Typhoid fever was a particularly virulent and deadly bacterial disease transmitted by the ingestion of food or water contaminated with the faeces of an infected person. During the second half of the 19th century the mortality rate from typhoid in Chicago was on average 65 per 100,000 peaking at 174 per 100,000 in 1891. In the Spanish-American war of 1898 it was reckoned that more soldiers died from the fever than from yellow fever or wounds sustained in the conflict. The Typhoid Board established during that particular conflict promoted a batch of sanitary measures such as disinfection, camp relocation and water sterilisation to try to contain and eliminate the spread of the disease.
It was an English country doctor, William Budd, who whilst treating patients during a local typhoid outbreak hit upon the causal link between the spread of the disease, the presence of so-called poisons in their excretions and the fact that the disease could be spread to healthy people through the consumption of contaminated water. Unsurprisingly for the time Budd’s prescription was a policy of strict isolation to thwart the spread of the disease.
It was not until 1880 that the bacillus responsible for causing the disease was identified, by Karl Joseph Eberth – it bears his name – and the first vaccine was developed by the British bacteriologist, Almroth Edward Wright, at the Army Medical School in the Hampshire town of Netley. It was trialled successfully during the Boer War and during the First World War the British army was the only force to be fully immunised against the disease.
On civvy street a combination of pro-active vaccination campaigns and gradual improvements of sanitation systems and water supplies made substantive combinations towards reducing the likelihood of an outbreak.
When an outbreak occurred the public health authorities took draconian action, following the principles espoused by Budd. Perhaps the most draconian measures were adopted by the New York authorities against one Mary Mallon.
In the summer of 1906 a wealthy New York banker, Charles Henry Warren, took his family on holiday and, as you do, hired a temporary cook, Mary Mallon. Six of the eleven family members contracted typhoid – an unusual occurrence in Oyster Bay – whilst Mallon was a cook and when Mallon moved on to other temporary cooking positions members of the families she cooked for went down with typhoid.
Eventually, the authorities realised that the common denominator was the 40 year old Irish cook who seemed to be the epitome of rude health. Mallon refused to believe she was a carrier of the disease although whilst detained by the authorities she admitted poor hygiene and that she didn’t understand the need to wash her hands. She was held in isolation in a clinic on North Brother Island for three years before being released upon condition that she changed her occupation.
Mallon found work as a laundress but the lure of the kitchen proved too much and changing her name to Mary Brown was soon behind the stove. But everywhere Brown went, typhoid followed her, the most devastating outbreak being at Sloane Hospital for Women in the Big Apple in 1915 where 25 people were infected and 2 died. By this time the authorities twigged that Brown was Mallon and Typhoid Mary as she was dubbed was back in isolation on North Brother Island. She was never released spending her last 23 years in isolation before dying in 1938 of pneumonia. A post-mortem autopsy revealed evidence of live typhoid bacteria in her gallbladder and her body was cremated.