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Sir Percivall Pott, Sir James Paget, and soot cancer of the hand
Correspondence
George von Békésy, who won the Nobel prize in 1961, was not, however, a physician. He graduated as a chemist in Bern, Switzerland, in 1921 and then did a PhD in physics in Budapest, Hungary, in 1923. After World War I he was unable to get a teaching job at a university and instead became a post-office engineer at the research institute of the Hungarian postal service. When international calls had to be accepted by operators at the Budapest central exchange, they had difficulty understanding because of static and interference. It was George von Békésy’s job to correct this problem. To fully understand the physiological process of hearing he learnt how to successfully autopsy the inner ear— something the anatomists and surgeons of his time were unable to do. von Békésy subsequently created a model to help him to comprehend the physical mechanism of stimulation within the cochlea, for which he received his Nobel prize.
Andrew E Czeizel [email protected] Foundation for Community Control of Hereditary Diseases, Budapest, Hungary 1
2
Csonka A. Hungary makes slow progress in health-system reform. Lancet 2004; 363: 1957. Kapronczay K, Szilveszter VE. Híres magyar orvosok. Budapest: Galenus, 2002.
Sir Percivall Pott, Sir James Paget, and soot cancer of the hand Occupational hand cancers are unusual and not frequently noted. However, Sir James Earle, the son-in-law of Sir Percivall Pott, immediately noted the following occupational skin cancer in 1800. A patient presented to him with an enlarging lesion of the palm of the hand. Earle, like Pott, worked at St Bartholomew’s Hospital in London, UK, and knew about the association between chimney sweeps and cancers of the scrotum (“soot” cancers) first published by Pott in 1775.1 Earle noticed the unusual appearance of this 582
recognised immediately as such. It predates the first description of basal-cell carcinoma of the skin by Arthur Jacob in 1827.4
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Keith Denkler [email protected] University of California San Francisco, Larkspur, CA 94939, USA 1
2
Figure: Sir James Paget’s illustration of soot cancer of the hand (bottom) and the actual specimen preserved at St Bartholomew’s Hospital (top) Reproduced from reference 3.
hand cancer and the fact that it was of similar appearance to soot cancers. He inquired whether the patient was a chimney sweep, yet the patient replied that he was a gardener. On further questioning, the patient revealed that his occupation required him to spread ashes in the garden daily and he used this cancerous hand to carry the bucket of ashes. Earle speculated that frequent exposure to soot vapours had caused this cancer. Earle suggested surgery, but the patient declined and sought out faith healers, herbalists, and naturalists. After continued development of the cancer over the ensuing 4 years, the patient returned to Earle and underwent an amputation in 1804.2 At 1-year followup, the patient remained free of disease and without metastases. Earle published this case report in 1819 in his collection of the works of Sir Percivall Pott.2 Sir James Paget discussed this case and illustrated the hand in his Lectures on Surgical Pathology published in 1854.3 Since then it has remained ignored, lost, and not referenced. However, the specimen still exists and has remained at St Bartholomew’s Hospital for 200 years (figure). This lost specimen is the first occupational soot cancer of the hand, and was
3
4
Pott P. Chirurgical observations relative to the cataract, the polypus of the nose, cancer of the scrotum, different kinds of ruptures, and the mortification of the toes and feet. London: Hawes, 1775: 1–208. Pott P, Webster J, Earle J. The chirurgical works of Percivall Pott, with his last corrections. To which are added, a short account of the life of the author; a method of curing the hydrocele by injection; and occasional notes and observations by Sir James Earle. Philadelphia: James Webster, 1819: 291–95. Paget J. Lectures on surgical pathology: delivered at the Royal College of Surgeons of England. Philadelphia: Lindsay and Blakiston, 1854: xv, 699. Jacob A. Observations respecting an ulcer of peculiar character which attacks the eyelids and other parts of the face. Dublin Hosp Rep 1827; 4: 231.
Department of Error Petricoin EF III, Ardekani AM, Hitt BA, et al. Use of proteomic patterns in serum to identify ovarian cancer. Lancet 2002; 359: 572–77—In this Mechanisms of Disease article (Feb 16, 2002), the conflict of interest statement (p 577) should have included the following: “E F Petricoin and L A Liotta are co-inventors on a patent application (number 20030004402) for an algorithm to detect hidden patterns in biological data.” Quinlivan A, Box H, Evans SF. Postnatal home visits in teenage mothers: a randomised controlled trial. Lancet 2003; 361: 893–900— In the table of this Article (Mar 15, 2003), the second column heading should have been “Home visit group (n=65)” and the third column heading “Control group (n=71)”.
www.thelancet.com Vol 364 August 14, 2004
George von Békésy, who won the Nobel prize in 1961, was not, however, a physician. He graduated as a chemist in Bern, Switzerland, in 1921 and then did a PhD in physics in Budapest, Hungary, in 1923. After World War I he was unable to get a teaching job at a university and instead became a post-office engineer at the research institute of the Hungarian postal service. When international calls had to be accepted by operators at the Budapest central exchange, they had difficulty understanding because of static and interference. It was George von Békésy’s job to correct this problem. To fully understand the physiological process of hearing he learnt how to successfully autopsy the inner ear— something the anatomists and surgeons of his time were unable to do. von Békésy subsequently created a model to help him to comprehend the physical mechanism of stimulation within the cochlea, for which he received his Nobel prize.
Andrew E Czeizel [email protected] Foundation for Community Control of Hereditary Diseases, Budapest, Hungary 1
2
Csonka A. Hungary makes slow progress in health-system reform. Lancet 2004; 363: 1957. Kapronczay K, Szilveszter VE. Híres magyar orvosok. Budapest: Galenus, 2002.
Sir Percivall Pott, Sir James Paget, and soot cancer of the hand Occupational hand cancers are unusual and not frequently noted. However, Sir James Earle, the son-in-law of Sir Percivall Pott, immediately noted the following occupational skin cancer in 1800. A patient presented to him with an enlarging lesion of the palm of the hand. Earle, like Pott, worked at St Bartholomew’s Hospital in London, UK, and knew about the association between chimney sweeps and cancers of the scrotum (“soot” cancers) first published by Pott in 1775.1 Earle noticed the unusual appearance of this 582
recognised immediately as such. It predates the first description of basal-cell carcinoma of the skin by Arthur Jacob in 1827.4
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Keith Denkler [email protected] University of California San Francisco, Larkspur, CA 94939, USA 1
2
Figure: Sir James Paget’s illustration of soot cancer of the hand (bottom) and the actual specimen preserved at St Bartholomew’s Hospital (top) Reproduced from reference 3.
hand cancer and the fact that it was of similar appearance to soot cancers. He inquired whether the patient was a chimney sweep, yet the patient replied that he was a gardener. On further questioning, the patient revealed that his occupation required him to spread ashes in the garden daily and he used this cancerous hand to carry the bucket of ashes. Earle speculated that frequent exposure to soot vapours had caused this cancer. Earle suggested surgery, but the patient declined and sought out faith healers, herbalists, and naturalists. After continued development of the cancer over the ensuing 4 years, the patient returned to Earle and underwent an amputation in 1804.2 At 1-year followup, the patient remained free of disease and without metastases. Earle published this case report in 1819 in his collection of the works of Sir Percivall Pott.2 Sir James Paget discussed this case and illustrated the hand in his Lectures on Surgical Pathology published in 1854.3 Since then it has remained ignored, lost, and not referenced. However, the specimen still exists and has remained at St Bartholomew’s Hospital for 200 years (figure). This lost specimen is the first occupational soot cancer of the hand, and was
3
4
Pott P. Chirurgical observations relative to the cataract, the polypus of the nose, cancer of the scrotum, different kinds of ruptures, and the mortification of the toes and feet. London: Hawes, 1775: 1–208. Pott P, Webster J, Earle J. The chirurgical works of Percivall Pott, with his last corrections. To which are added, a short account of the life of the author; a method of curing the hydrocele by injection; and occasional notes and observations by Sir James Earle. Philadelphia: James Webster, 1819: 291–95. Paget J. Lectures on surgical pathology: delivered at the Royal College of Surgeons of England. Philadelphia: Lindsay and Blakiston, 1854: xv, 699. Jacob A. Observations respecting an ulcer of peculiar character which attacks the eyelids and other parts of the face. Dublin Hosp Rep 1827; 4: 231.
Department of Error Petricoin EF III, Ardekani AM, Hitt BA, et al. Use of proteomic patterns in serum to identify ovarian cancer. Lancet 2002; 359: 572–77—In this Mechanisms of Disease article (Feb 16, 2002), the conflict of interest statement (p 577) should have included the following: “E F Petricoin and L A Liotta are co-inventors on a patent application (number 20030004402) for an algorithm to detect hidden patterns in biological data.” Quinlivan A, Box H, Evans SF. Postnatal home visits in teenage mothers: a randomised controlled trial. Lancet 2003; 361: 893–900— In the table of this Article (Mar 15, 2003), the second column heading should have been “Home visit group (n=65)” and the third column heading “Control group (n=71)”.
www.thelancet.com Vol 364 August 14, 2004