Upon dissecting a portion of scrotum af fected with chimney-sweeper's cancer, the part is found to present very similar appearances to those of carcinoma of the lip. The tissue at the base of the ulcer is dense, indurated, and distinctly laminated, and possesses very little vascularity. On examining some matter scraped from the base of a soot-wart shortly after its removal from the body, I perceived a number of caudate and spindle-shaped nucleated cells. Epithelial cells have likewise been observed in several cases, and the dis ease is regarded as belonging to the epithelial form of cancer. On examining some diseased glands in the groin in a case of scrotal cancer, I found them enlarged and indurated, and composed of a whitish brown or yellowish white substance, mixed up in some places with a soft curd-like matter, or greyish pus, con tained in thin white cysts.
Carcinoma scroti is, with few exceptions, confined to chimney-sweepers ; and the irrit ating action of the soot on the skin of the scrotum is no doubt its exciting cause. A similar disease occasionally occurs in other parts of the skin, but the scrotum being sel dom cleansed and well adapted to harboursoot 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 he 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 I have met with the disease occurred between the ages of thirty and 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 ltfc, 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 pation, 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 for 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 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, after 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.s weeper 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 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 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 fected.-1- These cases show that, when the inguinal glands are indurated, they may be excised with a fair hope of a successful result.
Metanosis.— 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.$ Fibrous tumours.— A small fibrous tumour is occasionally developed in the areolar tissue of the scrotum. It may acquire the size of the testicle, and being firm and of an oval form, resembles a supernumerary gland. I have met with only one case of this form of tumour. Dr. Mott, of the United States, excised an enormous mass from the scrotum of a man about seventy-three years of age. The scrotum was twelve to fifteen times its Ordinary hulk, and was filled with tumours of a stony hard ness, from the size of a nutmeg to that of a large pea. The tumours had all a very white appearance, and the integuments over two or three of the largest, having been ulcerated for upwards of a year, poured forth a foetid discharge, together with a white substance resembling mortar. The disease was upwards of twenty years' duration. I have no doubt this disease was originally of a fibrous cha racter. The calcareous matter and other changes resemble those occasionally observed in large fibrous tumours of the uterus. A tumour of a similar character and of great size was removed by operation from the scrotum of a man in St. Vincent's hospital, Dublin, by Dr. O'Ferrall.#