Typhoid Mary | Cook, Carrier, Captive | 3
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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 Malin 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 Malin. Thank you for taking the time to speak with me. Time? 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. 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 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. Yes, I can see that these are humble lodgings. 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 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.

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 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? Yes.

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

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.

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On June 20, 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 family 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. Seema Yasmin, Clinical Assistant Professor of Medicine at Stanford University and host of the podcast Our Big Shot. Our conversation is next.

Dr. Seema 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

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 U.S. that captures only about 150 to 450 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 Mallon were screened for illnesses when they came through, for instance, Ellis Island? About 70% of immigrants coming into the U.S. 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 U.S. 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, quote unquote, loathsome contagions.

but also for disabled people and what they called defected people. They wanted healthy migrants entering the U.S. 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.

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 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 Mellon, 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 seemed 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 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. 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're 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 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

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. 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?

Typhoid fever is an illness that's caused by a bacteria called Thalmonella enterica therobar typhi, or Thalmonella 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 enter cells of the immune system and is able 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 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.

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. Why do you think Mary Mallon was singled out? 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 fit

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 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 positive.

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.

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?

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 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. 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? I

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, 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...

It's 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. Twenty years ago, on July 7th, 2005, the 7-7 bombings rocked London.

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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?

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 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. What

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

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 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. Yes.

Tell us that story. What is flesh-eating 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 saying,

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. 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 five hours from Phoenix, Arizona into Window Rock,

to the Navajo Nation capital, 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 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 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 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 of this is

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. 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 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.

So it sounds like 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 and

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 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 U.S. 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?

I can. And of course, there's also a through line from the Navajo 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 Navajo Nation outbreak of flesh-eating bacteria, I had a

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 am 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. 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 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 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 U.S. 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 U.S.,

And things go completely wrong when she arrives at the Newark airport. 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. 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.

It speaks to the fact that Casey had done this incredible work, risking her own safety in Sierra Leone and come back and fall in 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

from her case? 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 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 three 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. It's your girl Kiki and if you haven't heard my podcast, baby, this is Kiki Palmer. You're missing out.

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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? 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 1915. We're still only about four 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 left.

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. 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 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. 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 handle it.

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

an 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, 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 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 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 per

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. 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 whose affluence

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

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 onto 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 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 Mallon'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 with this need to protect the public's health. We made grand mistakes in the case of Mary Mallon. Mary Mallon was a

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. Seema Yasmin, thank you so much for talking with me today on American History Tellers. Thank you, Lindsay. That was my conversation with Dr. Seema Yasmin, clinical assistant professor of medicine at Stanford University and host of the 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.

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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 Polly Stryker and Alita Rozanski. Our senior interview producer is Peter Arcuni. Managing producer, Desi Blalock.

Senior Managing Producer is Callum Plews. Senior Producer is Andy Herman. And Executive Producers are Jenny Lauer-Beckman, Marshall Louis, and Erin O'Flaherty for Wondering. We're counting down the days. July 4th weekend, Essence Festival of Culture, sponsored by Coca-Cola, returns to the city that raised the rhythm, New Orleans.

Four days, one community, endless joy. A Jill Scott John featuring Miss Patti LaBelle and Jasmine Sullivan. Maxwell, Babyface to Erykah Badu, the Isley Brothers to Boyz II Men, DeVito to Boojie Banton, Lurilla to Master P. We pay tribute to the legends, celebrate the icons, toast the disruptors, and honor all that makes us

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