This is a part of the Sick Saturdays feature, in which we have a sick discussion on the symptoms and biology behind infectious illnesses.

Zac Efron and Typhoid Mary (whose real name was Mary Mallon) are two people you’ve probably heard of. Right off the bat, you probably don’t think they have much in common. However, there’s at least one shared characteristic between the two.

As her nickname suggests, Mary Mallon had typhoid fever. And in December of 2019, Zac Efron also contracted the disease while filming in Papua New Guinea.

Typhoid can be a life-threatening infection, and it was for Efron . . . but not so much for Mary Mallon. What exactly is typhoid fever?

The truth behind typhoid

Caused by the bacterium Salmonella enterica subtype Typhi, typhoid is no longer much of a problem in the Global North. But its status as a health risk persists in developing nations, especially in south Asia. In 2015 alone, more than 12 million people across the globe contracted typhoid fever.

Typhoid is spread through food and water contaminated with fecal matter, or by contact with an infected person. Among symptoms of the infection are fever, headache, abdominal pain, weakness, appetite loss, constipation or diarrhea, and in some cases, confusion or a chest rash (rose spots). 

Symptoms usually come on gradually, starting within one to three weeks following an exposure. The only definitive way to diagnose typhoid is to test a blood or stool sample.

Since typhoid fever is a bacterial infection, it is treated with antibiotics. However, the bacteria that cause typhoid are becoming increasingly resistant to many antibiotics.

Complications including intestinal perforation, encephalitis, and dehydration can cause death. When untreated, typhoid fever can persist for weeks to months. The infection may have a death rate of around 20%

Even after recovering from a bout of typhoid, some people can harbor S. enterica subtype Typhi in their intestinal tract. Known as chronic carriers, these people continue to be capable of spreading the disease.

The causative agent of typhoid, S. enterica subtype Typhi, was isolated in 1880, though an immunization for the disease (which is not completely effective) was not available until 1911. And no antibiotic suitable to treat typhoid existed until 1948.

So prior to the advent of a treatment for typhoid, and still in the Global South, chronic carriers were a serious threat to public health. One famous chronic carrier once responsible for an outbreak in the United States was Mary Mallon, or Typhoid Mary.

colorized electron micrograph of salmonella invading human cells

Cooking up an illness

Mary Mallon was born in Ireland in 1869; she immigrated to New York with her family when she was 14 or 15. She found work as a cook for a number of wealthy families in Manhattan and Long Island.

In late 1906, while Mallon was serving in the Warren family household in Oyster Bay on Long Island, six of the eleven family members were diagnosed with typhoid.

To determine the cause of the household outbreak, the Warrens hired a sanitary engineer, George Sober. Initially, Sober believed the cases of typhoid were the result of contaminated freshwater clams. But when it turned out not all who were sick had eaten clams, Sober had to broaden his investigation.

Sober’s research found that Mary Mallon was the source of the infections. Mallon once had an active case of typhoid fever, but thought she was cured.

But it turns out even despite being asymptomatic, Mary was a chronic carrier. Sober surveilled Mallon and found out that of the eight families she had worked for, seven had seen familial outbreaks of typhoid.

Mary Mallon was the first known instance of a chronic carrier of typhoid fever.

Upon making his discovery, Sober enlisted the help of the New York Department of Health to contain the infection’s spread. An uncooperative Mallon only gave stool samples after five hours of protesting against members of the health department and local police force.

When Mallon tested positive, authorities moved her to an isolated cottage at Riverside Hospital, a facility for quarantinable diseases that was on an island in the East River.

After about two years of confinement, Mary Mallon had her stool tested for typhoid 163 times. 120 of the samples were positive. However, health officials never discussed with her the severity of what it meant to be a chronic carrier.

In 1909, Mallon tried to sue the health department. A year later, the new health commissioner agreed to free her on the condition that she not work as a cook.

Unbeknownst to the city, Mallon never intended to follow that requirement. When first released, she worked as a laundress, although she made about half as much money as she previously had. 

She again became employed as a cook in 1915, at a maternity hospital. During her tenure there, Mallon infected at least 25 patients and staff members. 

In retaliation to her actions, Mary was placed in quarantine at Riverside Hospital once more. She lived there until her death in 1938. 

From then on Mallon was known as “Typhoid Mary” and was the subject of cartoons and jokes. She became a teaching point in medical literature.

Mary Mallon no doubt knowingly endangered the lives of many people. Over her career, she is confirmed to have spread typhoid to 53 individuals, which killed 3 of them. But did she deserve the treatment she received? 

black and white photo of Typhoid Mary/Mary Mallon in bed

The ethics of isolation

After reading her story, you might think Mallon was a serious danger to public health. While that may be true, no one ever told Mary the extent of her condition.

Doctors seemingly always had time to request stool samples from Mary, but never to talk to her. She was unaware why she was forcibly quarantined or how she was the source of so many illnesses. 

By the time of her death, 400 additional asymptomatic typhoid carriers had been named in New York City alone, though none other than Mallon was confined as a punishment.

Although some scholars agree that her isolation was necessary as a health precaution, the legality and ethics of the Typhoid Mary case and isolation in general continue to be debated.

Which brings up the question of whether prisoners should be put in solitary confinement. Social isolation has been linked to a number of detrimental health effects, such as depression, impaired cardiovascular function, and decreased immunity.

What do you think? When is isolation necessary, if ever? How do you balance a person’s right to freedom with the need to protect public health or safety? Comment your opinions and share this article below.

Delaney

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electron micrograph of purple salmonella cells with white and purple text reading 'all about typhoid'
human immune cell micrograph on a black background with white and orange text reading 'what is typhoid?'

2 Comments

Nguyen Thi Tam · August 28, 2020 at 8:36 pm

Great! Thank you!

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