Happy Friday!
I returned from the North American Neuro-Ophthalmology Society (NANOS) meeting a few days ago, held in Boston. The meeting was great, as always – and so good to see everyone! Several people commented on my frequent traveling (it took a few seonds to register how they knew about it). Thank you to those who expressed how much they enjoy the posts.
On this day in 1915, Mary Mallon was quarantined in New York City. "So what?", you may be thinking. You may know her by her alias, Typhoid Mary. Having heard the term applied to others who are either sick a lot or at risk of spreading an illness, I never knew the story behind the name. So here we go.
Mary Mallon immigrated to the U.S. from Ireland in 1883 and made a living doing domestic work, mostly as a cook. No one knows when she personally contracted typhoid but nearly two dozen people were affected by the illness between 1900-1907. They all lived at the household of Charles Henry Warren, a wealthy New York banker, where she worked. Mary disappeared by the time she was identified as the carrier.
She then worked in Oyster Bay, Long Island, where 6 of 11 people in a house rented by Mr. Warren became ill with typhoid in 1906. Typhoid fever had a 10% mortality rate at the time. The homeowners hired George Soper, a sanitary engineer from the New York City Department of Health with expertise in typhoid fever epidemics, to investigate. He and his colleagues determined that the illness was caused by contaminated water, possibly transmitted through freshwater clams. Meanwhile, Mary, who was infected but asymptomatic (the first described "healthy carrier"), continued working as a cook, moving from household to household until she resurfaced in 1907 at a Park Avenue home in Manhattan. Soper linked all 22 cases recorded in the area to her and tried to track her down to test her urine, feces and blood. She fled again but Soper and the long arm of the law caught up with her, and she was committed to an isolation center in the Bronx. There was no vaccination or treatment for typhoid then and she was considered a threat to public health. After unsuccessfully suing the Health Department, she appealed to the U. S. Supreme Court for her release. It was granted on the condition that she never handle food again. She was back on the road in 1910.
Soper searched for her again four years later after a typhoid epidemic broke out in a New Jersey sanitorium and a hospital in Manhattan. You guessed it – she had worked as a cook in both places – definitely a parole violation. She infected at least 25 people, doctors, nurses and staff, two of whom died. At that point, she was referred to as "Typhoid Mary" and was the subject of joke and cartoons, eventually included in medical dictionaries. She was found in a suburban home in Westchester County, NY and was taken back to the isolation center where she lived the rest of her life. She died of long-term complications of a stroke in 1932.
In retrospect, she was never educated as to why she was a risk factor and was stigmatized when she just wanted to work. None of the other 400-plus healthy carriers in New York were forcibly confined or victimized like she was.
Typhoid fever (a.k.a. enteric fever) is a bacterial infection caused by Salmonella typhi (but not the same as salmonella infection or typhus). It infects the intestines and causes high fever, stomach pain, headache, pink spots on the trunk, diarrhea (sometimes bloody) or constipation. It can also affect the lungs. Typhoid fever is common in rural areas of developing countries without modern sanitation, such as in South and Southeast Asia, Central and South America, Africa and the Caribbean. Pakistan, India and Bangladesh are high risk areas. It affects up to 21 million people yearly. The infection is spread by contaminated water as well as through contact, such as doorknobs touched by infected people who don't wash their hands after going to the bathroom.
Typhoid is diagnosed using symptoms, travel history (or location of residence) and lab tests. It can be isolated from blood, stool, urine, skin biopsy or bone marrow and treated with antibiotics. However, the bacteria can develop antibiotic resistance and there is concern that the number of effective antibiotics will decrease over time, leaving no good treatment options.
The best solution is to avoid contracting it in the first place by getting vaccinated (oral and injectable forms are available). When traveling to or living in an endemic area, don't prepare food for others if you are sick, wash your hands with soap and water after preparing food, eating or using the bathroom, and wash surfaces and utensils used to prepare food before and after use. If you're not sure, eat only well-cooked or packaged food and...don't drink the water (unless it is treated). Bottled water is the safest to drink and cook with.
Have a good weekend!
https://www.youtube.com/watch?v=2JGTKK5cMXM
A good reference if you are interested: Farineli F, Tsoucalas G, Karamanou M, Androutsos G. Mary Mallon (1869-1938) and the history of typhoid fever. Annals of Gastroenterology 2013;26(2):132-134.