Today, I would like to begin by writing about Queen Mary I, the first queen of England to rule suo jure (in her own right and not because she married into the royal family, aka queen regnant) better known as Bloody Mary, daughter of Henry VIII and his first wife, Catherine of Aragon. Henry and Catherine were married for 24 years, initially happily, and Catherine could match Henry's intellectual interests and she was a competent regent - a paragon of royalty. However, her Spanish descent did nothing to save Henry's first surviving daughter, Mary, from scrutiny when she married the Spanish King Philip II.
Mary has often been painted as a murderess, similar to the Chinese empress Wu Zetian. They were women who didn't need a man to rule a country (already a strike against them) and were judged for the morally questionable things they did without considering the improvements that came from their reign. Wu Zetian promoted women's rights, scholarly study, trade, and safe travel, while Mary planted the seeds for financial reform, exploration, and naval expansion that her half-sister built upon. She also did a lot to restore the place of the Catholic church, which was important to a lot of the English at that time. Unfortunately, therein lies the controversy. She ordered the burning of some 280 Protestants, which, while very brutal and inhumane by today's standards, was not an unusual punishment and was considered by many a reasonable punishment for heresy. She was not the only monarch in English history to kill a somewhat large number of people and especially not for religious reasons, but after she married Philip, her decisions were considered to have "Spanish influence," and for mostly being a woman but probably some other things, she went down in history as the madwoman Bloody Mary (while Wu Zetian is nicknamed the Chinese Queen of Hearts, undeservedly) and Mary was even immortalized in a children's game. Yayyyyy. However, in my opinion, "Bloody" Mary was nowhere near as scary (if you weren't a Protestant) as Typhoid Mary.
So who was she?
Good place to start paying attention if you weren't before
Mary Mallon was an Irish cook born in 1869, better known by the name "Typhoid Mary." Maybe you've heard of her, maybe you haven't, but did you know....
- She was forcibly quarantined twice
- She used false names to escape health authorities, since she was technically forbidden from working as a cook
- Experts think she was born with typhoid fever - her mother was infected during pregnancy
- She's thought to have caused at least 51 cases of typhoid fever and as many as 122
- She was the first case of an asymptomatic carrier being discovered and quarantined
- Even as a cook, she rarely washed her hands because germ theory is just kooky scientist brain bubbling
Overview:
The Disease
Presentation
In the first week, body temperature slowly rises and resting heart rate lowers. Headache, cough, and general discomfort are usually present (understandably). A bloody nose is seen in roughly a quarter of cases and there may be abdominal pain. There's a decrease in the number of circulating white blood cells and a relatively higher number of lymphocytes (a specific kind of immune cell). There is typhoid present in the blood. 😬
Uh-oh, here we go. Welcome to week 2. High fever around 40 degrees Celsius and generally too tired to get up. Slower heart rate and funky pulse things. In around a third of patients, the characteristic rose spots of typhoid fever appear. The lower right abdomen is swollen and painful, and the liver and spleen are also swollen.
On to week 3. High fever, delirium, malnutrition, and dehydration. Internal hemorrhaging due to bleeding in immune tissue in the gut is serious, but not usually fatal. A perforation of the small intestine is very dangerous and may not even be noticed until someone develops septicemia (blood poisoning, very nasty and very dangerous) or peritonitis (inflammation of the internal lining of the abdomen) but is almost always fatal. Inflammation in a lot of key organs (brain, bone, heart, lungs, etc.) is common and Not Good for staying alive.
Diagnosis and Treament
Okay, so those are the stages of disease. They're not very pleasant. Moving on... the disease is transmitted via the fecal-oral route, which is also not terribly pleasant to think about. The best way to test for the disease is by culturing a blood, bone marrow, or stool sample, but there is another test that works at certain times called the Widal test, which tests for the presence of anti-typhoid antibodies. Unfortunately, it's prone to false positives and sometimes false negatives, and is also rather time-consuming. There are many other tests that work in a similar manner, but the best way remains culturing.
The most common treatment is antibiotics, which makes sense for a bacterial disease. With perforations or inflammation, sometimes surgery is required but it is less common.
History
In 430 BCE, typhoid fever killed a third of the population of Athens, including Pericles, which ended a time of cultural flourishing and economic growth known as the Golden Age of Pericles in Athens. With this, power shifted from Athens to Sparta and ended Athenian dominance in Ancient Greece. At the same time, Attica was also plagued with typhoid fever.
Two epidemics hit Mexico in 1545 and 1576, causing anywhere from 7 to 17 million deaths. Between 1604 and 1624, typhoid fever claimed the lives of over 6,000 settlers of the New World. During the American Civil War (1861-1865), 81,360 soldiers died of dysentery and typhoid, many more than those who died from battle wounds. It's also thought to have killed or contributed to the deaths of two American presidents. During the Spanish-American war (1898), again, more people died of typhoid fever than of battle wounds. Why is it all the Americans? Honestly...
In the early 1900s, Miss Mary Mallon arrives onstage. Yeah, see above. If you thought that was bad...well, let's say that she was just a famous one. In 1937, the safe water supply of an area in London needed servicing. While that one was being treated, the water supply used in the meantime was not safe and caused 341 cases of typhoid fever and 43 deaths. In 1964, contaminated meat (🤮) caused at least 400 cases and 3 deaths. In 2004 and 2005, an outbreak in the Democratic Republic of Congo caused over 42,000 cases and 214 deaths.
The Present
Unfortunately, typhoid fever definitely exists in the present. We know how to prevent it and there are treatment options, but doing the right thing costs a lot of money. Currently, around 9 million people get sick from typhoid and 110,000 die from it each year according to the WHO, but other estimates go as high as 20 million, despite the fact that there are at least two WHO-prequalified vaccines getting incorporated into childhood immunization programs in typhoid endemic regions. Children are at highest risk for contracting the disease, especially in areas with high antibiotic resistance.
We can solve this. With better living conditions and education, typhoid fever can be eliminated.
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