January
06
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Percivall Pott: Orthopedics and Occupational Health
By Michael J. North
Percivall Pott, engraved from an original portrait by Nathaniel Dance-Holland, London, 1785.
National Library of Medicine #B026992
Today we commemorate the 300th anniversary of the birth of Percivall Pott (1714–1788), an English surgeon who is known as one of the founders of orthopedics and occupational health.
Percivall Pott was the son of a scrivener (or scribe) and notary in London by the same name. After receiving an education at a private school, he was apprenticed at the age of fifteen, at his request, to surgeon Edward Nourse, an assistant surgeon at St. Bartholmew’s Hospital in London. He became a liveried member of the Barber-Surgeon’s Company in 1739 and was later appointed assistant surgeon at St. Bartholomew’s and one of the first members of the Royal College of Surgeons when it was founded in 1753.
In 1756, Pott suffered a compound fracture of the leg while riding a horse; his fellow surgeons were called in to consult and amputation was thought the only way to save his life. His mentor Edward Nourse intervened and stopped the amputation, and Pott spent three months in bed while his fracture healed successfully. It was during this time that Pott wrote his first of over 40 monographs, A Treatise on Ruptures (London, 1756). In 1764, he published another article on hernias in the Philosophical Transactions of the Royal Society, and the Society elected him as a fellow, and the following year he became senior surgeon at St. Bartholomew’s Hospital. In his private practice he treated a number of notable patients, including Samuel Johnson, Thomas Gainsborough, David Garrick, and William Cruikshank. He answered correspondence from all over Europe from other surgeons seeking his advice on specific cases and wrote more than 40 treatises on topics ranging from cataracts to paralysis of the lower extremities. He was especially known for his belief in the continual improvement of medical knowledge through close observation of cases and sharing that knowledge with others in the field.
Three conditions were named after Pott: Pott’s disease, Pott’s puffy tumor, and Pott’s fracture. In 1760, Pott described what would later be called Pott’s puffy tumor, an abscess of the periosteal membrane of the skull (making the forehead swell) caused by osteomyelitis. Pott was famous for describing what was later called Pott’s disease, which was a form of tuberculosis which affected the spine and caused serious damage to the intervertebral discs. Pott first described how this condition led to paralysis of the lower limbs in his 1779 publication, Remarks on that Kind of Palsy of the Lower Limbs, Which is Frequently Found to Accompany Curvature of the Spine. The term “Pott’s fracture” was given to a fracture of the ankle, later named by physicians after Pott’s famous fracture from his fall from a horse in 1756, although it has since been determined that his fracture was not of the ankle but of the upper leg; the name Pott’s fracture has remained nonetheless.
Percivall Pott also opened the door on a new field of occupational health when he proved an association between an exposure to soot by chimney sweeps in London and cancer of the scrotum: the first time an environmental hazard encountered in the workplace was shown to cause cancer. Most chimney sweeps at the time were boys, some as young as four years old, and many of them would get scrotal squamous cell carcinoma, which they called soot wart, in their late teens or early twenties. His publication on the topic in 1775, in his Chirurgical Observations, also contributed to the creation of the field of epidemiology and the passage of the Chimney Sweepers Act of 1788, which set the minimum age for chimney sweeps at eight years.
The National Library of Medicine has a large collection of works by and about Percivall Pott and his illustrious career. To learn more about them, please feel free to contact us at hmdref@mail.nlm.nih.gov.
Michael J. North is the Head of Rare Books and Early Manuscripts in the History of Medicine Division at the National Library of Medicine.
Probably going to stop doing chimney sweep work.
Mr. Sternick and I have a similar reaction. It is curious. Why would the work of chimney sweeps lead to cancers of the scrotum, specifically? Were there other cancers that were associated specifically with chimney sweeping? What was the mechanism of exposure to carcinogens that led to scrotum cancer?
The cancer in question was a squamous cell carcinoma, which is actually a form of skin-cancer. It is thought that as the chimney sweeps did their work and got covered in soot, they would sweat and this would carry the soot down to the folds of the skin of the scrotum, where it would accumulate. It wasn’t until 1922 that it was determined that coal soot can be carcinogenic. Other health hazards for the boys in these jobs included getting stuck in the chimneys or flues, deformities of the spine from holding themselves in odd positions for long periods, and asthma.
Thanks for the explanation; it’s very interesting. I wonder if there are any statistics or estimations as to how many chimney sweeps died after being stuck. The hazards of that occupation were truly numerous. With the release of “Saving Mr. Banks,” I am reminded of the whimsical scenes of chimney-sweeps popping out of chimneys in the 1964 Disney film, ‘Mary Poppins,. It’s an entertaining sequence, which I still appreciate, but it belies the seriousness and danger involved in the actual work. Thanks again for an enlightening article and follow-up comment.
Thank you for your comments. We are always glad when our posts can spur discussions and further research.
The small children were pushed down the chimneys feet first and neked. Clothing would have hung them up on their way down. Thus was the chimney soot repeatedly ground into the underside of ther scrotums.
Great post, thanks. I’ve known the term Pott’s Disease as referring to vertebral tuberculosis, but his involvement in occupational heath and epidemiology are interesting. I am guessing he must be one of the earliest proponents of those fields. I am curious as to how Pott’s Disease was eventually attributed to tuberculosis which is caused by a mycobacterium discovered by Koch in 1882 – a hundred years after Potts described the spinal condition.
Pott’s Disease was attributed to tuberculosis of the spine by French physician Jacques Mathieu Delpech in his work, “De l’Orthomorphie,” published in Paris in 1828, the first volume of which is available via the Medical Heritage Library here: https://archive.org/details/delorthomorphiep01delp. It is unclear to me how physicians of the period knew that pulmonary and spinal tuberculosis had simlar pathological roots without yet knowing about the tuberculosis mycobacterium and its role, but clearly Delpech got it right on some level.