Miami Herald - October 12, 2004
Glenn Garvin, ggarvinherald.com

It's easy enough to sneer at Fidel Castro's quarantine camps for AIDS victims, and most of us do. But tweak your imagination a little bit: Make the disease more highly contagious, more easily spread, completely untreatable, and then move it to the United States. What would we do? Or don't bother to imagine -- just watch The Most Dangerous Woman in America, a reminder that modern medicine cannot cure ethical dilemmas.

An episode of PBS' popular science program Nova, The Most Dangerous Woman in America recounts the story of Typhoid Mary -- a cook in New York City in the early 1900s who carried the typhoid germ.

Though never ill herself, she infected 49 people, three fatally, before city authorities quarantined her on an island in the Hudson River, where she spent the last two decades of her life.

The Most Dangerous Woman in America starts out as a stirring detective story as freelance epidemiologist George Soper tries to track down the source of a typhoid outbreak on Long Island that infected six members of the same household.

He soon discovered that the cook, a pretty 38-year-old woman named Mary Mallon, had worked for eight families in 10 years. Six of them fell victim to typhoid. Soper approached her to collect blood and stool samples to see if she could be carrying the disease.

"I supposed she would be glad to know the truth," he would later recall.

Instead, she threatened him with a meat fork. It eventually took five cops to drag Mallon to a paddy wagon, where a public health inspector had to sit on top of her all the way to the hospital. Tests confirmed his suspicions that Mallon was "a human culture tube" for typhoid and -- without trial or any other due process of law -- Mallon was locked up.

As this documentary makes clear, there was more than a touch of class warfare in the way New York City's health authorities handled Mallon. They would eventually discover scores of other typhoid carriers, but only Mallon -- a stubborn Irish immigrant who made clear her contempt for the technocratic elite -- was quarantined.

But their heavy-handed approach didn't look so bad when, after she was freed by public outrage whipped by up the Hearst newspapers, Mallon got a job as a hospital cook and promptly infected more than two dozen new victims. There were no complaints when Mallon was sent into an internal exile again, this time for good.

Typhoid was an incurable killer in 1906, when Mallon first came to the attention of authorities. Today it has been nearly extinguished by vaccines and antibiotics, and concern about typhoid epidemics in the United States may seem quaint.

Yet, if a disease like Ebola or SARS were to get loose here, the issues raised by the case of Typhoid Mary would be anything but antique.

"It is the prime dilemma of public health," says one of the medical experts in The Most Dangerous Woman in America. "How do you protect the health of the masses of the people if it is jeopardized by an individual whose liberty you are thinking of taking away?"

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