One of my favorite movies as a child was “Mary Poppins.” Aside from the wonderful music and various characters, I really enjoyed the chimney sweep, Bert, as played by Dick Van Dyke, the great comedian. This reflected the state of how homes were heated during the 18th and 19th centuries and as late as Edwardian times in England, with fireplaces as the primary source of comfort. As a consequence, significant attention had to be paid to dealing with the chimney, which would become filthy and clogged.
The truth is that Bert is totally unrepresentative of what chimney sweeps were truly like. He is large and robust. Chimneys were narrow and thin. As a consequence, the occupation of chimney sweeps was conducted by small children who would be recruited from poor families, omnipresent in those difficult times. The children would be utilized naked, slathered with grease, and sent scurrying up the chimney with brooms and the other paraphernalia necessary to clean the flue and chimney. Of course, they would thus become covered in soot and dirt from the combustion of coal or wood. Since bathing was not a regular, frequent practice, they would be filthy most of the time—in that, Bert did seem to emulate the condition of the chimney sweep.
Sir Percival Pott was a surgeon born in London in 1714. He has made many contributions to medicine and his name can be recognized by most physicians by the conditions that bear his name. For example, tuberculosis of the spine, which he described, is known as Pott’s disease. He is considered the father (parent?) of orthopedics for his many contributions to that field in terms of describing the management of bone fractures and dislocations.
While cancer of the scrotum was first described in 1731, Pott recognized that it mainly seemed to occur in chimney sweeps. He published this finding in 1775. Not only did he recognize that it occurred almost exclusively among chimney sweeps, coming to be called “chimney sweepers’ carcinoma,” but in his 1775 paper he opined that it was due to the soot that was perennially present between the rugae and folds of the scrotum.
Pott not only complained about the soot. He also inveighed against the conditions under which these children worked. He claimed that they were brutalized, suffered severely from heat and cold, and were not well fed or housed. Reminiscent to our times, the public, chimney industry and insurance companies basically argued that a few cases of chimney sweepers’ carcinoma were a reasonable price to pay to make the homes of London safe from smoke and chimney fires. But with time, social activists did finally make headway and there were reform acts to protect these children, ultimately banning these practices.
There are now many known occupational and environmental causes of cancer, but Pott is credited with describing the first occupational and environmental carcinogen. In truth, I always think it is Bernardino Ramazzini of Modena, Italy, who is often called the Father of Occupational Medicine as he published a textbook on occupational medicine in 1700. In his book, he cautioned about the hazards of various chemicals, dusts, metals, poor posture and the like with regard to risk of disease, though not specifically with regard to cancer. The one “occupational” cancer risk he did describe was an increased risk of breast cancer among nuns, which he attributed to their celibacy and lack of sexual intercourse.
Soot is a product of combustion and, as such, contains polycyclic aromatic hydrocarbons, perhaps the main carcinogen in tobacco smoke, and a well known class of powerful chemical carcinogens. Thus, longstanding exposure of the skin of the scrotum to these powerful carcinogens can lead to malignancy, specifically a squamous cell carcinoma.
In 1981, the National Cancer Institute commissioned a study of the causes of cancer by two leading epidemiologists, Sir Richard Doll and Richard Peto. Their analysis, widely quoted and cited, ascribed an estimate of 2-3% to occupation as its responsibility for the overall burden of cancer. In subsequent years, many chemicals and other occupational exposures have been described to make up this figure. But the first began with those who sing, “Chim Chim Cher-ee, Chim Chim Cher-ee …”
Alfred I. Neugut, MD, PhD, is a medical oncologist and cancer epidemiologist at Columbia University Irving Medical Center/New York Presbyterian and Mailman School of Public Health in New York.
This article is for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Always seek the advice of your qualified health provider with any questions you may have regarding a medical condition or treatment.
By Alfred I Neugut
