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As with society, hospitals at the time could be quite hierarchical but were still caring places.
Looking back to 1923 goes beyond most of our lifespans, a time before television, or bathrooms in many homes. Easy to imagine that society and medicine, including dermatology were archaic but this was not the case.
The St John’s Institute of Dermatology had been founded in 1863, with a specialist School of Dermatology in place by 1885. By 1923, the postgraduate London School of Dermatology was based at the hospital.
Attitudes beyond the profession were not so helpful, the public stigma associated with some conditions, you could lose your job for having a skin disorder. A few well advertised “cures” were perilous but professional support was in place.
A Specialist Field
The British Association of Dermatology and Syphililogy had existed briefly but in 1922, the Medical Society for the Study of Venereal Diseases was founded. The two disciplines soon separated, leaving the British Association of Dermatologists.
Still our leading body and even in 1923, members recognised, or referred to many skin conditions as they do now, from urticaria, to impetigo, or psoriasis.
Procedures we still use were in place, such as taking smears and subsequent laboratory testing. Science was seen to be advancing rapidly, bringing changes to diagnosis and treatment for skin conditions.
Advances In Dermatology
Alongside laboratory analysis, in practice microscopy improved. The term dermoscopy was first used in 1920, to describe the use of skin surface microscopy.
We were still a long way from laser technology but treatment included a concentrated carbon arc light (known as a Finsen lamp). Often to treat conditions such as lupus, with chemo-therapeutic agents tried alongside the light.
An approach we would recognise today, whilst others came and went, such as x-rays being used to treat eczema. Levels of success were variable and undesirable effects on tissue cells were acknowledged even then.
Health and safety in a legal sense barely existed but risks from a variety of substances were understood. The term Baker’s Eczema arose, reflecting a reaction on their arms from the use of potassium persulphate as a flour improver.
The Disease Landscape
Much we know now was not available, the human genome not even a concept. Greater understanding in many fields has taken us forward, yet most general skin conditions we live with were part of life in the 1920s.
An exception is skin cancer, conditions such as basal cell carcinoma (known as rodent ulcer) were diagnosed, along with melanoma but in smaller numbers.
Lack of awareness may have played a part, along with access to medical care for people with limited means. The core reasons were lower longevity in the 1920s and few overseas holidays, with related sun exposure.
Medical dermatology needs to reflect the times this is in, priorities have changed, along with ideas and procedures. Still fair to say that a century ago, dermatologists were there to care for your skin.