Public Health Law Map - Beta 5 - Medical and Public Health Law Site

we are due for another worldwide epidemic of bubonic plague. The population of
rodents and fleas that is necessary to fuel such an epidemic is present, and the disease
is endemic in most of the western United States. The question is not what would start
such an epidemic but why it has not already started.
Public health procedures backed by strong laws are necessary to combat plagues. If
disease control measures are postponed endlessly while policy is debated, the disease
may spread so widely that no measure can contain it. More vigorous public health
efforts, such as closing gay bathhouses as soon as it became obvious how HIV was
spread, might have reduced the extent of the epidemic. Had the bathhouses been
closed in the late 1970s when it became obvious that they were the vector for the
spread of hepatitis B (HBV), HIV might have emerged slowly enough that gay men
could have learned of its existence before infection became so widespread.
3. Carrier State
Typhoid Mary has become a general term for a person spreading a communicable
disease. Typhoid Mary was an actual person, and typhoid carriers are not unusual.
Most big cities have typhoid carriers who are registered with the health department,
and they are living and working in the community. Because the carrier state cannot
be cured with antibiotic treatment, the carriers must live with certain restrictions:
they may not work as food handlers or as child care attendants. They can safely work
in such establishments at other jobs— for example, as a restaurant accountant. This is
an example of the restrictions on personal freedom that a health officer has the legal
authority to impose on an individual as a disease control measure.
If a carrier is under orders to restrict activities and does not comply with the orders,
the health officer may take stronger actions, including quarantine or incarceration.
Typhoid Mary was a threat because she worked as a cook and refused to stop this
work. Every time the health department located her, usually through a new outbreak
of typhoid, she would move and change her name but not her occupation. She was
finally placed under house arrest to keep her from cooking and infecting others.
Typhoid Mary infected more than a hundred people, killing several of them, before
the more restrictive measures were imposed.
A 1941 case involving a typhoid carrier is a good example of the court’s view of the
appropriateness of disease control measures. The case concerned whether the identity
of typhoid carriers could be disclosed when necessary to prevent their handling food
and thus exposing others to their disease:
The Sanitary Code which has the force of law … requires local health
officers to keep the State Department of Health informed of the names, ages
and addresses of known or suspected typhoid carriers, to furnish to the State
Health Department necessary specimens for laboratory examination in such
cases, to inform the carrier and members of his household of the situation and
to exercise certain controls over the activities of the carriers, including a
prohibition against any handling by the carrier of food which is to be
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