PATRICK P. ROWAN looks at some of the great medical disasters from time past

When 15-year old Mary Mallon left her native Cookstown, County Tyrone, to live in New York she would not have had any idea that she would become famous for all the wrong reasons.

At first she stayed with an aunt and uncle and developed an interest in cooking. This led her to be able to seek employment as a cook and a good cook she was said to be. She acquired a name for herself as a cook among some of the wealthy matrons in New York – but she had one major disadvantage.

She left a trail of sickness and death after her when she suddenly fled from each place of employment!

In 1900 when she worked in a house in New York residents developed typhoid fever. The following year when she worked in Manhattan illness soon spread through the family and the laundress died.

She was employed as a cook by a large number of families but soon developed a pattern to her way of working. As soon as symptoms of typhoid fever appeared in the family, Mary fled to seek a new place of employment. She had 8 jobs in 7 years.
When Charles Warren, a wealthy New York banker, was taking his family on holiday, Mary was brought along as cook. The result was that six of the eleven people in the party became ill with typhoid fever.

Typhoid fever is rare now in countries where the standard of hygiene is good, but is still a scourge in less developed countries. It is due to infection from the bacillus Salmonella typhi carried in infected water or food from persons excreting the organism in their faeces but don’t show symptoms.

In a small number of people who develop the disease, the bacillus continues to be harboured in the gall bladder so they can continue to excrete the bug without being aware of the danger.

Mary Mallon was one of these people who had no symptoms but was a carrier and was the first such carrier to be recognised in the United States.

The disease can have a mortality rate of 10 to 30 per cent but with modern treatment with antibiotics and fluid replacement the mortality is now as low as 1 per cent.

Finally, the members of a family who had suffered as a result their employing a certain cook wondered if there was any association between their illnesses and the cook who had abruptly left their employment so they decided to start an investigation.

They were lucky to get George Soper, a civil engineer with experience of typhoid fever, to try to solve the problem. Soper found that Mary had been employed in 8 jobs between 1900 and 1907. During the time Mary worked in these households, 22 people became ill and one young girl died from typhoid fever. He found Mary to be a tall, heavily built lady aged around 40 who was in perfect health.

When he approached her to provide urine and faeces specimens she went to attack him with a carving knife so he fled – but he was not to be frightened off. He decided to try again and this time brought Dr Bert Hoobler with him.

Mary created an angry scene when the two men appeared so they had to retreat once again but Soper was very persistent. He applied to the New York City Health Department and they sent a Dr Josephine Baker to interview Mary but she wasn’t having any dealings with officialdom.

Dr Baker returned accompanied by 5 policemen and an ambulance but Mary was not to be found on the premises. She had absconded through the back door. It was only after a five-hour search that she was found in an outdoor toilet and was taken into custody. Then, screaming and kicking, she was carried to the ambulance.

In prison, stool and urine samples were sent for examination and it was determined that her gall bladder was the site from which the typhoid bacilli were excreted. Mary did not believe in frequent hand washing nor would she consent to have her gall bladder removed.

 The only option left was to continue confining her so she was held in isolation for three years at a clinic on North Brother Island. Then the Health Commissioner decided to release her on condition that she never work as a cook again and take precautions that she didn’t spread any more infection.

Mary continued to be contrary. Given a job as a laundress on discharge she soon changed her name to ‘Mary Brown’ and over the next five years continued to be employed as a cook, spreading infection wherever she worked.

In 1915 she was working as a cook in Sloan Hospital for Women in New York when 25 people were infected and two died. The police arrested her and she was returned to quarantine on North Brother Island where she was to remain for the rest of her life.
She still refused to have her gall bladder removed. She was allowed to work in the island’s laboratory washing bottles but suffered a paralysing stroke later and died on November 11, 1938. Autopsy confirmed that her gall bladder was the site from which all the infections originated.

Estimates of the total fatalities due to infections resulting from ‘Typhoid Mary’s’ cooking vary but some put it as high as 50. ÷