Lecture One- Typhoid Mary

Biology 118 AIDS and Other Health Crises Instructors Professor Diane Spillane (dspill) Graduate Student Instructors Carrie Poon Sophia Ceulemans Wei Perng Kelly Ylitalo Aley Joseph Adina Al Hazzouri Issues for Discussion Biology of health and Disease Public Health and Public Policy Issues Infectious Disease Environmentally transmitted Sexually transmitted Subject Matter Typhoid Mary, Cholera, Tuberculosis, Plague, Influenza, Anthrax, Smallpox, Syphilis Kuru and Mad Cow Disease AIDS Expectations Background: none Ask questions To become literate in science Must understand some basic biology (Can antibiotics cure the flu? Why or why not?) Expectations-continued To be able to understand public health policy at a basic level and engage in sensible discussions about it in general and with regard to AIDS in particular To understand human behavior regarding infectious disease (as it is, not as it should be) Textbooks No text for lecture Required reading for discussion ?Deadly Feasts? by Richard Rhodes ?And the Band Played On? by Randy Shilts Waitlist Instructions Get on an electronic waitlist for a discussion section Show up next Tues. or Wed. and sign in We will arrange overrides for as many students as possible. We will follow waitlist order to fill slots Exams Four in class exams 2 week notice for special requests All will be non-comprehensive 25 points each (25 questions) January 29th February 19th March 24th April 21st Grading Policy Straight Scale 60-69 = D 70-79 = C 80-89 = B 90-100 = A Plus and Minus used Anything over 97 points = A+ Using CTools https://ctools.umich.edu/portal What?s there? Course Policies Lecture notes Announcements Sample exam questions/exam answers SAMS Link to seeing your grades Typhoid Mary An outbreak in Oyster BAY (summer,1906) Charles Warren, a New York Banker, rented a house for the summer 6 out of 11 members of the Warren household developed typhoid fever 3 family members and 3 staff affected Symptoms of typhoid fever Headache, malaise, high fever Constipation, sometimes diarrhea Rash on abdomen and trunk Enlarged spleen Sometimes delirium If untreated (in 1906 there was no treatment) By 4th week, symptoms subside Convalescence begins Fatal in about 10% of cases In the Oyster Bay breakout, all eventually recovered Out beak limited to people living in this house The landlord was afraid he wouldn?t be able to rent the house in the future This was a high class beach community Hired George Soper to find the source Ruled out all the usual sources Food, well water, barn Even clams from the bay Mary Mallon Suspected He traced her former employment (through the agency) An Irish immigrant, middle-aged woman Apparently a good cook Left household approximately 3 weeks after the outbreak 10 years, 8 families, 7 outbreaks of typhoid fever 22 infected, 1 died George Soper ?visits? Mary Mallon Believed Mary to be a healthy carrier Not sick herself, but shedding germs Would be first in U.S. if could confirm Mary was now (March 1907) working for a family on Park Avenue He appeared unannounced and tells her she is spreading typhoid fever He wants her to go to the hospital and give stool, urine, and blood sample Mary Mallon Apprehended Soper convinces the health dept. that Mary is likely carrier Hermann Biggs sends Josephine Baker who calls in the police Mary dragged away to the Willard parker Hospital and samples taken by force Typhoid bacilli (salmonella typhi) found in her stool Mary confined to North Brother Island George Soper and the Scientific View The germ theory is new Koch and Pasteur in the 1880?s and 1890?s No good treatment, some vaccination success Germs as targets Shift to individual health/depersonalization of disease Charles Chapin?s views Same or different Major policy issues It?s all so scientifically sound How could one not cooperate? Mary Mallon and the Public View She had never been sick Suggestion of ?unclean? an outrage Miasmas Unhealthy airs vs. germs Treatment Fresh air, good food, rest Sanitation becomes almost a moral crusade Some Issues The Boards of health and their new power Ethnicity Gender issues Boards of Health Since colonial days, but usually transient Enforcement of quarantine and sanitation Late 1800?s NYC Board granted board consideral powers Greater NY Charters Section 1169 ??use all reasonable means for ascertaining the existence and cause of disease..? Section 1170 ?..may remove to a proper place any person sick with any contagious, pestilential or infectious disease..? The Big Dilemma Protect health of public vs individual?s civil liberties Sick = contagious (yes) Infected = sick (?) Infected = contagious (?) Contagious = dangerous Ethnicity The ?dirty? Irish Working class Job options were few Class solidarity during her escape from Josephine Baker The stubborn Irish Was Mary thought of as a project to advance Soper?s career (not a person) Gender Prejudice Unmarried No man to control her Lived in apt. of a man Is she a rebel? Female Expect to act docile Not a breadwinner; no career During Mary?s Confinement Refused to have her gall bladder removed as a condition for release Took medication for a time;stopped due to side affects Not all doctors/public health officials agreed with her confinement There were other known carriers Mary?s Day in Court (1909) An Irish lawyer takes up her case Argued that she did not have due process and could not legally be held Her own laboratory?s tests conflicted with the health Depts. Many households were not infected The Media?s Contribution Publicity helps her, stressing no due process And demonizes her ?Typhoid Mary, the most dangerous woman in America.? Hearst might have been bankrolling the case (increase his paper?s circulation?) Missed Opportunities Never challenged ?carrier = sick? Never asked other public health experts Never asked how many other carriers there were Judge ordered her confined as a threat Agreed with public health officials Typical of the day Mary?s Release In 1910, a new health commissioner takes over (Lederle) Releases Mary after? Making her promise to check in regularly (they were already doing this with others!) Makes her agree not to work as a cook Health Department loses track of Mary after a few years Outbreak at Sloane Maternity Hospital January 1915, outbreak at hospital 25 ill, 2 die Mary had changed names, was again cooking Was returned to N. Brother Island Mary--1915 -1938 Remained on N. Brother Island for rest of her life (23 years) Was allowed some day trips into NYC Worked as a lab tech in the hospital Died November 11, 1938 (age 69) Net 47 cases, 3 deaths attributed to Mary Issues for Today Isolation as protection Identification and labeling Victimhood vs. blame Civil liberty vs. community protection Isolation as Protection Huge power in public health officer Care of sick vs protection Which is primary ?recent? case of man with TB traveling on a plane (2007) Cuban AIDS solution Identification and Labeling Not neutral Marginilized to start with Power relations Gaetan Dugas Victimhood vs. Blame Sufferer or scapegoat Alternatives: what if they retrained Mary? They did later on (on the island) Civil Liberty vs. Community Protection What should we isolate/who should we protect? Disease Moral corruption (pornography) Political threats (ideologies) Religious sects