Typhoid Mary: Captive to the Public's Health (review)

A scholarly book that is both intellectually stimulating and beautifully written is always call for celebration. Finishing Judith Walzer Leavitt’s new book made this reader feel like popping open a bottle of champagne. Typhoid Mary combines meticulous research, penetrating commentary, marvelous illustrations, and first-rate prose to produce a thought-provoking, moving account of one of the most remarkable stories in the history of American public health.

The facts of the case are themselves riveting. The Irish immigrant cook Mary Mallon was the first thoroughly documented case of a healthy carrier in the United States. She was arrested in 1907 after a zealous sanitary engineer named George Soper linked her employment as a cook to typhoid outbreaks in a number of wealthy households. When laboratory analysis of her feces and urine revealed high concentrations of the typhoid bacillus, officials of the New York City public health department confined her on North Brother Island. After Mallon sued unsuccessfully for her release in 1909, a new city health commissioner granted her freedom in 1910, on the condition that she never seek employment as a cook again. But in 1915 Mallon was discovered cooking at the Sloane Maternity Hospital, after a typhoid epidemic broke out there, and she was returned to North Brother Island, where she died in November 1938. For her role in causing some forty-seven cases of illness and three deaths due to typhoid fever, Mary Mallon spent a total of twenty-six years in confinement.

Leavitt reconstructs and interprets Mallon’s story from seven overlapping perspectives, each of which constitutes a chapter of the book. The first two, the medical and the public health perspectives, are closely intertwined. Leavitt provides an excellent overview of the healthy carrier concept and its relation to the new bacteriology, and then examines the city health department’s strategies for identifying and isolating carriers as they developed in the wake of Mallon’s case. Chapter 3 looks at the legal arguments over Mallon’s imprisonment, particularly her unsuccessful 1907 lawsuit, which pitted her rights to individual freedom against the state’s obligation to protect the public’s health. Chapters 4 and 5 explore the social and cultural dimensions of the case, examining the class, ethnic, and gender prejudices that shaped the health department’s treatment of Mallon, and were reflected in journalists’ coverage of the story. In chapter 6, Leavitt has Mallon speak for herself, using published statements, personal letters, and oral histories with people who knew her to explore what her life was like after her status as a healthy carrier was discovered. The seventh chapter provides a fascinating survey of the “Typhoid Mary” story as it has been told and retold in the decades since her death. In the conclusion, Leavitt reflects on the lessons of Mallon’s case for the contemporary public health movement.

A short review cannot do justice to the insights Leavitt generates from these overlapping stories, but let me point to a few of her most important accomplishments. First, she provides a crystal-clear articulation of the tension between individual rights and public health imperatives involved in Mallon’s case, laying out both sides of the question in a balanced, thoughtful way. By comparing Mallon’s treatment with the health department’s handling of the hundreds of carriers subsequently identified in the 1910s and 1920s, Leavitt highlights the circumstances that made Mallon’s case both distinctive and tragic. Mallon’s refusal to accept the scientific evidence for the carrier state, combined with her personal background and behavior, made her seem a particularly culpable, menacing figure to Progressive Era public health officials; from their standpoint, she was an expendable victim to the greater public health good. As physician Josephine Baker put it, it was “her own ‘bad behavior’” that “‘inevitably led to her doom’” (p. 68).

By juxtaposing such statements with Mallon’s own sense of anger and bewilderment at being “banished like a leper,” in her words, Leavitt...