Her real name was Mary Mallon, and as far as she knew, she had never contracted typhoid fever. But in 1907, when New York City health officials arrested her on charges of endangering the public health, she became forever known as "Typhoid Mary."

Mallon, an Irish immigrant cook, entered history as the first known healthy carrier of typhoid in the United States. Although she showed no signs of illness, investigators determined that she had unwittingly transmitted the disease to at least 22 people through her cooking.

She was confined on a tiny island in the East River. After three years, officials decided to release her, provided she no longer prepared food for a living. But in 1915, she was discovered working in the kitchen of a maternity hospital, where a new outbreak of typhoid fever had erupted. This time, she was sent back to isolation on North Brother Island - where she was held, under protest, for the remaining 23 years of her life.

Her story offers one of the most dramatic examples in US history of a dilemma now facing the nation: how to balance individual freedoms with the need to protect the public health.

While Sept. 11 promises many changes in civil liberties - from the use of military tribunals to facial scans at airports - some of the most profound effects on Americans may come from the government's need to protect against the spread of disease in the event of a biological attack.

Many states are already considering adopting powers that would allow them to quarantine entire cities, seize food supplies, and mandate the vaccination of large segments of the populace. At times in the past, some of these moves have ignited protest, even rioting.

For most Americans, of course, the threat posed by widespread disease is a distant memory. The last outbreak of smallpox in the United States, for example, came in 1949.

But now, the shadow of bioterrorism is forcing public-health officials to prepare, once again, for a possible deadly contagion. For the first time in a half-century, authorities are considering the legality and practicality of extreme measures, such as requiring the public to be tested for diseases or seizing property.

As a result, the balance between public health and civil liberties, which in recent decades had been tilting more toward individual freedom, may be about to swing back, in ways reminiscent of Mary Mallon's day.

Americans, many of whom have grown accustomed to challenging public-health measures - from farmers fighting state efforts to spray fields for mosquitoes, to soldiers refusing to be vaccinated against anthrax - could suddenly experience restrictions on such basic freedoms as movement.

These "are complicated issues," Jeffrey Koplan, director of the Centers for Disease Control and Prevention (CDC), acknowledged at a recent press conference. "Do we have an easy answer for them? No."

Under the Constitution, states have the primary responsibility for protecting public health. While the federal government no doubt would coordinate the response to a bioterror attack, state health officials would be at the fore.

So, in the wake of recent anthrax attacks, state officials across the country have been rushing to review public-health laws - and often concluding they lack adequate authority to combat a major bioterror event.

Some state public-health laws date back 100 years or more - and can seem almost absurd in today's context. In Massachusetts, the penalty for resisting quarantine is a $10 fine.

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