1016 



TESTICLE (ABNORMAL ANATOMY). 



seems more exposed to the disease. Sir James 

 Earle has related the case of a man who had 

 a large sore resembling chimney-sweeper's 

 cancer which reached from the bend of the 

 wrist to the knuckles, occupying almost the 

 whole of the back of the left hand. The man 

 was a gardener, and for several springs had 

 been in the habit of strewing soot on the 

 ground round the young plants to preserve 

 them from slugs. He carried the soot in 

 an old garden pot which hung on his left 

 hand, while he strewed the soot with his 

 right. 



The predisposition to cancer scroti appears 

 in some instances to be hereditary. The late 

 Mr. Earle extirpated the testicle and diseased 

 integuments from a sweep aged thirty-five, a 

 patient in St. Bartholomew's Hospital, whose 

 grandfather, father, and one brother had all 

 perished from the effects of the disease. A 

 father and son were once in St. George's 

 Hospital at the same time on account of it. 

 Mr. Cusack mentions that he removed a 

 soot-wart from the hand of a female who 

 carried on the business of chimney-sweeping, 

 and that he had previously excised an ex- 

 crescence of the same nature from the ear of 

 her son.* 



Cancer scroti occurs more commonly at 

 the middle period than at any other time of 

 life. In the majority of cases which 1 have 

 met with the disease occurred between the 

 ages of thirty anil forty. Those exposed 

 however to the action of soot may become 

 affected at a much earlier period. Mr. Wadd 

 has figured a diseased prepuce and soot-wart 

 on the scrotum from a boy aged fifteen ; and 

 Sir J. Earle witnessed a case of the disease 

 as early as at eight years of age. It appears 

 that the seeds of this malady are sown in 

 early l.fb, but in general do not germinate 

 until they have remained for some time dor- 

 mant in the system. What is the permanent 

 effect on the scrotum produced by soot, which 

 thus renders it in certain individuals so pecu- 

 liarly susceptible of a cancerous action at 

 some distant period, we cannot explain ; but 

 that the soot, though the exciting cause of 

 the disease, may in some instances be a remote 

 one, is shown by several striking facts. It is 

 known that persons who have been sweeps 

 when young, but have abandoned the occu- 

 pntion, have afterwards been attacked with 

 chimney-sweeper's cancer, although they have 

 long been removed from all contact with soot. 

 A sailor between forty and fifty years of age, 

 was admitted into the London Hospital, with 

 an ulcerated sore on the scrotum, presenting 

 all the characters of genuine chimney-sweeper's 

 cancer. The inguinal glands were indurated 

 and enlarged, and subsequently ulcerated. 

 He had been brought up as a sweep ; but lor 

 the last twenty-two years, during which period 

 he had served at sea, he had not been em- 

 ployed amongst soot in any way whatever. 

 The disease first appeared in the scrotum 



* Dublin Journal of Medical Science, vol. xxi 

 ]>. 137. 



about three years before. In this case, there- 

 fore, the injurious influence of soot must have 

 been exerted nineteen years before the ap- 

 pearance of disease, during which long period 

 he was entirely removed from the effects of 

 its exciting cause. It has sometimes hap- 

 pened, alter the morbid parts had been com- 

 pletely extirpated, and the wound healed, 

 the patient having avoided further contact 

 with soot, that the disease has re-appeared 

 as it were afresh, a second and even a third 

 time ; not, however, in the cicatrix of the 

 wound, but on a different part of the scrotum. 

 These, and similar facts, lead to the conclu- 

 sion that though abandonment of his occupa- 

 tion may render the adult chimney -sweeper 

 less liable to cancer, it by no means forms a 

 satisfactory security against its occurrence. 



Cancer scroti chiefly extends its ravages by 

 affecting the contiguous tissues, and has little 

 disposition to contaminate the lymphatic 

 glands or distant parts. An instance is on 

 record of an old chimney-sweeper, who had 

 been subject to this disease for forty years, 

 and had undergone three operations for its 

 removal, yet even then the glands in the groin 

 were unaffected.* A man aged fifty-one who 

 had been a chimney-sweeper ever since the 

 age of seven years, was a patient of mine on 

 account of this disease. He had been re- 

 peatedly attacked with it during a period of 

 twenty-two years, and had submitted to no 

 less than five operations for its removal. The 

 glands in one groin became affected only a 

 few months previously. Ulceration took place, 

 and the patient died from its irritative effects 

 on the constitution. On a careful' examina- 

 tion of the body, no trace of internal disease 

 could be detected; The cancer was strictly 

 limited to the groin and scrotum. Mr. B. 

 Cooper has likewise recorded a case of chim- 

 ney-sweeper's cancer which ended fatally; 

 and on examination none of the glands or 

 viscera of the interior of the body were af- 

 fect ed.-j- These cases show that, when the 

 inguinal glands are indurated, they may be 

 excised with a fair hope of a successful result. 



j\felanosis. Notwithstanding the dark co- 

 lour of the skin of the scrotum, melanosis is 

 an exceedingly rare affection of this part. 

 Indeed, the only case of its occurrence there 

 with which I am acquainted, is one that hap- 

 pened in my own practice. The patient was 

 a cabinet-maker, aged thirty-two, and the 

 disease commenced as a small dark spot, ap- 

 parently produced by some black deposit be- 

 neath the epidermis, raising it a little above 

 the surrounding surface. This spot increased 

 until it formed a fungous growth. I excised 

 the part, but the disease re-appeared in the 

 scrotum and in the glands of the groin six 

 months afterwards. It made, however, very 

 slow progress, and did not destroy the patient 

 for six years.J 



* Mr. Hawkin's Lecture on Tumours. Lond. 

 Med. Gazette, vol. xxi. p. 842. 



f Lond. Med. Gazette, vol. xliii. p. 532. 



j Vide Report of the Case in Loud. Journal of 

 Medicine, vol. i. p. 220. 



