Percivall Pott and cancer scroti

Abstract

The name of Percivall Pott is perpetuated through three eponymous diseases, Pott's fracture, Pott's disease of the spine, and Pott's puffy tumor. His other important clinical observation, however, does not bear his name. Pott gave notice of a disease (1775) which was 'peculiar to a certain sort of people (and) which has not at least to my knowledge, been noticed, I mean the chimney sweepers' cancer'. The disease was not exclusive to the sweeps any more than the colic of Poitou was the sole prerogative of lead workers, but is was a disease, said Pott, to which they had a special liability. Scrotal cancer had been described almost 40 years before Pott wrote and there is a much older reference to 'Canker of privities' in burial records of the Parish of St Botolph without Aldgate from 1589 to 1599 (Forbes, 1971). It is not clear from these records which anatomical site is meant and most authorities ascribe priority in the description of scrotal cancer to Bassius in 1731. There are grounds for thinking, however, that the condition which Bassius described was perineal abscess with the formation of sinuses to the scrotum rather than carcinoma, in which case, the first description of the malignant lesion of the scrotum should be attributed to Treyling in 1740 (Kipling, Usherwood, and Varley, 1970). Pott has become famous for his observation because of the causal link which he established between occupation, and malignancy, although in his own day, the significance of this association was not fully understood. His description of the disease produced in its wake a succession of accounts from other authors. After the publication of his tract, clinical reports appeared with some regularity, increasing in number during the early part of the nineteenth century. It is likely that many surgeons had been acquainted with the disease before Pott wrote on the subject but that they had wrongly diagnosed and treated it. The disease continued to confine itself mainly to the sweeps, and of all people, they had a singularly hard fate, for, writes Pott 'in their early infancy, they are most frequently treated with great brutality, and almost starved with cold and hunger; they are thrust up narrow, and sometimes hot chimneys, where they are bruised, burned and almost suffocated; and when they get to puberty, become peculiarly liable to a most noisome, painful, and fatal disease'. The plight of the chimney boys was a scandal which persisted long into the following century. It was not until Lord Shaftesbury succeeded in having his Chimney Sweepers Act passed (1875) that the scandal was brought to an end. This Act succeeded where others had failed by introducing a system of licensing which was imposed upon the sweeps and for which the police were made responsible. By these means Shaftesbury was able to remove a disgrace which had been peculiar to the British Isles.