Dirty Hands

New York City was an early epicenter of the COVID-19 pandemic in the United States, largely due to its population density, which created ideal conditions for contagion. But 2020 was not the first year an epidemic visited New York. Eerie relics from past diseases may still be seen, if one knows where to look. In the middle of the East River, just between the Bronx and Rikers Island are two tiny islands, overgrown with vegetation, currently designated as bird sanctuaries. The larger island, North Brother, contains crumbling old buildings, now abandoned for over half a century, that played a role in the epidemiological history of New York. The twenty-acres of North Brother once contained hospitals and residences in which patients with highly communicable diseases were quarantined. One famous patient wrote to her lawyer in 1908, “I am not segregated with the typhoid patients—there is nobody on this island that has typhoid. There was never any effort by the Board authority to do anything for me excepting to cast me on the Island and keep me a prisoner without being sick or needing medical treatment.” The author of this letter was Mary Mallon, known in popular culture as “Typhoid Mary.”

In 1907, Dr. George A. Soper, an epidemiologist, was called in to investigate a sudden typhoid outbreak in the family of a New York banker, one General William Henry Warren. Mr. Warren had rented a house at Oyster Bay where he and his family of three and their seven servants stayed for the summer. Of the eleven people in that household, six contracted typhoid within days of each other, and the landlord was afraid he would never be able to rent the place again unless the mystery surrounding the disease’s source was solved. At the time when Dr. Soper investigated the Warren family, very little was known about how typhoid spread. Then current theories blamed it on contaminated water or milk, or rotting organic matter, or sewer gasses. But because of the odd pattern of outbreaks in this and other cases, Dr. Soper came to suspect that humans were somehow spreading the disease. Meticulous sleuthing narrowed the possibilities down to one person: Mary, the cook, who had left shortly after the first case of typhoid appeared in the household.

Dr. Soper uncovered Mary’s recent employment history through the agency that placed her. He discovered that in the previous few years, she had worked in several households that exhibited the same pattern. In Dr. Soper’s own words, “a well-to-do and socially prominent family, soon after moving from the city to the country for the summer, experienced an outbreak of typhoid fever. In no instance had its cause been satisfactorily explained. The cook always left soon afterward. She had never been suspected.”

We now know that typhoid is a type of salmonella, and is mostly spread through uncooked food contaminated by fecal matter. Mary, when she used the toilet, would apparently soil her hands and return to the kitchen without washing them. While the food she cooked was probably safe, the fresh fruits and vegetables were most likely not.

After Mary was captured, she was held against her will on North Brother Island, where she was housed in a private bungalow. She had a comfortable arrangement and freedom to move around the island, but still felt herself to be a prisoner. After almost three years, she was released with the promise that she would not work as a cook or handle the food of others, and also that she would check in with the Department of Health every three months. She kept none of these promises, and for five years eluded detection by changing her name and seeking work on her own, without going through the agencies that knew her. Among other places, she worked at a hotel, a restaurant, and a sanatorium. The number of people she infected during this time is unknown. She was eventually found and returned to North Brother, where she spent the final twenty-three years of her life.

Mary never believed she was an asymptomatic carrier of typhoid, for she never showed any symptoms of the disease herself. But stool samples repeatedly showed she continued to produce typhoid bacilli her whole life, most likely in her gallbladder. She maintained she had been falsely imprisoned, without ever having been tried or even accused of a crime. Her lawyer sued to get her released from quarantine, but the suit was thrown out, partly on the strength of Jacobson v. Massachusetts, 197 U.S. 11, in which Chief Justice Harlan wrote, “The liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good... The possession and enjoyment of all rights are subject to such reasonable conditions as may be deemed by the governing authority of the country essential to the safety, health, peace, good order and morals of the community.” In Mary Mallon’s case, the Department of Health took away her career and her freedom of movement for life, without a trial or even a hearing. But, in fact, all she had to do was wash her hands.

From the 2021 National Ethics Bowl. Prepared by

Robert Boyd Skipper: Chair, Case Preparation Committee
Robert A. Currie
Deni Elliott
Cynthia Jones
Heather Pease