What Mary Poppins Didn't Tell Us About Chimneysweeps

Hint: It can't be cured with a spoonful of sugar

Bert, Mary, Michael and Jane covered in coal soot. Source: Time magazine. Wash those kids’ faces STAT!

As a child, I loved Mary Poppins. Lying on my bed, I sometimes hoped the wind would change and deliver Mary to help my brother and I clean up our rooms (and our family) with her magic bag and spoonful of sugar. Of course, she never appeared and we swallowed our bubble-gum flavored amoxicillin with more than a bit of coaxing.

Disney, if you can believe it, brushed over a bit of the dark side of early 20th century British life. Turns out that the affable Bert is not even close to a true representation of cockney chimneysweeps. In reality, chimneysweeps of the time were children Michael’s age who led brutal, dangerous, miserable, and short lives. Often dying of scrotal cancer. Yup. Not so supercalifragilisticexpialidocious…

The most famous chimneysweep (R). A more accurate picture of a "climbing boy" (L)

Now on to chim-chiminey sweeps…

A tax levied on the number of chimneys a home possessed pushed enterprising builders to construct complicated internal passageways which emptied into a single chimney. These passageways contained in brick walls quickly filled with soot leading to fires and ash-filled air. The narrow passageways (often less than a foot wide) could only be traversed by children, namely young boys. Many were orphans and others sold into indentured service by their parents. Boys as young as 4 working under a master sweep entered the chimney from the roof, slid down the narrow flues and scrubbed the soot from the brick which fell into drop cloths in the fireplaces below.

Cross-section of a seven-flue, single chimney diagram for a four-story house. Note the child stuck in the fifth flue. Source: Mechanics’ Magazine 1834

In the absence of child labor laws, these boys worked long hours in claustrophobic conditions with little relief.   The job was so dangerous that if one of the boys got stuck in a chimney, the child often suffocated to death before a brick mason could be located to cut him out. (To motivate boys who were scared, their overseers often lit a small fire in the hearth below thus the saying “light a fire underneath you.”) Those who lived suffered from traumatic injuries, lung damage and were often rendered blind from the constant eye irritation.

The death of two climbing boys in the flue of a chimney. Source: England’s Climbing Boys by DR. George Phillips.

Many boys also developed scrotal lesions called “soot warts” which doctors attributed to venereal disease. Treatments included arsenic paste, scraping the lesions off with a knife and even surgical removal of part of the testicle (without anesthesia.) These remedies provided only temporary relief and eventually the sores spread to the anus and inner thigh causing excruciating pain and eventually death.

English physician Percival Pott first postulated a connection between the occupation of the boys to their deaths from scrotal cancer.  He observed that this cancer was not present in other lower class working scruffs like gravediggers, butchers, or cobblers. In a 1775 report, he suggested that the sweat produced by working in the still warm chimneys mixed with soot and trapped toxins in the folds of the testicles.  Prolonged exposure to the soot awakened a cancerous growth which “seizes the testicle, which it enlarges, hardens, and renders truly and thoroughly distempered.” He lacked the tools and knowledge at the time to know precisely what exactly in the soot caused the cancer, but it was clear that these boys were the only ones getting it.

Surgical specimen of chimney sweep’s cancer in a boy’s scrotum. Source: Hunterian Museum of the Royal College of Surgeons

And now we know why…

Years later, scientists discovered that coal soot contains a chemical called benzopyrene. Benzopyrene on its own is not dangerous. However, when absorbed by the body it is metabolized into another chemical which causes DNA damage. Unfortunately for these young men, this damage occurs at a critical piece of DNA that controls part of the body’s cancer detection system. 

A gene on our 17th chromosome codes for an important protein that defends our body against cancer. This protein is called p53.  Scientists refer to p53 “the guardian of the genome” due to its crucial role in addressing potentially harmful DNA damage.

When p53 finds DNA damage, it decides if the damage can be repaired or if the cell should die.  If the DNA damage is too extensive, p53 tells the cell to die. If the damage can be repaired, p53 repairs the damage and gets the cell back to work. What a cool little guy!

p53 (blue) examining DNA (purple) for damage. Source: Memorial Sloan Kettering Cancer Center

If the DNA blueprint to build p53 is damaged by a carcinogen like the benzopyrene found in coal soot, p53 doesn’t function correctly. Cells with DNA damage are allowed to reproduce resulting in groups of abnormal cells (aka cancer).

Obviously, the process is way more complicated than this, but you get the point. Mutations in the DNA of p53 are associated with most cancers. If only there was a way to protect our hardworking p53 from damage…

Photo by Bogdan Kupriets on Unsplash

That’s exactly what some European governments did when they read Dr. Pott’s paper. Although they didn’t know they were helping to protect p53 specifically, countries implemented mandatory daily baths for young chimneysweeps while others required sweeps to wear impermeable tight-fitting clothing. By the early 20th century, most countries had also implemented basic child labor laws, setting a minimum age for employment. These were some of the first occupational safety rules.

Today, most of us are not regularly exposed to coal soot. And personal hygiene practices have improved significantly.  The World Health Organization has identified over 100 carcinogens that governments monitor in our air (benzene, asbestos, hydrocarbons), water (arsenic) and at our jobs. Much of this work is accomplished in the United States by the Environmental Protection Agency (EPA) and the Occupational Safety and Health Administration (OSHA)

Me at Glacier Lake. Banff, Canada

When history repeats itself…

Recent Supreme Court decisions have unfortunately reduced the power of these agencies to reduce our exposure to cancer-causing chemicals. Like Britain’s chimneysweeps, exposure to these chemicals in childhood may not manifest as cancer until young adulthood which seems tragically preventable. Scientists estimate that 7-19% of cancers are caused by environmental exposures including air pollution and chemicals. Other scientists think this is a gross underestimate. It is possible that cancers could be completely prevented by updating our environmental policies to reflect the current scientific evidence.  

Thankfully, we have come a long way from childhood exposure to coal soot.  We have not, however, done all we can do to prevent our children from being exposed to cancer-causing chemicals. That work continues.

On my mind…

The US spends over $4.3 trillion a year (17% of GDP) on medical care. Twice as most other developed countries. And yet our life expectancy is much lower than our peer countries. This brilliant piece in The Economist explains where the money is going.

Some of my most treasured moments with patients are when dark humor emerges, and we laugh at the absurdity of a terrible situation.

Chemo Freak

‘s cartoons capture the irreverent side of cancer treatment and may ring true to many of you.

November is Lung Cancer Awareness Month. Lung cancer kills 350 Americans a day - more than breast, prostate and pancreatic cancer combined. And yet, improvements in lung cancer outcomes contributed the most to higher cancer survivor rates.