On cancer of the scrotum in chimney-sweeps and others : three lectures delivered at the Royal College of Surgeons of England / by Henry T. Butlin.

  • Butlin, Henry T. (Henry Trentham), 1845-1912.
Date:
1892
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Licence: Public Domain Mark

Credit: On cancer of the scrotum in chimney-sweeps and others : three lectures delivered at the Royal College of Surgeons of England / by Henry T. Butlin. Source: Wellcome Collection.

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    4i I am myself prepared to go farther, and think that the soot of brown coal, wood, charcoal, and peat is innocuous in this respect, but further proofs may perhaps be asked for before this is admitted. I take it that no pathological question is ever so thoroughly settled or so deeply buried but that it contains the germs of new questions in pathology, often more complex and more diificult to answer than the original question. Sooner or later these present themselves, not always in a welcome fashion, and not always to the original inquirer, but with a repeated intrusion which at length compels attention ; so, from the conclusions which have been set down, arise various considerations which may be expressed in the form of queries, some of which may be answered now or may be thought to have been already suffic-iently answered, while the remainder await an answer at the hands of someone better fitted to cope with the problems they contain than I am. Are these substances (soot, tar, and paraffin) equally potent on the integument of all parts of the body, or are certain areas of the integument especially liable to be influenced by them ? What are the essentials in these substances which prepare the integument for the occurrence of cancer ? Is the prepara- tion due to the action of one or of several elements in each substance, and are the same essential elements present and active in all the different substances ? Is cancer of the mouth and tongue in smokers and chewers of tobacco due to the same or a similar active element in the tobacco smoke and juice ? How far are the floating particles of soot in the air responsible for the occurrence of cancer of other parts of the body, particularly of the respiratory and alimentaiy tracts, and how far does the smoke nuisance of large towns tend to the increase of cancer ? To the first of these questions I would reply that the evi- dence points very strongly to a specific action of the sub- stances (soot, tar, and paraffin) on the tissues of the scrotum. It has been shown in the course of these lectures how little liable the scrotum is, under all ordinary circumstances, to the occurrence of cancer. Yet it is the seat of election of the cancer which is induced by the action of these substances. This special liability of the scrotum has been again and again attributed to the peculiar character of the integument, espe- cially to the deep depressions between the rugae, from which it is difficult to dislodge the nocuous substances. The same reasons should make the scrotum the seat of election of cancer in many dirty occupations, in which scrotal cancer is practically unknown. Again, other parts of the surface of the body which are quite as much exposed to the action of these nocuous substances (soot, tar, and paraffin)—for instance, the pubes and insides of the thighs—are very rarely attacked. And, as I think, a more powerful argument, the areas of the integu- ment which are particularly prone to cancer generally, of the upper part of the face and of the lower lip, are not more often attacked by cancer in soot, tar, and paraffin workers than in other men. Yet these parts, in the sweeps, are covered every day with a coating of soot, and are exposed to the fumes and probably also to the actual liquids in the workers in tar and paraffin. A certain immunity from cancer may certainly be claimed for them on the ground of the daily washing which every sweep, however dirty he may naturally be, performs.