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A bold, mesmerizing novel about the woman known as "Typhoid Mary," the first known healthy carrier of typhoid fever in the burgeoning metropolis of early twentieth century New York.
Mary Mallon was a courageous, headstrong Irish immigrant woman who bravely came to America alone, fought hard to climb up from the lowest rung of the domestic service ladder, and discovered in herself an uncanny, and coveted, talent for cooking. Working in the kitchens of the upper class, she left a trail of disease in her wake, until one enterprising and ruthless "medical engineer" proposed the inconceivable notion of the "asymptomatic carrier" - and from then on Mary Mallon was a hunted woman.
In order to keep New York's citizens safe from Mallon, the Department of Health sent her to North Brother Island where she was kept in isolation from 1907-1910. She was released under the condition that she never work as a cook again. Yet for Mary - spoiled by her status and income and genuinely passionate about cooking - most domestic and factory jobs were heinous. She defied the edict.
Bringing early twentieth-century New York alive - the neighborhoods, the bars, the park being carved out of upper Manhattan, the emerging skyscrapers, the boat traffic - Fever is as fiercely compelling as Typhoid Mary herself, an ambitious retelling of a forgotten life. In the hands of Mary Beth Keane, Mary Mallon becomes an extraordinarily dramatic, vexing, sympathetic, uncompromising, and unforgettable character.
The day began with sour milk and got worse. You were too quick, Mary scolded herself when the milk was returned to the kitchen in its porcelain jug with a message from Mr. Kirkenbauer to take better care. He was tired, Mary knew, from the child crying all night, and moaning, and asking to be rocked. And he was worried. They'd tried to spare himMary, Mrs. Kirkenbauer, and the nanny had taken shifts with the boy, but the boy's room was just across the hall from his parents', and the boards of the new house creaked and whined, and the women sometimes forgot to keep their voices lowered, and finally Mr. Kirkenbauer had emerged from the master bedroom in his nightshirt to ask what could be done. "Give him to me," he'd said to Mary at the start of her shift, just as the bleary-eyed nanny hurried back to her small room at the rear of the house.
At two o'clock in the morning none of them cared about being seen in their nightclothes. She'd handed the boy to his father, a baby really, still a baby; they called him a boy because he'd started calling himself a boy, but it wasn't true just yet, in six more months, perhaps, yes, but not yet, not with those fat legs and cheeks, that unsteady, tottering step, the fact that he still loved a lap more than any chair. Mr. Kirkenbauer had observed in a whisper, "He's very warm." He put his pursed lips against the boy's forehead. Then he handed the child back to Mary and sat on the chair in the corner as she rocked the boy and told him all the wonderful things the morning would bring. Did he want to see a sailboat? Mary asked. Did he want to throw rocks in the river? Did he want a warm bun straight from the oven? But the child only stared, and cried, and wrapped his hot arms around Mary's neck, tight, like they were at sea, and she his buoy, and he was terrified of losing his grip.
Mary tried not to make too much of the milk being sent back, of the expression on the butler's face that was meant to mime Mr. Kirkenbauer's, and she reminded herself that Mr. Kirkenbauer was exhausted when he complained about the milk, they all were, and who knew what tone he'd really used when he gave the message to the butler, who had struck Mary from her first day as a nervous type. Mrs. Kirkenbauer was still upstairs, sleeping or trying to, and the nanny was giving the boy a cool bath, his third in as many hours. A light rash had bloomed across his chest, and in the very early hours of the morning Mrs. Kirkenbauer had suggested a plaster of bread and milk, or running to a neighbor for linseed oil, but Mary had said no, she'd seen the rash before, there was nothing for it but rest and trying to get the boy to eat something. The Kirkenbauers weren't the richest family Mary had ever worked for. Their kitchen was not as modern as most where Mary had cooked. But they were kind people, they paid her good wages, and other than a few specific requests from Mrs. Kirkenbauer, Mary had leave to do the shopping and serve whatever she liked.
Sometimes, after supper, Mrs. Kirkenbauer pitched in with the scrubbing, which Mary was baffled to discover she didn't mind. A mistress who hung around the kitchen with her hands in pots and pans and pantry would normally be intolerable, and if Mary had been told this was the way it was going to be she never would have taken the job in the first place, but now that she was there, and had gotten to know them, she was surprised to find that she didn't mind a bit. Mrs. Kirkenbauer had three sisters in Philadelphia and said she missed female company more than anything. Mary continually tried to take the temperature of her mistress's ease, so that perhaps, one day, she'd work up the nerve to ask her a question. Had she always been a person of means, or only when she married Mr. Kirkenbauer? The Kirkenbauers didn't know many people in Dobbs Ferry yet, which meant they seldom entertained, which meant Mary rarely had to cook for more than the three in the family and the staff and herself. The house looked at the Hudson, and on Sundays when the weather was fine they had picnics on the riverbank and always invited any among the servants who had not traveled home to their own families for the day.
Excerpted from Fever by Mary Beth Keane. Copyright © 2013 by Mary Beth Keane. Excerpted by permission of Scribner. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Please be aware that this discussion guide may contain spoilers!
Mary Mallon was a brave, headstrong Irish immigrant who journeyed alone to America. She began as a laundress, but with an innate talent for cooking, Mary ascended the domestic service ladder and worked as a cook for upper-class families. Unbeknownst to Mary, she left a trail of Typhoid fever and death in her wake. One "medical engineer," proposing a new theory of "asymptomatic carriers," traced the fever back to the woman we now know as "Typhoid Mary." To prevent Mary from further spreading the disease, the New York Department of Health isolated her on North Brother Island for three years. A condition of her release was that she would never cook professionally again. But Mary's passion for cooking, combined with the meager alternatives available to her, propelled her to defy the edict. In Fever, Mary Beth Keane brings early twentieth century New York City alive - the neighborhoods, the bars, the mansions, the factories, the rising skyscrapers and the perils of city life. Keane's retelling of Typhoid Mary's life transforms a tabloid interest into a complex and unforgettable character.
Topics & Questions for Discussion
1. The story of Mary Mallon exemplifies a conflict between personal liberty and public health. Examine both sides of this conflict, discuss whether you think Mary's case was handled well, and consider how it would have been dealt with today.
2. In early twentieth century New York, class and background dictated a person's prospects. Find moments in the text when people discriminated against Mary as a poor Irish woman. How does Mary handle these situations? Are there any instances when Mary uses her identity to an advantage?
3. Mary and Alfred live together as an unmarried couple. Many people felt these circumstances were inappropriate, and the issue arises repeatedly. Are there any consequences to their situation? Would things have turned out differently had Alfred proposed to Mary?
4. The vibrant image of Mary's hat, "cobalt blue with silk flowers and berries cascading around the brim" (p. 63) stays with her during her exile on North Brother and into the future. What does the hat symbolize for Mary? Consider when Mary encounters Mrs. Bowen wearing the exact same hat; Mrs. Bowen maintains that her hat is "similar, Mary, not identical. But I see what you mean." (p.67) Why does Mrs. Bowen deny that she has the same hat as her cook?
5. Alfred constantly moves between various odd jobs in the city and in Minnesota, while Mary seems to have few choices: cooking (or baking), laundry, and factory work. Discuss how gender affects the characters' options during this time. Consider Alfred and Mary, as well as the others in their building (Mila Boriello, Fran Mosely, Joan Graves, Jimmy Tiernan), Liza Meaney, and John Cane.
6. The media, particularly the newspapers, play a significant role in Mary's story. Reread the article printed at the beginning of the novel. (p. 14) How do reporters influence the outcome of Mary's trial?
7. Compare Mary's situation to the case of the dairy farmer upstate. Why and how were they handled differently?
8. Mary has a justified distrust of doctors and others in the medical profession, especially after learning that the gall bladder surgery so emphatically pushed on her would have been completely futile. Later, when the doctors try to explain the way germs and disease spread, to Mary it "sounded like a fairy tale meant for children, a little world too small for the human eye to see, or like religion, in that they were asking her to believe such a thing existed without giving her a chance to look at it, hold it, understand it." (p. 232) Consider the portrayal of the medical profession throughout the story. Compare Mary's experiences with doctors to Alfred's after his injuries. How do the doctors mislead Alfred?
9. Mary is an extremely headstrong and stubborn character. Yet, when Alfred refuses to taper off his medicine at the reduction clinic, Mary does not protest at all. Why does Mary let Alfred descend so far into addiction?
10. After her first release from North Brother, Mary abides by her promise not to cook. But as time passes she eventually is drawn back to the profession: first at the bakery, and then at the hospital. How does she justify her decisions, despite the risk to others? Do you think she believes she is responsible for passing Typhoid through her cooking? Why or why not? At what point does she give in to the reality of her predicament?
11. The story is split into three sections: 'Habeas Corpus', 'Liberty' and 'His Banner Over Me Is Love. Discuss what each part-title illustrates about the events that happen within the section.
12. Why do you think the Epilogue comes from Mary's own voice, in the first person? How does this shift affect your reading of the final pages of the story? Do you gain any further insight into Mary's character from these pages?
Enhance Your Book Club
1. Alfred uses the Oppenheimer cure to conquer his alcoholism. Research and discuss this method: What exactly does it entail? When did it become popular? What were the success rates? Were there other 'cures' prevalent during this time?
2. Find an article about the real Mary Mallon. How does your reading fit into Mary Beth Keane's fictional version of Typhoid Mary?
3. Mary Mallon was one of the first healthy carriers to be discovered, but subsequently many more were identified. Research and share your findings on healthy carriers of disease. How did the government handle similar individuals in the future?
Unless otherwise stated, this discussion guide is reprinted with the permission of Scribner. Any page references refer to a USA edition of the book, usually the trade paperback version, and may vary in other editions.
Mary Beth Keane's Fever is a hit with BookBrowse readers. 22 out of 23 reviewers gave it 4 or 5 stars. Here is what they say about the book that puts a real face to the name Typhoid Mary:
Heart-wrenching and dark but I was unable to put the book down. Amidst the churning and changing of bustling New York City, Mary is trying to find understanding and meaning and some element of peace in a world where she unwittingly has become an angel of death (Paul R). This novel is the story of a two-fold love: Mary's love of cooking and of the ne'er-do-well Alfred, her long-time companion. This fictionalized account of Mary depicts her as a strong immigrant woman who battled for a better life for herself (Kathleen S). The book and the character, Mary, are both unforgettable (Jean N).
Keane doesn't hesitate to make Mary the contradictory and wonderfully complex character that she truly was:
Keane has given the reader a real character we can like or dislike, but cannot ignore. In the end I still couldn't make up my mind whether to give Mary a loud boo or a rousing cheer. Definitely a good read (Joan C). You alternately like, hate and feel sorry for Mary who, although a smart woman, cannot accept the fact that she is a healthy carrier of typhoid. The fact that she cooks for a living makes for a dangerous situation. Rich in characters and in setting, this book is a winner (Rebecca J). My heart empathized with Mary Mallon's fear and anger when she was pursued and quarantined as a public health danger, but my head told me that Dr. Soper had to do all he could to avoid widespread outbreaks of typhoid fever (Helen S).
Fever is historical fiction at its very best:
Wow! Loved, loved, loved this book. It usually takes me a good 100 pages to get into a book... not so with Fever. After reading the first five pages I was hooked (Teresa R). An unforgettable story of an Irish immigrant who came to New York at the beginning of the twentieth century. You will learn how the poor coped with urban life, and how the seriously ill were treated by the Department of Health, which was trying to protect the health of the public. As historical fiction, Fever will not disappoint (Annette S). We've all heard about Typhoid Mary, but who was she? Not only did I learn about this tremendous woman, Mary Mallone, I also was put right into the streets and tenements of the early 1900s. Get this book it is an absorbing read. I gobbled the words down, typhoid be darned! (Darcy C) Fever captured my interest immediately and held on to it throughout the novel. Keane has melded the facts of that frightening time with the humanity of her characters and the quickly changing ethics of the early twentieth century (Becky M). I chose to read Fever because I knew nothing about Typhoid Mary except her name, and wondered why her memory had lasted so long. And now I know. Beyond that, this book gives a vivid and informative portrayal about that period in our history. For instance did you know that there was a small island in New York Harbor called North Brother to which they sent all TB victims? That's where Mary was sent for years. All in all, a well-written and gripping narrative which brings to life a little-known period of our history (Tilli F).
Readers can't help but put themselves in Mary's difficult position:
Unexpectedly I came to like Mary Mallone. Mary, like so many of us, long denied truths that were evident to most others. She made me stop and take a look at my life, wondering what I might be denying about myself (Donna T). I felt that Mary Beth Keane did an excellent job weaving fact and fiction to profile this infamous woman. I found it just as interesting to read about life in New York City in the early 1900s. My great-grandparents were also immigrants in New York City during this same time period and I have a greater appreciation of what their life might have been like (Elise B). I can't stop thinking about Fever. I felt so sorry for Mary. I realize that these scientists were trying to protect the community from infection, but I put myself in her position. She was healthy young woman; and the media made her out to be nothing more than a disease by labeling her Typhoid Mary. I loved the book, Keane has written a fascinating and also heartbreaking human story (Mary S).
Finally, Fever is a strong catalyst for fascinating conversation and lively debate:
I wonder how most readers will feel about what was done to Mary. This book would definitely be a valuable tool in schools discussing medical ethics and the rights of patients and the public (Peggy K). Fever is told from Mary's point of view and you get a real sense of who she was and how being labeled a typhoid carrier affected her. Mary's actions can be interpreted many ways making this an excellent book for book clubs (Mary M). I would recommend this book to anyone who enjoys historical fiction and to book clubs that like discussing moral and ethical issues (Donna T).
Reviewed by BookBrowse First Impression Reviewers
Rated of 5
by Lora O. (Antioch, CA)
Rough Beginnings of the American Public Health System
I have a bookshelf of books on various diseases, both non-fiction and fiction and I understand the causes of typhoid, but I never thought of what it might feel like to be a healthy carrier of such a deadly disease until I read Mary Beth Keane's chilling and moving novel about Mary Mallon, aka "Typhoid Mary". I felt I could relate to this amazing, scrappy, intelligent, hard working woman, who fought to develop a career and rise above poverty by becoming a talented and innovative cook for wealthy families. The author so achingly described the shunning and ostracism of Mary and how bewildered she was, knowing she was a good, moral, talented and healthy woman who couldn't imagine she could be the cause of death of those around her.
The author's vivid description of early 1900 streets of New York were amazing. The portrayal of medical science at the turn of that century, fumbling it's way to an understanding of the cause of disease and the beginning of the public health system was well researched and well drawn. But as the men around Mary were so dismissive and arrogant and unable or uninterested in helping Mary to understand the transmission of typhoid, I think the author also did a poor job of explaining typhoid's history and transmission.
Apart and separate from the typhoid, I think this book stands as on of the best books about Irish immigrants that I have ever read. The characters were wonderful and believable and Mary's story was truly heartbreaking.
I want to recommend this book to my book club and think there are interesting medical issues that would make for a delightful discussion.
Rated of 5
by Liz C. (Kalamazoo, MI)
Mary Beth Keane has created an intriguing, empathetic portrait of "Typhoid Mary" in Fever. Mary Mallon is a hard working, independent, talented and sympathetic character. I also found the story of Mary's fictional (?) and troubled lover, Alfred, and their relationship captivating. Keane brings the neighborhoods and people of early twentieth century New York alive in this novel. If you enjoy good writing, historical fiction and strong women characters I highly recommend Fever.
Rated of 5
by Lynne G. (rockville, MD)
Fever by Mary Beth Keane
Fever is a remarkable book. The author's characters are so real that they remain with you after you have put down the book. Moreover, you wonder what they are doing while you are away from them. She has conjured up long gone people and brought them back to life. Her writing is beautiful and she has great empathy for her characters. Although it is a difficult read because of the many hardships they face, you will gain perspective on lives of immigrants, appreciation for how far medical science has come and you will feel very grateful to your ancestors who made the trip to America under very difficult circumstances. I highly recommend this book and author.
Rated of 5
by Peggy K. (Long Beach, CA)
On the surface here you have a simple story of a young Irish woman trying to make good in America. A good read but this isn't just any young woman, this is the woman we all know now as Typhoid Mary. The book fictionalizes her personal life using the facts of her medical history. That is what makes it the most interesting and what will generate discussion with book clubs and schools hopefully. There are a whole list of questions that could be generated by the actions taken against Mary. I enjoyed that part of the book more really and though it took Mary most of her life it seems to realize how wrong she had been I wonder how most readers will feel about what was done to her. This book would definitely be a valuable tool in schools discussing medical ethics and the rights of patients and the public.
Rated of 5
by Mary M. (Lexington, KY)
Typhoid Mary's Story
"Fever" is a fascinating fictional account of the woman known as Typhoid Mary. The story is told from Mary's point of view and you get a real sense of who she was and how being labeled a typhoid carrier affected her. Ms. Keane does a wonderful job of humanizing Mary. The descriptions of early New York and the people who lived there bring the story to life. Mary's actions can be interpreted many ways making this an excellent book for book clubs. I really enjoyed this book.
Rated of 5
by Paul R. (Albuquerque, NM)
Fever by Mary Beth Keane
Heart wrenching and dark but I was unable to put book down. The historical setting is a fascinating time in history - amidst the churning and changing of bustling New York City is the main character trying to find understanding and meaning and some element of peace in a world where she unwittingly has become an angel of death.
Rated of 5
by Debi B. (Charleston, SC)
Fever ~ Mary Beth Keane
Fever is the story of Mary Mallon: Typhoid Mary, the Germ Woman. She was a head-strong Irish immigrant who wanted to succeed in America as a domestic cook. She was a carrier of typhoid fever, which she didn't seem to acknowledge or want to admit to the deadly consequences of being a carrier of the disease. At times I found myself angry at Mary, but mostly, I felt sorry for her.
I really liked this book and found it hard to put down. Mary Beth Keane writes in such a way it was like watching her movie, rather than reading her book. I didn't want it to end.
Rated of 5
by Deanna W. (Port Jefferson, NY)
This fictionalized biography puts a human face on Typhoid Mary. We learn about the woman behind the facts and rumors. We also get a vision of every day life in the streets and tenements of early 1900's in NYC. The story is told from Mary's perspective as she comes to terms with her tragic situation.
Typhoid is a life-threatening illness caused by the bacteria Salmonella Typhi. Approximately 400 cases are found in the U.S. per year (mostly due to traveling) but it is prevalent in the developing world where a staggering 21.5 million people are infected per year, and 200,000 of those people die. Here is a short history of its origins, symptoms, and prevention.
History of Typhoid
Between 430-424 BC an unidentified plague killed a full one third of the population of Athens. Among those who died was the the great general, orator and statesman, Pericles, the defacto leader of Athens. It was a major moment in time as it marked the end of the Golden Age of Pericles and shifted power in Greece from Athens to Sparta. Another famous Greek, the historian Thucydides, contracted this unidentified illness but didn't die, and it is his writing about this time that elucidates the outbreak.
Scientists argue about whether this plague was, in fact, typhoid fever. A 2006 study of ancient dental pulp (the living center of the tooth made from connective tissue and cells) detected DNA sequences that are similar to typhoid, but the study has been disputed because of possible flaws in its methodology. Typhoid fever was difficult to understand and pinpoint, most likely because its symptoms are varied and systemic. In fact, until the mid-19th century doctors couldn't distinguish it from typhus and malaria. Once it was isolated and understood, Typhoid was often associated with wars. It killed over 6000 US settlers between 1607-1624, and over 80,000 Union soldiers died from it during the American Civil War.
Contaminated food and water are the primary culprits of Salmonella Typhi ingesting either of these substances allows the bacteria to enter a person's body. The bacteria then penetrate the intestines where it multiplies in lymphoid tissue. The incubation phase of typhoid fever is between 10-14 days, after which the early symptoms begin to show: headache, stomach ache, general achiness, and restlessness. Fever starts low and increases as each day progresses, reaching as high as 104 F. Accompanying these symptoms may also be cough, nosebleeds, diarrhea, or constipation. The infected person often develops a rash that lasts for a few days. If treatment hasn't been sought after a week or so, other internal problems may occur such as ulcers (because intestinal walls have become inflamed) or hemorrhaging (fragments of dead intestinal tissue erode blood vessels). And in the third week of the infection other serious complications may follow: pneumonia, heart failure, encephalitis and meningitis to name only a few. If the high fever continues, the person enters a state of delirium as well.
Without treatment, about 25% of all cases are fatal. In positive outcome situations, the fever goes down on its own, and symptoms slowly disappear. Treatment is typically a course of antibiotics, only available since the 1940s, which is highly effective (although not entirely, see below.)
The Spread of Typhoid
Contamination of public water sources is a common way for typhoid fever to spread. Also food handling by contagious people or people who are carriers (like real-life Typhoid Mary, the main character in Mary Beth Keane's Fever.) Typhoid can also be spread by flies carrying the disease or by using contaminated water for cleaning purposes. Fish from contaminated water or vegetables irrigated by contaminated water are other ways the disease can spread.
Identification of the Disease and Vaccination
In 1880, Karl Joseph Eberth, a German pathologist and bacteriologist, discovered a bacterium that he believed was the cause of typhoid, and four years later, another German pathologist, Georg Theodor August Gaffky confirmed Eberth's results.
Soon after, in 1896, Almroth Edward Wright, an Anglo-Irish-Swedish immunologist, introduced a typhoid vaccine which proved to be successful at preventing the disease, and in 1909, Frederick F. Russell, a U.S. Army physician developed another vaccine which became the centerpiece of the first vaccine program in which an entire army was immunized. This, too, was hugely successful.
Public sanitation programs and best hygiene practices were utilized around the same time early 20th century and these greatly contributed to the reduction of typhoid fever as well. 1908 saw the chlorination of drinking water in the US, and in 1942 antibiotics were introduced as a standard clinical treatment for typhoid. All of these advancements saw the decline of mortality due to typhoid fever. However, recent studies have shown that typhoid is becoming resistant to the three first-line drugs used in fighting it chloramphenicol, ampicillin, and co-trimoxazole.
Bust of Pericles after Kresilas, Altes Museum, Berlin
Mary Mallon (Typhoid Mary) in a hospital bed.
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