The Healthy Carrier ‘‘TYPHOID MARY’’ AND SOCIAL BEING In 1907 the discovery of the first known ‘‘chronic typhoid germ distributor’’—or healthy carrier—was announced to the members 2 of the Biological Society of Washington, D.C.∞ The theory that an apparently healthy person could transmit a communicable disease was al- ready under investigation in Europe and the United States, but the research was new and controversial.≤ No one had persuasively documented such an individual in the United States until an engineer in the U.S. Army Sanitary Corps known for his work on typhoid was called in to investigate a typhoid outbreak in a house on Long Island. He was Dr. George A. Soper, and the ‘‘carrier’’ he discovered was Mary Mallon, an Irish immigrant who worked as a cook for the family vacationing in the Long Island house and who would become infamous as ‘‘Typhoid Mary.’’ She would become the most invoked symbol of the dangerous carrier of communicable disease from that time into the present, as a result of the stories fashioned about her in the years following her identification. Soper was a masterful storyteller, and the early accounts of his discovery conspicuously present his epidemiological investigations as narratives of detection.≥ The details are convincing and conform to the expectations of the narrative. Having ruled out all other possibilities of transmission in the house and grounds, to which the disease had been confined, he became suspicious of a missing cook and set out to find Mary Mallon. Enlisting the help of the somewhat shady owner of the employment agency through which Mallon had found work, he discovered a trail of typhoid epidemics that tracked her through her domestic engagements. Here, he concluded, was the ‘‘fact’’ that could substantiate the hypothesis of the healthy carrier of typhoid. And he proceeded to locate and contact Mallon to inform her of her status as a ‘‘living culture tube and chronic typhoid germ producer.’’∂ Downloaded from http://read.dukeupress.edu/books/chapter-pdf/638352/9780822390572-003.pdf by HAVERFORD COLL/MAGILL LIB user on 10 September 2020 According to these accounts, Mallon dismayed the medical and public- health communities by her unwillingness to believe Soper’s hypothesis and submit to be tested for evidence of the typhoid bacillus. The child-hygiene pioneer Sara Josephine Baker, sent in her capacity as a public-health official to collect blood and urine specimens from Mallon, described her as ‘‘mania- cal in her integrity,’’ and Soper reported being stunned that he could not ‘‘count upon her cooperation in clearing up some of the mystery which surrounded her past. I hoped,’’ he explained, ‘‘that we might work out to- gether the complete history of the case and make suitable plans for the pro- tection of her associates in the future.’’∑ Public-health officials responded to Mallon’s recalcitrance by forcibly removing her to a contagious hospital, where they ordered the collection and evaluation of her bodily excretions. ‘‘It was her own bad behavior that inevitably led to her doom,’’ remarked Baker. ‘‘The hospital authorities treated her as kindly as possible, but she never learned to listen to reason.’’∏ Mallon’s 1909 legal appeal brought her plight to public attention, and she elicited a significant amount of public sympathy, but the court declared her a threat to public health and ordered her return to the Riverside Hospital on North Brother Island, off the east coast of Manhattan. A change in the administration of the department of public health resulted in her liberation the following year; she was ordered to give up her profession and to report regularly to the department of public health. But within two years of her release, Mary Mallon assumed an alias and disappeared. In the story Soper tells about his nemesis, this willful disobedience proved beyond doubt that she was the threat he had avowed her to be from the start. His version of her story dominated the newspaper accounts of her rediscovery in 1915, which depicted her as a public menace and ensured her enduring notoriety as ‘‘Typhoid Mary.’’ The story derives its power from its role in demonstrating an important scientific theory: the existence of a healthy human carrier of a communi- cable disease. The idea of the healthy carrier was based on the assumptions of the germ theory of disease—that specific microbes caused particular diseases—as well as on epidemiological observation. The identification of such individuals in turn supported that theory, which was still contested in the early twentieth century and shaped the direction of medical research and public health policies. For public-health workers, the healthy carrier was ‘‘not merely a passive transmitter of infection’’ but ‘‘also a breeding- ground and storehouse of these specific organisms’’ that offered ‘‘the best explanation for the maintenance of the infection in communities.’’π Healthy carriers mandated the role of experts, both in the laboratory and in the field, The Healthy Carrier 69 Downloaded from http://read.dukeupress.edu/books/chapter-pdf/638352/9780822390572-003.pdf by HAVERFORD COLL/MAGILL LIB user on 10 September 2020 who could make visible what most people could not see but which con- stituted a threat to their health and well-being: microbes and the means of their transmission. In the laboratory, ever-improving microscopes and staining techniques made it possible to identify and classify microbes. The identification of a healthy carrier, however, relied primarily on narrative evidence: the cre- ation of a compelling story about the etiology of a disease outbreak. The story had to turn theories—in this case, the discoveries of bacteriological research—into plausible explanations, and technical terms and concepts into the ‘‘truths’’ of lived experience. Turning the identification of a healthy carrier into a story was central to the development of epidemiology. The story explained how epidemiological investigation worked, as well as why it was so important. It transformed the threat of Mary Mallon, the healthy carrier, into ‘‘Typhoid Mary,’’ the symbol of epidemiological efficacy. The story of that transformation was the U.S. archetype, as well as the most sensationalist manifestation, of the healthy-carrier narrative. The story demonstrated, first, that she was a human vector of typhoid (that is, she was capable of transmitting without falling victim to the disease); second, that she posed a danger to the community; and, finally, that her isolation was justified. In so doing, it established the social as well as medical importance of epidemiology. The healthy human being turned pathogen called attention to the bodily interconnectedness of people living in and moving through the shared spaces of cities and of the nation. The story of Typhoid Mary helped to fashion the experience of those spaces, showing how the realization of those connections required new models of being in the world. It offered a medical basis for emergent ideas of social and political belonging, including a renovated sense of social responsibility in a time of growing individualism.∫ The impossibility of identifying all healthy carriers meant that all individuals had to change their behaviors and social interactions. Cleanliness became not only a solution but a measure of citizenship, for, as one writer intoned, ‘‘modern science has shown us that the environment which man makes for himself, the habit of life which he practices, determines his liability to the disease.’’Ω Conversely, the unfortunate metamorphosis represented by the carrier state raised a political dilemma that the story also addressed: the conflict arising from the state’s obligation to safeguard both civil liberties and public health and well-being. Weaving ideas about contagion into the fabric of social being, these public-health accounts introduced experts, such as the epidemiologist, who would serve a mediating role between citizens and the state. In so doing, they helped to facilitate a shift in scales of public- health initiatives from the local to the national. 70 The Healthy Carrier Downloaded from http://read.dukeupress.edu/books/chapter-pdf/638352/9780822390572-003.pdf by HAVERFORD COLL/MAGILL LIB user on 10 September 2020 The story of Typhoid Mary was actually a composite of accounts penned not only by Soper but also by lawyers, journalists, and members of the medical and public-health establishments. Despite its prototypical status, her story was not entirely unfamiliar. At the time Soper charged the cook with her carrier status, typhoid was endemic, prevalent to the point of national crisis, according to the medical and popular press of the time (which may partly account for the public fascination with this case), and each of the outbreaks had been investigated and evidently explained in some other way. Soper and his colleagues therefore had to demonstrate that Mallon’s connection to those outbreaks was causal rather than coinciden- tal. Soper had to create a persuasive narrative, and he did so not only through laboratory work and the epidemiological narrative of detection but also by borrowing the features of another, more familiar, story of contagion: the conventional melodramatic tale of venereal disease. Hints of venereal contagion permeated the accounts of the carrier cook, and they registered the power of that imagery at the turn of the twentieth century. Venereal disease evoked social as well as medical anxieties. From the medical to the popular press, religious treatises to popular fiction, dis- cussions of venereal disease addressed the transformations in the structure and function of families and the gender roles they reproduced that resulted from the pressures of urbanization and industrialization. These discussions typically worked to negotiate changes in familial and social structure by linking changing gender roles and sexual mores to the fate of the white race and therefore to the security of the nation.