Afterword

The Conquest of Typhoid

George A. Soper, the man who saved both Galveston, Texas, and Ithaca, New York, is fated never to be remembered for those achievements as much as he is for identifying and capturing the woman who came to be known as Typhoid Mary.

Mary Mallon was a typhoid carrier, little different from other typhoid carriers except that she refused to limit her opportunities to infect other people. Mary was a cook, quite a good one according to legend, and was employed in fine homes up and down the Eastern Seaboard, especially in the New York metropolitan area. Soper was hired in 1906 by George Thompson, who owned a summer rental house in Oyster Bay, Long Island, where six people in the household of eleven had become ill with typhoid. Worried that he would never be able to rent it again, Thompson asked Soper to investigate the causes of the outbreak.

In a 1939 letter to the British Medical Journal in London, Soper said that the techniques he used to identify and find Typhoid Mary were “an outcome of my work for the control of the epidemic of over 1,300 cases of typhoid at Ithaca, N.Y., in 1903, where I had seen typhoid spread from person to person and initiated energetic measures to prevent it.” Once he learned that the hiring of Mary Mallon as the cook for the house coincided with the start of the epidemic, he began following her trail. “It was a difficult investigation, partly because I was not called for more than six months after the outbreak and the people had become separated and the house vacated. The cook (Miss Mallon) could not be found for some months and then proved most refractory.”1 One definition of that last word is “obstinately resistant to authority or control.” Mary was all that and more.

Other authors have explored the Typhoid Mary story in great depth, so we need not replicate their work here. Her importance is as an advertisement for the danger of typhoid carriers. While few people in America knew exactly what a typhoid carrier was before her detention (among them Soper, who thought that only the carrier’s urine could spread the disease), through the magic of newspapers, the reality of typhoid carriers who spread their germs through both urine and feces became known.

The odd thing about Typhoid Mary is that she came to be widely blamed for the Ithaca epidemic even though she had absolutely nothing to do with it. This belief got started because there appeared to be a gap in her work history around the time of the Ithaca tragedy. But the only way Mary could have triggered the epidemic was if she had traveled to Ithaca and for some reason walked out into the bush to defecate on the banks of Six Mile Creek. The chances of that having happened seem decidedly remote. Even if for some reason she had decided to stop cooking in fine homes or institutions to sling hash in a rough immigrant work camp, the worst she could have done would be to infect some of the workers. Chances are the sick workers would have been sent away before they could take their own trip to the bank of the stream.

Yet this zombie story has made its way through the entire twentieth century and into the twenty-first, even finding its way into medical textbooks. Recitations of this myth can be found in the Bismarck Tribune of North Dakota on March 20, 1925, the Fresno Bee of Nov. 7, 1960, and the Van Nuys News of California on June 29, 1961. The newspapers can often blame syndicated columns and wire stories that they use without rechecking the information, but how about medical book publishers? The Mary Myth is found in Dr. Charles E. Simon’s Human Infection Carriers: Their Significance, Recognition and Management, published in 1919; R. L. Huckstep’s Typhoid Fever and Other Salmonella Infections, published in 1962; and Microbiology for Surgical Technologists by Paul Price and Kevin B. Frey, published in 2003. There are undoubtedly other examples. It is more comical than serious, perhaps only to be stamped out with better editing.

The greatest advances against typhoid early in the twentieth century came from better sanitation and cleaner water, especially after chlorine began to be used to kill germs in drinking water around 1909. The first usage, a dramatic success, was in Jersey City, New Jersey, and it spread rapidly after that. In the last years prior to chlorine, the average typhoid death rate in the United States was about 25 per 100,000, similar to the death rate from motor vehicle accidents now. By 1920, the death rate was down to about 8 per 100,000, and by 1948, to an almost imperceptible level.2

That was good, but still no cure for typhoid existed once you caught the disease. And outside of the developed world, typhoid remained endemic. In 1948, Paul Burkholder, a Yale University scientist, discovered a mold-like organism called an actinomycete in a soil sample that arrived from Venezuela. He was being funded by Parke, Davis & Company of Detroit, Michigan, to search for new antibiotics in soil samples from around the world. Actinomycete, later renamed chloramphenicol, proved effective against typhus, scrub typhus, and typhoid fever itself. Dr. Eugene Payne of Parke, Davis took a small amount with him on a trip to Bolivia and working with two Bolivian physicians, tried it on sixteen patients who were near death from typhus. All recovered.3 At the end of 1948, Dr. Perrin Long, professor of preventive medicine at Johns Hopkins University, disclosed that chloramphenicol, now carrying the trade name of chloromycetin, had brought dramatic cures to ten typhoid patients at the University of Maryland Hospital.

Tests conducted by a team led by Theodore E. Woodward found that typical typhoid patients showed dramatic improvement beginning on the third or fourth day of treatment. Fever declined, the classic rose spots disappeared, and headaches became less painful. In one dramatic case, where perforation and bleeding had begun, chloromycetin eventually saved the man’s life without doctors having to resort to surgery. The body healed the perforation.

The next step was to synthesize chloromycetin so it did not have to be made directly from the actinomycete organism. That was achieved by Dr. Mildred Rebstock, a twenty-eight-year-old chemist on the Parke, Davis staff. The final step was to produce the synthesized drug in industrial quantities of consistent quality, and Parke, Davis assigned that task to its production facility in Holland, Michigan.4 The author’s father, who was a young chemist working on the project, described it as complex, difficult work, but ultimately successful. “We essentially had to trick nature,” Paul W. DeKok remembered. It was a heady time to be a chemist.

Chloromycetin became a big seller for Parke, Davis & Company but eventually fell out of favor because of potentially serious side effects, including deafness or even death. Other drugs, including ciprofloxacin, are more common treatments for typhoid now. There are no outbreaks in America anymore like the one in Ithaca in 1903. Typhoid is worrisome only for those Americans who travel to Third World countries, but even then they have the comfort of knowing that their chances for a quick recovery are high if they are so unlucky as to catch the disease.