Percivall Pott: Orthopedics and Occupational Health
By Michael J. North
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 email@example.com.