A Chronic Typhoid CarrierAuthor(s): A. R. FOLEYSource: Canadian Journal of Public Health / Revue Canadienne de Sante'e Publique, Vol. 35, No.5 (MAY, 1944), pp. 196-197Published by: Canadian Public Health AssociationStable URL: http://www.jstor.org/stable/41978656 .

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A Chronic Typhoid Carrier

A. R. FOLEY, M.D., Dr.P.H. Provincial Epidemiologist

Ministry of Health and Social Welfare , Quebec

March 30, 1942, Monique W. came down with typhoid fever. Monique, three years old, was living with her parents in the City of Quebec, in a

protected environment, drinking only safe water and pasteurized milk. The child had spent the three previous week-ends at her grandmother's, Mrs. B., at Château-Richer, a quaint and nice little village near Ste. Anne de Beaupré, on the shore of the St. Lawrence River.

On the occasion of her visits to her grandmother, the child had taken raw- milk procured from a local dealer, C, but no other case could be traced to this source. The water system supplied fifteen families. This water came from a spring, but surface water could be introduced into the system through a cross- connection during droughts and this had been done in February and March. B. coli was found in a water sample taken for analysis. No other case of typhoid fever could be attributed to this water, but, on the other hand, Monique was the only child who was not used to this drinking water. The origin of the case was attributed to the consumption of water of doubtful quality. B. typhosum was isolated from the faeces and classified as type F according to the method of Craigie and Yen.

In October 1943, Madeleine L., a 16-months-old cousin of Monique W. and also a granddaughter of Mrs. B., came down with typhoid fever while visiting at Château-Richer from September 9th to October 24th. The child had been at her grandmother's for more than a month when the first symptoms of the disease were observed: thus, the case belonged to Château-Richer. An isolation of B . typhosum was made and again we had a strain of type F.

The occurrence of a second case of the same type in the family led us to the possibility of a carrier in the home, leaving aside the water-borne origin of the cases. Whilst our investigation was in progress, Madeleine had been brought back to her father's, Dr. L. at Cap-de-la-Madeleine, and on November 7, 1943, Dr. L.'s maid, Domithilde R., came down with typhoid fever. An isolation of the bacillus was made from the faeces, with again a type F strain. It was rather easy to determine a direct contact between Madeleine and the servant : the maid used to hold the safety pins in her teeth while changing the diapers of the baby.

At Château-Richer, the investigation was being made and soon centered around Mrs. B. herself. In September, 1898, during a visit to Charlesbourg, she came down with a disease diagnosed clinically as typhoid fever by the physician. The disease was not severe, though the patient was in bed for twenty-one days. Later she entered the boarding school of the Ursulines, where she made her

Presented at the twelfth annual Christmas meeting of the Laboratory Section , Canadian Public Health Association , held in the Royal York Hotel , Toronto , on December 75 and 16 , 1943 .

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May 1944 A CHRONIC TYPHOID CARRIER 197

studies. She was married when she was twenty-four years old and raised a large family, but none of her children ever got typhoid fever or a disease resembling an enteric infection.

In August 1937 she went to Syracuse, N.Y., with her husband, and eight days after her return home she came down with a rather severe paratyphoid B fever. A blood culture was made and B. paratyphosum B isolated.

In September 1943 Mrs. B. was admitted to l'Enfant-Jesus Hospital in Quebec for hepatic troubles, with jaundice: an X-ray plate showed four gall- stones and a long bladder.

She returns home to find her granddaughter Madeleine L. on a visit. One day Madeleine is found in the bathroom playing with a face-towel in the water- closet.

The first specimen of faeces submitted by Mrs. B. gives an isolation of B . typhosum, type F. This person of a very nice education has been a chronic typhoid carrier for forty-five years.

In summary, the investigation shows the following sequence of events : 1. The first typhoid case, Monique W., an F type, was thought to be water-

borne. 2. The second case (Madeleine L.) was also caused by an organism of

the F type and led us to look for a carrier. 3. The maid was contaminated by Madeleine directly, and was also an F

type. 4. The grandmother, Mrs. B., was proved to be a typhoid carrier of the F

type. 5. Mrs. B. has been a carrier for forty-five years. 6. In the past months, she has been suffering from gall-stones and it is to

be presumed that on the occasion of bile discharges into the intestines she has been passing bacilli located in the gall-bladder.

7. The typing being done as a routine in our Laboratories, two successive F types invited us to search for a carrier, when it was perfectly reasonable to think that the cases could be water-borne.

In conclusion, this carrier should not bring any additional cases: Mrs. B. is a person of good education who knows how to wash her hands and she has put a Yale lock on the toilet room.

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