). College of Charleston, 66 George Street, Charleston, South Carolina 29424, USA; [email protected].Acknowledgments. I would like to thank Nathan Crowe for reading a draft of this essay.1 Judith Walzer Leavitt, Typhoid Mary: Captive to the Public’s Health (Boston: Beacon, 1996). Subsequent references to this work are indicated in the text by page number.2 Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, Mass.: Harvard Univ. Press, 1998).3 Christoph Gradmann, Laboratory Disease: Robert Koch’s Medical Bacteriology (Baltimore: Johns Hopkins Univ. Press, 2009); and Richard McKay, Patient Zero and the Making of the AIDS Epidemic (Chicago: Univ. Chicago Press, 2017).4 Jacob Steere-Williams, “A Conflict of Analysis: Analytical Chemistry and Milk Adulteration in Victorian Britain,” Ambix, 2014, 61:279–298; and Christopher Hamlin, “Bacteriology as Cultural System: Analysis and Its Discontents,” History of Science, 2011, 49:269–298.5 She explored the topic in a 1992 Isis article: Judith Walzer Leavitt, “‘Typhoid Mary’ Strikes Back: Bacteriological Theory and Practice in Early Twentieth-Century Public Health,” Isis, 1992, 83:608–629.6 Michael Worboys, Spreading Germs: Disease Theories and Medical Practice in Britain, 1865–1900 (New York: Cambridge Univ. Press, 2000).7 Thomas F. Gieryn, Cultural Boundaries of Science: Credibility on the Line (Chicago: Univ. Chicago Press, 1999); and Jacob Steere-Williams, The Filth Disease: Typhoid Fever and the Practices of Epidemiology in Victorian England (Rochester, N.Y.: Univ. Rochester Press, 2020).8 Anne Hardy, Salmonella Infections, Networks of Knowledge, and Public Health in Britain, 1880–1975 (Oxford: Oxford Univ. Press, 2015). Previous articleNext article DetailsFiguresReferencesCited by Isis Volume 111, Number 4December 2020 Publication of the History of Science Society Article DOIhttps://doi.org/10.1086/712254 Views: 1660 © 2020 by The History of Science Society. All rights reserved.PDF download Crossref reports no articles citing this article.