HX07 Chimney sweep’s carcinoma; the first occupational cancer and Pott’s brilliant perspective

Abstract Despite what childhood films suggest, the life of a chimney sweep was not one of glamour and dance routines. Rising to prominence in the aftermath of the Great Fire of London in 1666, when the clearing chimneys of soot became obligatory, young boys from poor families composed much of the workforce needed to fit into the narrow flues most homes had. Doing a predictably dirty job, chimney sweeps often worked naked to ease their manoeuvring into the flue. It was arduous work and, as bathing was rare, sweeps left soot to sit on their skin. Through this, an occupational disease would arise in later life that caused untold suffering, and it took the wisdom of the brilliant Percival Pott to recognize it. Throughout the 17th to 19th centuries, chimney sweeps presented to doctors with lesions of the scrotal skin. A diagnosis of venereal disease was often made, yet these spots and sores did not behave like those expected from sexually transmitted disease. In many cases they progressed to destructive tumours that engulfed the underlying testicle, metastasizing and inevitably killing the patient. Such was the pain that late-stage disease caused, there were reports of self-mutilation in attempts to cut off the affected area. Once it spread to the lymphatics, death was a certainty. Percival Pott was a brilliant 18th century surgeon famed for the discovery of the eponymous Pott’s disease. While investigating an outbreak of scrotal tumours in chimney sweeps he came to the realization that soot trapped within the rugae of the scrotal skin was the causative agent in the development of this disease. Being a child of impoverished surroundings, Pott was famed for the care he provided his patients, and dedication to helping those in poverty. On chimney sweep’s carcinoma he wrote: ‘The fate of these people seems singularly hard…they are thrust up narrow and sometimes hot chimneys, where they are buried, burned and almost suffocated; and when they get to puberty become liable to a most noisome, painful and fatal disease’ (Waldron HA. A brief history of scrotal cancer. Br J Ind Med 1983; 40: 390–401). Pott’s work helped encourage the introduction of legislation, the Chimney Sweepers Act 1788 and its subsequent revisions, to improve the conditions of chimney sweeps. While adherence in England was poor, other nations introduced uniforms to protect sweeps’ skin from the damaging residues. It was not until the 1900s that the carcinogenic mechanisms of chimney soot were elucidated, proving Pott’s hypothesis correct (Dronsfield A. Percival Pott, chimney sweeps and cancer. Education in Chemistry 2006; 40–2).