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The Bush Hill Hospital, which housed the sick poor, was desperately understaffed. When Philadelphia’s mayor asked the public for help, a French-born merchant from Santo Domingo named Stephen Girard stepped up and recommended his compatriot, Dr. Jean Devèze, to head the hospital. Devèze refused to believe that yellow fever was contagious and he disapproved of Rush’s aggressive treatments. Devèze later became a world authority on yellow fever.

The first major American yellow fever epidemic hit Philadelphia in July 1793 and peaked during the first weeks of October. Philadelphia, then the nation’s capital, was the most cosmopolitan city in the United States. Two thousand free blacks lived there, as well as many recent white French-speaking arrivals from the colony of Santo Domingo, who were fleeing from a slave rebellion. Major Revolutionary political figures lived there, and in the first week of September, Thomas Jefferson wrote to James Madison that everyone who could escape the city was doing so. The epidemic depopulated Philadelphia: 5,000 out of a population of 45,000 died, and chronicler Mathew Carey estimated that another 17,000 fled.

African Americans played a vital role in the epidemic of 1793. Rush pleaded for the help of Philadelphia’s free black community, believing that African Americans were immune to the disease. African Americans worked tirelessly with the sick and dying as nurses, cart drivers, coffin makers, and grave diggers. Absalom Jones and Richard Allen, religious leaders who would later go on to found the first black churches of Philadelphia, African Episcopal Church of St. Thomas, and African Methodist Episcopal Church, respectively, described their experience as volunteers in 1793: “at this time the dread that prevailed over people’s minds was so general, that it was a rare instance to see one neighbor visit another, and even friends when they met in the streets were afraid of each other, much less would they admit into their houses.” This was not the only horror that Absalom Jones and Richard Allen observed. They observed horrendous behavior from the fearful citizens of Philadelphia: “[Many white people]…have acted in a manner that would make humanity shudder.” Despite Dr. Rush’s theory, 240 African Americans died of Yellow Fever.

the Caribbean refuges brought Yellow Fever. Philadelphia's ravenous mosquitoes provided the perfect vehicle for spreading the disease by first lunching on an infected victim and then biting a healthy one

Unbeknownst to the city's inhabitants, all the necessary ingredients for an unprecedented health disaster were now in place.

first fatalities appeared in July and the numbers grew steadily.

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

    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.