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    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.

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

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

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:

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.

Typhoid Mary, for intentionally spreading the deadly illness

In turn-of-the-century New York City, typhoid was a growing problem. The Department of Health had a lot on its plate; in addition to typhoid, it was trying to quell out­breaks of smallpox, tuberculosis, diphtheria and whooping cough that were sweeping through the area [source: NOVA]. Luckily,

scientists had developed a sophisticated understanding of microbial diseases and how they spread -- even if everyone in the lay public didn't quite

rasp all of it yet.The Department of Health knew what caused typhoid, but dealin

g with the spread of the disease was another question altogether. It's a question that plagues us to this day. It's no longer considered humane to simply cast contagious disease victims out of society and into the wilderness to fend for themselves. What exactly to do with them remains controversial. Authorities must walk the line between keeping their societies safe from debilitating illness and infringing on the victims' personal rights. This controversy reached a fever pitch in early 20th-century New York when it came to one individual.It might surprise you to learn that this fervor revolved around someone who was actually immune to typhoid. Though it's uncommon, some people are naturally immune to the illness, meaning they can carry the parasite and never suffer from a single symptom. Nevertheless, these people can just as easily spread the disease to others. This was the case for one Mary Mallon, aka Typhoid Mary. She was in the wrong place at the wrong time as well as in the worst possible occupation for a carrier of typhoid: She was a cook.

Painful diarrhea, high fever, nasty red rashes and sleeplessness typically characterize the illness. Left untreated, typhoid can result in death.

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

To be sure, Mary Mallon was not entirely blameless when she knowingly returned to cooking in 1915, but the blame must be more broadly shared. Much of what Mallon did can be explained by events greater than herself and beyond her control.

the New York City Health Commissioner who had released her in 1910

, helped her find a job in a laundry, it did not provide the wages or job satisfaction to which she had previously become accustomed. Nor did it provide the social amenities, as limited as they were, of domestic work in the homes of New York's upper class.

Lederle's words of obligation to help her in 1910

did not provide her

long-term gainful employment.

precipitously locked Mallon up, succeed in convincing Mallon that her danger to the health of people for whom she cooked was real and lifelong. The medical arguments that carried weight among the elite at the time and have become more broadly convincing since did not resonate with her. There was no welfare system to support her. There was no viable "safety net," practical or intellectual, for an unemployed middle-aged Irish immigrant single woman.

An old file card detailing results from tests on stool specimens from Mary Mallon gives a capsule history of her capture and quarantine. Enlarge

Hard choices

Health officials chose not to deal with their first identified healthy carrier in a flexible way.

Part of the New York American article of June 20, 1909, which first identified Mary Mallon as "Typhoid Mary" Enlarge

Proper treatment

The Most Dangerous Woman in America.

After recovering from typhoid fever, some people still can become carriers of the bacteria. This means that they'll have no symptoms, but do have the bacteria in their bodies and can pass it on to other people.

How People Get It People usually get typhoid fever by drinking beverages or eating food that has been handled by someone who has typhoid fever or is a carrier of the illness. Those infected also can pass the disease onto others directly (for example, by touching them with unwashed hands). People also get the illness by drinking water that is contaminated by sewage that contains the S. Typhi bacteria. For these reasons, the disease is common in areas with poor sanitation and inadequate water treatment. It is also common in tropical and subtropical areas around the world, including Africa, Asia, and Latin America

Salmonella Typhi lives only in humans.

eat food or drink beverages that have been handled by a person who is shedding Salmonella

If you drink water, buy it bottled or bring it to a rolling boil for 1 minute before you drink it. Bottled carbonated water is safer than uncarbonated water. Ask for drinks without ice unless the ice is made from bottled or boiled water. Avoid popsicles and flavored ices that may have been made with contaminated water. Eat foods that have been thoroughly cooked and that are still hot and steaming. Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easily contaminated and are very hard to wash well. When you eat raw fruit or vegetables that can be peeled, peel them yourself. (Wash your hands with soap first.) Do not eat the peelings. Avoid foods and beverages from street vendors. It is difficult for food to be kept clean on the street, and many travelers get sick from food bought from street vendors.

If you are traveling to a country where typhoid is common, you should consider being vaccinated against typhoid. Visit a doctor or travel clinic to discuss your vaccination options. Remember that you will need to complete your vaccination at least 1-2 weeks (dependent upon vaccine type) before you travel so that the vaccine has time to take effect. Typhoid vaccines lose effectiveness after several years; if you were vaccinated in the past, check with your doctor to see if it is time for a booster vaccination. Taking antibiotics will not prevent typhoid fever; they only help treat it. The chart below provides basic information on typhoid vaccines that are available in the United States.

TYPHOID feverTYPHOID Mary, 1869-1938

Provides information on the case of Mary Mallon, the famous spreader of typhoid fever in the 1900s

http://search.ebscohost.com/login.aspx?direct=true&db=voh&AN=9660565&site=src-live&scope=site

A few people can become carriers of S. typhi and continue to release the bacteria in their stools for years, spreading the disease.Typhoid fever is common in developing countries, but fewer than 400 cases are reported in the U.S. each year. Most cases in the U.S. are brought in from other countries where typhoid fever is common.

bacteria travel through the blood to your lymph nodes, gallbladder, liver, spleen, and other parts of the body

bacteria, t

acteria enter your body

travel into your intestines

then into your blood

contaminated

Some persons become carriers

Some people with typhoid fever develop a rash called "rose spots," which are small red spots on the abdomen and chest.

Typhoid fever is common in developing countries.

Fewer than 400 cases are reported in the U.S. each year. Most cases in the U.S. are brought in from other countries where typhoid fever is common.

High fever (103°F, or 39.5°C) or higher and severe diarrhea occur as the disease gets worse.

and abdominal pain.

Early symptoms include fever,

continue to release the bacteria in their stools for years, spreading the disease.

Abdominal tendernessAgitationBloody stoolsChillsConfusionDifficulty paying attention (attention deficit)DeliriumFluctuating moodHallucinationsNosebleedsSevere fatigueSlow, sluggish, lethargic feelingWeakness

Symptoms usually improve in 2 to 4 weeks with treatment. The outcome is likely to be good with early treatment, but becomes poor if complications develop.

Prevention