History of Medicine: Mary Mallon’s Case Influence

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The development of early medicine derived from conflict between traditional practice and scientific discoveries. The lack of adequate understanding of how doctors conducted their practice led to conflict with social institutions. Using Mallon’s case, the study shows a disconnect in understanding medical science by social institutions. Revolutionists faulted the claims of early physicians on the premise that they adopted scientific processes to advance their profession rather than help the sick. The physicians, on the other hand, pursued the scientific application of knowledge and failed to connect it to clinical practice. The scenario led to outrage about the decision to isolate Mallon as a preventive measure for typhoid. The medical discoveries of the early 20th century failed to gain traction in society because of the disconnect between medical practice and social institutions.

Mary Mallon’s case raised critical concerns about the application of scientific knowledge to the management of diseases. Whereas women felt that the decision to isolate her was based on her carrier status for typhoid, other parties drew attention to her social status as a domestic servant and ethnicity. In 1990, the court decided the isolation of Mary Mallon on North Brother Island under the care of the health department because she was a health hazard to members of the society. Although Mary was healthy, new biotechnological advances had established that she was a carrier of the disease. However, the debates that emanated from the case raised issues about medical practice and its connection with social and cultural expectations. In her status as a woman, the legal and health practitioners envisioned her as a spreader of the disease because she was a woman. Analysts focused on Mary’s career as a source of her isolation, observing that perhaps she could not have suffered the fate if she had embraced a different career. The challenges of early medicine touched on societal perceptions about the relationship between the doctor and the patient. According to Warner, ethicists in society disputed the notion of advanced research in preventive medicine and quality of care. Some clinicians raised their objections to these innovations and averred that good health was a factor of a good diet. The societal conflicts surrounding early medicine formed the establishment of medical care in modern times.

The relationship between scientists and clinicians in the early 1800 shaped the societal acceptance of modern medicine. In America, clinicians voiced divergent opinions about the inclusion of science in treatment. Healthcare professionals who supported the innovations envisioned the relationship between science and practice to harmonize disciplines to achieve better health management. Skeptics, however, averred that science had no connection with treatment based on their trust in the effectiveness of existing methods that comprised diet management. However, scientists needed medical practitioners to test their new knowledge towards efficacy in patient management. In the preceding years, harmony between researchers and healthcare workers created synergy for the benefit of society. However, debates about the application of medicine discriminately persisted within society.

The Mary Mallon case creates a basis for analyzing society’s perception of the application of medical knowledge. Medical research discovered that although carriers did not depict clinical signs, they could spread infections to others. However, the isolation of Mallon as a woman caused anger among feminists who thought that the reasons for the action derived from her social roles. As a domestic worker, she routinely prepared meals for her employer’s family and could spread the infection to other persons through physical contact. The outbreak of Yellow Fever and cholera in New York in the early 20th century showed American society’s changing attitudes towards medical research. Initially, the city’s administration took simple measures to contain the disease, including street cleaning, fumigation, and prayer meetings. However, the city management created the Metropolitan Board of Health in 1986, heralding an era of professional management of diseases. Under the framework, politicians could not ignore the severity of pandemics, nor could public members perceive epidemics as diseases of the poor, immigrants, and other low-status members of the society. In the nineteenth century, clinical workers began appreciating the significance of scientific research in medicine.

Many healthcare institutions in New York appreciated bacteriology in understanding the spread of disease through laboratory-based research. Consequently, health protection workers promoted the mass production of vaccines that could treat various infections among both children and adults. New York gained renown for its advancement in bacteriology research borrowed from medical practice in Europe. However, Americans in medical research into the mainstream of society by using the media and political forums to raise awareness. The interconnection between science and social life in America defined the success of medical science in America. New York successfully obtained public support for medical research because the administration created an independent body with extensive power to provide diagnosis, care, and supervision for persons with infectious diseases. The approach was a departure from the Mary Mallon situation that pitted social institutions against the medical researcher. The creation of a professional body to manage infections in the 20th Century in America significantly contributed to medical wellness.

Medical practice evolved from the pursuit of independence by various units to realizing the power of harmonization. According to Brooks, European physiologists successfully lobbied for distinct recognition from medical anatomy. Leveraging the innovations in physics and chemistry, the physiologists created a distinct profession and gained an elevated status in the medical field. However, innovations in America took a different tangent, and the two departments progressively merged towards developing medical solutions. Professionals in healthcare realized that students undertaking physiology intended to join medical care practice. The relationship between the two disciplines was initially parasitic but progressively evolved into interdependence.

The progress towards interdependence of physiology and clinical practice suffered slow adaptation because of the attitudes of medical workers. Geison (2017) notes this prejudice when he refers to the statement by a clinician towards his ward clerks in 1888. The Healthcare worker advised the junior officers to forget everything they had learned in physiology if they intended to practice in the nursing sector. The attitude was a manifestation of the ingrained biases towards the integration of medical science. Training institutions played a critical role in developing professionals in the medical field. Geison postulates that while many medical students expressed interest in human physiology, they disliked the practical training that accompanied the discipline. Although medical training schools increasingly employed physiologists with laboratory training, they did not transfer the experience to their students. The students, therefore, graduated with a biased mind towards interprofessional integration and displayed these attitudes in their practice.

The early researchers practiced in an environment devoid of medical structures and thus suffered social stigma for their actions. George Soper defended the action to isolate Mallon from a society based on scientific evidence. Soper claimed that his discovery of carrier genes in Mary Mallon was a result of extensive laboratory research. In other defense of his decision, Soper observed that the American Association for the Advancement of Science recommended him for the investigation because he was the most qualified professional to carry out the task. Although Mallon’s diagnosis and separation action were derived from empirical study, the healthcare fraternity failed to create a harmony between treatment and culture. Social analysts gauged the practicality of the action based on Soper’s religious and social class against Mallon’s position in society. In this regard, they saw Soper’s action as an act of responsiveness to the plight of the less fortunate in society. Soper, however, acknowledged the objectivity of his actions even though they did not yield the desired actions.

The non-rational forces in society conflicted sharply with scientific knowledge, as evidenced by Mallon’s scenario. Although feminists accused the medical fraternity of a gendered approach to healthcare, Soper’s sentiments about women reflected the reality of society in the early 1800. Women ordinarily worked in the domestic sphere taking care of their families, and only ventured out to seek employment when their husbands lost their jobs. However, the professional roles that women undertook in the marketplace reflected the domestic roles and revolved around the laundry and textile, and clothing industries. In this connection, Soper rightly observed that Mallon was highly likely to spread typhoid fever to more people through her profession. However, modern health practitioners must seek to achieve societal support for their medical decisions by creating avenues for public participation in preventive medicine discussions.

Despite the scientific justification for isolating Mallon, Soper’s sentiments against women were insensitive to their roles in the family. In criticism of women in the upper class, Soper averred that they were hasty in their hiring decisions, thus exposing their family members to typhoid. Soper further blamed the middle-class women who tended to their sick children in person for bringing the virus to their kitchen and transmitting it to the whole family. While articulating medical realities, health workers must demonstrate sensitivity to their address’s gender and cultural realities. Advocacy methods and public awareness campaigns can significantly enhance public acceptance of innovations in the field of medicine.

Healthcare workers must demonstrate sensitivity to the patient’s social, legal, and social aspects in their medical exercises. Hassan draws reflections on Mary’s case and observes that the medical fraternity subjected her to rights violations because of the constant surveillance mechanisms they employed. Mallon was treated as a criminal because of her status, and this diminished her humanity. The medical fraternity can adopt the strategy adopted by New York in managing epidermis when the state authorities established the Board of Health.

Public participation in healthcare in New York was critical and ensured humane treatment for infected persons. However, the constitution of these bodies must consider the extreme situation where politicians overtake the administration of the process for their selfish ends. Debates about inclusivity in the Board of Health in New York led to the appointment of a politician to represent laypeople on the board. The action was counterproductive to the initiative as the politician transformed the department into a strategy for his public appeasement campaigns leading to the resignation of several physicians to the board. While healthcare boards must incorporate public members, they must guard against political interference that diminishes the authenticity of the initiatives.

The medical crisis that broke out in New York triggered political leadership to establish a scientific method of fighting cholera. The death of twenty-two passengers aboard the Moravia steamship due to intestinal attacks led to drastic changes in the management of pandemics in New York. The city management responded to the crisis through traditional methods but was unsuccessful in stemming the disease. The management of the pandemic by the Board of Health continued to attract public attention as its president, Dr. William Jenkins, continued to assure the public that the situation was under control. The state had initiated quarantine measures, among other initiatives, but they failed to reduce the infection significantly. Jenkins sought political intervention in the crisis by asking for assistance from the mayor.

The political leadership made great strides and facilitated the swearing-in of additional physicians who conducted the US Navy ships in preparation for the subsequent twenty-day quarantine. The board’s activities received wide attention through reportage on the front page of the New York Times. The association led to funding arrangements for the health board for research. The available funds helped establish a new department of a pathology division, bacteriology, and disinfection under the New York Health Department. The events in New York after the cholera outbreak demonstrated the importance of political power in achieving effectiveness in pandemic management. While the initial involvement of a politician on the board, the second engagement bore significant fruits in developing public goodwill towards the management procedures.

The historical authors take different approaches while analyzing the advent of medical research. Leavitt undertakes a sociological approach and analyzes how their isolation of Mary reflected the societal perceptions of disease management. Patient laws through indirect quotations show that the action of healthcare workers to isolate a carrier client overlooked her human rights. Carter still examines the Mary Mallon case from traditional versus modern medicine practices and offers insight into the source of conflict between different social institutions following Mallon’s isolation.

Medical evolution in America relates to similar developments in Europe. Geison focuses on the historical evolution of medical research in New York compared to Europe. In his analysis, Geison reveals the disconnect between physiologists and clinicians and how the conflict hindered the incorporation of scientific studies into healthcare. Hasian explores the legal, medical, and community forces that surrounded the confinement of Mary Mallon into isolation based on her carrier status for typhoid. The NOVA article takes a personal reflection of Mallon as she describes her experiences under the hands of doctors. The text helps readers establish a balance between the postulations of different authors considering the patient’s sentiments. The investigation by Wald examines disease-causing vectors and the attitudes held by society. The author uses the case of Mallon to develop the theory of social control. The diverse perspectives of the various authors are critical in the development of the history of medical research.

The sociological aspect of medical research is displayed through attitudes and fears of exclusion and gender bias. Leavitt captures the social stereotypes that existed in society about gender and social class in healthcare. Whole clinicians enjoyed popularity for their remedies in treatment, and society viewed research as a fruitless exercise by elite researchers to develop their profession. Members of the society looked at their efforts as fruitless efforts that failed to resonate with the existing medical situations. Soper verbalizes the stereotypes when confronting middle-class women for spreading typhoid in the families through their caregiving mannerisms. Soper’s views also revealed the prevailing gender stereotypes that formed the structure of society. Community members expressed their displeasure that the decision to isolate Mallon derived from her role as a woman.

Medical personnel identified people based on their interaction with women through food in their efforts to trace contacts following Mallon’s confinement. Besides, women above the age of forty years were required to undergo examination regardless of their typhoid status. The clinical officers took charge of the decision to isolate the patient without consideration of her opinion. Gillberg & Jones fault the paternalistic approach to healthcare for its neglect of the client’s opinion and translating physicians into authoritative instructors. The approach contravenes medical ethics that promote the right of the patient to participate in wellness decisions. Gillberg & Jones opine that the feminist pragmatic approach to healthcare fosters a partnership between the clinicians and the client in medicine administration. Doctors must, however, consider public interest as they consider the interests of the clients. Patients who lack information about the danger they pose to society may resist recommendations from healthcare workers and jeopardize the efficacy of medical practice.

Critics of early medical research observe that it narrows down the understanding of disease and overlooks public interest. Leavitt studies literature on medical evolution and observes that the new public health characterized by studying disease etiology took attention away from the broader focus on extensive sanitation and social welfare programs. In this connection, the early public health reformers focused on social welfare in disease management. However, Leavitt is skeptical about the effectiveness of laboratory research in identifying disease-causing microbes and eliminating them from the environment. Charles Chapin, the Providence, Rhode Island’s health officer in the early 20th century, expressed excitement about advancing medical research in identifying the causes of disease.

Chapin postulated that innovation Bacteriology compelled society to depart from the sanitary reforms that comprised street cleaning, removal of household garbage, and regulation of offensive trade. Bacteriology, according to his postulation, “Drive the last nail in the coffin” of the filth theory for the prevention of disease (Leavitt (1992). Chapin propagated the premise that health was an individual responsibility and urged public members to avoid contact with fresh secretions and turn away from coughing or loud-talking neighbors. Leavitt nevertheless says that Chapin’s strategy failed to eliminate typhoid from the environment because of his narrowed view of its spread. Researchers connected the persistence of typhoid infections to healthy-looking individuals, which led to the labels of ‘germ distributors’ and “healthy carriers.” The ‘germ distributors’ theory gained popularity when Mary Mallon was arrested and isolated after authorities traced her tracks and established that she had spread typhoid to households through her cooking services. Although researchers found traces of the virus in her feces, the public raised concerns about her inhumane treatment during her arrest and confinement.

The controversies surrounding the handling of Mary Mallon as a carrier for typhoid emanated from the disconnection between the practical and theoretical aspects of medicine. According to Amer (2019), American physicians pursued an epistemological approach to medicine that created a divide between intellectual identity and intellectual morality. Consequently, society saw their research as a pursuit of personal gains with limited utility in managing sicknesses. However, researchers achieved harmony between science and moral legitimacy, thus achieving an integrated approach. However, Amer revealed that clinicians bear a negative attitude towards moralists claiming that they are disjointed from the real world. Clinicians often encounter medical decisions that require moral judgment, but they do not appreciate how their actions connect with societal expectations.

Healthcare workers can achieve greater integration of clinical practices by adhering to accepted societal moral codes. The integration journey in American clinical research advanced through conflicts between various stakeholders in healthcare. Physiology has occupied a respectable place in America’s medical intellectualism and helped practitioners streamline theory to practice. Physicians, however, differed in perspective from therapeutic practitioners who relied on the sensual assessment of an individual to achieve a diagnosis. According to the proponents of empirical clinical observation for conducting a diagnosis, therapists could only explain clinical procedures but could not conduct medical practice. Successive collaborations have established the connection between various spheres of healthcare, including therapeutic approaches and physiology.

The handling of the first carrier patient for typhoid revealed a lack of existing laws to guide medical practice. The personal testimony of Mary Mallon shows that she was frustrated through the whole ordeal. While her isolation protected the public from infection, authorities failed to accord her a chance to participate in the decision to confine her. In several instances, Mallon writes that physician workers neglected her requests for care, which frustrated her stay at the facility. Nyholm & Koskinen observe that patients’ lack of participation in healthcare decisions compromises dignity in care. Clinical practice has evolved since identifying the first carrier case, and health workers abide to elaborate codes of ethics. Modern practitioners can learn from the Mallon case and other aspects in the evolution of physiology research to refine their practice.

The evolution of Medical research in healthcare in America revolves around the disconnect between the various disciplines in care. Clinicians preferred solutions that centered around the maintenance of hygiene and observance of good nutrition. However, early medical researchers proposed a departure from these community-wide approaches and advanced studies to identify and eliminate disease-causing pathogens. Medical researchers relied on laboratory experiments for their research and diminished the efforts of clinicians.

The discovery and treatment of Mary Mallon as the first carrier for typhoid revealed the contribution of social factors regarding patient management. Authorities arrested Mallon and subjected her to forceful confinement sparking debate about the gendered management of medical clients. Although the confinement decision helped stem the spread of the virus, medical practitioners can draw important lessons about patient care from Mallon’s case. Mallon represents the growth of empirical studies to support clinical decisions and their contribution to the advancement of medicine. The challenges in early healthcare management arose due to disjointed knowledge development. Modern medical practitioners must collaborate with the client and social institutions to ensure the delivery of quality patient management.

References

Primary Sources

Carter, Rosalind. 1997. “The Legacy of Typhoid Mary.” The Lancet 349(9053): 739. Web.

Brooks, Janet. 1996. “The Sad and Tragic Life of Typhoid Mary.” CMAJ: Canadian Medical Association Journal 154(6): 915. Web.

Leavitt, Judith Walzer. Typhoid Mary: Captive to the Public’s Health. United States: Beacon Press, 2014.

Leavitt, Judith Walzer. 1992. “‘Typhoid Mary’ Strikes Back Bacteriological Theory and Practice in Early Twentieth-Century Public Health.” Isis 83(4): 608-629. Web.

“NOVA | The Most Dangerous Woman in America | In Her Own Words.” PBS, Public Broadcasting Service, Web.

Secondary Sources

Amer, Ahmed Bait. “The Health Care Ethics: Overview of the Basics.” Open Journal of Nursing 9, no. 2 (2019): 183-187.

Geison, Gerald L. “3. Divided We Stand: Physiologists and Clinicians in the American Context” In the Therapeutic Revolution edited by Morris J. Vogel and Charles E. Rosenberg, 67-90. Philadelphia: University of Pennsylvania Press, 2017. Web.

Gillberg, Claudia, and Geoffrey Jones. “Feminism and healthcare: Toward a feminist pragmatist model of healthcare provision.” (2019).

Hasian, Marouf A. 2000. “Power, medical knowledge, and the rhetorical invention of ‘Typhoid Mary’” Journal of Medical Humanities 21(3): 123-139. Web.

Marineli, Filio, Gregory Tsoucalas, Marianna Karamanou, and George Androutsos. “Mary Mallon (1869-1938) and the history of typhoid fever.” Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology 26, no. 2 (2013): 132.

Nyholm, Linda, and Camilla AL Koskinen. “Understanding and safeguarding patient dignity in intensive care.” Nursing ethics 24, no. 4 (2017): 408-418.

Rosner, David. Hives of Sickness: Public Health and Epidemics in New York City. United States: Museum of the City of New York, 1995.

Steere-Williams, Jacob. “A “Menace” or a Martyr to the Public’s Health?.” Isis 111, no. 4 (2020): 818-821.

Wald, Priscilla. 1997. “Cultures and Carriers:” Typhoid Mary” and the Science of Social Control.” Social Text no. 52/53: 181-214. Web.

Warner, John Harley. 1991. “Ideals of Science and Their Discontents in Late Nineteenth- Century American Medicine.” Isis 82(3): 454-78. Accessed February 16, 2021. Web.

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History of Medicine: Mary Mallon’s Case Influence

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