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RAMAZINI has written a book De Morbis Artificium..--The colic of Poictou is a well known distemper; and every body is acquainted with the disorders to which painters, plumbers, glaziers, and the workers in white lead, are liable: but there is a disease as peculiar to a certain set of people, which has not, at least to my knowledge, been publicly noticed; I mean the chimney-sweepers' cancer.
It is a disease which always makes its first attack on, and its first appearance in, the inferior part of the scrotum; where it produces a superficial, painful, ragged, ill-looking sore, with hard and rising edges: the trade call it the soot-wart. I never saw it under the age of puberty, which is, I suppose, one reason why it is generally taken, both by patient and surgeon, for venereal; and being treated with mercurials, is thereby soon and much exasperated. In no great length of time, it pervades the skin, dartos, and membranes of the scrotum, nod seizes the testicle, which it enlarges, hardens, and renders truly and thoroughly distempered; from whence it makes its way up the spermatic process into the abdomen, most frequently indurating and spoiling the inguinal glands: when arrived within the abdomen, it affects some of the viscera, and then very soon becomes painfully destructive. a
a From the soot being collected and remaining in the moist rugae of the scrotum, it is not difficult to conceive why the disease should generally begin in that part; but I have seen the true soot wart in the face of a chimney-sweeper, just under the left eye, who had never suffered from the disease in any other part; though he said he had sometimes felt little hardness in the scrotum, which, when they grew troublesome, he picked off; but he had never perceived any sore, ulceration, or considerable hardness in that part.
Mr. Putt has observed that he never saw the disease under the age of puberty; bet since the publication of his treatise I saw it in an infant under tight years of age, who was brought into St. Bartholomew's hospital, and was an apprentice to a chimney-sweeper. I showed it to Mr. Pelt, who acknowledged it to be the true disease, and that he had not before seen it in so young a subject. It had infected all the lower part of the scrotum; but as the testis had not imbibed the poison, the diseased part being removed, the wound healed, and the boy was discharged perfectly well. E.
The fate of these people seems singularly hard; 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.
Of this last circumstance there is not the least doubt, though perhaps it may not have been sufficiently attended to make it generally known. Other people have cancers of the same parts: and so have others, besides lead-workers the Poictou colic, and the consequent paralysis: but it is nevertheless a disease to which those persons are peculiarly liable; and so arc chimney-sweepers to a peculiar kind of cancer in the scrotum and testicles.
If there be any chance of putting a stop to, or preventing this mischief, it must be by the immediate removal of the part affected; I mean that part of the scrotum where the sore is; for if it be suffered to remain until the virus has seized the testicle, it is generally too late even for castration. I have many times made the experiment; but though the sores, after such operation, have, in some instances, healed kindly, and the patients have gone from the hospital seemingly well, yet, in the space of a few months, it has generally happened, that they have returned, either with the same disease in the other testicle, or in the glands of the groin, to with such wan complexions, such pale leaden countenances, such a total loss of strength, and such frequent and acute internal pains, as have sufficiently proved a diseased state of some of the viscera, and which have soon been followed by a painful death.
If extirpation ever bids fair for the cure of a cancer, it seems to be in this case; but then the operation should be immediate, and before the habit is tainted. The disease, in these people, seems to derive its origin from a lodgement of soot in the rugae of the scrotum, and at first not to be a disease of the habit. In other cases of a cancerous nature, in which the habit is too frequently concerned, are have not often so fair a prospect of success by the removal of the distempered part; and are obliged to be content with means, which I wish I could say were truly palliative. But here the subjects are young, in general in good health, (at least at first,) the disease brought on them by their occupation, and in all probability local; which last circumstance mar, I thinly, be fairly presumed from its always seizing the same part: ail this makes it (at first) a very different case from a cater which appears in an elderly man, whose fluids are become acrimonious from time, as well as other causes; or from the same kind of complaint in women who have ceased to menstruate. But be 911 this as it may, the scrotum is no vital organ, nor can the loss of a part of it ever the attended with any the smallest degree of inconvenience; and if a life can be preserved be the removal of all that portion that is distempered, it will be a very good and easy composition; for when the disease has got head, 0t is rapid in its progress, painful tai all its attacks, and most certainly destructive in its event. b
This species of cancer, which Mr. Pott has so accurately described, appears to be produced by some peculiar acrimonious quality in soot, when incorporated and fermenting with the secretions an the skin of some persons, whose constitutions are disposed to undergo a certain change, or receive a new modification of their inherent properties. As chimney-sweepers are in the constant habit of being in contact with soot, it follows that they must be most liable to a disease which is evidently caused by it; but, as was before observed, those only whose constitutions are disposed to receive the poison are infected; not one in many hundreds being injured by it. Mr. Pott seemed to suppose that this species of cancer was peculiar to chimney-sweepers; but I have strong grounds for thinking that he was mistaken in that idea. There are instances, though I believe them to be very rare, (as I know no one, either author or practitioner, who has noticed them); yet there an instances or other persons being infected by the contact or effluvia of soot; and as a caution for every one to be careful of handling it, or in any way being exposed to its action, I will relate the case of a man who was attacked with this dreadful disease to a most lamentable degree, and was brought into the hospital. The scrotum and testis, with the spermatic chords, together with the glands in the groin, were included in a large phagedenic ulcer. The nature of the disease was so marked and evident, that I took for granted that he was a chimney-sweeper, and was much surprised to find that his business was quite of another kind. I could not, however, avoid repeatedly asking him if he had ever had any thing to do with sweeping-chimneys; he assured me not. Some time after he told me, that on considering the questions which I had so often urged, he recollected that not many years before he had lodged at the house of a chimney-sweeper in the apartments of which soot bags and soot were deposited. He did not appear very accurate in his account, but thought in recollection that the complaint began in the scrotum soon after he left the chimney-sweeper's house. This goes nearly to prove that soot in substance, or perhaps the volatile parts of it, have the power of producing disease; and not any thing peculiar to the occupation or manner of life to which chimney-sweepers are subject. Probably the man's body, or his linen, were liable to be daubed with snot, or the dust arising from it; and the scrotum was first affected, as it is among chimney-sweepers, for the reason before given; that of the moist rugae retaining the poison more readily than other parts.b
As a further caution to persons who may be employed in making use of soot, to be careful in washing and cleansing themselves, I will mention another case which I met with, and to which in my mind; goes pretty clearly to ascertain the fact, that soot is of a dangerous nature, and capable of producing in other people, as well as chimney-sweepers.
Allan Spragg, aged 49, cane into St. Bartholomew's hospital, on account of a large cancerous sore, which reached from the bend of the wrist to the knuckles, occupying almost the whole of the back of the left hand. He had been under the care of many persons, and various applications and internal medicines had been given. The circumference of the sore rose in large ulcerated tumors, and seemed inclined to spread. In some parts of the middle it appeared in a healing state--in other parts ulcerated; but he said different parts of it had often healed and broke out again, as we afterward found it inclined to do. There was an indescribable something in the appearance of the complaint, which put me in mind of the sooty-wart, or chimney-sweeper's cancer; for there is a peculiar appearance in that disease, to the eye of any one who has paid attention to it, very different from any other cancerous sore. This led me to make a particular inquiry into this person's life and occupation. He said he was a gardener: that about five years before (in 1810) he was employed in a garden at Lowlayton, in Essex; that in the spring of that year he was engaged about two hours every morning to strew soot on the ground, round the young and tender plants, to preserve them front the slugs; that he carried the soot in an old garden-pot, which hung on his left hand by a handle over the top, while he strewed it with the right. About this time he conceived the wart commenced near the knuckles and continued not very troublesome all that year; the next spring he was again employed to distribute soot; the wart was then increased and ulcerated, and continued growing worse all that year. The spring following he again used soot in the same manner; the sore then spread, and grew larger, which made work of any kind very difficult to him.
It is to be remarked that the right hand which strewed the soot was unaffected. Probably from that action it got rid of the effect of the effluvia; but the left, being two hours exposed to the vapours or dust arising from the soot, as it was continually stirred up, a lodgement of it was probably made on the thin skin at the back of the hand. The man said he always washed his hands before he came in to breakfast, but such persons are not always very accurate in their ablutions.
For the last two years he had not used soot, but the sore continued to spread rapidly; however he kept on working till October, 1804, when he was incapable of using the hand. December 27th, he came into the hospital. The various means which were used, both internally and externally, to endeavour to stop the progress of, and cure the disease, it is unnecessary to detail in this place, as unfortunately none of them proved of any very material service; for though sometimes one part appeared healing, another continued to open and spread. In verum naturá there may probably exist a cure for this dreadful malady, but it has hitherto escaped our researches.
Poor Allan left the hospital several times, and put himself under the care of some soi-disans doctors, both male and female, who promised to cure him, but always returned with the disease worse and worse, till at last he submitted to amputation, after which the excruciating pains which he had suffered soon left him and as a pretty clear proof of the locality of the disease, and that it was not constitutional, the wound from the operation healed kindly, and he got perfectly well. E
CONTENTS OF VOL. I.
Page A SHORT Account of the Lore of the Author i Observations on the Nature and Consequences of those Injuries to which the Head is liable from External Violence 29 Wounds of the Scalp 31 Effects of Contusion on the Dura Mater, and Parts within the Scull 44 Contusion with Wound 63, 65, 76. 78, 83 ------- without Wound 67, 70, 73, 74 Contusion joined with Extravasation 80 Separation or Destruction of both Tables of the Scull from Contusion 85 Figures anti Fractures of the Cranium without Depression 94 Simple Fracture 121 Fractures of the Cranium with Depression 135 Extravasation and Commotion 148 Observations on that Disorder of the Eye commonly called Fistula Lachrymalis 179 General Remarks on Fractures and Dislocations 217 Compound Fractures 265 Of Dislocations in general 287 A Treatise on Ruptures 305 Those capable of easy and immediate Reduction 323 Those that are found irreducible, but not in a State of Inflammation 327 Those which are reducible, but attended with Pain and Hazard 333 Those which are in such a State as to be irreducible by the mere Hand, and in which a Chirurgical operation is necessary for the Preservation of the Life of the Patient 341 Parts composing a Rupture, when so diseased as to be unfit for imme- diate Reduction, what then becomes necessary 358 Ruptures in Females 367 The crural or femoral Hernia 370 The congenial Hernia 372 The umbilical Rupture 376 The ventral Hernia, &c. 380 Attempts toward a radical Cure 382 Observations anti Cases relative to Ruptures 391 Intestinal Herniĉ 406 Congenial Herniĉ 418 Hernia Vesicĉ Urinariĉ 433 An ovarian Hernia 436
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