Typhoid Mary Should Have Washed Her Hands
A simple task like washing your hands goes a long way in alleviating the spread of communicable diseases
Two weeks ago I wrote a blog about the flu, and now I have the flu!
It’s a direct correlation, right? Just like all those people who think they got the flu from the flu shot?
I’m a scientist. I know better than to assign causation so flippantly. As long as we’re talking about correlations let’s discuss one that is real—hand washing and disease prevention.
After years of reminding my kids to wash their hands, now I have to remind my flu-infected self, especially now when I am most contagious. And for the next week I must be extra cautious, since the flu can also be transmitted up to six feet through coughing and talking.
Typhoid Mary probably wouldn’t have shared my concerns. Mary did not wash her hands. As an asymptomatic carrier of potentially fatal Salmonella typhi, she kept working and infecting people even after she was told to stop.
NYC’s Mary Mallon was a cook who contaminated at least eight NY-area families who employed her in the early 1900s, disappearing after each outbreak. I can relate with her need to earn a living, to make a choice about careers and earning potential. And I empathize with the stigma she must have felt: she was not a microbiologist or an epidemiologist, and she did not understand why she was being targeted.
Scientists in the late 1800s had already determined that typhoid fever was caused by a microorganism. By the early 1900s, a dawn of an amazing time in science, medical doctors and investigators described the epidemiology of this outbreak in the Journal of American Medical Association, and they honed in and practically stalked Mary once they realized she was a likely carrier. She was not deterred and evaded capture from the police and public health authorities. When she was captured, police forced her to give stool samples, and committed her to a quarantine hospital housed on tiny North Brother Island in the Bronx. She protested and sued, and eventually a new commissioner set her free with the assurance she would not cook again.
We don’t know if Mary washed her hands but she certainly didn’t stop cooking. She changed her name and got a job at Sloane Maternity in Manhattan, where two of the 25 hospital staff that she contaminated died of typhoid fever within three months. Her ruse was discovered in 1910 and she was forced into quarantine isolation again at North Brother Island, her home until her death in 1932; the tabloid newspapers debated if it was a cruel punishment or a necessary measure. Knowing her unwillingness to cooperate I can imagine the authorities had no choice. Even today there are a dozen diseases that can legally cause you to be quarantined, like Ebola, SARS, and yes, any influenza outbreak that might trigger a pandemic.
Typhoid fever still affects over 26 million worldwide each year. At least one in six infected people are asymptomatic and do not realize they are carrying the microbe, which can hide and manipulate cell macrophages, normally on the front line attack. The majority of cases are preventable through use of safe water, adequate sanitation, vaccination, and, most sustainable of all, simple hygienic behavior, such as thorough hand washing with soap.
How many major epidemics could be quelled by following this simple rule? As I left the house today to pick up takeout (flu or no flu my teenagers require food) I thought about my movements. I used my sleeve to hold the door, handed money over carefully, and touched the bottoms of the cups. Influenza lasts up to 24 hours on surfaces. I really don’t know if I will prevent my kids from getting my flu, but I can certainly try.
So now that I have written a blog about typhoid fever, that means I might get typhoid fever, right? Ah, no, epidemiological data will not support that, but I think I will go wash my hands anyway…