South Med J 58: 779, 1965 ing in death have also been re- 10. FERNHOFF PM, OAKLEY GP: Alphafetoprotein as predictor of fetal 19. LIDDELL K: Malignant change in ported.13'14 neural-tube defects. Lancet 2: 368, chronic varicose ulceration. PractiOne must be aware of possible 1975 tioner 215: 335, 1975 neoplastic change in untreated me- 11. THORP RH: Carcinoma associated 20. HALLIDAY JP: Squamous cell carciningomyeloceles after years of mewith myelomeningocele. Case report. noma in a venous ulcer. Med J A ust chanical irritation and chronic bacJ Neurosurg 27: 446, 1967 1: 449, 1968 terial infection. The defect, lacking 12. POPE M, ToDoRov AB: Cutaneous 21. BROWN HW, RIVERA J: Epidermoid a protective epithelial cover, must be squamous cell carcinoma as a rare carcinoma arising in a pilonidal sinus. complication of cervical meningocele. viewed regularly with a high degree Report of a case and review of the Birth Dejects 11: 336, 1975 of suspicion, as with other chronic literature. mt Surg 50: 435, 1968 ulcers; squamous cell carcinoma is a 13. LOVE JG: Delayed malignant devel- 22. DONSKY HJ, MENDELSON CG: Squamopment of a congenital teratoma with ous cell carcinoma as a complication well known complication of burn and spina bifida. Case report. J Neurosurg hidradenitis suppurativa. Arch of other .117 chronic venous ul29: 532, 1968 Dermatol 90: 488, 1964 cers,18'20 pilonidal sinuses,21 long- 14. MICKLE JP, MCLENNAN JE: Malignant 23. HUMPHREY PLAYFORm U, H, standing bacterial and fungal infecteratoma arising within a lipomeninLEAvELL UW Squamous JR: cell carcitions,'2.' vaccination scars26'27 and gocele. Case report. J Neurosurg 43: noma arising in hidradenitis suppura761, 1975 even tattoos.28 Once change is noted, tivum. Arch Dermatol 100: 59, 1969 biopsies should be done to establish 15. ARONS MS, LYNCH JB, LEWIS SR, et 24. FORSTROM L: Carcinomatous changes al: Scar tissue carcinoma: Part I. A a histologic diagnosis. If malignancy in lupus vulgaris. Ann Clin Res 1: clinical study with special reference is established, an intensive search for 213, 1969 to burn scar carcinoma. Ann Surg metastases, lymph node involvement 25. CAPLAN RM: Epidermoid carcinoma 161: 170, 1965 arising in extensive chromoblastomyand local invasion must be made for 16. BOSTwICK J iii, PENDERGRAST WJ, cosis. Arch Dermatol 97: 38, 1968 proper staging and subsequent treatVASCONEZ LO: Marjolin's ulcer: an MARMELZAT WL: Malignant tumors 26. ment. immunologically privileged tumor? in smallpox vaccination scars. Ibid, p Plast Reconstr Surg 57: 66, 1976 We thank Dr. Clair Williams for his 17. DIDOLKAR MS, GERNER RE, MOORE 400 permission to publish this case. 27. REED WB, WILsON-JONEs E: MaligGE: Epidermolysis bullosa dystronant tumors as late complication of phica and epithelioma of the skin: References vaccination. Arch Dermatol 98: 132, review of published cases and report 1. American Academy of Orthopedic Surgeons: Symposium on Myelomeningocele, Mosby, St. Louis, 1972, pp 1-20 2. FREEMAN JM: Practical Management of Meningomyelocele, Univ Park Pr,
of an additional patient. Cancer 33: 198, 1974 18. PENNELL TC, HIGHTOWER F: Malignant changes in post-phlebitic ulcers.
1968 28. MCQUARRIE DG: Squamous-cell carcinoma arising in a tattoo. Minn Med 49: 799, 1966
Baltimore, Md, 1974, pp 1-22
3. SMITh ED (ed): Spida Bitida and the Total Care of Spinal Myelomeningocele,
CC Thomas, Springfield, Ill,
Historical notes typhoid fever
1965, pp 3-46 4. HARRIS HW, MILLER OF: Midline
cutaneous and spinal defects. Arch Dermatol 112: 1724, 1976 5. HEMMER R: Meningoceles and myeloceles, in Progress in Neurological Surgery, vol 4, KRAYENBUHL H (ed), Phiebig, White Plains, NY, 1971, pp
192-226 6. SPECHT EE, GOODNER EK, TANAGHO EA, et al: Myelomeningocele: a symposium on orthopedic, ophthalmologic, urologic, psychological and social, neurosurgical and general considerations. West J Med 121: 281, 1974 7. BROCK DJH, SUTCLIFFE RG: Alphafetoprotein in the antenatal diagnosis of anencephaly and spina bifida. Lancet 2: 197, 1972 8. COLTART TM, SELLER MJ, SINGER
JD, et al: Amniotic fluid concentrations of alpha-fetoprotein (AEP) in early normal pregnancy, and pregnancy complicated by neural tube defects. A review of 18 months experience. Guy's Hasp Rep 123: 121, 1974 9. MILUNSKY A, ALPERT E: The value
of alpha-fetoprotein in the prenatal diagnosis of neural tube defects. J Pediatr 84: 889, 1974
In 1856 William Bud, a British small-town practitioner, published a series of articles in which he demonstrated that in the stools of patients with typhoid there was an agent that carried the disease to other patients (Dowling HF: Fighting Infection, Harvard University Press, Cambridge, Massachusetts, 1977). He evolved a system for preventing the spread of typhoid that included boiling contaminated linen, chemically disinfecting the discharges from typhoid patients and having attendants wash their hands. He considered that "the sewer may be looked upon... as a direct continuation of the diseased intestine" and urged that water and milk be boiled during an epidemic. Charles Murchison, a person of some prominence, dismissed these views and held that putrefaction was the cause of typhoid; Murchison's views prevailed for some time. In the early 1900s and until recently the greatest health problem
related to typhoid was deciding on the proper management of carriers of the disease. In 1906 George Soper of New York City's health departm.nt investigated six cases of typhoid that had occurred in one household. He learned that a recently employed Irish cook had left abruptly after a stay of 3 weeks. When he finally traced the cook he discovered that she had been the cause of seven epidemics of typhoid in 6 years. Her name was Mary Mallon, but she came to be known as Typhoid Mary. In all, she was responsible for approximately 60 cases of typhoid, 3 of which were fatal, in New York City. Once discovered, Mary was kept in hospital for 3 years, but she discharged herself and, against medical advice, took a job involving the handling of food; this led to a further series of epidemics. Cholecystectomy was the only known treatment for carriers at the time, but Mary would have no part of it; she spent the last 23 years of her life in hospital under what we today would call protective custody.u
CMA JOURNAL/OCTOBER 7, 1978/VOL. 119 741
of an additional patient. Cancer 33: 198, 1974 18. PENNELL TC, HIGHTOWER F: Malignant changes in post-phlebitic ulcers.
1968 28. MCQUARRIE DG: Squamous-cell carcinoma arising in a tattoo. Minn Med 49: 799, 1966
Baltimore, Md, 1974, pp 1-22
3. SMITh ED (ed): Spida Bitida and the Total Care of Spinal Myelomeningocele,
CC Thomas, Springfield, Ill,
Historical notes typhoid fever
1965, pp 3-46 4. HARRIS HW, MILLER OF: Midline
cutaneous and spinal defects. Arch Dermatol 112: 1724, 1976 5. HEMMER R: Meningoceles and myeloceles, in Progress in Neurological Surgery, vol 4, KRAYENBUHL H (ed), Phiebig, White Plains, NY, 1971, pp
192-226 6. SPECHT EE, GOODNER EK, TANAGHO EA, et al: Myelomeningocele: a symposium on orthopedic, ophthalmologic, urologic, psychological and social, neurosurgical and general considerations. West J Med 121: 281, 1974 7. BROCK DJH, SUTCLIFFE RG: Alphafetoprotein in the antenatal diagnosis of anencephaly and spina bifida. Lancet 2: 197, 1972 8. COLTART TM, SELLER MJ, SINGER
JD, et al: Amniotic fluid concentrations of alpha-fetoprotein (AEP) in early normal pregnancy, and pregnancy complicated by neural tube defects. A review of 18 months experience. Guy's Hasp Rep 123: 121, 1974 9. MILUNSKY A, ALPERT E: The value
of alpha-fetoprotein in the prenatal diagnosis of neural tube defects. J Pediatr 84: 889, 1974
In 1856 William Bud, a British small-town practitioner, published a series of articles in which he demonstrated that in the stools of patients with typhoid there was an agent that carried the disease to other patients (Dowling HF: Fighting Infection, Harvard University Press, Cambridge, Massachusetts, 1977). He evolved a system for preventing the spread of typhoid that included boiling contaminated linen, chemically disinfecting the discharges from typhoid patients and having attendants wash their hands. He considered that "the sewer may be looked upon... as a direct continuation of the diseased intestine" and urged that water and milk be boiled during an epidemic. Charles Murchison, a person of some prominence, dismissed these views and held that putrefaction was the cause of typhoid; Murchison's views prevailed for some time. In the early 1900s and until recently the greatest health problem
related to typhoid was deciding on the proper management of carriers of the disease. In 1906 George Soper of New York City's health departm.nt investigated six cases of typhoid that had occurred in one household. He learned that a recently employed Irish cook had left abruptly after a stay of 3 weeks. When he finally traced the cook he discovered that she had been the cause of seven epidemics of typhoid in 6 years. Her name was Mary Mallon, but she came to be known as Typhoid Mary. In all, she was responsible for approximately 60 cases of typhoid, 3 of which were fatal, in New York City. Once discovered, Mary was kept in hospital for 3 years, but she discharged herself and, against medical advice, took a job involving the handling of food; this led to a further series of epidemics. Cholecystectomy was the only known treatment for carriers at the time, but Mary would have no part of it; she spent the last 23 years of her life in hospital under what we today would call protective custody.u
CMA JOURNAL/OCTOBER 7, 1978/VOL. 119 741
