Salmonella Typhi

1. Dr. Maliha Parvin
Typhoid Mary

2. Introduction
 Mary Mallon, also known as Typhoid Mary, was an
Irish-American cook. She was the first person in the
United States identified as an asymptomatic carrier of
the pathogen associated with typhoid fever. She was
considered to have caused at least 10 typhoid fever
outbreaks that included 51 cases and 3 deaths over
the course of her career as a cook.

4. Early life
 Mary Mallon was born in 1869 in Northern Ireland.
She migrated to the United States in 1883. She lived
with her aunt and uncle for a time.
 Like the majority of Irish immigrants at that time she
initially found work as a domestic servant. With time it
became apparent that she had a talent for cooking,
and around 1900 Mallon started to work as a cook for
affluent families in the New York City area.

5. Professional Life
 Between 1900 and 1907 she worked for several rich
families and a strange pattern developed that
wherever Mary worked people within the household
would develop typhoid fever. This was unusual as in
the early 1900s in the United States, typhoid fever
mainly affected poor urban communities, but these
households were affluent, and doctors practicing in
the area at the time were surprised by the
demographics of these cases.
 In the year 1906, Mary took a position in Oyster Bay,
Long Island, working for a wealthy banker called
Charles Warren and within two weeks 10 of the 11
family members were hospitalized with typhoid.
 She repeatedly changed her jobs after an outbreak
began. Mallon was subsequently hired by other
families, and outbreaks followed her.

6. The Investigation
 In late 1906, one family hired a typhoid researcher named
George Soper to investigate. Soper thoroughly
investigated and found that Mallon was involved in all of
the outbreaks.
 But Soper was unable to locate her because she generally
left after an outbreak began. He learned of an active
outbreak in a penthouse on Park Avenue and discovered
Mallon was the cook. Two of the household's servants
were hospitalized, and the daughter of the family died of
typhoid.
 When Soper approached Mallon about her possible role in
spreading typhoid, she adamantly rejected his request for
urine and stool samples. Since Mallon refused to give
samples, he decided to compile a five-year history of
Mallon's employment. Soper found that of the eight
families that hired Mallon as a cook, members of seven
claimed to have contracted typhoid fever.

7. First Quarantine (1907–1910)
 The New York City Health Department finally sent a physician
Sara Josephine Baker along with police forces to take her into
custody.
 Mallon attracted so much media attention that she was called
"Typhoid Mary" in a 1908 issue of the Journal of the American
Medical Association.
 In prison, Mallon admitted she did not understand the purpose of
hand-washing. Her stool and urine samples were found positive
for Salmonella typhi. Authorities suggested removing her
gallbladder, but she refused.
 Mallon was held in isolation for three years at a clinic located on
North Brother Island. Eventually the public health authorities
decided that Mallon could be freed if she agreed to stop working
as a cook. Finally Mallon agreed that she was prepared to
change her occupation. On February 19, 1910, She was
released from quarantine and returned to the mainland.

8. A newspaper illustration during her first imprisonment conveyed
the public’s morbid fascination with her: An aproned woman
casually drops miniature human skulls into a skillet, like eggs.

9. Second Quarantine (1915–1938)
 After several unsuccessful years of working as a
laundress, she changed her name to Mary Brown
and returned to her former occupation. For the next
five years, she worked in a number of kitchens;
wherever she worked, there were outbreaks of
typhoid.
 In 1915, Mallon started a major outbreak at Sloane
Hospital for Women in New York City. 25 people were
infected, and two died. She again left, but the police
were able to find and arrest her. After arresting her,
public health authorities returned her to quarantine.
She was still unwilling to have her gallbladder
removed.

10. Mary Mallon (Typhoid Mary) in her hospital
bed on North Brother Island, New York

11. Death
 Mallon spent the rest of her life in quarantine at the
Riverside Hospital. Six years before her death, she
was paralyzed by a stroke. On November 11, 1938,
she died of pneumonia at age 69. A post-mortem
found evidence of live typhoid bacteria in her
gallbladder. Mallon's body was cremated, and her
ashes were buried.

12. Legacy
 Among the infections Mallon caused, at least three deaths
were attributed to her; however, because of her use of
aliases and refusal to cooperate, the exact number is not
known. Some have estimated that she may have caused
50 fatalities.
 Although she harbored the extremely contagious bacteria
that cause typhoid fever, Mallon never demonstrated any
of its symptoms—which include fever, headaches and
diarrhea. Immune to the disease herself, Mallon was the
first asymptomatic typhoid carrier to be identified by
medical science, and there was no policy providing
guidelines for handling the situation. Public-health
authorities determined that permanent quarantine was the
only way to prevent Mallon from causing significant future
typhoid outbreaks.
 Today, "Typhoid Mary" is a colloquial term for anyone who,
knowingly or not, spreads disease or some other
undesirable thing.

13. Modern Medical Science
 In August 2013, researchers at the Stanford University
School of Medicine announced they were making
breakthroughs in understanding the exact science behind
asymptomatic carriers such as Mallon. The bacteria that
cause typhoid may hide in macrophages, a type of
immune cell.
 Individuals can develop typhoid fever after ingesting food
or water contaminated during handling by a human carrier.
The human carrier may be a healthy person who has
survived a previous episode of typhoid fever yet continues
to shed the associated bacteria, Salmonella typhi, in
feces and urine.
 Washing hands with soap before touching or preparing
food, washing dishes and utensils with soap and water,
and eating only cooked food are all ways to reduce the risk
of typhoid infection.

14. Carrier Status
 A carrier is an individual who harbors the organism
but is not infected as measured by serologic studies
(no evidence of an antibody response) or by evidence
of clinical illness. This person can still infect others,
although the infectivity is often lower than with other
infections. Carrier status may be of limited duration or
may be chronic, lasting for months or years. One of
the best-known examples of a long-term carrier was
Typhoid Mary, who carried Salmonella typhi the
causative organism of typhoid fever.

15. Reference
 https://en.wikipedia.org/wiki/Mary_Mallon
 https://www.history.com/news/10-things-you-may-not-
know-about-typhoid-mary
 https://www.pastmedicalhistory.co.uk/the-terrible-tale-
of-typhoid-mary/
 https://www.britannica.com/biography/Typhoid-Mary
 https://www.smithsonianmag.com/history/the-
frightening-legacy-of-typhoid-mary-180954324/
 Epidemiology by Leon Gordis (5th Edition)

16. Thank You