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As a historian with acne, few things irritate me more than people trying to claim that acne cases exploded in the modern era. The history of acne has been covered in both the popular and scholarly press; at this point, there’s no excuse for this misinformation. The resilient belief that our superior past lifestyles prevented acne from forming comes out of the same magical historical thinking that inspires dangerous nonsense like raw water and skipping vaccines. People do realize that it’s possible to read about the past in books rather than experience dysentery firsthand, right?!
At a time when things like the Black Death and smallpox had yet to be cornered into CDC labs, doctors and patients were very interested in treating acne — even when they realized it didn’t pose a threat to one’s health. The ancient Roman physician Celsus (c. 25 BC–c. 50 AD) side-eyed the treatment of acne, writing in the sixth book of De Medicina, “To treat pimples and spots and freckles is almost a waste of time, yet women cannot be torn away from caring from their looks.”
By the 18th century, a modern perspective on acne had emerged. Daniel Turner, a surgeon and the author of the first book wholly devoted to dermatology, defended his interest in treating acne. “I shall make no Apology for spending Time, or taking the same Pains to remove the Blemishes incident to the Face by some, as I have done to retrieve a former good Complexion lost by other Kinds of Illness,” he wrote in 1731. “I cannot think the Talk below the Dignity of a Physician.” In his “Lectures on the theory and practice of medicine” from 1839, Dr. John Elliotson describes acne as “exceedingly common, and not at all contagious, nor dangerous.” Yet Elliotson clearly thought acne was worthy of study since he discussed its treatment at length.
A few things were happening in the 18th and 19th centuries that paved the way for specialization in dermatology and the medical treatment of acne. Chief among them was the professionalization of the practice of medicine. Turner is a good example: When he registered as a medical practitioner, it was under the Barber-Surgeons’ Company of London in 1691 — as in, his guild included both the people who cut into flesh and those who cut hair and fixed up teeth.
Over time, the practice of medicine became increasingly specialized and male. Even midwifery, assistance with the birthing of babies, transferred from women to male midwives in the 18th century (this shift is how women came to give birth while lying on their backs in bed instead of sitting on birthing stools, by the way — it was more comfortable for the male doctors). It’s entirely possible that healing women, who mostly transmitted their expertise orally, handled the treatment of acne before male doctors decided to give it a go.
Undergirding the professionalization of medicine was the scientific revolution, which started in roughly the mid-16th century and ran through the 18th-century Enlightenment. Scientists, often people we today would consider wealthy amateurs, studied things like math, astronomy, physics, and even alchemy. For medicine, the scientific revolution meant picking up the medical and anatomical work of the ancients and adding to it by examining real human bodies, living and dead. Human autopsy was controversial and even banned in some places by religious authorities, but access to corpses allowed scientists like Andreas Vesalius to create new anatomical drawings that helped the practice of medicine become modern.
In the days before Instagram and YouTube, physicians were already using their knowledge of skin to serve up pimple-popping content. Elliotson discussed how young men and women could be plagued by elevated spots with black tops for four or five years, but the spots could be extracted. “By squeezing them, you force out what is called a maggot, but it is only the contents of the sebaceous follicles,” he writes, “and by continued squeezing, you may force out stuff as long as the follicles will supply it.” In the case of older patients with rosacea, Elliotson described the condition as maggots that lie in a bed of roses. Dermatological disorders were often named as though human skin were harboring or taking on the properties of animals and insects.
The ancient approach to acne treatment seems like a direct ancestor of the DIY skinternet. Ancient Egyptians and Greeks used honey in their treatment of acne. Celsus recommended “galbanum and soda pounded in vinegar to the consistency of honey” for removing spots. What we would call “natural” skin care remedies for acne persisted into the modern era and were used alongside formulations that sound like they’d require a chemistry set. Thomas Bateman wrote in his 1836 edition of A Practical Synopsis of Cutaneous Diseases that a patient believed that bruised parsley caused severe inflammation that healed her acne; he also highlighted some of the ancient-recommended topicals, such as vinegar, honey, emulsion of bitter almonds, turpentine(!!!), and myrrh.
The toilet of Flora, first published in 1772, includes a number of recipes for waters intended to cure pimples that use everything from veal and newly laid eggs to apples, celery, and fennel. The mixtures sound more like a Sunday roast than effective skin care. One Flora recipe recommends putting a hot crust of bread on mouth pimples that have formed “in consequence of having drank out of a glass after an uncleanly person.” It all sounds a bit ridiculous, but kitty litter face masks happened on our watch, so it’s hard to be too judgey.
The scientific revolution helped doctors identify substances that could quickly change and often shed skin; the problem was that many of the substances that busted open zits could take a few years off one’s life. Bateman wrote that one Dr. Underwood recommended a solution of carbonate of potass, presumably the modern potassium carbonate, a strongly alkaline liquid that sounds like a great way to needlessly piss off one’s skin for a week.
Bateman’s A Practical Synopsis of Cutaneous Diseases goes straight off the rails and suggests various compounds containing mercury for stubbornly acneic skin before dropping a rec for a solution that includes hydrogen cyanide, a “colorless, extremely poisonous and flammable liquid that boils slightly above room temperature.” Elliotson recommends a nitrate of quicksilver, another mercury preparation. Mercury was a popular topical medicine at the time, but the element is so toxic that the workers who made felt hats using it inspired the phrase “mad as a hatter” due to the mercury poisoning they experienced.
If you think flaky, raw “tretface” from Retin-A is bad, imagine “mercface” from the application of mercury compounds to pimples. Yet it was the turn toward science-y skin care, driven by the scientific revolution and newly professionalized physicians, that established dermatology as a field worthy of study and set research on a course that would eventually end with (and someday surpass, please gawd) prescription retinoids such as Differin and Retin-A as well as isotretinoin (a.k.a. Accutane).
One of the sadder examples of attempted acne treatment that I found in the course of my research comes from an anecdote mentioned in Robert Caro’s biography of Lyndon B. Johnson. While studying for his undergraduate degree in Texas, the future president convinced a young man — who was already frequently bullied for a possible intellectual disability — to put fresh cow manure on his face in order to treat his serious acne and then wrap a towel with eye holes around the manure to keep it in place. Upon seeing the young man attempt the treatment the next day, LBJ convinced him to add more so it would “work.”
The incident should remind us that modern dermatology took acne seriously and attempted to offer the latest scientific treatment methods — though sometimes caustic and even potentially deadly — while the general population served up laughter, suggestions to drink more water, toothpaste spot treatment remedies, and bullshit.