Typhoid Mary | Cook, Carrier, Captive | American History Tellers

What this episode is about

The narrative centers on Mary Mallon, famously known as "Typhoid Mary," exploring her life as a carrier of typhoid fever and the ensuing isolation she faced on North Brother Island. Through an imagined interview with a reporter, the story delves into her experiences of being treated as a public health threat, highlighting the tension between her perceived role as a disease carrier and her assertions of being healthy.

Key takeaways

• In 1909, public health meant sacrificing individual freedom; how far have we really come since then?
• Mary Mallon's confinement reveals societal fears: contagion often clubs the innocent for the sake of the 'wealthy safe.'
• Typhoid Mary, a symbol of health hysteria, reminds us: blame often lands on the marginalized, not the system.
• With only 150-450 annual typhoid cases today, we ponder: what diseases still hide in the corners of society?
• Mary's story blurs truth and justice—are we protecting public health or executing social bias under the guise of safety?

Who speaks in this episode?

• Lindsey Graham (Host) · 16 min speaking
• Dr. Sema Yasmin (Guest) · 25 min speaking

What is discussed, and when

1. 0:00 – 5:00: Typhoid Mary, Mary Min, New York American, New York Supreme Court
2. 5:00 – 10:00: Mary Min, Dr. Sema Yasmin
3. 10:00 – 15:00: Mary Min
4. 15:00 – 20:00: Epidemic Intelligence Service, Mary Min, Navajo Nation
5. 20:00 – 25:00: Navajo Nation
6. 25:00 – 30:00: Epidemic Intelligence Service, Navajo Nation, Doctors Without Borders
7. 30:00 – 35:00: Mary Min
8. 35:00 – 40:00: Typhoid Mary, Mary Min, Dr. Sema Yasmin

Notable quotes from "Typhoid Mary | Cook, Carrier, Captive | American History Tellers"

• 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 Min.

  about Mary Min · at 0:21

• You can tell by the intensity in her voice, she means what she says. She intends to challenge her confinement.

  about Typhoid Mary · at 3:29

• 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 Min's…

  about Dr. Sema Yasmin · at 4:54

• Illness that's caused by a bacteria called Salmonella anterica thear ty or salmonella ty for short. And this bacteria, even once someone's been treated, which we now do have…

  about Salmonella enterica serotype Typhi · at 10:59

• Officer in the Epidemic Intelligence Service. What is that and what did you do for them? The Epidemic Intelligence Service is a CDC program that trains physicians veterinarians…

  about CDC · at 17:19

• 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…

  about Doctors Without Borders · at 27:42

• 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…

  about JAMA · at 37:12

Who and what is mentioned in this episode?

People

• Mary Min — Person · Historical subject / case study (Typhoid Mary) · 10 mentions · first at 0:27
  Central figure in the episode’s narrative about forced isolation, asymptomatic carriage, and public-health ethics; the transcript appears to refer to Typhoid Mary (Mary Mallon) but repeatedly renders the surname as “Min/Melon.”
• Dr. Sema Yasmin — Person · Main guest (expert interviewee) · 2 mentions · first at 5:08
  Provides expert commentary connecting Mary Mallon’s case to modern public health practice, ethics, quarantine vs. isolation, and her own outbreak-investigation experience (CDC EIS, Navajo Nation, Ebola-era policy).

Companies & orgs

• CDC — Company · Case study · 4 mentions
  Mentioned as the organization behind the Epidemic Intelligence Service, playing a crucial role in public health.
• New York American — Company · Case study · 2 mentions · first at 0:15
  Mentioned as the newspaper that published the interview with Mary Min, playing a key role in publicizing her story.
  On June 20th, 1909, the New York American newspaper published an interview with Mary Min describing her forced isolation on North Brother Island. The Sunday edition reached.
• Doctors Without Borders — Company · Case study · 1 mention · first at 27:47
  Mentioned in the context of Casey Hickox's medical mission, highlighting international public health efforts.
• JAMA — Company · Case study · 2 mentions
  Mentioned as the journal that published the term 'Typhoid Mary', highlighting its role in medical literature.

Concepts & topics

• Typhoid Mary — Concept · Core topic · 7 mentions · first at 0:51
  Central figure in the episode, discussing her forced isolation and the public health implications of asymptomatic carriers.
• Epidemic Intelligence Service — Concept · Key argument · 5 mentions · first at 17:19
  Discussed as a CDC program that trains disease detectives, highlighting its role in public health investigations.
  Officer in the Epidemic Intelligence Service. What is that and what did you do for them? The Epidemic Intelligence Service is a CDC program that trains physicians veterinarians…
• Salmonella enterica serotype Typhi — Concept · Key argument · 3 mentions
  Discussed as the bacteria causing typhoid fever, central to understanding Mary Min's condition.

Places & events

• Navajo Nation — Place · Setting · 6 mentions · first at 19:11
  Discussed as the location of a flesh-eating bacteria outbreak investigation, highlighting public health challenges in sovereign nations.
  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 US to…
• New York Supreme Court — Place · Setting · 1 mention · first at 4:58
  Mentioned as the venue where Mary Min challenged her confinement, highlighting legal aspects of public health.
  Accused of spreading disease and misery to the unsuspecting family she worked for through her cooking. Later that month, Min would legally challenge her situation and with the…

Full transcript with timestamps

0:01 Wonder. 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 Min. As you step into the one room cottage where Min has been isolated, you spot her seated in a wooden chair by the window. Tall with thick blonde hair, you're surprised to find she looks perfectly healthy. Good afternoon, Miss Melon. Thank you for taking the time to speak with me. Time? Huh? That seems to be all I have these days. They've taken everything else from me. 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.

1:03 I'm sorry. I didn't mean to. I know. I know. You're relieved to see her expression soften and she gestures for you to take a seat. 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. Well, you can see for yourself how I'm being treated cooped up in this cottage. You take a moment to glance around the room. It's a cramped space, no larger than 20 ftx 20 ft, with a wooden dresser, a small desk, and a window looking out onto an elm tree. Beyond that, you can see the wararf where you arrived on the ferry earlier today. Yes, I can see that these are humble lodgings.

1:43 She just stares at you with her piercing blue eyes. So, you decide to change the subject. Maybe we could start with your arrival here on the island. How did you find it when you first came here? When I was first brought here over 2 years ago, I was terrified, alone, and confused. They immediately set about putting me through tests, poking and proddding me like a mule. They even tried to get me to undergo surgery. H what kind of surgery? 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. Have they administered any medications? Yes, but their effects were so severe, I refused to continue taking them. They were going to be the death of me. 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

2:37 they would prevent you from infecting others with such a terrible disease. They're liars. I'm not infecting anyone. The doctors say you most certainly are, and that you're here in order to keep the public safe. 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 2 years without any say in the matter. But that's all going to change soon. What do you mean? 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.

3:27 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

4:03 from Wondery. I'm Lindsey Graham and this is American History Tellers. Our history, your story. On June 20th, 1909, the New York American newspaper published an interview with Mary Min 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 family she worked for through her cooking. Later that month, Min 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 Min's isolation and the ways in which her treatment and the early 20th century informs the approach to public health today is Dr. Sema Yasmin, clinical assistant professor of medicine

5:12 at Stanford University and host of the podcast our big shot. Our conversation is next. Dr. Sema Yasmin, welcome to American History Tellers. Great to be here with you, Lindsay. So, we don't often hear about typhoid outbreaks today, but how prevalent was typhoid in the early 1900s? 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

6:16 cases of typhoid every year. Very, very different situation to what we were seeing in New York City in the early 1900s. Of course, this sort of screening or surveillance was not present at this time. What can you say about how immigrants like Mary Malin were screened for illnesses when they came through, for instance, Ellis Island? 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 proddding 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 quote unquote loathsome contagions, but also for disabled people and what they called defected people. They wanted healthy

7:18 migrants entering the US. 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 diagnosis. 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. 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? 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

8:16 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 Malon, the subject of our conversation, ended up at one point. You mentioned that there are other islands. I assume that they were employed as well. 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. 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. These locations felt purposefully isolated and desolate and people didn't want to work with these

9:10 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 TV patients at one of these New York City quarantine hospitals. The hospital was called Seue 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. 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? 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

10:06 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, hey, you can't go about your regular business. I am going to restrict your movement even though you feel okay.

10:45 And this brings us neatly back to Mary Min. 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? Typhoid fever is an illness that's caused by a bacteria called Salmonella anterica thear ty or salmonella ty 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 and is able

11:43 to trick it into allowing the microbe to make a home inside the body of someone who feels perfectly fine. So even today our understanding of this mechanism is incomplete. What did health and sanitation authorities know then about asymptomatic carriers? very very little. And I think that this lack of understanding and some misinformation about asymptomatic carriers contributed to Mary Min'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 six% of people who recover from typhoid carry it as an asymptomatic person. But at that time when Mary Malin was discovered to be a carrier, there were other people in New York City who also came to be discovered as being carriers.

12:40 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 Malin 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 Melon came to be detained while other people who were carriers like her didn't have their movement restricted at all. Why do you think Mary Min was singled out? Disease is never just about the microbe itself.

13:18 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 Malin 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. She lived in a tenement building and all of these things counted against her. Do you think any of Mary's actual behavior or reluctance to cooperate also contributed to her treatment? Potentially. Mary really went at it with the public health authorities. There's a famous scene

14:18 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°. 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.

14:52 Mary had none of that. 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 okayish because you know surgery 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? 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? It can be removed and every

15:43 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 Malin 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. So, was this the choice in front of Mary Min then? She vehemently denied that she had the disease or could spread the disease, but was given perhaps a choice.

16:20 Isolation on North Brother Island or perhaps a fatal surgery. And what kind of choice is that? And I think about that a lot as a physician and 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.

17:12 We'll return to the case of Mary Malin 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? 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 US 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 and to save so many lives when diseases are spreading. Let's dig into uh the term disease detective. Are you literally burning up shoe leather on the street?

18:15 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 sole 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 in toilets trying to see what pathogen had spread to make people sick. 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 What

19:16 is flesheating bacteria and what were you asked to do? 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 colloally we call flesh eating bacteria. The proper name for it is group A invasive streptococcus.

19:50 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. 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 onto the reservation and assist you?" Eventually, we do get an agreement together. And I remember driving about 5 hours from Phoenix, Arizona into Window Rock to the

20:41 Navajo Nation Capitol, meeting the tribal leaders and the public health officials 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?" So, how did you get people to talk to you on a Native American reservation where there's a a healthy distrust of government? 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

21:34 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. Well, how did you get to the heart of the outbreak? We had been given information about people who were sick, so the cases, and about the index patient, 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 doortodoor, we are trying to find our patient zero, the

22:27 first person who became infected and became sick. And we start to get hints, Lindsay, about who this was. We're told it's a woman. We're told that she's unhoused. We're told that she has substance misuse issues, that she often hangs out outside of 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.

23:11 So it sounds like uh this was detective work and diplomacy. How did this episode on the Navajo Nation affect you personally? It reminded me that when we train as scientists, 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 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. So

24:13 flesheating 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 own 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? I can. And of course, there's also a throughine from the Navajo Nation investigation to me then being a journalist, which was never in the plan, in Dallas when Ebola arrived in Dallas.

24:53 So what had happened during that Navajo 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 Navajo translator were going home to home on the Navajo 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, 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.

25:51 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. 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

26:44 don't have running water? Is it just my ignorance? I had all these questions. And it was actually 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 2014 and I start getting these texts from the nurse who became famous, Casey Hickox. Casey and I were

27:36 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 Newick airport. She makes front page news because Casey is detained at Newwork, 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

28:36 misunderstanding of the science and so much fear at the height of an epidemic and Casey became a casualty of that situation. There was even a nickname given to her, something familiar to people who've been listening to this series. Uh it wasn't Tywood Mary but Ebola Casey. 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. 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? It demonstrated for a lot of people that science and public health do not operate or exist in a vacuum.

29:31 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 to us 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 3 days during 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.

30:40 So returning to Mary Min, she spent 3 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 3 to five people died from Mary spreading typhoid over the years. As a doctor, how do you think about what she did? 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.

31:23 It's 1915. We're still only about 4 years into having a vaccine against typhoid. It's not widely available and it won't be until 1948 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, 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

32:24 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. So because Mary Min 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 1938. When you think about this case, I guess what do you see as the balance between individual freedom and the greater public good? I think about the context in which all of this happened.

32:56 So, we're talking initially the summer of 1906. 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 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

33:57 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, they were so agrieved that this could happen to them that they had hired a very enthusiastic sanitation worker, not a public health worker, sanitation worker called George Soer, 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 that I have studied on this is that George Soaper wanted to protect the health and well-being 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. So, we're often making difficult decisions to treat or not to treat, to isolate, to

34:53 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. 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? We have laws on the books that allow us to take away someone's ability to live freely.

35:48 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 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

36:49 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 Malin was. So what is your ultimate judgment then on the medical establishment and their treatment of Mary Malin? 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, JAMAMA, 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,

37:46 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 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. 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 Min's case? Why is she still relevant today? Why do we talk about her? Public health is difficult to get right. You are balancing the freedoms and the rights of an individual

38:45 with this need to protect the public's health. We made grand mistakes in the case of Mary Malin. 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. 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. Sema Yasmin, thank you so much for talking with me today on American History Tellers. Thank you, Lindsay. That was my conversation with Dr. Sema Yasmin, clinical assistant professor of medicine at Stanford University and host of the

39:45 Our Big Shot podcast 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.

40:22 American History Tellers is hosted, edited, and executive produced by me, Lindsey Graham for Airship. Sound design by Molly Bach. Supervising sound designer is Matthew Filler. Music by Thrum. Additional writing by Dorian Marina. This episode was produced by Paulie Striker and Alita Rosanski. Our senior interview producer is Peter Aruni. Managing producer Desi Bllock. Senior managing producer is Callum Plus. Senior producer is Andy Herman and executive producers are Jenny Lowry Beckman, Marshall Louie and Aaron Olity for Wondering.

Questions about this episode

Who speaks in "Typhoid Mary | Cook, Carrier, Captive | American History Tellers"?

Lindsey Graham (Host), Dr. Sema Yasmin (Guest).

What is "Typhoid Mary | Cook, Carrier, Captive | American History Tellers" about?

The narrative centers on Mary Mallon, famously known as "Typhoid Mary," exploring her life as a carrier of typhoid fever and the ensuing isolation she faced on North Brother Island. Through an imagined interview with a reporter, the story delves into her experiences of being treated as a public health threat, highlighting the tension between her perceived role as a disease carrier and her…

What is mentioned in this American History Tellers episode?

11 people, works and ideas are mentioned, including Mary Min, Typhoid Mary, Dr. Sema Yasmin, CDC, Epidemic Intelligence Service, Salmonella enterica serotype Typhi. Each one on this page links to its own page with every episode that mentions it.

How long is "Typhoid Mary | Cook, Carrier, Captive | American History Tellers"?

The episode runs 41 min; the transcript is about 6,788 words in 47 timestamped sections.

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