Typhoid Mary (3 page)

     Carriers were a very hot concept in the new world of epidemiology, a theory unproven in the United States. In Germany, however, the respected bacteriologist Dr. Robert Koch had recently investigated repeated outbreaks of typhoid in a Strasbourg bakeshop. The bakery was clean. The water supply was uncorrupted. Yet well-heeled customers were getting sick. Dr. Koch questioned the proprietor and found that she had, years earlier, contracted typhoid, but had survived the experience and was now, seemingly, fully recovered. After testing her, Koch found that even though she was devoid of symptoms and to all outward appearances a healthy person capable of working and going about her tasks like everyone else, she was in fact still teeming with typhoid germs, exuding them through her bowel movements and spreading them with improperly cleaned hands. This was a revolutionary discovery, and news of it had found its way to New York, where it was discussed with interest. Soper had read the transcript of a speech Koch had given on the subject a couple of years previous.

     Dr. Soper had learned of seemingly clean and affluent homes in Mary Mallon’s past being struck with typhoid after her employment. Now he was confronted with similar circumstances in yet another place she had worked. Given that no human carrier such as Koch’s bakery proprietor had ever been identified in America, Soper was suddenly very, very interested in getting his hands on the mysterious Mary Mallon.

     That she was evidently not interested in being found only piqued the good doctor’s interest to even greater pitch:

Where is she? Of course I did not know  . . . for Mary is clever, and she hardly ever works under the same name at two different places.

     At this point, Soper already seems to have formed in his mind a picture of Mary as some kind of Moriarty-esque nemesis, an elusive and crafty adversary with the answer to all his questions, but always just out of reach.

     He wanted her badly. His day-to-day work, by this time, had become closer to a detective’s than a microbe-hunter’s, interviewing witnesses, poring over records. He felt good. He was going to make his bones with this case. He foresaw himself as the poster boy for epidemiologists and health professionals, an honored and much-sought-after speaker at all the medical societies, a hero to the afflicted, a newspaper personality, idol to generations of aspiring sanitary engineers.

     Furthermore, he knew that his work was important. Typhoid was lethal and, especially in 1906 and 1907, no joke.

     These were boom times. It was a new century and a new world that Soper lived in. The 1900 Chicago World’s Fair had once and for all convinced Americans that they lived in a great country, a major world power, on a par – at least – with the European monarchies. Any inferiority complex New Yorkers and Americans might once have felt was rapidly disappearing in the light of an increasingly powerful, worldwide naval presence, a national construction explosion, the emergence of a newly affluent and pleasure-seeking middle class, the recent developments of subway systems, mass-produced automobiles, a tunnel under the Hudson River, new entertainments, libraries, an exuberantly sensationalistic press, and the warm glow of having recently drubbed the Spanish in Cuba and the Philippines. Great strides had been made in the fighting of disease and the word ‘epidemic’ was now an embarrassment to a city. An earlier epidemic of typhoid and cholera had had New York and Philadelphia pointing fingers at one another, each claiming the other was responsible for the outbreak, both mortified that something so closely associated with the squalor of the old world would be blamed on their fair metropolis.

     Soper’s description of an earlier experience with a typhoid epidemic gives a flavor of what a man in his position saw as his responsibility, of what he perceived himself to be up against:

I went to Ithaca in 1903 when one person in ten was sick, and one person in a hundred was dying from the disease. You have no idea of the state of mind I found the people in. They didn’t know what to do; didn’t know where to go; didn’t know whom to suspect and whom to trust  . . .

     These were the stakes as Soper saw them. Confusion, suspicion, contagion, neighbor pitted against neighbor, panic in the streets, and ultimately, chaos and death.

     Epidemics – especially unexplained ones – tended to bring out the worst in people, and the ‘carrier’ theory, however fearful its implications, was far preferable to some of the alternatives. In the past citizens thought to be contagious – particularly if they were members of the minority or underclass – had hardly been taken to the bosom of their communities. Instead the usual outcome was for mob rule to win out. It was not unheard of for those thought to be infected to be run out of town on a rail or set adrift in the Long Island Sound – often at the point of a gun – or worse still. As Soper saw it, he needed a quick and tidy solution to the Oyster Bay problem.

     Looking at pictures of Soper – a serious, narrow-faced, whippetlike man with a neat mustache and a receding hairline – one gets the impression of not so much the dogged detective he might have liked to see himself as, but of a timid, fastidious scientist, a man ensconced in reasoned practice and methodology. That he might have been racist, sexist, and far too influenced by the prejudices of his class – as has been suggested by revisionist accounts – a flawed, ambitious fellow who looked for the first likely Irish woman he could clap the manacles on – does not present itself through photography. Nor do we get much of that from his work later in life: tomes with titles such as:
The Air and Ventilation of Subways (1908), Modern Methods of Street Cleaning (1909), Further Studies of European Methods of Street Cleaning and Waste Disposal With Suggestions (1930),
and of course, what proved his masterwork, the story for which he became best known, the pamphlet with a title like a Victorian detective story’s
The Curious Case of Typhoid Mary (1939).

     George Soper looks from his photographs not to be a nice guy. He looks like someone who was bullied in high school, a nerd, a geek, an apple-polishing dirt-wonk with an unseemly interest in filth and how to make it go away.

     It was not for a good many more months, not until March of 1907, that Soper finally came face to face with Mary Mallon. It was then that reports reached him that a family on Park Avenue in New York City had been stricken with typhoid. Two cases had initially been reported. A maid was ill, and a daughter of the people who owned the house, a beautiful young woman in her twenties, was lying on her deathbed. The family were reportedly beside themselves with grief. The girl died two days later, and soon the nurse who had attended her became stricken as well.

     The details of the case as they reached Soper were indeed tragic, another example of bad things happening to people to whom bad things are not supposed to happen; but what particularly excited Soper, got that Sherlock Holmes mojo working again, was the news that there was a new cook fitting the description of Mary Mallon
still
employed by the stricken family.

     He gushed:

Imagine my surprise and my utter joy when I found the famous germ-carrier working as a cook in that household.

     The cook in question, and indeed it was Mary Mallon, did not quite share the good doctor’s enthusiasm. She showed true displeasure when Soper, who rushed over to the Park Avenue address immediately upon receiving the news, suddenly showed up at her job, accusing her in no uncertain terms of causing the typhoid which right then was draining the life from one member of her employer’s family.

I thought after I found her all would be easy; shortly I was to be disappointed, for having found Mary I had the greatest difficulty arranging an interview. Finally she agreed to talk with me, and in company with a physician I met her outside the house.

     To his dismay, Mary did not see Soper as the answer to some long-troubling question about the series of odd and unpleasant coincidences that had long followed her. He stood an accuser, and she reacted thus, and her reaction seems to have come as a complete surprise to him.

     Here, at this first meeting between pursuer and pursued, is where things began to go terribly wrong – at least for Mary Mallon and any future she might have had. What was said here, and
how
it was said, would set the tone for everything that happened after.

Chapter Two

Typhoid Sucks

Typhoid: Until the mid-nineteenth century, no one even knew what it was. All that was known for sure was that lots of people were dying from it – and had been dying from it for a long, long time.

     As far back as 1607, in Jamestown, Virginia, where typhoid would retroactively be credited with wiping out 6,000 settlers, officials knew something was devastatingly wrong. But people died of so many things in those years: typhus (a different disease entirely – spread by fleas and lice), cholera, yellow fever, smallpox, measles, throat distemper, influenza, scarlet fever, as well as typhoid – most of them indistinguishable from each other in eras marked by unwashed, undernourished, maltreated, and poorly housed folks who tended to die young anyway. Against a backdrop of frequent epidemics, famines, plagues, abject poverty, and rudimentary to nonexistent health care, it is no surprise that it took so long to even give the thing a name.

     But in 1880, only twenty-six years before Mary Mallon went to work in Oyster Bay for the Warren family, a man named Karl Erberth isolated the particular organism associated with typhoid fever, identified it, and allowed future doctors to at least differentiate between typhoid and all the other microbes that were likely to kill you before you hit middle age. Erberth’s discovery was the first step down the road to a vaccine (as opposed to a cure).

     Even so, typhoid continued to be a serious problem – not the least for the military. In the war against South Africa, Britain lost an incredible 13,000 troops to the disease, a staggering body count, especially when weighed against total battlefield losses of only 8,000.

     As recently as 1948, there was virtually nothing a doctor could do against typhoid, other than put the patient to bed and hope for the best. There was by then a vaccine extant, but that was like shutting the barn door long after the mad cow had wandered off to do his business. As late as the midteens, medical practitioners were still not certain that the vaccine even worked (it did). Antibiotics had not yet been discovered. So before 1948, it must have been pretty terrifying to recognize the all-too-familiar symptoms of typhoid. And they were familiar: outbreaks in 1865 and 1885 had decimated residents of major American cities. An earlier incident, when heavy rains flooded Lake Michigan, commingling sewage with drinking water, had left an estimated 90,000 dead of cholera and typhoid, so people tended to take outbreaks very seriously. In New York State alone in 1906, there had been over 3,000 cases reported, with more than 600 fatalities.

     First came a sudden and prolonged high fever – brain-boiling temperatures that could reach 104 to 105 degrees. Powerful headaches followed, accompanied by gut-roiling nausea and the disappearance of appetite. Victims often developed a bad cough, hoarseness, rampaging diarrhea or constipation. Frequently adding to their discomfort and misery were skin rashes, inflammation, and tenderness in the abdomen. Until antibiotics hit the market in the late 1940s, about 10 per cent of typhoid sufferers died from the disease. Even after antibiotics, about 1 per cent still never recovered and eventually succumbed. As late as 1997, there were 17 million cases of typhoid reported worldwide, with about 600,000 deaths resulting.

     Even today, in underdeveloped countries like Vietnam and Mexico, where antibiotics at first seemed to be working wonders, 75 per cent of typhoid cases are now said to be drug-resistant.

     Typhoid is an infectious disease caused by a bacillus called
salmonella typhi
. Simply put, typhoid fever is transmitted by food and water that has been contaminated with human feces or urine. Polluted water is the most common source of infection. When water from toilets and outhouses drains into water used for bathing and drinking, you start seeing cases of typhoid. Shellfish such as clams, mussels, and oysters which have been taken from contaminated beds can give you typhoid. Likewise, dairy products which have had close encounters with sewage, can be – and have been – linked with the spread of the disease.

     And, of course, people can give you typhoid, as long as the bacteria exists in their systems. For most people sick with typhoid, this means that for the week prior to their being bedridden (during which time they probably have not yet been diagnosed), until about a week after, they are infectious. Many (about 10 per cent) will continue to exude bacteria in their stools for about three months, and about 2 to 5 per cent will become permanent carriers, the bacteria settling comfortably into their gallbladders and digestive tracts like rent-controlled pensioners. This last statistic is important, because the beleaguered Mary Mallon was believed to be one of these unfortunate few – a carrier for life, a one-woman bacteria manufacturing machine, an endless supply of very bad things.

     If you want your city, town, or prefecture to remain free of typhoid, experts recommend that you endeavor mightily to protect and chlorinate the water supply – basically keeping it sewage-free. It is suggested that human waste be disposed of in a safe and sanitary manner and that latrines be kept fly-proof. And you don’t want typhoid carriers handling your food. Particularly raw food.