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THE LANCET
The legacy of Typhoid Mary social expectations and prejudices. She cites similar cases of healthy typhoid carriers employed as food handlers who J M Leavitt. Boston, MA: Beacon Press. 1996. Pp 331. were given alternatives to isolation, $25. ISBN 0-9070-2102-4. including job re-training. These men, who were financially supporting fami“Before god and in the eyes of decent The ascendency of the new science was lies, were viewed as less dangerous to men, my name is Mary Mallon. I was underscored by Mary Mallon’s court the public than a lower-class, single, christened and baptised Mary Mallon. I hearing, in which her positive laboratofemale Irish immigrant. Furthermore, lived a decent, upright life under the ry cultures formed the central argument her angry and uncooperative behavname of Mary Mallon until I was seized. in the health department’s case. The iour—when apprehended by public(Then I was) locked up in a pest-house judge viewed these reports as incontrohealth officials, she came out “fighting and rechristened ‘Typhoid Mary’, the vertible evidence that she was dangername by which the world has ever since and swearing”—may have led officials ous to society, and denied her release known me.” to conclude that rehabilitation was from isolation. Repeat intermittent posimpossible. itive cultures over the years were used Mary Mallon’s example raises issues his is the story of Mary Mallon, as evidence to continue her isolation. with which we continue to struggle durthe first healthy typhoid carrier The legal basis by which the health ing this era of AIDS and resurgent to be traced in North America. tuberculosis. How do we protect the department could quarantine ill Believing that she threatened the health public’s health when it is threatened by patients with communicable diseases of those around her, New York City an individual, without infringing on that such as smallpox was already estabhealth officials arrested her in 1907, individual’s civil liberties? Detention is lished by the early twentieth century. and again in 1915, forcibly isolating her still used as a strategy of for a total of 26 years. last resort after a series Judith Walzer Leavitt of less restrictive meahas written an insightful sures have been analysis of the scientific, attempted. However, social, and political there have been marked forces that shaped the changes in public health public-health response to policy in New York Mallon’s identification. City. In 1993, faced Her points are meticuwith an epidemic lously documented; the of multidrug-resistant chapter notes themselves tuberculosis, the New make fascinating readYork City Health Code ing. This excellent book was amended to permit should appeal to a broad detention of patients readership of publicwith tuberculosis who health practitioners, were non-adherent to social historians, and treatment until cured. others interested in the New due-process safeinteraction of science guards were added and societal values. including more freLeavitt begins by sumquent, regular court marising the facts, then review of the detention reviews the story from This coloured scanning electronmicrograph shows lamellae from order, avoiding the different perspectives— fractured bone in crystal formation. The crystals have been colour indefinite isolation Mary from Mallon’s personal coded according to their maturity. In unfractured bone, the lamellae Mallon experienced. account of her incarcerawould be arranged in concentric circles around the Haversian canals, Furthermore, the health tion to epidemiological with the more mature lammellae on the outside. This micrograph code was amended only and legal analyses of the (magnification⫻1770; Pietro Motta) is one of 116 images of all parts after much consultation events. The disadvantage of the human body in Inside Information—imaging the human body. and comment by legal, of this format is that it William A Ewing. London: Thames and Hudson. 1996. Pp128. medical, and communimakes the text repeti£12.95. ISBN 0-500-27881-4. ty organisations. tious because many of The primary mission these perspectives overof health departments is lap. However, the perto protect the public’s health. In develHowever, Mallon’s case raised the spectives also diverge, making the point oping health policies to deal with old question of whether forcible quaranthat there is no single truth to this and new, emerging pathogens we can tines could be extended to healthy peostory. benefit from the contribution The first chapters place the story in ple, and whether such people could be of numerous perspectives, including the context of the then new science of isolated indefinitely. Although her historical ones. bacteriology. New laboratory techlawyer argued that her constitutional niques to identify micro-organisms, right to due process had been violated, including typhoid bacilli, enabled the court confirmed the health departhealth officials to identify individuals ment’s authority to protect the Rosalind Carter who, while healthy themselves, were public. Bureau of Communicable Disease, shadding infectious agents, and thus Leavitt argues that Mary Mallon’s Department of Health, 125 Worth Street, were a “menace to the public health”. harsh treatment was also the result of New York, NY 10013, USA Typhoid Mary Captive to the public’s health
T
Vol 349 • March 8, 1997
739
The legacy of Typhoid Mary social expectations and prejudices. She cites similar cases of healthy typhoid carriers employed as food handlers who J M Leavitt. Boston, MA: Beacon Press. 1996. Pp 331. were given alternatives to isolation, $25. ISBN 0-9070-2102-4. including job re-training. These men, who were financially supporting fami“Before god and in the eyes of decent The ascendency of the new science was lies, were viewed as less dangerous to men, my name is Mary Mallon. I was underscored by Mary Mallon’s court the public than a lower-class, single, christened and baptised Mary Mallon. I hearing, in which her positive laboratofemale Irish immigrant. Furthermore, lived a decent, upright life under the ry cultures formed the central argument her angry and uncooperative behavname of Mary Mallon until I was seized. in the health department’s case. The iour—when apprehended by public(Then I was) locked up in a pest-house judge viewed these reports as incontrohealth officials, she came out “fighting and rechristened ‘Typhoid Mary’, the vertible evidence that she was dangername by which the world has ever since and swearing”—may have led officials ous to society, and denied her release known me.” to conclude that rehabilitation was from isolation. Repeat intermittent posimpossible. itive cultures over the years were used Mary Mallon’s example raises issues his is the story of Mary Mallon, as evidence to continue her isolation. with which we continue to struggle durthe first healthy typhoid carrier The legal basis by which the health ing this era of AIDS and resurgent to be traced in North America. tuberculosis. How do we protect the department could quarantine ill Believing that she threatened the health public’s health when it is threatened by patients with communicable diseases of those around her, New York City an individual, without infringing on that such as smallpox was already estabhealth officials arrested her in 1907, individual’s civil liberties? Detention is lished by the early twentieth century. and again in 1915, forcibly isolating her still used as a strategy of for a total of 26 years. last resort after a series Judith Walzer Leavitt of less restrictive meahas written an insightful sures have been analysis of the scientific, attempted. However, social, and political there have been marked forces that shaped the changes in public health public-health response to policy in New York Mallon’s identification. City. In 1993, faced Her points are meticuwith an epidemic lously documented; the of multidrug-resistant chapter notes themselves tuberculosis, the New make fascinating readYork City Health Code ing. This excellent book was amended to permit should appeal to a broad detention of patients readership of publicwith tuberculosis who health practitioners, were non-adherent to social historians, and treatment until cured. others interested in the New due-process safeinteraction of science guards were added and societal values. including more freLeavitt begins by sumquent, regular court marising the facts, then review of the detention reviews the story from This coloured scanning electronmicrograph shows lamellae from order, avoiding the different perspectives— fractured bone in crystal formation. The crystals have been colour indefinite isolation Mary from Mallon’s personal coded according to their maturity. In unfractured bone, the lamellae Mallon experienced. account of her incarcerawould be arranged in concentric circles around the Haversian canals, Furthermore, the health tion to epidemiological with the more mature lammellae on the outside. This micrograph code was amended only and legal analyses of the (magnification⫻1770; Pietro Motta) is one of 116 images of all parts after much consultation events. The disadvantage of the human body in Inside Information—imaging the human body. and comment by legal, of this format is that it William A Ewing. London: Thames and Hudson. 1996. Pp128. medical, and communimakes the text repeti£12.95. ISBN 0-500-27881-4. ty organisations. tious because many of The primary mission these perspectives overof health departments is lap. However, the perto protect the public’s health. In develHowever, Mallon’s case raised the spectives also diverge, making the point oping health policies to deal with old question of whether forcible quaranthat there is no single truth to this and new, emerging pathogens we can tines could be extended to healthy peostory. benefit from the contribution The first chapters place the story in ple, and whether such people could be of numerous perspectives, including the context of the then new science of isolated indefinitely. Although her historical ones. bacteriology. New laboratory techlawyer argued that her constitutional niques to identify micro-organisms, right to due process had been violated, including typhoid bacilli, enabled the court confirmed the health departhealth officials to identify individuals ment’s authority to protect the Rosalind Carter who, while healthy themselves, were public. Bureau of Communicable Disease, shadding infectious agents, and thus Leavitt argues that Mary Mallon’s Department of Health, 125 Worth Street, were a “menace to the public health”. harsh treatment was also the result of New York, NY 10013, USA Typhoid Mary Captive to the public’s health
T
Vol 349 • March 8, 1997
739