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Mallon, now extremely suspicious of these health officials, refused to listen to Baker, Baker returned with the aid of five police officers and an ambulance. Mallon was prepared this time. Baker describes the scene:

Mary was on the lookout and peered out, a long kitchen fork in her hand like a rapier. As she lunged at me with the fork, I stepped back, recoiled on the policeman and so confused matters that, by the time we got through the door, Mary had disappeared. 'Disappear' is too matter-of-fact a word; she had completely vanished.3

footprints were spotted leading from the house to a chair placed next to a fence. Over the fence was a neighbor's property. They spent five hours searching both properties, until, finally, they found "a tiny scrap of blue calico caught in the door of the areaway closet under the high outside stairway leading to the front door."4

After a trial and then a short run from health officials, Typhoid Mary was recaptured and forced to live in relative seclusion upon North Brother Island off New York. Who was Mary Mallon and how did she spread typhoid fever? An Investigation

For the summer of 1906, New York banker Charles Henry Warren wanted to take his family on vacation. They rented a summer home from George Thompson and his wife in Oyster Bay, Long Island. Also for the summer, the Warrens hired Marry Mallon to be their cook.

On August 27, one of the Warren's daughters became ill with typhoid fever. Soon, Mrs. Warren and two maids became ill; followed by the gardener and another Warren daughter. In total, six of the eleven people in the house came down with typhoid. Since the common way typhoid spread was through water or food sources, the owners of the home feared they would not be able to rent the property again without first discovering the source of the outbreak. The Thompsons first hired investigators to find the cause, but they were unsuccessful. Then the Thompsons hired George Soper, a civil engineer with experience in typhoid fever outbreaks. It was Soper who believed the recently hired cook, Mary Mallon, was the cause. Mallon had left the Warren's approximately three weeks after the outbreak. Soper began to research her employment history for more clues. Mary Mallon was born on September 23, 1869 in Cookstown, Ireland. According to what she told friends, Mallon emigrated to America around the age of 15. Like most Irish immigrant women, Mallon found a job as a domestic servant. Finding she had a talent for cooking, Mallon became a cook, which paid better wages than many other domestic service positions. Soper was able to trace Mallon's employment history back to 1

900. He found that typhoid outbreaks had followed Mallon from job to job. From 1900 to 1907, Soper found that Mallon had worked at seven jobs in which 22 people had become ill, including one young girl who died, with typhoid fever shortly after Mallon had come to work for them.1 Soper was satisfied that this was much more than a coincidence; yet, he needed stool and blood samples from Mallon to scientifically prove she was the carrier.

Bubonic plague, the disease's most common form, refers to telltale buboes—painfully swollen lymph nodes—that appear around the groin, armpit, or neck. Septicemic plague, which spreads in the bloodstream, comes either via fleas or from contact with plague-infected body matter. Pneumonic plague, the most infectious type, is an advanced stage of bubonic plague when the disease starts being passed directly, person to person, through airborne droplets coughed from the lungs. If left untreated, bubonic plague kills about 50 percent of those it infects. The other two forms are almost invariably fatal without antibiotics.Yersinia pestis is extraordinarily virulent, even when compared with closely related bacteria. This is because it's a mutant variety, handicapped both by not being able to survive outside the animals it infects and by an inability to penetrate and hide in its host's body cells. To compensate, Y. pestis needs strength in numbers and the ability to disable its victim's immune system. It does this by injecting toxins into defense cells such as macrophages that are tasked with detecting bacterial infections. Once these cells are knocked out, the bacteria can multiply unhindered.Victims are so overwhelmed that they're more or less poisoned to death as the bacilli gather in thick clots under the skin, where a passing flea might pick them up. Other grim side effects can include gangrene, erupting pus-filled glands, and lungs that literally dissolve.

Plague still exists in various parts of the world. In 2003, more than 2,100 human cases and 180 deaths were recorded, nearly all of them in Africa. The last reported serious outbreak was in 2006 in the Democratic Republic of the Congo in Central Africa, when at least 50 people died. The United States, China, India, Vietnam, and Mongolia are among the other countries that have confirmed human plague cases in recent years.Most people survive if they're given the correct antibiotics in time. Good sanitation and pest control help prevent plague outbreaks since they need crowded, dirty, rat-infested conditions to really get going.There are fears that plague bacteria possibly could be used for a bioterror attack if released in aerosol form.

Outbreaks of the flu occurred in nearly every inhabited part of the world, first in ports, then spreading from city to city along the main transportation routes. India is believed to have suffered at least 12,500,000 deaths during the pandemic, and the disease reached distant islands in the South Pacific, including New Zealand and Samoa. In the United States about 550,000 people died. Altogether an estimated 25,000,000 persons throughout the world perished, most during the brutal second and third waves. Other outbreaks of Spanish influenza occurred in the 1920s, but with declining virulence

    George Thompson, the owner of the house, was particularly worried, concerned that no well-to-do New Yorkers would be of a mind to rent his home the following season if it was associated with disease. The house was very large, and expensive to run. Thompson himself, though the owner of four other homes, could not afford to live there. If the house lay vacant, it would mean disaster. Desperate, he called in experts to track down the source of the contagion, hoping it came from outside the property and eager for someone to prove it.     Drinking water was analyzed. The single indoor toilet, the cesspool, manure pit, and outhouse were all examined and ultimately rejected as the possible source of infection.

    Dairy products were inspected.     An old woman who lived on the beach was considered a likely suspect. She had offered the family clams for sale, and these were scrutinized minutely, but no one else in th

e town who had eaten shellfish from the same source had fallen ill.

    Thompson, unsatisfied with the inconclusive results from local health authorities on the scene and from his hired experts, reached out to friends in New York City, looking for someone, anyone, to help him with his embarrassing problem.     Salvation didn't exactly ride in on a white horse. Nor was Dr. George Soper hero material exactly. Dr. Soper was not even in fact a medical doctor. He was a sanitary engineer — as one newspaper described him: `a doctor to sick cities.'     Called into the fray, he took the train out to Oyster Bay from the city and set immediately to work. After reviewing the findings of the first medical men on the scene, as well as those of earlier experts who had scrutinized the drinking water, trash and sewage, he began questioning members of the household, inquiring about visitors, ultimately receiving a comprehensive list going back an impressive ten years. To the best of his ability, Soper examined the medical histories of each of these individuals, eventually ruling all of them out as possible sources.

    Soper now uncovered `other episodes', as he called them. Provocatively, there was a two-year period for which there were no records available at all for Ms. Mallon's employment — the period between the Gilsey family incident and Mary's arrival in Oyster Bay.     The two-year blank was tantalizing to Soper. Where had Mary been? Who had she been cooking for? She must have been cooking somewhere ... The sanitary engineer's mind teemed with disturbing images. He no doubt pictured the cook stirring soup in some unknown and very busy cellar kitchen, barehanded, unknowing, infecting untold multitudes of solid citizens with potentially deadly bacilli.     Dr. Soper's breathless, self-serving, yet ultimately unreliable accounts to newspapers give a sense of how excited he was, how exhilarated by the thrill of the chase and the tantalizing prospect of being onto something really important. At first he had anticipated a case that might last only a few weeks — a little sea air, a few bowls of steamers, some resolution, and back to the city — but now he found himself further drawn into a quest which had already occupied him for a full four months. The Warrens were long gone — back home with the other summer renters. The weather had turned colder, the house now stood empty.

    He went over the facts of the case as they had presented themselves to him. Here he had an unexplained outbreak of typhoid in an area where no typhoid of any kind had been previously. The home was immaculate, clean from top to bottom. All other possible sources of infection had been examined and ruled out. The only new element introduced into the household had been a cook. The cook handled food, which all the afflicted members of the household had eaten. The disease broke out, and the cook was now gone. Had she left under different circumstances, say, the disappearance of a diamond necklace, the cops — or any investigator — would have been looking very hard in her direction.     Soper got a description of the suspect: a woman of about forty, tall, with a buxom build, blond hair, blue eyes, and a firm mouth and jaw. It was remarked that she was `a pretty good cook', though she was observed by some interviewees in retrospect as bein

`not particularly clean' in her work habits and `difficult to talk to'.     Writing later, Soper describes what he did next:

    This was frustrating. Things usually went pretty quickly in cases like this. Feces in the water supply, contaminated milk, a sickly visitor, and case closed. Not so at the Thompson house. Soper began to `walk the cat backward' in search of an answer.     Typhoid's incubation period was known to be ten to fourteen days long, so he focused on a time on or before August 20. Soper was intrigued by the news that on the fourth of the month, the Warrens had seen fit to change cooks. More significantly, the new cook, a Mary Mallon, was now missing, having left without notice or explanation some three weeks after the sickness began.     A missing cook! It was the kind of lead that criminal investigators find almost too easy, too good to be true; evidence of a kind that prosecutors like to present to jurors as indicating `guilty knowledge', the kind of red flag that Miss Marple or Hercule Poirot would disregard automatically as being just too obvious. Look at it: A murder or some other felony is committed in a household or place of business, and someone who used to be there is suddenly no longer there. It doesn't take an investigative mastermind to deduce who to go looking for first. It was circumstantial evidence of the most provocative kind, and Soper was well acquainted with the old saw about circumstantial evidence: `It's like finding a goldfish in your milk. It doesn't prove anything — but it's mighty suspicious'.

    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:

    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:

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 str

icken 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.

    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.

    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.

There is no specific treatment for those with yellow fever beyond good nursing and supportive care. The disease, however, is completely preventable. People can be rendered immune to the virus through vaccination, and outbreaks can be contained by eliminating or controlling mosquito populations. Thanks to such measures, the great yellow fever epidemics of the late 19th and early 20th centuries are no more. Nevertheless, the disease is still present in tropical Africa and South America, where access to vaccine is sometimes lacking

An infectious disease, yellow fever infects humans, all species of monkeys, and certain other small mammals. The virus is transmitted from animals to humans and among humans by several species of mosquitoes. Yellow fever is one of the great epidemic diseases of the tropical world, and in earlier centuries it was one of the great plagues of the New World. At one time the tropical and subtropical regions of the Americas were subjected to devastating epidemics, and serious outbreaks occurred not only as far north as Philadelphia, New York, and Boston but also as far away as Spain, France, England, and Italy.

An infectious disease, yellow fever infects humans, all species of monkeys, and certain other small mammals. The virus is transmitted from animals to humans and among humans by several species of

tious disease, yellow fever infects humans, all species of monkeys, and certain other small mammals. The virus is transmitted from animals to humans and among humans by several species of

WHO fact sheet Disease Outbreak News: yellow fever International travel and health: yellow fever International Health Regulations (IHR)

Key Dates relating to the event: This terrible plague started in Europe in 1328 and lasted until 1351 although there were outbreaks for the next sixty years

called the Black Death because one of the symptoms produced a blackening of the skin around the swellings.

buboes were red at first, but later turned a dark purple, or black.

spread of the Black Death followed all of the Trade Routes to every country

Nearly one third of the population of died - about 200 million people in Europe The 1328 outbreak in China caused the population to drop from 125 million to 90 million in just fifty years7500 victims of the disease were dying every day

first symptoms

nervous system collapsed, causing extreme pain and bizarre neurological disorders

inspiration for “Dance of Death” rituals

skin blackene

the skin blackened, giving rise to “The Black Death.

“pocket full of posies,” that people carried with them and held near their faces to ward off the horrid odor

uncharacteristically cremated—the “ashes, ashes,”—and finally, death would come, and we would “all fall down.”

Fleas feeding on infected rodents can transmit the disease to people as well

Once infected, people can infect others by coughing, sneezing, or close talking

The origin of “The Black Death” dates to an outbreak in China during the 1330s

Unlike smallpox, the plague is still a threat in some parts of the world. Yersinia pestis, the bacterium that causes bubonic plague, is transmitted through rat-tainted fleabites in densely populated cities and in countries with poor hygiene, or in the open country from infected wild rodents. The most common form of human plague is a swollen and painful lymph gland that forms buboes.

Plague vaccines have been used since the late nineteenth century, but their effectiveness is uncertain. Vaccination reduces the incidence and severity of disease resulting from the bite of infected fleas, but it isn't 100 percent effective. The plague vaccine is licensed for use in the United States and is available for adults at high risk—people who live in the western United States, people who will be in parts of the world where plague is still endemic, and people who are around rodents. Severe inflammatory reactions are common, and plague vaccine should not be given to anyone with a known hypersensitivity to beef protein, soya, casein, or phenol. Finally, the vaccination routine is complex and requires frequent boosters to maintain its effectiveness.

Pneumonic plague is more difficult to treat, and even with antibiotics, victims can die from it. Pneumonic plague occurs when the infectious bacteria infects the lungs. The first signs of illness in pneumonic plague are fever, headache, weakness, and a cough that produces blood or watery sputum. The pneumonia progresses over two to four days and, without early treatment, death ensues.

Bubonic Plague

Mary continued to work as a cook,

outbreak likely was caused by contaminated wate

until 1907

outbreak in the Manhattan household that involved a death from the disease, Soper met with Mary. He subsequently linked all 22 cases of typhoid fever that had been recorded in New York City and the Long Island area to Mary.

Again Mary fled

Four years later Soper began looking for Mary again when an epidemic broke out at a sanatorium in Newfoundland, N.J., and at Sloane Maternity Hospital in Manhattan, N.Y.; Mary had worked as a cook at both places. She was at last found in a suburban home in Westchester county, New York, and was returned to North Brother Island, where she remained the rest of her life. A paralytic stroke in 1932 led to her slow death six years later on Nov. 11, 1938.

Mary claimed to have been born in the United States, but it was later determined that she was an immigrant. Fifty-one original cases of typhoid and three deaths were directly attributed to her.

In 1906