¹ One rougher-out at an Accrington foundry in 1898, one weaver, of Clitheroe, in 1918, one corporation labourer of Accrington in 1918, and eight cotton-mule spinners (in Accrington, one in 1926, and one in 1928; in Bolton, one in 1928; in Clitheroe, one in 1924, and one in 1925; in Haslingden, one in 1911; in Whittle-le-Woods, near Chorley, one in 1889 which was the earliest certain case of scrotal cancer in a spinner admitted to the Blackburn Royal Infirmary; and in Withnell, one in 1918).

² (1) Cotton-mule spinner, aged 34. Sarcoma testis. Died 12. xii. 96, as a labourer, of cancer of testicle and bowel. (2) A. W., aged 49. Creeler 3 years, cotton weaver 25 years, corporation gasworks labourer 9 years. Testicular tumour (? sarcoma) excised 24. iii. 06. Carcinoma of inner canthus of left eye 5¼ years later, alive 20½ years later.

³ (1) J. W., aged 70, labourer. 24. iv. 28, cotton-mule spinner 23 years, cotton-mill labourer 37 years ? papilloma of scrotum; 16. x. 29 ? papilloma scrotum, hypertrophied prostate. Died 31. x. 29 as labourer at a cotton-waste works of myocardial degeneration, enlarged prostate (operation), senility. (2) C. K., aged 64, cotton-mule spinner. On 17. i. 27 he attended hospital as an out-patient for observation of ? epithelioma of scrotum. No operation was found necessary and he was alive and apparently well 5 years later. Subsequent investigation revealed the interesting fact that he died in hospital after operation for cancer of the sigmoid on 6. iii. 33.

⁴ J. C., of Church, aged 55, chemical labourer. “Tubercular nodules over scrotum”, 4. ix. 22.

⁵ A. B., aged 43, bricklayer. “Penis and scrotum (syphilitie).”

⁶ (1) H. E., aged 34, labourer. 15. viii. 77, gangrene of scrotum and stricture of urethra. 4. xi. 97, epithelioma of scrotum, aged 54. 22. xi. 97, malignant disease of perinaeum. Died 12. vi. 98, aged 54, as a general labourer, of cancer of the scrotum. (2) J. F., aged 53, cabman. 29. viii. 99, epithelioma of penis. 26. iii. 1900, epithelioma of scrotum as a groom, aged 54. Died 22. xi. 1900, as a cab driver, of fungating epithelioma of the groin. (3) W. R., aged 65, collier. 30. x. 17, epithelioma of scrotum, urethral fistula, perineal abscess, fungating malignant prostate. Died 24. i. 18, as labourer at a coal yard, of malignant prostate. (4) W. K., aged 67, farm labourer and general labourer 44 years, retired 7 years. 27. xi. 22, epithelioma of scrotum as an out-door labourer. 18. xii. 22, epithelioma of penis as a labourer. Alive 9 years later, penis removed but scrotum and testicles intact. Died 7. ix. 34, as a retired labourer for a property builder, of myocardial degeneration and chronic bronchitis.

⁷ (1) J. G., aged 33, cotton-mule spinner. 5. v. 96, malignant recurrent disease of testis and groin glands. Died on 1. vii. 96 of “carcinoma”. (2) R. G., aged 54, labourer. 6. vii. 81, epithelioma of testis and penis, removal of testis. 24. ii. 82, epithelioma of testis as an oiler. Died 12. iv. 82, as a cotton piecer, of cancer of penis 2 years. (3) J. P., aged 30, cotton-mule spinner. Phagedena of scrotum and penis. Died 31. i. 76, aged 57, as an operative cotton spinner. (Not sufficient evidence as to cause of death. (Coroner.)) (4) G. R., aged 52. Cotton weaver as a boy, coal carter 30–35 years, in army 3 years, coal-yard labourer 6 years. Died 23. viii. 21, as a labourer at a coal yard, of carcinoma of penis and scrotum.

⁸ There are still a few female piecers at the mules in certain districts.

⁹ Sometimes described as self-actor minder.

¹⁰ (1) C. P. (a retired spinner), aged 71. A hand-loom silk weaver in Coventry for 8 years, a cotton-mule spinner for 54 years, and retired for 3 years in 1917. He died of senile decay in 1929, aged 83, 11½ years after the removal of the growth. (2) W. S. (an ex-spinner), aged 62 in 1919. In a biscuit factory as a boy, a foundry worker for 13 years, a cotton-mule spinner for 30 years, and then a cotton-mill labourer (hoist man) for 4 years. He died of angina pectoris and acute nephritis 8 months after recognition of the growth. (3) J. E. B., aged 50. A railway labourer for 18 years (including 14 as a platelayer), a labourer on the tramways for 6 years, and a spinner for 6 years regularly and for 9 years irregularly.

¹¹ (1) W. A., aged 70. Cotton-mule spinner 50 years, under spinning master in the cotton-mule spinning room and retired, 12 years. (2) W. S., aged 62. Worked at a biscuit factory as a boy, then at a foundry for 13 years, cotton-mule spinner 34 years, cotton-mill hoistman 4 years. (3) J. R. T., aged 58. Cotton-mule spinner 40 years, foundry labourer 3 years, bobbin carrier 7 years (had epithelioma of the right ear almost concurrently). (4) R. B., aged 61. Cotton-mule spinner 40 years, cotton-mill labourer (proved to be an oiler and greaser and labourer in yarn cellar) 11 years. (5) B. B., aged 68. Cotton-mule spinner 33 years, unemployed 3 years, bobbin carrier 24 years.

¹² (1) W. S., aged 64. Cotton-mule spinner 53 years, iron-foundry labourer 1 year. (2) C. H., aged 68. Cotton-mule spinner 42 years, polisher at iron foundry 18 years. He died at the age of 74 of “senile decay”. (3) W. Y., aged 68. Cotton-mule spinner 15 years, labourer in cotton mill 11 years, iron driller 35 years. Alive 4¾ years later. (4) W. W., aged 54. Cotton-mule spinner 38 years, odd jobs 2 years, labourer (proved to be a foundry labourer) 2 years.

¹³ J. C., aged 43. Cotton-mule spinner 25 years, Corporation street sweeper ? 5 years.

¹⁴ C. T. P., aged 39. Cotton-mule spinner 15 years, gas-lamp lighter 9 years, Corporation labourer in automatic gas-lamp department 3 years.

¹⁵ K. C., aged 64. Cotton-mule spinner 34 years, grocer 22 years.

¹⁶ P. C., aged 58. Cotton-mule spinner 36 years, caretaker at Wcsleyan Chapel 12 years.

¹⁷ R. P., aged 56. Cotton-mule spinner 34–36 years, cotton-willow tenter 10–12 years. This is an exceptional instance of a willowing machine being placed in an ordinary cotton mill to deal with flat strips for recarding.

¹⁸ We have a record of an analogous case of a cancer of the hand in a man, aged 31, who had been in contact with mineral oil when employed as a cotton-mule spinner for 7 years and, after 5 years' interval in the army, in contact with tar as a gas-retort stoker for 7½ years. [See “Some landmarks in the progress of industrial medicine”, S. A. Henry, Camb. Univ. Med. Soc. Mag., 12, No. 2, 1935.]Google Scholar

¹⁹ Lawrence described a similar case of a chimney sweep suffering from cancer of the left ear who had had a scrotal cancer removed 2 years previously, and attributed the occurrence of the growth on the ear to the sweep's habit of carrying bags of soot on his left shoulder. Lancet, ii, 265. 5018.Google Scholar

²⁰ The total number is 1105. In 646 of these, the term epithelioma is used; in 273, carcinoma; in 173, cancer; in nine, sarcoma; in two, rodent ulcer; in one, malignant papilloma; and in one, teratoma. Random sampling suggests that the cases of sarcoma were primarily testicular in origin, or cases of epithelioma. Of the twenty included cases of cancer of scrotum and penis, the few which may have been primarily penile are probably more than balanced by those of the seventy-eight cases of cancer of penis and scrotum allocated to the penile list, which proved to be primarily scrotal.

²¹ W. S., aged 59. Doffer in ring room and then under overlooker 29 years, overlooker 20 years.

²² G. B., aged 49, whose working life of 42 years consisted of throstle spinning as a youth, and when this form of spinning was replaced by ring spinning he worked his way up to overlooker in the ring room. After a short period out of work he was obliged to return to the ring room in the lower capacity of ring jobber for a short time before the disease manifested itself.

²³ Bolton, Oldham and Stalybridge two each; Burnley, Hyde, Middleton, Salford and Stock-port one each.

²⁴ R. C., aged 59. On a rope walk 2 years, cotton piecer and spinner 30 years, cotton stripper and grinder 7 years, cotton-mule spinner 4 years, unemployed 4 years, engineer's labourer at a cotton mill 3 years.

²⁵ (1) E. B., aged 42. Cotton piecer as a boy ? 6–8 years, ring-room labourer and labourer in a cotton-waste card room 24–26 years. (2) B. H., aged 61. Cotton-mule spinner 4 years, railway stoker 14 years, engine tenter 5 years, cotton-mill engineer 14 years, and steam and hot-water pipe fitter 12 years. (3) P. M., aged 64. Cotton-mule spinner 8 years, cooper 34 years, labourer in the mule room 10 years.

²⁶ M. B., aged 56. Throstle spinner 4–6 years, cotton-mill labourer (taking skips from repair shop to warehouse) 40 years.

²⁷ G. H., aged 63. Diagnosis on death certificate, “Carcinoma (scrotum and penis)”. Previous diagnosis at hospital, “carcinoma of urethra for which penis and scrotum were removed”.

²⁸ W. R. F., aged 50. House painter and decorator 23 years, metal driller in machine too department 14 years.

²⁹ H. W., aged 32. Cotton-mule spinner 14½ years, in army 4 years (infantryman 1 year, Lewis gunner 3 years), iron driller at a textile machine works a few months.

³⁰ T. R., aged 44. Cotton piecer 10 years, tapper driller at textile machinery works 24 years.

³¹ R. H., aged 63. Coal getter at a coal mine 30 years, iron-foundry labourer 22 years. Multiple carcinomata, one at root of penis, one on scrotum at junction with left thigh, and one on hand.

³² G. M., aged 70. Cotton operative mule spinner 22–24 years, sawyer on log frame in wood working department of a textile machinery works 40 years.

³³ H. W., aged 82. Tar distiller 28 years, road navvy 4 years, grocer 30 years.

³⁴ (1) E. S., aged 68. Cotton-mule spinner 53 years, road sweeper 5 years, and caretaker at a Methodist Church 2 years. (2) B. W., aged 61. Cotton-mule spinner 21 years, greengrocer (with intervals of light cartage) 18 years, munitions labourer at an engineering works 5 years, and caretaker of Council Schools 6½ years.

³⁵ A. W., aged 50. Cotton-mule spinner 39 years, Corporation scavenger 9 months.

³⁶ One of these after 51 years' employment as a card-room jobber had retired for 6 years before the disease manifested itself.

³⁷ (1) W. S., aged 53. Cotton piecer 10 years, card-room cop carrier and then stripper and grinder 26 years, labourer at textile machinists wheeling loam for pattern makers 8 years. (2) H. B., aged 51. Cotton-mule piecer 4 years, in cotton chamber 2 years, stripper and grinder in card room 32 years.

³⁸ J. H. H., aged 66. Joiner's labourer 28 years, groom 16 years, lap carrier and waste bagger in card room 5 years.

³⁹ (1) G. H. B., aged 68. Cotton-mule spinner 18 years, unemployed 4 years, cotton mixer 24 years, cotton-mill labourer and waste bagger 2½ years. (2) J. W. S., aged 52. Cotton-mule spinner 34 years, blowing-room hand 7 years. (3) A. G., aged 48. Cotton spinner 35 years, cotton chamber man 8 months.

⁴⁰ J. W. F., aged 75. At a tar chemical works over 40 years (including 15 years in the coal-gas house), night watchman at same factory, 12 years.

⁴¹ C. F., aged 47. Cotton weaver 30–32 years, labourer at water-paint works 4 years to re cognition of cancer of the shoulder and 6 years to recognition of cancer of the scrotum.

⁴² W. C., aged 70. Cotton-mule piecer 2 years, cotton weaver 42 years, fish and fruit salesman 15 years.

⁴³ There was also one case of an Oldham man, aged 42, who had been a weaver of camel-hair belts for 20 years and previously a bobbin carrier for 5 years.

⁴⁴ C. C., aged 65. Cotton weaver 34 years, loom sweeper and oiler 20 years.

⁴⁵ J. O., aged 69. Cotton-mule spinner 47 years, loom sweeper and retired 10 years.

⁴⁶ Described in the death registei as artist painter (1), journeyman painter (2), house painter (6), painter and decorator (1) and retired house decorator (1). Cursory sampling of five of these showed that two were in the painting and decorating trade (in one case for the whole of his working life of 38–40 years and in the other for a time unknown), in two the cancer proved to be primarily penile, while one could not be traced.

⁴⁷ (1) A. F., aged 70. Fish trawler 47 years, fish packer on wharf including mending and tarring of nets, 9 years. (2) W. K., aged 60. Sea fisherman 30 years, labourer on shore 10 years, fish hawker 8–10 years.

⁴⁸ A. C., aged 43. In Royal Marines to age of 40, proprietor of a fish restaurant 3 years.

⁴⁹ E. H., aged 55. Cotton-mule spinner 13 years, railway telephone wireman 23 years, retired 5 years.

⁵⁰ J. S., aged 56. Cotton-mule spinner 41 years, labourer in steel department of an electric works 2 years.

⁵¹ J. K., aged 65. Cotton-mule spinner 47 years, packer at a bleach works 4 years, storekeeper at an electric works 4 years.

⁵² R. B. B., aged 68. Butcher's boy at first, machine-boy printer 1½ years, machine printer 5 years, compositor 10 years, assistant rotary and general printing machine minder 40 years, his duties including lubricating the machines, assisting in setting up the stereotype printing plates, cleaning of machines and printers' ink rollers. General contact with ink and oil.

⁵³ (1) G. A. W., aged 72. At first a wine and spirit merchant's assistant (duration unknown), lithographic printer 43 years, retired 4 years. (2) C. H., aged 72. Railway booking clerk more than 20 years, in ticket printing department of a railway works (eventually as manager) more than 30 years, retired 4 years.

⁵⁴ J. C., aged 50. In a jute mill 6 years, in army 4 years, in a jute mill 17 years, in army 6 years inspector in Corporation Gas Department 2–4 years.

⁵⁵ (1) H. W., aged 56. Butcher 16 years, gas maker at a steel works (first on old gas-producer plant and then retort stoker on Mond gas plant) 26 years. (2) J. R., aged 44. Glass carrier 20 years, gas maker at a glass works 10 years.

⁵⁶ J. R. B., aged 52. Cotton-mule spinner 10 years, railway-carriage cleaner, and shale-oil gas maker at railway works 28 years.

⁵⁷ One of these had been so employed for 40 years but only in the winter, being a bath stone dresser in the summer months.

⁵⁸ A. G., aged 48. Cotton-mule spinner 9–10 years, gas-works stoker 6 years, a working manager (handling all parts of the work including mechanical repairs) 18 years.

⁵⁹ W. H. W., aged 53. Machinist in engineer's wood-working department 5 years, van driver for mineral water manufacturer 1 year, tar distiller 7 years, gas-works yard labourer for 25 years (on carburetted water gas plant 6 years, on purifying plant 6 years, and boiler fireman 13 years).

⁶⁰ E. D. C., aged 54. Cotton-mule spinner 13 years, labourer in an engineering works 3 years and in a railway yard 6 months, pipe fitter and syphon attendant at gas works 22 years.

⁶¹ During the same period there were six other coke-oven workers (described as foreman (1), tar main labourer (1), by-product worker (1), hydraulic main man (1), gas regulator (1) and coke burner (1)) who died of the disease. Investigation showed that all had worked on a coke-oven plant for periods ranging from 12 to 45 years, three at least having been on the hydraulic mains for 9–13 years (including one who had previously worked on Beehive ovens for 23 years). Two had previous occupations, one as a coal miner for 14 years and the other as a blacksmith and tramcar repairer for 16 years. There was also one described as a blast furnaceman who proved on enquiry to have worked for a firm of iron founders using blast furnaces but no coke ovens, his occupation being that of a dipper of cast-iron pipes into a tar solution.

⁶² One of these had also a secondary primary growth on the lip, the extension of which was the main cause of death.

⁶³ J. W., aged 73. Pit pony driver 6 years, coal getter 47 years, tar labourer and pitch getter at a tar distillery 8 years, watchman 6 weeks.

⁶⁴ J. M., aged 64. At a bacon shop in youth, at gas works 13 years, at a tar distillery (pumping creosote and anthracene oil) for 18 years.

⁶⁵ (1) E.G., aged 45. Cotton-mule spinner 28 years, in azo department of synthetic dye works 3 years. (2) P. H., aged 55. Breaker in of horses in Ireland 3 years, fireman in a glasshouse 73 years, and labourer in synthetic dye works 6 years.

⁶⁶ We have omitted a case of a man described in the hospital records as a collier who, according to the hospital notes, had “epithelioma of the scrotum—urethral fistula—perineal abscess— fungating malignant prostate”. On his death certificate his occupation was described as that of a labourer at a coal yard, and it was stated that he died of malignant prostate, thus suggesting that the scrotal condition was not necessarily primary.

⁶⁷ A coal hewer of Glamorganshire, aged 26, who died of “sarcoma of scrotum” is excluded.

⁶⁸ This figure includes four who had previously worked in'a cotton-spinning mill.

⁶⁹ W. H. W., aged 56. In a brickyard 29 years, colliery engine stoker 17 years.

⁷⁰ (1) R. L., aged 50. Cotton spinner 33 years, Council roadman and lamplighter 6 years, colliery surfaceman 2 years. (2) R. B., aged 67. Cotton spinner 46 years, colliery carter 2 years, colliery fan engine tenter 8 years. (3) J. H., aged 55. Worker in a cotton mill 2 years, ? occupation 17 years, colliery surfaceman (joiner, labourer, and oiler of head gear, pulleys, and ropes) 16 years. (4) J. H. K., aged 66. Coffer and in waste breaking room of cotton mill 20–25 years, colliery surfaceman 30–35 years.

⁷¹ (1) S. J., aged 53. Coal hewer about 20 years, datal man repairing roads underground 20 years. (2) H. H., aged 69. Coal hewer about 50 years, waste workman repairing airways a few years, retired 2 years. (3) J. S. R., aged 76. Coal hewer about 50 years, lampman 3 years, weigh clerk 6 years, in prison and workhouse 3 years. (4) A. P., aged 67. Coal hewer 40–45 years, general labourer in colliery rolling mills and blast furnaces (using coke) 10 years. (5) J. M., aged 60. Coal hewer 19 years, colliery platelayer 30 years (see later).

⁷² The possibility of trauma when dragging the metal rails along between the thighs may be noted.

⁷³ (1) J. G. S., aged 77. Gardener most of his life, Corporation park lodge keeper 2 years. (2) R. G., aged 38. Corporation gas-works labourer 20 years (13 as retort-pipe cleaner). (3) M. F., aged 62. Refuse collector 20 years, previous occupation not traced. (4) F. B., aged 59. Cotton-mule spinner 8 years, labourer 15 years, night watchman and “knocker up” 25 years, Corporation groundsman 3–4 years. (5) J. H. S., aged 55. Cotton-mule spinner 30 years to first operation, then Corporation tram conductor for 12½ years to second operation. (6) H. R. H., aged 54. Tram conductor and previously driver of horse tram. (7) M. S., aged 42. Woollen machinist 28 years, Corporation tram car cleaner 1½ years. (8) J. H., aged 76. Corporation yard man, not traced. (9) F. D., aged 68. Jobbing joiner 30 years, Corporation market sweeper 3 years, retired 3 years. (10) G. B., aged 81. Corporation carter, not traced. (11) A. W., aged 50. Cotton-mule spinner 30 years, Corporation scavenger 9 months.

⁷⁴ H. H., aged 61. Regular soldier many years, tar boiler for Highways department of Corporation 30 years.

⁷⁵ J. K., aged 71. Builder's labourer 30 years, Corporation pavior (with a little tar boiling and spraying) for 15 years.

⁷⁶ W. H. F., aged 64. Excavator ? years, pitch loader at a tar distillery 15 years, street pavior on tar boiler 6 years.

⁷⁷ C. M., aged 70. Occupation ? years, Corporation tar boiler 19 years, Corporation road sweeper 1 year.

⁷⁸ W. G. P., aged 66. Labourer at iron works and gas works 28 years, fettler of sanitary pipes at a pottery works 26 years.

⁷⁹ W. C., aged 74. Brick presser 52 years, brick burner feeding brick kilns with small coal 10 years.

⁸⁰ K. W., aged 78. Cotton weaver 12 years, brick presser 50 years.

⁸¹ A. B., aged 72. Farm labourer 60 years. Amputation of penis 21. xi. 16, died of cancer of scrotum 1. iii. 19.

⁸² W. H., aged 60. Tenter in a woollen mill 8 years, coal-tub hoist attendant at colliery 3 years, woollen weaver 4 years, coal carter and small farmer 31 years.

⁸³ (1) W. L. D., aged 55. Jobber at a cotton doubling mill 11 years, boiler stoker at cotton mill 29 years. (2) S. K., aged ?. Beltman and oiler at flax and cotton spinning mills in Ireland 18 years, in army 4 years, attendant at wood gas plant and oiler at match works 8 years. (3) E. A. J., aged 40. Bus driver ? years, carrier of coal and gas-works coke more than 10 years, in army 4 years, kiln fireman at carborundum works 3 years.

⁸⁴ (1) E. R., aged ?. Coloured marine fireman in merchant service. (2) J. H. M., aged 71. Ship stoker 15 years, stoker at textile machinists 40 years, retired 2 years.

⁸⁵ This must not suggest that heat rays are not a primary factor in causation of epithelioma of other parts of the skin, especially such as are exposed.

⁸⁶ W. J. C., aged 79. Shoeing smith 43 years, smallholder and seller of produce 25 years.

⁸⁷ Since six of the spinners suffered from two primary scrotal cancers at different times the number of cases (138) exceeds the number of persons (132) by six.

⁸⁸ We were informed by this man's relatives that he had numerous cancers on the skin when he died.

⁸⁹ The site of election of a cutaneous epithelioma in the patent fuel worker is on the head and neck, but in the worker on the presses in the paraffin shed of a shale-oil refinery it is on the upper limb.

⁹⁰ We have a record of an epithelioma following upon a burn caused by a splash of hot tar, but the patient had been in previous contact with tar for many years.

⁹¹ As in the case of burns, abrasions, and lesions caused by lupus or syphilis.

⁹² While later it may be possible to show the full number of occupations in which epithelioma of the scrotum actually occurs, we have limited ourselves in this paper to an attempt to show the occupations in which it has occurred in the Blackburn area.

⁹³ As, for instance, in the case of the man described as a blast furnaceman who, as previously referred to, was found to have spent a substantial amount of time in tar dipping.

⁹⁴ We have a record of a case of epithelioma of the hand in a man who made creosoted firelighters in his spare time at home.

⁹⁵ As in the case of the glass and china dealer, street sweeper; night watchman, hoist man, sewage worker, and caretaker.

⁹⁶ As with soot in farming, rays in stoking, and oil in foundry work, bearing in mind also the possibility of the presence of radioactivity.

⁹⁷ E.g. oil and tarry products.

⁹⁹ It must not be forgotten that many known carcinogenic agents are derived from coal by heat.

⁹⁹ The occurrence of the disease in brush makers would be confirmatory evidence in favour of wood tar being carcinogenic seeing that this material is used for implanting the bristles. Although there is no case of death from cancer of the scrotum in any such worker between 1911 and 1930, one case of death from cancer of the penis and six from cancer of head or neck (including three of rodent ulcer) occurred in brush makers varying in age from 53 to 77 (average 65·4) years, thus suggesting that the carcinogenic action, if any, is slow and that the site of election is on the “head and neck”, a part of the body specially exposed to fume from the molten pitch owing to the nature of the process.