Typhoid Mary | Cook, Carrier, Captive | 3

In 1906, a New York health department investigation into an outbreak of typhoid fever led to the discovery that a cook, Mary Mallon, was an unsuspecting ""healthy carrier"" of the deadly bacteria. This discovery forever altered Mallon’s life, thrusting her into a national spotlight as the infamous ""Typhoid Mary."" In this episode, Lindsay is joined by Dr. Seema Yasmin, clinical assistant professor of medicine at Stanford University and former Epidemic Intelligence Service officer. Dr. Yasmin discusses how Mary Mallon became a target of public health authorities and a symbol of the clash between individual rights and public safety. Be the first to know about Wondery’s newest podcasts, curated recommendations, and more! Sign up now at https://wondery.fm/wonderynewsletter Listen to American History Tellers on the Wondery App or wherever you get your podcasts. Experience all episodes ad-free and be the first to binge the newest season. Unlock exclusive early access by joining Wondery+ in the Wondery App, Apple Podcasts or Spotify. Start your free trial today by visiting wondery.com/links/american-history-tellers/ http://wondery.com/links/american-history-tellers/ now. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Lindsay Graham?

  Audible subscribers can binge new seasons of American History Tellers early and ad-free right now. Join Audible in the Audible app or by subscribing on Apple Podcasts.

• 0:23Lindsay Graham?

  Imagine it's a warm summer day in June 1909. You're a reporter for the New York American newspaper and you've taken the ferry across the East River to reach North Brother Island, where the city's health department treats patients with contagious diseases. You're here today to visit the island's most mysterious patient, Mary Mallon. As you step into the one-room cottage where Mallon has been isolated, you spot her seated in a wooden chair by the window. Tall, with thick blond hair, you're surprised to find she looks perfectly healthy.

• 0:56Speaker 01

  Good afternoon, Ms. Mallon. Thank you for taking the time to speak with me.

• 1:00Speaker 02

  Time? Ha! That seems to be all I have these days. They've taken everything else from me.

• 1:06Lindsay Graham?

  Your heart races, realizing you may have made a bad start. If she ends the interview before it's even begun, your story is doomed.

• 1:14Speaker 01

  I'm sorry. I didn't mean to.

• 1:15Speaker 02

  I know, I know.

• 1:17Lindsay Graham?

  You're relieved to see her expression soften, and she gestures for you to take a seat.

• 1:23Speaker 01

  Let me explain why I've come. We think our readers will be interested in hearing about your plight. In your own words, that is.

• 1:30Speaker 02

  Well, you can see for yourself how I'm being treated, cooped up in this cottage.

• 1:35Lindsay Graham?

  You take a moment to glance around the room. It's a cramped space, no larger than 20 feet by 20 feet, with a wooden dresser, a small desk, and a window looking out onto an elm tree. Beyond that, you can see the wharf where you arrived on the ferry earlier today.

• 1:50Speaker 01

  Yes, I can see that these are humble lodgings.

• 1:54Lindsay Graham?

  She just stares at you with her piercing blue eyes, so you decide to change the subject.

• 2:00Speaker 01

  Maybe we could start with your arrival here on the island. How did you find it when you first came here?

• 2:05Speaker 02

  When I was first brought here over two years ago, I was terrified, alone and confused. They immediately set about putting me through tests, poking and prodding me like a mule. They even tried to get me to undergo surgery.

• 2:19Speaker 01

  Hmm, what kind of surgery?

• 2:21Speaker 02

  That's just it. At first, they said surgery to remove my gallbladder. Then it was part of my intestines. If you didn't know any better, you'd think they were making the whole thing up.

• 2:31Speaker 01

  Have they administered any medications?

• 2:33Speaker 02

  Yes, but their effects were so severe, I refused to continue taking them. They were going to be the death of me.

• 2:39Speaker 01

  Well, according to the doctors I spoke with this morning, you are a quote "incubator of typhoid germs." Surely some uncomfortable treatments are worth it if they would prevent you from infecting others with such a terrible disease.

• 2:52Speaker 02

  They're liars. I'm not infecting anyone.

• 2:54Speaker 01

  The doctors say you most certainly are, and that you're here in order to keep the public safe.

• 2:59Speaker 02

  Safe from what? I'm not a threat. I'll tell you why I'm here: to make wealthy people feel safe. That's it. Do you think I'd be here if I owned a fancy house in Manhattan instead of working in their kitchens? I've been seized by force, shipped to this island, and kept here for two years, without any say in the matter. But that's all going to change soon.

• 3:24Speaker 01

  What do you mean?

• 3:25Speaker 02

  I've got my own evidence that I don't carry any typhoid germs. And with your papers' help, the public will soon learn of this injustice. I'm going to get my freedom back.

• 3:38Lindsay Graham?

  You scribble furiously in your notepad. You can tell by the intensity in her voice, she means what she says. She intends to challenge her confinement. You don't know whether this woman really does pose a danger to the public, or is suffering a grave injustice. But you're sure of one thing: her story will sell newspapers. And there's no better time to publish your article than this Sunday's Big Edition. The world needs to know about Typhoid Mary.

• 4:07Speaker 03

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• 4:38Lindsay Graham?

  Hi, I'm Lindsay Graham, the host of American History Tellers. In our latest series, U.S. Army Lieutenant Adolphus Greeley and 24 other men embark on a scientific expedition to the Arctic in 1881. But despite achieving several triumphs of discovery, the men will soon face tragedy. Listen to American History Tellers on Audible or wherever you get your podcasts.

• 5:04Lindsay Graham?

  From Wondery, I'm Lindsay Graham, and this is American History Tellers. Our history, your story.

• 5:28Lindsay Graham?

  On June 20th, 1909, the New York American newspaper published an interview with Mary Mallon describing her forced isolation on North Brother Island. The Sunday edition reached nearly 800,000 readers across the city, and for many, it was the first time hearing about the strange case of Typhoid Mary, the Irish immigrant accused of spreading disease and misery to the unsuspecting families she worked for through her cooking. Later that month, Mallon would legally challenge her situation, and with the help of a lawyer, she would argue for her freedom before the New York Supreme Court. Here with me now to discuss the unique circumstances of Mary Mallon's isolation and the ways in which her treatment in the early 20th century informs the approach to public health today is Dr.

• 6:11Lindsay Graham?

  Seema Yasmin, Clinical Assistant Professor of Medicine at Stanford University and host of the podcast Our Big Shot. Our conversation is next.

• 6:23Lindsay Graham?

  Dr. Seema Yasmin, welcome to American History Tellers.

• 6:26Speaker 04

  Great to be here with you, Lindsay.

• 6:28Lindsay Graham?

  So we don't often hear about typhoid outbreaks today, but how prevalent was typhoid in the early 1900s?

• 6:35Speaker 04

  Imagine a situation in New York City over a century ago, where you have people living in really crowded and unsanitary situations. They're living, many families on top of one another in these tenement buildings. These are immigrants who've come mostly from Europe and other places. But it's such a densely populated area that it's the perfect breeding grounds for the bacteria that causes typhoid fever. It's a bacteria that spreads through food and water. So it kind of loves this situation in which people are so crowded. Nowadays, of course, we have a national surveillance system in the US that captures only about 150 to 450 cases of typhoid every year.

• 7:20Speaker 04

  Very, very different situation to what we were seeing in New York City in the early 1900s.

• 7:26Lindsay Graham?

  Of course, this sort of screening or surveillance was not present at this time. What can you say about how immigrants like Mary Mallon were screened for illnesses when they came through, for instance, Ellis Island?

• 7:37Speaker 04

  About 70% of immigrants coming into the US at that time in the early 1900s came through Ellis Island. And so the island had a very stringent method for examining immigrants. They had both Immigration Service Officers and US Public Health Service Officers literally poking and prodding immigrants. They called it "the line", and it was essentially a series of gates that made it look like a cattle pen for humans. And by their language, they were looking for "loathsome contagions", but also for disabled people and what they called "defected people". They wanted healthy migrants entering the US.

• 8:21Speaker 04

  And what this meant is, as they poked and prodded, if they felt that somebody looked ill to them, they would write on their clothing with chalk, different letters designated different diagnoses. And sometimes these folks would get put into a section of Ellis Island where they'd stay waiting further diagnostic testing for months or even years.

• 8:46Lindsay Graham?

  So that's an attempt at disease prevention, or at least to prevent immigrants with disease from immigrating into the United States. But what about quarantine, the other end of the prevention mechanism? How was it practiced in New York at the turn of the 20th century?

• 9:00Speaker 04

  The city really took advantage of the fact that it has these islands dotted in different places. And so there were sanatoriums and quarantine hospitals built on these outposts. And one example of this is a quarantine hospital that existed from the 1880s onwards called Riverside Hospital. And that was built on North Brother Island. That was a place where New Yorkers who had smallpox or TB, for example, would be quarantined. And in fact, it's where Mary Mallon, the subject of our conversation, ended up at one point.

• 9:31Lindsay Graham?

  You mentioned that there are other islands. I assume that they were employed as well?

• 9:34Speaker 04

  They were employed as well. And some of these islands you can now visit, they have relics of these former sanatoriums and quarantine hospitals. Some of them seem to be specifically reserved for patients with TB, or consumption, as they called it, at some times. And others were for a mix of patients with different infectious diseases.

• 9:54Lindsay Graham?

  So if I were there at the time, visiting one of these islands, what would I find in one of these sanatoriums? Can you give me some examples of who were there, both patients and staff?

• 10:04Speaker 04

  These locations felt purposefully isolated and desolate. And people didn't want to work with these patients that had infectious diseases, which at the time were not curable and may not even have been very treatable. Historically, there's a really famous group of incredible nurses who took care of TB patients at one of these New York City quarantine hospitals. The hospital was called Seaview Hospital, and the nurses came to be known as the Black Angels. Because what happened is when this hospital became a quarantine hospital, white nurses left. And it was black nurses who were left to care for these very sick and lonely patients.

• 10:46Lindsay Graham?

  I want to get a quick bit of nomenclature sorted here because we might use isolation and quarantine as synonyms, but in this case, they are not. Can you explain the difference?

• 10:56Speaker 04

  Quarantine and isolation mean two distinct things in public health. So isolation refers to the separation of someone who is sick, someone who has a disease that they could transmit to others, and separating them from others who are not sick is what we mean when we talk about isolation. Quarantine is different, and we might all be quite familiar with this term now because we lived through a quarantine. That's where you're separating and restricting the movement of people who may have been exposed to a contagious illness, but they themselves feel fine. And so quarantine can feel like a more powerful move. It can feel like a move that's taking away people's civil liberties in a way because of the fact that you're saying to someone who feels fine,

• 11:41Speaker 04

  "Hey, you can't go about your regular business. I am going to restrict your movement even though you feel okay."

• 11:47Lindsay Graham?

  And this brings us neatly back to Mary Mallon. She carried the bacteria that caused typhoid but was asymptomatic. Why don't we explain how someone could have the typhoid bacteria in their system and yet feel fine?

• 11:59Speaker 04

  Typhoid fever is an illness that's caused by a bacteria called Salmonella enterica serovar typhi, or Salmonella typhi for short. And this bacteria, even once someone's been treated, which we now do have antibiotics that can treat it, some people will still retain the microbe inside of their body. They can go on to become a chronic but asymptomatic carrier, meaning they've been treated, they've recovered, they feel great, but the bug is inside them and they're still able to shed it and pass the infection on to others. It's only recently that we've kind of started to understand more of the biology behind that and how this nifty microbe, how the bacteria enters cells of the immune system

• 12:44Speaker 04

  and is able to trick it into allowing the microbe to make a home inside the body of someone who feels perfectly fine.

• 12:53Lindsay Graham?

  So even today, our understanding of this mechanism is incomplete. What did health and sanitation authorities know then about asymptomatic carriers?

• 13:01Speaker 04

  Very, very little. And I think that this lack of understanding and some misinformation about asymptomatic carriers contributed to Mary Mallon's treatment and her experience of living with this bacteria. She's one of the first, if not the first asymptomatic typhoid carrier that we know of. But what I think is controversial is now we know that 1 to 6% of people who recover from typhoid carry it as an asymptomatic person. But at that time, when Mary Mallon was discovered to be a carrier, there were other people in New York City who also came to be discovered as being carriers.

• 13:42Speaker 04

  By some estimates, maybe a few hundred people in New York at that time were carriers. They weren't treated, though, in the same way as Mary Mallon, which makes me, as an epidemiologist and a public health doctor, think about the ways in which we treat people very differently, even if they are harboring the same condition. And there's a paper from 1909 that actually talks about this, talks about the fact that Mary Mallon came to be detained while other people who were carriers like her didn't have their movement restricted at all.

• 14:13Lindsay Graham?

  Why do you think Mary Mallon was singled out?

• 14:16Speaker 04

  Disease is never just about the microbe itself. It's also to do with the story around the illness. And typhoid fever, especially at that time, was considered a filthy disease of the poor, of people who lived in unsanitary conditions. It was considered a disease of immigrants. And so Mary Mallon fits the bill of the kind of person who would have this illness. Of course, she may have gone on to infect very affluent and wealthy people who lived not in crowded situations like hers. But when those people became infected or even became carriers, they didn't have that same stigma around the illness that Mary did because she was an immigrant, a woman, an Irish woman, a laborer.

• 15:01Speaker 04

  She lived in a tenement building, and all of these things counted against her.

• 15:06Lindsay Graham?

  Do you think any of Mary's actual behavior or reluctance to cooperate also contributed to her treatment?

• 15:13Speaker 04

  Potentially. Mary really went at it with the public health authorities. There's a famous scene that's painted of her with a meat fork in hand, brandishing it like a weapon at one of the public health workers. She didn't want to be told what to do. But again, think back to a situation in which we don't fully understand the biology and the pathophysiology of this illness. You're talking to someone who feels perfectly fine. Typhoid fever can cause a really high fever, 104 degrees. It can cause a rash, muscle aches and joint pains, a swollen abdomen. It can cause diarrhea, constipation, and in fatal cases, it can cause internal bleeding. Mary had none of that.

• 15:56Speaker 04

  And so you're having a conversation with someone where you're saying, we're going to restrict your movements, you need to do this and that. And they're saying, but I feel fine. How does any of that even make sense? And then one of the other options that they gave to her was gallbladder removal because they were learning that this bacteria can hide out in the gallbladder. That maybe nowadays might sound okay-ish because, you know, surgery's survivable. But over 100 years ago, it was hellish to endure a surgery like that. So saying to her, either quarantine in a really horrible place, all on your own, even though you feel great, or let's take out your gallbladder. I mean, what kind of an option are we giving to her?

• 16:35Lindsay Graham?

  I'm actually personally curious about this because my mother had her gallbladder removed and I don't know what the gallbladder does. Can it just be removed?

• 16:43Speaker 04

  It can be removed and every year, many, many people will undergo a gallbladder removal surgery. Maybe they have gallstones, maybe they've had an infection in the gallbladder. You can live without it. You might have to modify your diet a little bit, which your mother may have complained about. But back then, Mary Mallon, considering a gallbladder surgery, would have been thinking about potentially dying from an infection contracted during that surgery. So it's a really different decision to make then versus now.

• 17:13Lindsay Graham?

  So was this the choice in front of Mary Mallon then? She vehemently denied that she had the disease or could spread the disease, but was given perhaps a choice? Isolation on North Brother Island? Or perhaps a fatal surgery?

• 17:25Speaker 04

  And what kind of choice is that? And I think about that a lot as a physician in that we think we're offering people options, but sometimes all of the options really suck. And our patients end up stuck between a rock and a hard place. And again, that calculation of which choice you might pick is really different if you feel ill, if someone's going to offer you treatment. But at this point, Mary feels perfectly fine. And she's an immigrant woman, she's a laborer, she needs to cook to earn her living. And the authorities are trying to take all of that away from her.

• 18:06Speaker 05

  A trucker merges onto the I-10 in New Orleans. He checks his mirrors, the lane is clear. And then boom, impact. A pickup truck, seemingly out of nowhere, scrapes down the side of his 18-wheeler, multiple passengers inside. One man flees the scene. And the driver of the pickup, he doesn't seem all that upset. It didn't feel like a regular accident, because it wasn't. Across the city, truckers are getting sideswiped, all on the same stretch of the same freeway. And behind many of the cases is one person. A Hollywood stunt woman turned personal injury lawyer named Vanessa Moda. This podcast is a story about fake accidents that lead to real consequences and a scheme that ends in betrayal and murder.

• 18:51Speaker 05

  Listen to Over My Dead Body: Operation Sideswipe wherever you get your podcasts. Audible subscribers can binge all episodes early and ad-free right now. Join Audible in the Audible app or by subscribing on Apple Podcasts or Spotify.

• 19:06Lindsay Graham?

  By 1779, Benedict Arnold had sacrificed more for the revolution than almost any other man in America. One of George Washington's most effective commanders, he had nearly lost a leg in the Second Battle of Saratoga. But in return, Arnold believed he had been humiliated by con- And cheated of his glory by lesser men, so he decided to make them pay. Hi, I'm Lindsay Graham, the host of the podcast American Scandal. We bring to life some of the biggest controversies in U.S. history. Presidential lies, environmental disasters, corporate fraud. In our latest series, Benedict Arnold turns his back on his comrades in the Continental Army and secretly defects to the British. With the help of his wife, he plots to hand over the most important colonial fortress to the enemy

• 19:51Lindsay Graham?

  and doom the revolution he once served. Follow American Scandal wherever you get your podcasts. Audible subscribers can binge all episodes of American Scandal early and ad-free right now. Join Audible in the Audible app or by subscribing on Apple Podcasts.

• 20:14Lindsay Graham?

  We'll return to the case of Mary Mallon in a bit, but I want to ask you about your work today. You served as an officer in the Epidemic Intelligence Service. What is that and what did you do for them?

• 20:25Speaker 04

  The Epidemic Intelligence Service is a CDC program that trains physicians, veterinarians, nurses, and PhD scientists to become disease detectives, essentially frontline public health workers. So when I moved from London, where I was a hospital doctor, and I moved to the U.S. to train in public health, for me, it was a no-brainer to train in public health within the Epidemic Intelligence Service. It is literally the planet's premier training program for public health. It was established in 1951, and since then, the CDC's disease detectives have gone on to make incredible discoveries

• 21:07Speaker 04

  and to save so many lives when diseases are spreading.

• 21:12Lindsay Graham?

  Let's dig into the term "disease detective." Are you literally burning up shoe leather on the street?

• 21:17Speaker 04

  Yes, in fact, we call it within public health shoe leather epidemiology. And if you look it up online, the logo for the Epidemic Intelligence Service is a globe superimposed with a kind of torn up soul of a boot. Because being a disease detective, being an Epidemic Intelligence Service officer is very dirty grunt work. It's highly unglamorous. I ended up in situations in maximum security prisons where there was an outbreak of paralysis and I was literally on my hands and knees in a stab-proof vest, wearing a helmet and a face shield to be protected from potential attacks while I crawled the floor, looked

• 22:00Speaker 04

  in toilets, trying to see what pathogen had spread to make people sick.

• 22:05Lindsay Graham?

  Now, I've heard that one of your cases was in the spring of 2013, in which you investigated an outbreak of the horrible sounding flesh-eating bacteria that was striking the Navajo Nation in Arizona. Tell us that story. What is flesh-eating bacteria and what were you asked to do?

• 22:21Speaker 04

  One morning I was at my desk and truly, when you are an officer in the Epidemic Intelligence Service, no two days are the same. And I get this call early in the morning from a pediatrician working on the Navajo Nation in the Indian Health Service. And he says, look, something's going on. I'm starting to see a pattern. There are more and more people coming in with either early or late stages of this infection, which colloquially we call flesh-eating bacteria. The proper name for it is Group A invasive streptococcus. And so we start putting out feelers to find out if there really are more cases of this horrific illness. It can lead people to lose limbs. It can cause them to go into septic shock, end up in the ICU, and you can even die from it.

• 23:05Speaker 04

  And it's really heartbreaking because if you catch it early enough, it starts off as just kind of a mild pink rash, which if you treat it then, you could be saving someone's limb or saving their life. So then I go about the work of trying to piece together patterns, making inroads with public health workers and officials and tribal leaders in the Navajo Nation to say, look, we may be able To help you, do we have your permission because they're a sovereign nation, do we have your permission to come on to the reservation and assist you? Eventually, we do get an agreement together. And I remember driving about five hours from Phoenix, Arizona into Window Rock to the Navajo Nation capital, meeting the tribal leaders and the public health officials.

• 23:49Speaker 04

  And kind of being in that situation where you're rolling up your sleeves and you're just ready to dig in and you want to save lives and stop this awful bacteria from spreading. And I wasn't met with the kind of reception I thought I would have. They were not happy to see me, Lindsay. And I was like, wait, you haven't even met me. Like, what's happening?

• 24:09Lindsay Graham?

  So how did you get people to talk to you on a Native American reservation where there's a healthy distrust of government?

• 24:16Speaker 04

  What I had to do then was scientific diplomacy, which meant to say, hey, I'm ready to roll my sleeves up and jump into this investigation. We all want to save lives. And I also made it clear that we didn't necessarily have to lead the investigation. We could co-lead and share power. And also help to build capacity so that the tribe was also more able in the future to deal with outbreaks. And slowly, over the course of the outbreak, we did manage to kind of get to the heart of the outbreak and stop the disease from spreading further.

• 24:47Lindsay Graham?

  Well, how did you get to the heart of the outbreak?

• 24:50Speaker 04

  We had been given information about people who were sick, so the cases and about the index patients. So the first person that's been reported or known to be infected. And we had a small little office room. We had a whiteboard. We started writing names and making a, basically what looks like a spider's web. The network of who knows who, who's been in contact with who. If this person is sick, who else were they in touch with during the time that they were infectious? Who else should we be talking to in case we can catch them with the early stages of a rash? But all the time that we're doing this case finding and going door to door, we are trying to find our patient zero, the first person who became infected and became sick.

• 25:32Speaker 04

  And we start to get hints, Lindsay, about who this was. We're told it's a woman. We're told that she's House, we're told that she has substance misuse issues that she often hangs out outside of a particular supermarket, that she sleeps on people's couches and she doesn't really have her own home. We were determined to find this woman and she of course did not want to be found. For some reason, she herself had not become very severely or dangerously ill. And she didn't want to have anything to do with federal government intelligence officers, which I fully understand. And so it took a lot of detective work, but again, a lot of relationship building and explaining to find this woman. And eventually we did.

• 26:13Lindsay Graham?

  So it sounds like this was detective work and diplomacy. How did this episode on the Nataho Nation affect you personally?

• 26:21Speaker 04

  It reminded me that when we train a scientist, we're often not taught what people call quote unquote soft skills, peacemaking and relationship building and scientific diplomacy. And yet, these so-called soft skills are integral to a successful public health outbreak investigation. It also reminded me of just how important it is to have good relationships with different communities so that when there is a crisis, you can go in and be a trusted actor in that situation. And you're not having to spend precious time reassuring people when all you want to do is just dive in and try and save lives. And so it's really important when there's

• 27:05Speaker 04

  not a crisis to do that work of building good relationships so that you can just get the essential investigation done when things are really bad.

• 27:15Lindsay Graham?

  So flesh eating bacteria is bad, but Ebola I know is worse. And only a year after you were investigating in Arizona, Ebola came to the US. It happened when a small handful of people who had been helping treat Ebola patients in West Africa returned home. Most famously, the case here in my hometown of Dallas occurred. But you knew a friend of yours, a nurse, who was caught up in this turmoil as well when she returned home. Can you tell us what happened?

• 27:42Speaker 04

  I can, and of course, there's also a through line from the Nava Ho Nation investigation to me then being a journalist, which was never in the plan, in Dallas when Ebola arrived in Dallas. So what had happened during that Nava Ho Nation outbreak of flesh-eating bacteria, I had an aha moment of what I should do with my life. Because there was this one morning where small teams of us, it was me, a local public health worker and a Nava Ho translator, were going home to home on the Nava Ho Nation, asking really basic questions to people. Hey, have you seen anyone with this kind of rash? Do you know anyone who's been sick? Do you have this rash? And on this morning, maybe the first day of the investigation,

• 28:27Speaker 04

  this young mother opens the door. And she has very young kids kind of running around her ankles. And she says to me, I'm fine and my kids are fine, but I'm so worried about this disease because I know someone who ended up in the ICU. She says to me, how can I keep my children safe? And you know, at that time, there's all this uncertainty about who's infecting who and how can we find our patient zero. But in my kind of hubris as a public health doctor, I was like, aha, I know the answer to this question. And I said to this young mother, while this outbreak is spreading, here's what you need to do. Make sure you and your kids have really good hand hygiene. Wash your hands regularly with soap and water.

• 29:11Speaker 04

  And she looked at me and she said, with what water? And they had no running water and they had no flush toilets even. And I was just like, oh my gosh, I am so silly and this is such a ridiculous situation. I didn't know there wasn't running water. I did know that of course you are really vulnerable to a deadly outbreak like this one. If you don't have fresh water, that's just such a basic thing. And it was at that point that I started to really question where my career was going and how I would make an impact as a public health doctor. And I was thinking, are people in America aware that these reservations often don't have running water? Is it just my ignorance? I had all these questions and it was actually.

• 29:52Speaker 04

  That experience that led me to journalism school very soon after to train as a science journalist. Fast forward a year, I graduate from journalism school. I moved to Dallas of all places to be a staff writer at the Dallas Morning News. Then I'm questioning my career decisions because the biggest and deadliest Ebola outbreak is spreading in West Africa and I'm not there. And I'm thinking, what am I doing? Why did I become a journalist? I should be there as a public health physician, helping people with Ebola. And what do you know? Ebola arrives on our doorstep in Dallas and becomes this huge story. And so my expertise and my experiences and my qualifications at that point combined. Then we get to October of twenty fourteen and I start getting these texts from the nurse who became famous, Casey Hickox.

• 30:37Speaker 04

  Casey and I were peers at the CDC. She was one year below me in the Epidemic Intelligence Service. She was also a veteran nurse who went on medical missions with the nonprofit Doctors Without Borders. And so when the Ebola outbreak had started, Casey had gone to Sierra Leone to help out there on a medical mission for a month. Then she gets ready to return to the US thinking, you know, she'll have her temperature checked. She'll do all the right things to ensure she doesn't have Ebola. She's not bringing it into the US. And things go completely wrong when she arrives at the Newark Airport.

• 31:14Speaker 04

  She makes front page news because Casey is detained at Newark, put into a plastic tent without showers and things. And she's not given due process. And so she's frantically texting me, her friend from the CDC, who's now a journalist, saying, you need to help me. I need to get this story out. And it was such a confluence of science and politics and misunderstanding of the science and so much fear at the height of an epidemic and Casey became a casualty of that situation.

• 31:48Lindsay Graham?

  There was even a nickname given to her, something familiar to people who've been listening to this series. It wasn't Typhoid Mary, but Ebola Casey.

• 31:56Speaker 04

  It speaks to the fact that Casey had done this incredible work, risking her own safety in Sierra Leone and come back and fallen prey to basically officials and governors who wanted to be reelected and were pandering to the fear and actually not following the science.

• 32:14Lindsay Graham?

  Ultimately, Casey went home to Maine, where she was again caught up in fighting a strict quarantine. She never tested positive for Ebola. What do you think was learned from her case?

• 32:25Speaker 04

  It demonstrated for a lot of people that science and public health do not operate or exist in a vacuum. They are political because the world that we live in is political. And it reminded me for sure that when there's a lack of knowledge about a particular pathogen, whether it's typhoid fever 100 or so years ago, whether it's Ebola more recently, there's so much confusion and chaos and fear. And that can bring out the worst in people and lead towards putting science on the sidelines as those public health officials and some of those elected officials did. Casey ended up staying in that tent for three days, during

• 33:07Speaker 04

  which time she was texting me frantically. And then we published an essay that she wrote in the Dallas Morning News. She lawyered up and then she was in her home in Maine. But then elected officials from Maine became involved too. And it was such a messy situation in which politics and fear overtook the science.

• 33:38Speaker 06

  For decades, two legendary brands fought for the hearts of American bikers: Indian Motorcycle and Harley-Davidson. The battle looked a lot like Coke versus Pepsi or Ford versus Chevy, but tastes changed and Indian didn't adapt fast enough. The icon all but died. Then came the con men, the dreamers, a string of spectacular failures that kept Indian in the grave.

• 33:58Lindsay Graham?

  Until one company finally got it right. This is the story of an improbable revival and the reignition of an old rivalry. Hey, I'm David Brown, the host of the podcast Business Wars. And every season, we bring you the true stories behind the companies that shape our world. Indian's new owners are going all in, but an existential crisis looms. Can Indian and Harley recruit enough younger writers to survive? Make sure to follow Business Wars wherever you get your podcasts. Audible subscribers can binge all episodes of Business Wars early and ad free right now. Join Audible in the Audible app or by subscribing on Apple Podcasts.

• 34:32Speaker 07

  There are books that change how you see the world, and there are books that change how you see yourself. In a new podcast series, A Great Book with Barack Obama, President Obama sits down with a series of surprising and sharp guests to explore six books that have shaped his life and perspective on the world. From Song of Solomon and the Fire Next Time, to All the Pretty Horses and Gilead, the President is joined by guests like Tom Hanks and Ta-Nehisi Coates to reflect on how these timeless stories shaped his thinking on everything from fatherhood to leadership, and discover together what they tell us about the world we live in and the world we want to create.

• 35:17Speaker 07

  Audible subscribers can listen to all episodes of A Great Book with Barack Obama ad free right now, plus access each audiobook discussed in the series. Download the Audible app today.

• 35:37Lindsay Graham?

  So returning to Mary Mallon, she spent three years on North Brother Island. Then authorities released her in 1910 on the condition that she never worked as a cook again. She disappeared around 1912 and was later, in 1915, found working as a cook in a maternity hospital which had just experienced a typhoid outbreak. And it seems likely that an estimated three to five people died from Mary spreading typhoid over the years. As a doctor, how do you think about what she did?

• 36:08Speaker 04

  I think about the real life decisions that patients have to make when we give them options that kind of suck and they were really difficult options in Mary's case. It's nineteen fifteen, we're still only about four years into having a vaccine against typhoid. It's not widely available and it won't be until nineteen forty eight that we'd even have an antibiotic treatment for typhoid. So what options did Mary actually have? And how much was being explained to her about the pathophysiology of this disease? I think that's a really impossible situation to be in. Again, she's told you can go back to this awful place of living in isolation,

• 36:53Speaker 04

  having no family and friends around you, having no purpose in life, no ability to cook, which you love doing, and you feel fine, by the way. Or let's cut your gallbladder out, which is a surgery that might kill you through a fatal infection. We talk about the fact that she caused typhoid outbreaks and we'd want really solid evidence, an epidemiological link, that it was her. Because of course, there were other people walking around New York City at the time that were infectious, who were either asymptomatic or symptomatic. And at this point, you have to remember that Mary really has a target on her back. There are people looking to blame her.

• 37:30Lindsay Graham?

  So because Mary Mallon refused to stop working as a cook, public health authorities sent her back to North Brother Island, where she lived then for more than two decades until her death in nineteen thirty eight. When you think about this case, I guess, what do you see as the balance between individual freedom and the greater public good?

• 37:48Speaker 04

  I think about the context in which all of this happened. So we're talking initially the summer of nineteen oh six. Mary, this immigrant Irish cook, is working for rich people on Oyster Bay, Long Island. These are people who are wealthy bankers. They can afford to have all kinds of servants in their home. And they are just stunned when they start falling sick with typhoid because they cannot fathom that.

• 38:18Speaker 04

  Rich people like them could succumb to an illness of the poor and the unsanitary. So I think that context is really important. In public health, we're balancing what's right for the patient, the individual, in this case, someone who feels fine. And we're also thinking about how we protect public health more broadly. And I think about the fact that Mary died a really sad and isolated death. She died essentially alone and I don't think that was any fault of her own. There wasn't an antibiotic that could treat her for good. She could have had her gallbladder excised, but that would have been painful and it may have killed her. And in this context, of course, going back to the affluent home that was rented by this family on Oyster Bay, Long Island.

• 39:04Speaker 04

  They were so aggrieved that this could happen to them, that they had hired a very enthusiastic sanitation worker, not a public health worker, a sanitation worker called George Soper, who made it his mission to single out Mary and was really chasing her around the city. And his motivation, I think, from all that I have studied on this, is that George Soper wanted to protect the health and wellbeing of the rich. You know, he wasn't so concerned about the human rights of a poor Irish immigrant woman. When we're making these decisions in public health, we consider a balance of four principles. Beneficence, non-maleficence, justice and respect for autonomy.

• 39:46Speaker 04

  So we're often making difficult decisions to treat or not to treat, to isolate, to not isolate. And you're balancing these things of doing as much good as you can for the person and for public health. You want to not do any harm, but you also want to protect a person's right to live a good and full life. And Mary was denied that.

• 40:09Lindsay Graham?

  I'm thinking of an analogy with criminal justice. Certainly, if we discovered that there was a serial killer out there responsible for four or five deaths, and there seems to be clues pointing to one person, public outcry would be enormous to find the culpable individual. But we have real stringent boundaries in place to preserve even that person's civil liberties in the criminal justice system. What exists in the public health dimension?

• 40:37Speaker 04

  We have laws on the books that allow us to take away someone's ability to live freely. We can restrict someone's movement, typically when they are sick, but also if they have been an asymptomatic carrier of a disease. My concern is that we have access to these laws, but are we applying them evenly? In every single case, are we weighing moral principles in the most ethical manner? Or do some people get a really rough ride of it, perhaps because they are poor, or an immigrant, or a woman, or living in unsanitary conditions? Do we perceive them differently?

• 41:19Speaker 04

  And therefore, do we take a law that's on the books, but apply it in a much harsher way, a much more restrictive manner than we might perhaps someone who's affluent and has proximity to power? So again, with public health and politics being intertwined, public health officials have a lot of power, and they have the ability to strip someone of their freedom. And we have to be thinking of that at each turn, and thinking if we are applying those principles equally to all people. And in Mary's case, it feels like that did not happen, because we have evidence from the early 1900s that there were other asymptomatic carriers in New York City. They were not detained or treated or imprisoned in the way that Mary Mallon was.

• 42:03Lindsay Graham?

  So what is your ultimate judgment then on the medical establishment and their treatment of Mary Mallon?

• 42:08Speaker 04

  We have been complicit and still are complicit in maligning this woman, in stigmatizing this disease. And even that moniker, Typhoid Mary, was published in an article in a very prestigious medical journal that still exists, JAMA, or the Journal of the American Medical Association. And whether writers in that journal coined that term or were simply repeating it, they are also to blame in elevating that term in a way that the press then latched on to it. It really stuck. To this day, we talk about Typhoid Mary. We use it as a euphemism. In fact, just a few weeks ago, I was in an acting class in LA and just a small group of us. And one young woman sneezed and then she sniffed and, you know, people kind of looked over.

• 42:53Speaker 04

  And she said something like, oh, gosh, I'm just being Typhoid Mary over here, which just highlights how much this story has been perpetuated through culture without the context and the understanding that we're talking about a maligned immigrant woman who had really poor options and wasn't given adequate information or care in her case.

• 43:17Lindsay Graham?

  So I think we've been outlining generally the answer to this question, but I was wondering if you could give us some more specifics. What lessons are there for epidemiologists and for the medical establishment at large to be found in Mary Mallon's case? Why is she still relevant today? Why do we talk about her?

• 43:34Speaker 04

  Public health is difficult to get right. You are balancing the freedoms and the rights of an individual with this need to protect the public's health. We made grand mistakes in the case of Mary Mallon. Mary's story also reminds us of how the medical establishment can be complicit, continues to be complicit, in labeling ways in people that are stigmatizing and dangerous. When you have stigma around a disease, when you label a person in that way, it can prevent other people from coming forward and getting the care they need. That ultimately is terrible for public health. Stigma is dangerous.

• 44:17Speaker 04

  And we know from experience that shame fuels negative behavior. So there are many lessons from Mary's case that are still applicable to epidemiologists and public health physicians to this day.

• 44:30Lindsay Graham?

  Seema Yasmin, thank you so much for talking with me today on American History Tellers.

• 44:34Speaker 04

  Thank you, Lindsey.

• 44:35Lindsay Graham?

  That was my conversation with Dr. Seema Yasmin, Clinical Assistant Professor of Medicine at Stanford University and host of the Owl Big Shot Podcast.

• 44:46Lindsay Graham?

  From Wondery, this is the third and final episode of our series on Typhoid Mary for American History Tellers. In our next season, in July 1925, in the small town of Dayton, Tennessee, high school teacher John Scopes agrees to take part in a test case being orchestrated by the ACLU. After he's charged with breaking a state law forbidding the teaching of the theory of evolution, he's put on trial, and the ensuing spectacle will spark a national debate between science and religion and free thought and fundamentalism.

• 45:20Lindsay Graham?

  American History Tellers is only possible because of listeners like you, so thank you. And don't miss an episode. Be sure to follow American History Tellers on Audible or wherever you get your podcasts. Audible subscribers can binge new seasons of American History Tellers early and ad-free right now. Join Audible in the Audible app or by subscribing on Apple Podcasts. And to find out more about me, including my other podcasts, my live show, the history tours I'm arranging, and all sorts of other things, go to historyishuman.com. That's historyishuman.com.

• 45:57Lindsay Graham?

  American History Tellers is hosted, edited, and executive produced by me, Lindsay Graham for Airship. Sound design by Molly Vok. Supervising sound designer is Matthew Filler. Music by Thrum. Additional writing by Dorian Marina. This episode was produced by Polly Stryker and Alita Rozansky. Our senior interview producer is Peter Arcuni. Managing producer, Desi Blalow. Senior managing producer is Callum Pluse. Senior producer is Andy Herman. And executive producers are Jenny Lauer Beckman, Marshall Louis, and Aaron O'Flaherty for Wondery.

• 46:34Speaker 07

  You stepped out for your morning jog. Except it's not your usual morning jog. You started listening to an epic sci-fi book on Audible. Thirty chapters later, you've accidentally run a half marathon. You've lost track of how far you've run, somewhere just past the city limits. You can't stop. You have to find out what happens next. Then it's over. The universe seems bigger. You feel different. You feel... like you have no idea where you are. Audible. Stories that speak to you.