Dr. Baker and Typhoid Mary

On International Women’s Day, I thought it was appropriate to write about the shared history of two women who have changed the world around them, each in her own way.

In 1906, a typhoid fever epidemic broke out in New York. It was caused by Mary Mallon (known later as “Typhoid Mary”), an asymptomatic carrier (a person who is infected, but does not suffer from any symptoms) of the pathogen associated with typhoid fever. She is presumed to have infected around 50 people (three of whom died) at the time when she was working as a cook.

In those days, people of lower socio-economic status, without access to information or education, were not aware of the importance of hygiene. Their cleaning habits were erratic. Furthermore, the living conditions for most of them were appalling, especially when children were involved. If a member of a large family got infected, in the first half of the 20th century, chances were that the bacteria would spread to the whole family. The danger was even higher for the community if the infected person worked in the food industry. Typhoid fever is transmitted by ingestion of food or drinks contaminated with the feces or urine of an infected person. The pathogen can be spread through poor hygiene habits, or poor public sanitation conditions.

Born in 1869 in Northern Ireland, Mary Mallon migrated to the USA around 1883. She lived with her aunt and uncle and worked as a private cook for seven families, initially between 1900 and 1907. It remains unclear when and where exactly she had contracted the pathogen. What is known is that within weeks of her employment, people started getting sick.

An investigation conducted by a sanitation engineer hired by one of the families, concluded that Mallon was the source of the typhoid outbreak, since she was the only link between all the families. In 1906, the New York City Health Department sent Dr. Baker to identify and locate Mary Mallon, and convince her to be quarantined.

Sara Josephine Baker was born in 1873. Her father, a lawyer, and her brother died of typhoid fever when she was sixteen. Motivated by the tragedy, Baker decided to become a physician. She joined the Woman’s Medical College of the New York Infirmary in 1894, which she graduated in 1898. After that, Baker did a year’s internship at the New England Hospital for Women and Children in Boston, where she became aware of the connection between poverty and ill health that would occupy her for the rest of her career. She opened a private practice in New York in 1899, but her income was still low, so in 1901 she also started working part-time as a medical inspector for the city. After she successfully brought Mary Mallon into quarantine, she was made assistant commissioner of health in 1907, working on a number of high-profile health issues including smallpox vaccination.

Mallon was put in isolation for almost three years, but was released in 1910 under the promise that she would return every three months. However, “Typhoid Mary” disappeared, returning to her old occupation as a cook, creating again outbreaks of typhoid. After more than five years, Dr. Baker located her once more. This time, the “patient zero” spent her days in quarantine until 1938, when she died of pneumonia. It must be said that Mallon was not the only typhoid-infected cook working in New York at that time. What made her unique was that she did not suffer from the symptoms of the disease and that she was the only patient who was placed in quarantine for the rest of her life.

Mary Mallon during her first quarantine (Source)

In 1908, two years after the typhoid epidemic, the permanent chlorination of drinking water became the first major step toward the control of the disease. In 1909, a vaccine was developed, further reducing typhoid as a significant cause for morbidity and mortality. Further advances in public sanitation and hygiene made the incidence of typhoid fever to be now around 5 cases per 1,000,000 people per year in developed countries.

Dr. Baker died of cancer in 1945, leaving a life and work that were dedicated mostly to public health and child hygiene, implementing several programs that would save countless lives: training mothers how to care for their babies (how to clothe infants to keep them from getting too hot, how to feed them a good diet, how to keep them from suffocating in their sleep, and how to keep them clean); inventing an infant formula; lowering infant blindness by designing special containers (silver nitrate was given to babies in their eyes so as to prevent blindness; the problem was that the bottles became unsanitary after a while); advocating the professional training of midwives, and many more. Her efforts were recognized during her lifetime, becoming director of the city’s Bureau of Child Hygiene. She became the first woman to be a professional representative to the League of Nations (a precursor to the United Nations) when she served on the Health Committee for the United States from 1922 to 1924. She was also active in the New York State Department of Health, and became the President of the American Medical Women’s Association. By the time Dr. Baker retired in 1923, New York had the lowest infant mortality rate of any major American city.

Dr. Sara Josephine Baker in 1922 (Source)

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