Historian Katherine Aske explores the origins of dermatology, the development of knowledge surrounding skin diseases in the eighteenth century, and the important contributions women have made to medical history.
The history of skincare is long and at times, particularly gruesome. While that is no less true today, towards the end of the seventeenth and into the early eighteenth century, a specialist field regarding the medical treatment of the skin was beginning to emerge. As I have just been awarded a BA/Leverhulme Small Research Grants award to undertake a two-year research project into the origins of dermatology within the eighteenth century, I want to give a brief introduction to this innovative medical humanities project.
The project, ‘Skincare in Popular and Medical Culture, 1660–1800’, intends to uncover women’s knowledge of various skin diseases, conditions, and treatments, and their engagement with medical culture. It will examine personal accounts, such as letters, journals, and doctor’s notes, as well as domestic remedy books, advertisements, popular and professional medical literature. The project will evaluate the extent to which beliefs about skin were a result of the growing medical market in the eighteenth century, the rise in literature aimed at women, and the idealisation of healthy, clear skin in literary and popular culture. Its aim is to shed new light on women’s undervalued contribution in the development of dermatology.
My research focusses mainly on England and Scotland, from 1660 to the end of the eighteenth century. This period saw huge developments in medical and healthcare knowledge, with a rising number of medical publications becoming available in English rather than Latin, and the increasing availability of medical advice from local apothecaries and newly established dispensaries and hospitals. The Royal Colleges of Physicians, first established in London in the sixteenth century, and then Edinburgh in 1681, had seen medical education (at least for white men) evolve exponentially. This period was also one in which diseases of the skin became ever more publicly visible.
From 1661, the London Bills of Mortality began to be published more frequently, becoming weekly by 1664 and listing diseases such as the plague, scurvy and ‘Spotted Feaver’, alongside numbers of casualties. In the early eighteenth century, medical treatises specifically dealing with the skin as a specialist subject began to be published in English by professional doctors, such as Daniel Turner and Thomas Spooner, indicating a growing necessity to address the skin’s health and understand its specific diseases––not least, the smallpox. By 1796, the first vaccine to treat smallpox had been developed by surgeon Edward Jenner and changed the course of medical history.
What’s that Spot?
Recently, both of my young children have had chickenpox. My eldest had only a few spots, and then my youngest, precisely two weeks later, was covered from head to toe. They were both fine, and most of us will have had chickenpox as children, and the common symptoms tend to allow for easy diagnosis. However, other skin diseases, such as measles or hand, foot, and mouth, can present very similarly, with spots and a fever. The recent outbreak of ‘tomato flu’ in southern India will prove that even with our modern knowledge, diagnosing the skin can be tricky.
The identification and knowledge of skin issues and their subsequent care is at the heart of my research. Having worked as a pharmacy dispenser, and being frequently met with questions such as ‘what’s this and how do I treat it?’, I wondered how do we come to know the difference between chickenpox and hand, foot, and mouth? Between eczema and shingles? Usually, we ask for advice, whether from a medical professional, or perhaps our friends and relatives, or we learn from experience (or Google). But before the establishment of dermatology, or even standardised medical diagnosis, how did people identify a potentially harmful or contagious skin condition? Especially when deadly diseases, like smallpox, were at the forefront of public health concerns.
Knowing your Tingles from your Shingles
On the 10 May 1712, Jonathan Swift wrote in his Journal to Stella, ‘the doctors said that they never saw anything so odd of the kind; they were not properly shingles, but herpes miliaris, and twenty other hard names’ (vol. III, Letter XLVI). As shingles could easily be mistaken for several other dermatological complaints, including the much-feared smallpox, the first hurdle with treating the skin is one that we still have today: diagnosis.
At the beginning of the nineteenth century, a translation of Dr William Cullen’s 1784, originally Latin study, Nosology (a word for the categorisation of diseases), was published. The Edinburgh local suggested ‘it is of the highest importance that Physicians should be able to distinguish with certainty, each particular disease from every other’ (Nosology, 1808, p. ix). It might not be too difficult to imagine, but many diseases of the skin (and their treatments), were often grouped together based on their appearance: scabby, pus-filled, itchy, red…etc.
Much like their patients, medical practitioners in this period had widely varying knowledge and experience. But ‘professional’, university-educated medical advice was exacerbated by the domestic knowledge of medical treatments found in remedy books or handed down in handwritten family collections. In trying to avoid expensive doctor’s fees, self-diagnosis and self-treatment were being made ever easier through the availability of published medical advice in English, and over-the-counter remedies from apothecaries and local sellers alike.
So, when an individual was worried about their skin, whether they were in search of a better complexion, or in need of a cure for a suspicious pimple and could not afford a trip to the doctor, what were their options? A visit to a bookseller? A conversation with a neighbour? Or perhaps, an all-in-one much too-good-to-be-true store-bought remedy?
In 1709, Tatler, a weekly journal, advertised ‘The Royal Beautifier, or the greatest Cosmetick in the World’, that ‘certainly takes away Freckles, Spots, Pimples, Scurf [flaky skin], Morphew [blemishes], and Sun-burnings, and miraculously makes the Complexion plump, fresh and smooth, and delicately fair even to admiration’, for only two shillings and sixpence per pot (Tatler, 2 May 1710, Issue 167). Nestled between similar cosmetic adverts, the claims that such products addressed multiple but minor issues indicates that there was common knowledge of the difference between skin blemishes and diseases (which would have been accompanied by other health issues). Their promises also demonstrate the idealisation of ‘fair’ and ‘smooth’ complexions within British popular culture.
Surgeons, Socialites and Smallpox
Today the distinction between cosmetics and skincare is more apparent than it was in the eighteenth century, but the realms of health and beauty have never been entirely separate. One major concern for both was the contraction of smallpox.
Lady Mary Wortley Montagu, an intelligent, beautiful socialite and writer, was an adult victim of smallpox in 1715. Although she survived, she was dreadfully scarred, and lost her only brother to the disease. She wrote about the experience in a poem, ‘Saturday; the Small-Pox’:
Ye, cruel Chymists, what with-held your aid!
Could no pomatums save a trembling maid?
How false and trifling is that art you boast;
No art can give me back my beauty lost.
(Town Eclogues, 1747, p. 35)
But Lady Mary was not simply a woman who suffered at the hands of smallpox. Indeed, while her contribution to its eventual eradication is now beginning to be recognised, much of history has focused on Jenner for his world-changing smallpox vaccine.
Smallpox is thought to have been one of most lethal diseases, alongside consumption, in eighteenth-century Britain. Most commonly affecting children, early symptoms included high fever, fatigue and severe back pain, and less often, abdominal pain and vomiting. But following Jenner’s discovery of the smallpox vaccine in 1796, death rates began to drop significantly, and the last known case of naturally occurring smallpox was recorded in Somalia in 1977. However, its final victim was Janet Parker, a medical photographer at the Birmingham Medical School, who was exposed to the virus and died 11 September 1978. In 1980 the World Health Organization declared smallpox eradicated––the only infectious disease to ever gain this distinction.
However, the first ‘vaccine’ for smallpox began as variolation, or inoculation using controlled exposure to the virus. Variolation had been in practice outside of Europe long before the eighteenth century, but was introduced in England by Lady Mary in 1721, following her time in Istanbul. According to Isobel Grundy, while a resident in Turkey, Lady Mary discovered the inoculation process was a common procedure in folk medicine, administered locally by an old woman. With the help of Aberdeen-educated surgeon Charles Maitland, Lady Mary had her almost five-year-old son inoculated against smallpox. While she was not the first Western European to do this, she was the first to bring the practice home and to advocate it amongst her influential friends. However, she faced backlash for supporting the potentially dangerous process of inoculation (although its mortality rates were 0.5% compared to 20% for contracting smallpox). But variolation was a crucial step towards the vaccine, and Jenner was himself was inoculated through Lady Mary’s method. His dedication to a safer alternative, using the far milder cowpox after observing the disease amongst milkmaids, ultimately changed medical history.
Dr Katherine Aske is an award-winning literature and medical humanities scholar, working on women’s beauty and proto-dermatology in the long eighteenth century. She is available to contact on Twitter via @katieaske.
