Percivall Pott (6 January 1714, in London – 22 December 1788) was an English surgeon, one of the founders of orthopaedics, and the first scientist to demonstrate that cancer may be caused by an environmental carcinogen, namely chimney sweeps' carcinoma. Many diseases are his namesake including Pott's fracture, Pott's disease of the spine, and Pott's puffy tumour. It is believed that Pott's standard of living contributed to the rise of the surgeon within social standings.
Percivall Pott was born the son of Percivall Pott senior in London. His father died when he was a child, but Joseph Wilcocks, Bishop of Rochester, who was a relative of his mother, paid for his education. He served his apprenticeship with Edward Nourse, assistant surgeon to St Bartholomew's Hospital, and in 1736 was admitted to the Barbers' Company and licensed to practice.
He became assistant surgeon to St Bartholomew's in 1744 and full surgeon from 1749 till 1787. As the first surgeon of his day in England, excelling even his pupil, John Hunter, on the practical side, Pott introduced various important innovations in procedure, doing much to abolish the extensive use of escharotics and the cautery that was prevalent when he began his career.
In 1756, Pott sustained a broken leg after a fall from his horse. It is often assumed that his injury was the same one that later came to be known as Pott's fracture, but in reality, Pott's broken leg was a much more serious compound fracture of the tibia. As he lay in the muck, he sent a servant to buy a door from a nearby construction site, then had himself placed on the door and taken home. Surgeons cleaned the wound and discussed amputation, an operation which at the time had a very high rate of failure, as it often led to sepsis and death, but Pott prevailed on them to splint the leg, and he ultimately recovered completely. [1]
Percivall Pott's dedication to his patients and standard of care garnered Pott high praise and fame. He is generally regarded as one of the two greatest surgeons of the 18th century along with his student John Hunter. [2] Amid the patient wards, Pott also honed his writing skills and believed in patient education. [3] He would distribute pamphlets, noting his observations and thoughts on topics ranging from "head injuries, hydrocele, fistula, rupture, and fracture", in the hospital environment. [4] These pamphlets were in high demand and would sell for more than one shilling and sixpence. Between the 1760s and the 1770s over fourteen of Pott's pamphlets were in circulation. [4]
In 1769 Pott published Some Few Remarks upon Fractures and Dislocations. The book was translated into French and Italian and had a far-reaching influence in Britain and France. His name was written in the annals of medicine, by first describing arthritic tuberculosis of the spine (Pott's disease). He gave an excellent clinical description in his Remarks on that Kind of Palsy of the Lower Limbs. Among his other writings, the most noteworthy are A Treatise on Ruptures (1756), and Chirurgical Observations.
In 1765, he was elected Master of the Company of Surgeons, the forerunner of the Royal College of Surgeons of England.
In 1775, Pott found an association between exposure to soot and a high incidence of scrotal cancer later found to be a type of squamous cell carcinoma in chimney sweeps. This disease, later termed chimney sweeps' carcinoma due to Pott's investigation, was the first occupational link to cancer, and Pott became the first person to associate a malignancy with an environmental carcinogen, implicating chimney soot as a direct contact carcinogen to skin.
A manuscript copy of his 1779 lectures on surgery survives as part of the Manchester Medical Manuscripts Collection held by special collections at the University of Manchester Library with the reference MMM/15/2/6.
In 1786, he was honoured as the first Honorary Fellow of the Royal College of Surgeons of Edinburgh. [4] Shortly after, he retired in 1787 and was named a governor of St. Bartholomew's Hospital. [5]
in 1740, Percivall Potts married Sarah Elizabeth Cruttenden (1725-1811), daughter of the wealthy merchant Robert Cruttenden and his wife Sarah Cliff. They lived together in Lincoln's Inn Fields in London and had five sons and four daughters, including Joseph Pott, Archdeacon of London, Samuel, a leading newspaper editor and owner of Saunders Newsletter, and Mary (Polly), who married the long-serving Irish judge Robert Day. [4]
Although little more is known about Percivall Pott's private life, Pott is regularly described as having excellent character, and an archetypical English surgeon. It is believed that Pott's standard of living (he was rich enough to give Polly a dowry of £5000) was a contributor to the rise of the surgeon within social standings. [4]
Percivall Pott has influenced medicine and modern understanding of diseases. Many diseases are his namesake including: Pott's fracture, Pott's disease of the spine, and Pott's puffy tumor. One disease which does not, yet is important to Pott's legacy is chimney sweeper's carcinoma. Pott quickly recognised the association between carcinoma and chimney sweeps and published his findings in a piece titled "Chirurgical Observations relative to…the cancer of the scrotum." [6] [7] He wrote that the disease was, " peculiar to a certain sort of people [ and ] which has not at least to my knowledge, been publicly noticed – I mean the chimney-sweepers ’ cancer. The disease, in these people, seems to derive its origin from a lodgment of soot in the rugae of the scrotum." [7]
Scrotal cancer, although largely thought to have been identified by Percival Pott, had been thought to have been described nearly 40 years before Pott's "Chirurgical Observations" as a "canker of privities" per documentation in the burial records of the Parish of St. Botolph without Aldgate from 1589 to 1599. [8] These descriptions are ambiguous and it is unclear which anatomical parts are considered "privities". As such, most historians generally agree, that Bassius first correctly described scrotal cancer in 1731. [3] Some historians argue that what Bassius considered scrotal cancer was in fact perineal abscesses to the scrotum as opposed to carcinoma. The minority of historians who agree with this fact, attribute the discovery of scrotal cancer to Treyling in 1740. [3] [9]
As a surgeon, Pott was well respected and often assisted fellow surgeons. Pott was viewed as a mentor and even allowed other physicians and surgeons to live with him while under his guidance. [4] Despite the surgical trends of his time, Pott did not agree with severe treatments and heroic medicine but rather preferred gentler forms. Percivall Pott's son-in-law, James Earle, described Pott's surgery as being "divested of great part of its horrors, became, comparatively, a pleasing study." [9]
In addition to surgery, Pott's focused on public health as well drawing his attention to the challenges of chimney sweeps in his community. He wrote, "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." [7] Pott's approach was unique amongst his contemporaries in that he did not simply note an association but approached chimney sweeps' carcinoma from a causal perspective. His work helped later identify soot as the disease-causing agent. [3] Pott did not figure this out on his own, but rather pointed research in the right direction. During Pott's time, there were many discussions pertaining to the cause of scrotal cancer. James Earle believed that the cancer was caused as a result of the soot entering and residing in the rugae of the scrotum. He famously argued this point based on a trend seen where gardeners who used soot to kill slugs had developed skin carcinoma on their hands. In 1878, George Lawson suggested that the cancer was caused by the friction generated by the chimney sweeper's overalls against the scrotum while sifting through soot. This idea was explored by Passey in 1992 who demonstrated that it was the ethereal extract of soot which was capable of inducing sarcoma. [9] Furthermore, Pott also identified that prepubescent boys were most vulnerable to the carcinoma. [10] Pott rose to fame for these connections between occupational hazards and cancer malignancy even though the connection was not fully understood at the time. Pott's "Chirurgical Observations" provided a framework to shape the modern understanding of Occupational cancers.
Percivall Pott's work influenced a wave of research and change in public policies. After his initial publication, more clinical cases began to emerge rapidly over the following years. [2] This triggered a series of "Chimney Sweepers' Acts" which aimed to protect chimney sweepers. These facilitated the formation of societies like the "Society for Superseding the Necessity of Climbing Boys, by Encouraging a New Method of Sweeping Chimneys and for Improving the Condition of Children and Others Employed by Chimney Sweepers" in 1803 which included the likes of Dukes, Earls, and Royal Patrons. [9]
Despite the outcry and public demands to change chimney sweeping practices, such as suggesting that young chimney sweeping boys be replaced with mechanical devices, insurance companies, and homeowners argued that Chimney Sweeper's carcinoma was a small price to pay for the protection of the mass population against smoke and chimney fires. [11] [9] There was pressure for action as early as 1788, yet it was not until 1875 that Pott's work finally began to influence change: in this year a decline in scrotal cancer incidence and mortality was noted. [5]
Latter animal studies (1933) painting coal tar onto skin would demonstrate the role of the first proven chemical carcinogen benzo(a)pyrene, which occurs in high concentrations in smoke and chimney soot, with the process that Pott first identified. Pott's early investigations thus contributed to the science of epidemiology and the Chimney Sweepers Act 1788. [12]
Lung cancer, also known as lung carcinoma, is a malignant tumor that begins in the lung. Lung cancer is caused by genetic damage to the DNA of cells in the airways, often caused by cigarette smoking or inhaling damaging chemicals. Damaged airway cells gain the ability to multiply unchecked, causing the growth of a tumor. Without treatment, tumors spread throughout the lung, damaging lung function. Eventually lung tumors metastasize, spreading to other parts of the body.
In genetics, a mutagen is a physical or chemical agent that permanently changes genetic material, usually DNA, in an organism and thus increases the frequency of mutations above the natural background level. As many mutations can cause cancer in animals, such mutagens can therefore be carcinogens, although not all necessarily are. All mutagens have characteristic mutational signatures with some chemicals becoming mutagenic through cellular processes.
A chimney sweep is a person who clears soot and creosote 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 normal operation, a layer of creosote builds up on the inside of the chimney, restricting the flow. The creosote can also catch fire, setting the chimney alight. The chimney must be swept to remove the soot.
Johannes Andreas Grib Fibiger was a Danish physician and professor of anatomical pathology at the University of Copenhagen. He was the recipient of the 1926 Nobel Prize in Physiology or Medicine "for his discovery of the Spiroptera carcinoma". He demonstrated that the roundworm which he called Spiroptera carcinoma could cause stomach cancer in rats and mice. His experimental results were later proven to be a case of mistaken conclusion. Erling Norrby, who had served as the Permanent Secretary of the Royal Swedish Academy of Sciences and Professor and Chairman of Virology at the Karolinska Institute, declared Fibiger's Nobel Prize as "one of the biggest blunders made by the Karolinska Institute."
Benzo[a]pyrene (BaP or B[a]P) is a polycyclic aromatic hydrocarbon and the result of incomplete combustion of organic matter at temperatures between 300 °C (572 °F) and 600 °C (1,112 °F). The ubiquitous compound can be found in coal tar, tobacco smoke and many foods, especially grilled meats. The substance with the formula C20H12 is one of the benzopyrenes, formed by a benzene ring fused to pyrene. Its diol epoxide metabolites, more commonly known as BPDE, react with and bind to DNA, resulting in mutations and eventually cancer. It is listed as a Group 1 carcinogen by the IARC. In the 18th century a scrotal cancer of chimney sweepers, the chimney sweeps' carcinoma, was already known to be connected to soot.
An occupational disease or industrial 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 population, or in other worker populations. The first such disease to be recognised, squamous-cell carcinoma of the scrotum, was identified in chimney sweep boys by Sir Percival Pott in 1775. Occupational hazards that are of a traumatic nature are not considered to be occupational diseases.
Occupational lung diseases comprise a broad group of diseases, including occupational asthma, industrial bronchitis, chronic obstructive pulmonary disease (COPD), bronchiolitis obliterans, inhalation injury, interstitial lung diseases, infections, lung cancer and mesothelioma. These can be caused directly or due to immunological response to an exposure to a variety of dusts, chemicals, proteins or organisms. Occupational cases of interstitial lung disease may be misdiagnosed as COPD, idiopathic pulmonary fibrosis, or a myriad of other diseases; leading to a delay in identification of the causative agent.
Verrucous carcinoma (VC) is an uncommon variant of squamous cell carcinoma. This form of cancer is often seen in those who chew tobacco or use snuff orally, so much so that it is sometimes referred to as "Snuff dipper's cancer".
Surgery is the branch of medicine that deals with the physical manipulation of a bodily structure to diagnose, prevent, or cure an ailment. Ambroise Paré, a 16th-century French surgeon, stated that to perform surgery is, "To eliminate that which is superfluous, restore that which has been dislocated, separate that which has been united, join that which has been divided and repair the defects of nature."
Sir James Earle (1755–1817) was a celebrated British surgeon, renowned for his skill in lithotomy.
Chimney sweeps' cancer, also called soot wart or scrotal cancer, is a squamous cell carcinoma of the scrotum. It has the distinction of being the first reported form of occupational cancer, and was initially identified by Percivall Pott in 1775. It was initially noticed as being prevalent amongst chimney sweeps. The disease has also been seen in men exposed to mineral oil and those who worked with coal distillates.
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. In 1926, a British Home Office committee strongly favoured the view that this form of cancer was caused by the prolonged action of mineral oils on the skin of the scrotum, and of these oils, shale oil was deemed to be the most carcinogenic. From 1911 to 1938, there were 500 deaths amongst cotton mule-spinners from cancer of the scrotum, but only three amongst wool mule spinners.
Mirosław Jan Stasik was a Polish medical doctor and research toxicologist.
Henry Earle FRS (1789–1838) was an English surgeon.
The history of cancer describes the development of the field of oncology and its role in the history of medicine.
Thomas Kirkland M.D. (1721–1798) was an English physician and medical writer.
The following outline is provided as an overview of and topical guide to trauma and orthopaedics:
The treatment of broken bones and dislocated joints can be traced as far back as the Ancient Greeks. Hippocrates is credited with a method of reduction of a dislocated shoulder. 16th century Spanish texts talk about the Aztecs use of reduction of fractures using fir branches. The modern discipline of orthopaedics in trauma care developed during the course of World War I, but it was not until after World War II that orthopaedics became the dominant field treating fractures in much of the world. Today, the discipline encompasses conditions such as bone fractures and bone loss, as well as spinal pathology and joint disease.
Cancer prevention is the practice of taking active measures to decrease the incidence of cancer and mortality. The practice of prevention is dependent upon both individual efforts to improve lifestyle and seek preventive screening, and socioeconomic or public policy related to cancer prevention. Globalized cancer prevention is regarded as a critical objective due to its applicability to large populations, reducing long term effects of cancer by promoting proactive health practices and behaviors, and its perceived cost-effectiveness and viability for all socioeconomic classes.
Occupational cancer is cancer caused by occupational hazards. Several cancers have been directly tied to occupational hazards, including chimney sweeps' carcinoma, mesothelioma, and others.
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