Soot wart
Encyclopedia
Chimney sweep's cancer called Soot wart, is a squamous cell carcinoma
of the skin of the scrotum
. It has the distinction of being the first reported form of occupational cancer
, and was initially identified by Percival Pott in 1775.
The name came about as it was initially noticed as prevalent amongst chimney sweep
s.
of the skin of the scrotum
. It was first detected in 1775, where it affected chimney sweeps in their late teen and early twenties who had been in contact with soot since their early childhood. It was proposed that sweat running down their bodies had caused soot to accumulate in the rugae
of the inferior surfaces of the scrotum. Wart
s caused by the irritation from soot particles, if not excised developed into a scrotal cancer. This then invaded the dartos
, enlarged the testicle
and proceeded up the spermatic cord
into the abdomen
where it proved fatal. Irritation was discounted when it was experimentally shown in 1922, that an active ingredient of coal soot
was a carcinogen.
Percivall Pott (6 January 1714 – 22 December 1788) London
, England
) was an English surgeon
, one of the founders of orthopedy, and the first scientist to demonstrate that a cancer
may be caused by an environmental carcinogen
.
In 1765 he was elected Master of the Company of Surgeons, the forerunner of the Royal College of Surgeons. It was in 1775 that Pott found an association between exposure to soot
and a high incidence of Chimney Sweeps' carcinoma, a scrotal cancer (later found to be squamous cell carcinoma
) in chimney sweep
s. This was the first occupational
link to cancer
, and Pott was the first person to demonstrate that a malignancy could be caused by an environmental carcinogen
. Pott's early investigations contributed to the science of epidemiology
and the Chimney Sweeper's Act of 1788.
Pott describes Chimney Sweeps' carcinoma thus:
He comments on the life of the boys:
The carcinogen was thought to be coal tar
possibly containing some arsenic
.
Though Pott wrote no further papers on the subject, clinical reports began to appear suggesting that others had seen it without realising what it was and like Pott had said:
The disease was usually preceded by the development of hyperkeratotic lesion
s on the scrotum, which was what the sweeps called soot warts. These could be benign; sweeps often removed them themselves by trapping them in a split cane and cutting them off with a pocket knife. For instance:
But if the lesion had become malignant it was far more serious. Patients frequently delayed seeking medical opinion, and when they did many were in dreadful state. A 28 year old sweep approached Jefferies in 1825, who describes his condition:
paste poltice. The real cause of this cancer was unproved until the discovery of weak carcinogens in soot by Passley in 1922. Until then the most popular theory was that soot got trapped in the rugae
of the scrotum and this caused a general irritation. Sweeps were not known for their attention to bodily hygene and it was assumed they never washed their genitals. The youngest victim, recorded in 1790 by James Earle (Pott's son-in-law), was 8 yrs old. The disease was principally a British phenonomen, for example in Germany, sweeps wore tight fitting protective clothing which prevented the soot accumulating on the lower surface of the scrotum, while at one stage in the UK boys were sent up the chimneys naked.
was blamed on the carcinogenic content of shale oil
that was used to lubricate the rapidly revolving mule spindles
.
Squamous cell carcinoma
Squamous cell carcinoma , occasionally rendered as "squamous-cell carcinoma", is a histologically distinct form of cancer. It arises from the uncontrolled multiplication of malignant cells deriving from epithelium, or showing particular cytological or tissue architectural characteristics of...
of the skin of the scrotum
Scrotum
In some male mammals the scrotum is a dual-chambered protuberance of skin and muscle containing the testicles and divided by a septum. It is an extension of the perineum, and is located between the penis and anus. In humans and some other mammals, the base of the scrotum becomes covered with curly...
. It has the distinction of being the first reported form of occupational cancer
Occupational disease
An occupational disease is any chronic ailment that occurs as a result of work or occupational activity. It is an aspect of occupational safety and health. An occupational disease is typically identified when it is shown that it is more prevalent in a given body of workers than in the general...
, and was initially identified by Percival Pott in 1775.
The name came about as it was initially noticed as prevalent amongst chimney sweep
Chimney sweep
A chimney sweep is a worker who clears ash and soot from chimneys. The chimney uses the pressure difference caused by a hot column of gas to create a draught and draw air over the hot coals or wood enabling continued combustion. Chimneys may be straight or contain many changes of direction. During...
s.
Description
This is a squamous cell carcinomaSquamous cell carcinoma
Squamous cell carcinoma , occasionally rendered as "squamous-cell carcinoma", is a histologically distinct form of cancer. It arises from the uncontrolled multiplication of malignant cells deriving from epithelium, or showing particular cytological or tissue architectural characteristics of...
of the skin of the scrotum
Scrotum
In some male mammals the scrotum is a dual-chambered protuberance of skin and muscle containing the testicles and divided by a septum. It is an extension of the perineum, and is located between the penis and anus. In humans and some other mammals, the base of the scrotum becomes covered with curly...
. It was first detected in 1775, where it affected chimney sweeps in their late teen and early twenties who had been in contact with soot since their early childhood. It was proposed that sweat running down their bodies had caused soot to accumulate in the rugae
Rugae
Rugae is a term used in anatomy that refers to a series of ridges produced by folding of the wall of an organ. Most commonly the term is applied to the internal surface of the stomach...
of the inferior surfaces of the scrotum. Wart
Wart
A wart is generally a small, rough growth, typically on a human’s hands or feet but often other locations, that can resemble a cauliflower or a solid blister. They are caused by a viral infection, specifically by human papillomavirus 2 and 7. There are as many as 10 varieties of warts, the most...
s caused by the irritation from soot particles, if not excised developed into a scrotal cancer. This then invaded the dartos
Dartos
The dartos fascia is a fat-free layer of smooth muscular fiber outside the external spermatic fascia but below the skin. It is a continuation of Scarpa's fascia, which is a membranous layer of the subcutaneous tissue in the abdominal wall...
, enlarged the testicle
Testicle
The testicle is the male gonad in animals. Like the ovaries to which they are homologous, testes are components of both the reproductive system and the endocrine system...
and proceeded up the spermatic cord
Spermatic cord
The spermatic cord is the name given to the cord-like structure in males formed by the ductus deferens and surrounding tissue that run from the abdomen down to each testicle.-Contents of spermatic cord:...
into the abdomen
Abdomen
In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...
where it proved fatal. Irritation was discounted when it was experimentally shown in 1922, that an active ingredient of coal soot
Coal tar
Coal tar is a brown or black liquid of extremely high viscosity, which smells of naphthalene and aromatic hydrocarbons. Coal tar is among the by-products when coal iscarbonized to make coke or gasified to make coal gas...
was a carcinogen.
History
SirKnight
A knight was a member of a class of lower nobility in the High Middle Ages.By the Late Middle Ages, the rank had become associated with the ideals of chivalry, a code of conduct for the perfect courtly Christian warrior....
Percivall Pott (6 January 1714 – 22 December 1788) London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...
, England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
) was an English surgeon
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
, one of the founders of orthopedy, and the first scientist to demonstrate that a cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
may be caused by an environmental carcinogen
Carcinogen
A carcinogen is any substance, radionuclide, or radiation that is an agent directly involved in causing cancer. This may be due to the ability to damage the genome or to the disruption of cellular metabolic processes...
.
In 1765 he was elected Master of the Company of Surgeons, the forerunner of the Royal College of Surgeons. It was in 1775 that Pott found an association between exposure to soot
Soot
Soot is a general term that refers to impure carbon particles resulting from the incomplete combustion of a hydrocarbon. It is more properly restricted to the product of the gas-phase combustion process but is commonly extended to include the residual pyrolyzed fuel particles such as cenospheres,...
and a high incidence of Chimney Sweeps' carcinoma, a scrotal cancer (later found to be squamous cell carcinoma
Squamous cell carcinoma
Squamous cell carcinoma , occasionally rendered as "squamous-cell carcinoma", is a histologically distinct form of cancer. It arises from the uncontrolled multiplication of malignant cells deriving from epithelium, or showing particular cytological or tissue architectural characteristics of...
) in chimney sweep
Chimney sweep
A chimney sweep is a worker who clears ash and soot from chimneys. The chimney uses the pressure difference caused by a hot column of gas to create a draught and draw air over the hot coals or wood enabling continued combustion. Chimneys may be straight or contain many changes of direction. During...
s. This was the first occupational
Occupational disease
An occupational disease is any chronic ailment that occurs as a result of work or occupational activity. It is an aspect of occupational safety and health. An occupational disease is typically identified when it is shown that it is more prevalent in a given body of workers than in the general...
link to cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
, and Pott was the first person to demonstrate that a malignancy could be caused by an environmental carcinogen
Carcinogen
A carcinogen is any substance, radionuclide, or radiation that is an agent directly involved in causing cancer. This may be due to the ability to damage the genome or to the disruption of cellular metabolic processes...
. Pott's early investigations contributed to the science of epidemiology
Epidemiology
Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...
and the Chimney Sweeper's Act of 1788.
Pott describes Chimney Sweeps' carcinoma thus:
It is a disease which always makes it first attack on the inferior part of the scrotumScrotumIn some male mammals the scrotum is a dual-chambered protuberance of skin and muscle containing the testicles and divided by a septum. It is an extension of the perineum, and is located between the penis and anus. In humans and some other mammals, the base of the scrotum becomes covered with curly...
where it produces a superficial, painful ragged ill-looking sore with hard rising edges.....in no great length of time it pervades the skin, dartosDartosThe dartos fascia is a fat-free layer of smooth muscular fiber outside the external spermatic fascia but below the skin. It is a continuation of Scarpa's fascia, which is a membranous layer of the subcutaneous tissue in the abdominal wall...
and the membranes of the scrotum, and seizes the testicleTesticleThe testicle is the male gonad in animals. Like the ovaries to which they are homologous, testes are components of both the reproductive system and the endocrine system...
, which it inlarges(sic), hardens and renders truly and thoroughly distempered. Whence it makes its way up the spermatic processSpermatic cordThe spermatic cord is the name given to the cord-like structure in males formed by the ductus deferens and surrounding tissue that run from the abdomen down to each testicle.-Contents of spermatic cord:...
into the abdomenAbdomenIn vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...
.
He comments on the life of the boys:
The fate of these people seems peculiarly hard...they are treated with great brutality.. they are thrust up narrow and sometimes hot chimnies, [sic] where they are bruised burned and almost suffocated; and when they get to pubertyPubertyPuberty is the process of physical changes by which a child's body matures into an adult body capable of reproduction, as initiated by hormonal signals from the brain to the gonads; the ovaries in a girl, the testes in a boy...
they become ... liable to a most noisome, painful and fatal disease.
The carcinogen was thought to be coal tar
Coal tar
Coal tar is a brown or black liquid of extremely high viscosity, which smells of naphthalene and aromatic hydrocarbons. Coal tar is among the by-products when coal iscarbonized to make coke or gasified to make coal gas...
possibly containing some arsenic
Arsenic
Arsenic is a chemical element with the symbol As, atomic number 33 and relative atomic mass 74.92. Arsenic occurs in many minerals, usually in conjunction with sulfur and metals, and also as a pure elemental crystal. It was first documented by Albertus Magnus in 1250.Arsenic is a metalloid...
.
Though Pott wrote no further papers on the subject, clinical reports began to appear suggesting that others had seen it without realising what it was and like Pott had said:
[ as it occurs after puberty]....it is generally taken, both by patient and surgeon for venereal and treated with mercurial [salts].
The disease was usually preceded by the development of hyperkeratotic lesion
Lesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
s on the scrotum, which was what the sweeps called soot warts. These could be benign; sweeps often removed them themselves by trapping them in a split cane and cutting them off with a pocket knife. For instance:
"he... seized with a split stick and cut off with a razor. He remarked that it was not very painful. He resumed work the following day."
But if the lesion had become malignant it was far more serious. Patients frequently delayed seeking medical opinion, and when they did many were in dreadful state. A 28 year old sweep approached Jefferies in 1825, who describes his condition:
"The sore occupies the whole of the left side of the scrotumScrotumIn some male mammals the scrotum is a dual-chambered protuberance of skin and muscle containing the testicles and divided by a septum. It is an extension of the perineum, and is located between the penis and anus. In humans and some other mammals, the base of the scrotum becomes covered with curly...
and the inner angle of the thighThighIn humans the thigh is the area between the pelvis and the knee. Anatomically, it is part of the lower limb.The single bone in the thigh is called the femur...
, extending from the anusAnusThe anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,...
to the posterior inferior spinous process of the ileumIleumThe ileum is the final section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms posterior intestine or distal intestine may be used instead of ileum.The ileum follows the duodenum...
, presenting a surface as large as a man's open hand, with hard indurated edges and irregular margins, discharging a thin sanies, which is extremely offensive; the left testicleTesticleThe testicle is the male gonad in animals. Like the ovaries to which they are homologous, testes are components of both the reproductive system and the endocrine system...
is entirely denuded, and projects from its centre; in the left groinGroinIn human anatomy, the groin areas are the two creases at the junction of the torso with the legs, on either side of the pubic area. This is also known as the medial compartment of the thigh. A pulled groin muscle usually refers to a painful injury sustained by straining the hip adductor muscles...
is a mass of indurated glands, the size of a goose's egg, which appears to suppurate in the right groin: there is likewise an ulcerationGenital ulcerA Genital ulcer is an ulcer located on the genital area, usually caused by a sexually transmitted disease such as genital herpes, syphilis, chancroid, or thrush. Some other signs of having genital ulcers include enlarged lymph nodes in the groin area, or vesicular lesions, which are small, elevated...
, of the same malignantMalignantMalignancy is the tendency of a medical condition, especially tumors, to become progressively worse and to potentially result in death. Malignancy in cancers is characterized by anaplasia, invasiveness, and metastasis...
nature, about the size of a half-crown (5 cm). . ."
Despite the appearance of this growth, the unfortunate man was in no pain and his only complaint was that about 10 days before his admission he had bled from his groin and lost about a pint of blood.Even this, however, had not unduly affected his constitution.
Treatment
Treatment was by surgery, where all the diseased flesh was cut out: before the introduction of anaesthetics this was a simple process for the surgeon but terrifying for the patient. Alternative treatments were also proposed including the application of a arsenicArsenic
Arsenic is a chemical element with the symbol As, atomic number 33 and relative atomic mass 74.92. Arsenic occurs in many minerals, usually in conjunction with sulfur and metals, and also as a pure elemental crystal. It was first documented by Albertus Magnus in 1250.Arsenic is a metalloid...
paste poltice. The real cause of this cancer was unproved until the discovery of weak carcinogens in soot by Passley in 1922. Until then the most popular theory was that soot got trapped in the rugae
Rugae
Rugae is a term used in anatomy that refers to a series of ridges produced by folding of the wall of an organ. Most commonly the term is applied to the internal surface of the stomach...
of the scrotum and this caused a general irritation. Sweeps were not known for their attention to bodily hygene and it was assumed they never washed their genitals. The youngest victim, recorded in 1790 by James Earle (Pott's son-in-law), was 8 yrs old. The disease was principally a British phenonomen, for example in Germany, sweeps wore tight fitting protective clothing which prevented the soot accumulating on the lower surface of the scrotum, while at one stage in the UK boys were sent up the chimneys naked.
Related diseases
Decades later, it was noticed to occur amongst gas plant and oil shale workers, and it was later found that certain constituents of tar, soot, and oils, known as polycyclic aromatic hydrocarbons, were found to cause cancer in laboratory animals. The related cancer, mule spinners' carcinomaMule spinners' cancer
Mule spinners' cancer or Mule-spinners' cancer was a cancer, an epithelioma of the scrotum. It was first reported in 1887 in a cotton mule spinner...
was blamed on the carcinogenic content of shale oil
Shale oil
Shale oil, known also as kerogen oil or oil-shale oil, is an unconventional oil produced from oil shale by pyrolysis, hydrogenation, or thermal dissolution. These processes convert the organic matter within the rock into synthetic oil and gas...
that was used to lubricate the rapidly revolving mule spindles
Spinning mule
The spinning mule was a machine used to spin cotton and other fibres in the mills of Lancashire and elsewhere from the late eighteenth to the early twentieth century. Mules were worked in pairs by a minder, with the help of two boys: the little piecer and the big or side piecer...
.