In the year 1775 in England, a surgeon named Percivall Pott published his work as “Chirurgical Observations”. In it he described Scrotal Carcinoma, a malignant cancer of the scrotum. What was interesting was that he observed that this cancer was seen mostly in chimney boys.
He wrote that the fate of chimney sweeps seems to be singularly hard as in their infancy, they are treated with brutality, starved with hunger and cold. They are then thrust up narrow, hot chimneys where they are buried, burned & often suffocated.
And then on reaching puberty they suffer from a painful and fatal disease.
He described in detail squamous carcinoma of the scrotum. Here’s the text where he described the lesions. (Photo)
In 1788, the first of many “Chimney sweepers Acts” was passed bearing witness to the influence that Potts had on public opinion. In 1817, the House of Commons appointed a Committee to report the employment of boys as Chimney sweeps.
This committee recommended that this practice should be stopped and mechanical sweeps should be used. However, this recommendation was met with a lot of opposition from wealthy homeowners and master sweeps who depended on the slave labour of these boys for their livelihood.
They argued that it was better to sacrifice a few children than to expose an entire society to the harmful effects of pollution.
The horrific trade thus thrived and young boys continue to suffer from scrotal cancer at an alarming rate.
In 1890, Spencer claimed to have found soot in deep layers of the epidermis in patients who had scrotal cancer and postulated that it was the presence of the irritant (soot) within the cells that induced the malignant change.
A feature of this disease that was interesting was that it seemed to be an exclusively English disease. Cases were virtually unknown in America or even in Scotland. This problem was investigated by Henry Butlin who was a surgeon at St. Bartholomew’s hospital.
As Butlin interacted with chimney sweeps from the Continent, America and Scotland, he had established reasons. He said that it was partly due to the protective clothing they wore which consisted of a blouse with long sleeves tied at the wrist.
The blouse was tucked into the trouser and fastened tightly at the waist with a belt. The sweeps also wore gaiters and boots and also a tight hood on the head.
Whereas,the English chimney sweeps wore ill fitting clothes or no clothes at all,open necked shirts, no head covering.
Besides this, attention to personal hygiene was also an important factor.
Eventually enforced laws and stringent measures led to better personal hygiene, appropriate protective clothing and better working conditions.
Thus, we see that Potts observation was historically important as he not just described the disease but also - an inciting agent, a vulnerable population and a particular workplace or occupation.
In hindsight, he had described all three elements of an occupational disease.
Take home message from the thread - Understanding causation, rather than association, is more likely to lead to Public Health action and possibly prevention.

Also, I wish History of Medicine was taught in Medschool.

#Histmed #PublicHealth #MedTwitter

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More from @stethospeaks

9 Jun
Someone has sent me an anonymous message about their father's death. I will not share it publicly because I feel its a very personal account of the horrors you went through.

Firstly, I'm so sorry that you had to go through the same. Reading it brought tears to my eyes.
It also brought back memories of my father's death, he had passed away all alone in a hospital bed with nobody by his side. You asked, "how does obe overcome the death of a family member?" One doesn't. I lost my dad 15 years ago, the pain still is fresh, the wound still hurts.
There isn't a single day when I don't think of him. I'm guessing it will be the same for you. But you know, I like to do things he would have liked. Being a doctor was one of them.
You've mentioned that you want to discontinue your medical education. Ask yourself, would your +
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Inspired by @doctorandall to try this out.
Please say nice things.
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Pro tip for doctors :
If a patient opens up to you that they've been seeking therapy or psychiatric consult, don't stereotype their problems as "psychosomatic" or "its all in your head" just because they trusted you enough to be honest in a country where mental health is a taboo.
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I cannot even begin to understand how difficult it must be for patients who don't come from a place of privilege like I do.
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A wise lady once said that if I struggle to study while on leave, I should start planning my study hours such that they fall into schedule with ideally what would otherwise be my work hours.
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Dear @nandiniriyer, your advise has changed my life. Take love. ❤️
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Of all the advances of the 20th Century, the one that I think has impacted Women’s Health immensely is the availability of Contraceptive devices. 1/20
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Here’s a brief (okay, not so brief) history of IUDs.
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We have all been taught in school that Adenosine Triphosphate (ATP) is the energy currency of the cell. However, what I learnt fairly recently is that ATP has an Indian connect.
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Dr. Yellapragada Subbarao, was an Indian American Scientist who revolutionised the field of medicine.

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