A Physician’s Look at Charlotte Mason’s Views

A Physician’s Look at Charlotte Mason’s Views

I fear the reader may be inclined to think that I am inviting his attention for the most part to a few physiological matters—the lowest round of the educational ladder. The lowest round it may be, but yet it is the lowest round, the necessary step to all the rest. For it is not too much to say that, in our present state of being, intellectual, moral, even spiritual life and progress depend greatly upon physical conditions. (Home Education, p. 37)

Mason herself provides the clearest reason why I am writing on the subject of physical health and its role in education. Trying to educate the mind of a body that is not cared for optimally would be like building a coliseum on the sands of the seashore. We cannot separate our minds from our bodies, and so the utmost care of both should be our aim. Mason makes many bold health claims throughout her writings, especially in Home Education, volume I of her six-volume series. The reader might wonder whether her training in the time period in which she lived qualifies her to provide sound advice on the subject in today’s modern medical era. That was the question which drove me to investigate her health claims in light of modern medical advances. Yet this topic of optimizing health is so broad that someone could spend years studying the subject, say in medical school for example, and still not know the first thing about good health. Sadly, I know this to be true by personal experience.

Before I delve into my investigational findings, I should share my own qualifications on the subject. I received my MD degree from Vanderbilt University in 2005. After a one-year general surgery internship, I spent four years as the primary care provider to submarine sailors. I then completed my residency and became board-certified in dermatology, the study of the skin. Subsequently, I completed training in medical acupuncture and, just this past November, I passed the board certification exam administered by the Institute for Functional Medicine. My current work is as the director for an accredited dermatology residency program in the National Capital Region and at this same facility I am the Chief of Integrative/Functional Dermatology. Thus, I have my feet in two different academic worlds and view health from both a mainstream, pharmacologically-driven medical perspective as well as a holistic (yet still evidence-based), primarily non-pharmacologically driven medical perspective. Like anyone else, I am not without my biases. My objective in investigating Mason’s claims is to use the latest scientific literature, whether it is literature that is embraced by the western-trained physician or a functional medicine practitioner, to provide insight as to whether or not Mason’s claims have any scientific basis.

Mason’s advice covers many aspects of health. This will be the first article in a series of articles on Mason’s health claims. Since my strength is in dermatology, I will start by addressing her claims about the skin. Future articles will focus on topics such as food, fresh air (including night air), and exercise. These claims are certainly not without their controversies, which can make for an enjoyable journey. I also recognize the need to be sensitive to my audience knowing that there are strong, differing opinions about these subjects. I also invite feedback from the reader to provide evidence I may have overlooked or questions about other claims that for which you would like more clarity. For now, we’ll focus on the skin, because, as Mason puts it, “[w]hat is true of the skin is true all round, and we cannot go to work with a view to any single organ or function; all work together, and we must aim at a thorough grip of the subject” (Formation of Character, p. 140). The specific subtopics I plan to cover in this article related to the skin are:

  1. Sunshine
  2. Scarring
  3. Perspiration
  4. Skin rubbing, and
  5. Wool

To organize my findings, I have listed each subtopic followed by a quote from her writings. Part of my task is to interpret her claims into something I can research, sometimes requiring me to make assumptions about her intent that may or may not be accurate. There are occasions when I use surrogates to arrive at a conclusion. An example of a surrogate (which may or may not be valid) would be cholesterol level to determine cardiovascular health. In addition to Mason’s claims on the subject, I may also provide further information directly related to the topic that I think might be of interest to the reader. I have tried to use as many journal references as possible from PubMed to which I have access while the reader may not. However, in most cases, the abstract for each reference may be readily obtained via a simple internet search with no special library access required.

Sunshine

Quite healthy blood is exceedingly rich in minute, red disc-like bodies, known as red corpuscles, which in favourable circumstances are produced freely in the blood itself. Now, it is observed that people who live much in the sunshine are of a ruddy countenance… Therefore, it is concluded that light and sunshine are favourable to the production of red corpuscles in the blood; and, therefore… the children’s rooms should be on the sunny side of the house. (Home Education, pp. 34-35)

The broader, more practical advice that Mason gives in these statements is that children’s rooms should be on the sunny side of the house. To arrive at her conclusion, she makes the additional claims that blood that is rich in red corpuscles is healthy blood, that red corpuscles are made in the blood, and that sunshine increases the quantity of red corpuscles. We’ll start with her rather matter-of-fact statement that red corpuscles are produced freely in the blood. Unfortunately, Mason gets it wrong here. Red blood cells are in fact produced in the bone marrow (Adamson, 1996). This is a minor error, perhaps due to the lack of scientific discovery of her time, and has little impact on her broader claim about sunshine affecting the production of red blood cells. Next, let’s examine the claim that sunshine leads to a ruddy complexion and that this is a health benefit. An extreme manifestation of a ruddy complexion would be the disease known as rosacea. Rosacea has a well-known association with sun exposure, among other environmental risk factors (Aldrich, 2015). Unfortunately, the extreme ruddiness of rosacea is also associated with a host of other diseases, including auto-immune diseases, high cholesterol, cardiovascular disease, allergies, GERD, high blood pressure, and metabolic disease (poor blood sugar control) (Egeberg, 2016; Rainer, 2015). The more severe the rosacea, the more severe the comorbidities (Rainer, 2015). The comorbidities in rosacea are typical for inflammatory disorders.

So having a ruddy complexion to the point of being diagnosed with rosacea would not be consistent with improved general health. But not all people with a ruddy complexion have rosacea. Superficial blood vessels are induced by ultraviolet radiation (or sunlight), as they are often prominent in sun exposed areas, and are referred to as telangiectasias. Having a large number of these telangiectasias results in a background hue of redness, or ruddiness. This is different than the temporary redness that someone might experience from an acute sunburn. Ruddiness is more a consequence of chronic sun exposure. So Mason’s rather logical association between sun exposure and a red complexion is confirmed by current medical understanding. However, the idea that sun exposure leads to red skin is really secondary to Mason’s overall purpose.

The more important claim is that sunlight increases the red blood cells in the body (regardless of the complexion) which has an overall beneficial effect on health. Perhaps it may seem like a logical conclusion that if there are an increased number of blood vessels then there must be an increased number of red blood cells. However, up until recently, there was no scientific evidence to back this claim and most clinical scientists did not believe this to be true. However, the idea that sun exposure increases the amount of red blood cells has recently been studied. One of the surrogate markers that clinical investigators use when it comes to sun exposure is Vitamin D levels. With increased sun exposure, there is typically an increase in the amount of Vitamin D that is produced in the body (a small amount can be obtained through food as well). So the scientific question would be, do increased Vitamin D levels correlate with increased red blood cells? Or, put another way, do low Vitamin D levels correlate with anemia (low number of red blood cells)? The answer is yes (Sim, 2010). Low Vitamin D (and therefore sun exposure) is in fact associated with anemia. There have been a number of studies demonstrating this fact and almost all of them have been since 2010—nearly a century after Charlotte Mason made the claim that sunlight improves the blood count.

Before we celebrate a victory for Mason and her prescient observation, we need to take this one step further. Her final conclusion in her paragraph on sunshine is that children’s rooms should be on the sunny side of the house, with a south aspect if possible. There’s a problem with her conclusion. Unless the children’s rooms just have holes in them and are not glass windows, they will see no improvement in their vitamin D levels by having more sunlight in their rooms. The reason is that glass blocks UVB radiation, which is required for the body to make Vitamin D. Glass lets in UVA but not UVB. UVA is not involved in the production of Vitamin D and therefore would not increase the blood count in children. However, that doesn’t mean that it is a bad thing to have bedrooms (or any room) with sunlight streaming through the windows. Seasonal affective disorder (SAD) is a form of depression people tend to get in the wintertime because there is less light. This is typically alleviated by visible light and ultraviolet light is not necessary to improve one’s mood. Although I could not find any studies in the medical literature that looked at southern exposure of homes and SAD, the bottom line is that if someone is exposed to more light during the day, those who are prone to SAD will show fewer depressive symptoms. But is Mason talking about children’s bedrooms or any room that they occupy during the day? If we’re talking about a bedroom it also would likely be of no benefit since they don’t occupy the bedroom during most of the peak sun hours. However, it would be a reasonable conclusion to say that whatever room the children occupy during daytime hours would best be in the sun to maximize their mood.

But let’s take a step back a bit and set aside the nitty gritty details of Vitamin D, anemia, rosacea, inflammatory disorders, seasonal affective disorders, etc., and try to see Mason’s main message regarding sunshine. Mason is basically saying that sun exposure is good for you and throughout her writings, encourages hours of outdoor activity for children daily. This advice is, however, in contradistinction from that of dermatologists, who advise their patients to protect themselves from the sun because the sun causes skin cancer. That the sun causes skin cancer is not disputable. However, even dermatologists use ultraviolet light therapy to help many skin diseases. A very large study from Sweden, published in 2016, showed that there was a dose-dependent relationship between sun exposure and life expectancy (Lindqvist, 2016). One of the really surprising outcomes of this study was that non-smokers who avoided sun exposure had a similar life expectancy than smokers in the highest sun exposure group. Unfortunately, the study was not able to distinguish between an “active” lifestyle and being outside in the sun. In other words, the study could not answer the question of whether the people with more sun exposure were healthier simply because they were outdoors and more active, or because of the sunlight itself? As far as Mason is concerned, the two should not be separated. Mason promoted an active, outdoor lifestyle which leads to longer, healthier lives. In conclusion, although Mason lost several battles in her sunshine health claims, it appears that overall she has won the war in her promotion of outdoor activity.

You may, however, be asking what role sun protection, in particular, sun screen should play in all this. The advice that I typically give depends on how prone a person is to sun burn. Although I am not against unprotected sun exposure, I am against it when it leads to burning. I personally rarely wear sunscreen despite being outdoors frequently, but I take other measures to protect from burning. I usually wear a hat when I am outdoors and often wear long-sleeves even in the summer. I can do this and still get enough sun exposure to maintain reasonable Vitamin D levels because I have very fair skin. Someone who has darker skin and rarely burns, may need more sun exposure to get the required amount of Vitamin D and really may not need to protect themselves very much at all unless they are in direct sun for many hours of the day.

Finally, a word about sunscreen. If my skin is exposed to the sun enough in which I feel I might burn, I will use sunscreen. But I use physical blockers, such as zinc oxide and titanium dioxide. The reason is three-fold. First, they have broad coverage of wavelength protection. Secondly, they tend not to cause allergic reactions like the absorbable sunscreens such as oxybenzone (Landers, 2003). Thirdly, the absorbable sunscreens are not just absorbed in the skin but systemically and their levels can be measured in the urine (Janjua, 2004). The clinical significance of the systemic absorption is not known but adds to the overall toxic burden (to be covered in the wool section).

Scarring

… if a considerable portion of the skin be glazed, so that it becomes impervious, death will result. This is why people die in consequence of scalds or burns which injure a large surface of the skin… (Home Education, p. 35)

While this is not a health claim per se, in the sense that no one ever considered it a good thing to be burned or scarred, I would like to examine Mason’s assertion that people who have a large surface area of skin burned die because the skin is “glazed.” Her term “glazed” likely refers to scarring. When skin becomes scarred, it typically loses the hair, becoming smooth. It can also become shiny, which is especially prominent on the scalp when people experience what’s known as cicatricial alopecia or scarring hair loss. The smooth shiny appearance might also be described as glazed, like a fresh “hot now” Krispy Kreme donut. In second- or third-degree burns, scarring results from the deposition of collagen in the skin which replaces all the other structures in the deep dermis, including appendages (hair follicles and sweat glands). In that sense, because the sweat glands are obliterated, one might consider the skin that is scarred to be impervious, because sweat does not release as easily as from non-scarred skin. However, interestingly enough, the body has a means of compensating. When there is a portion of the skin that loses its ability to sweat, like in a scar, the rest of the skin sweats more in the non-affected skin so that the body puts out an equal amount of sweat to that of a body that is not scarred, as long as the body surface area affected by the scarring isn’t too great (Shapiro, 1982). Scarred skin can still have water permeate through it, even if the sweat glands are obliterated. So to say that scarred, or glazed skin is impervious is inaccurate (Kunii, 2003; Suetake, 1996).

But what about this idea that “death will result” if a “considerable portion” of the skin is scarred? When people have widespread scarring, it typically comes from burns. But burned skin is not glazed skin until it has scarred over. In other words, in order for someone to get to the point that their skin is glazed, they need to survive the acute phase of being burned. If we’re talking about a considerable portion of the skin being burned, there are two ways this may come about. First, a person could have many small burns over time (maybe an industrial worker who is involved with hot work?) that add up to a considerable portion of the skin. Typically someone would not die of the burn itself when there are many serially acquired individual small burns. However, if the burns occur all at once, for example if a pot of hot oil is spilled onto a child, or a person is caught in a fire, or a soldier is exposed to explosives, there may be considerable risk of death in the acute, or immediate phase, following the burn. In this case, the problem isn’t that the skin is impervious, but quite the opposite. With severe third-degree burns, the skin loses its protective barrier and instead of keeping the bad stuff out and good stuff in, substances can pass freely through the skin. Death, in this case, is often the result of infection which may be complicated by severe dehydration due to excessive water loss through the skin.

But in Mason’s claim, I don’t think she is referring to the acute phase, because the skin is not glazed in the acute phase. My interpretation is that she is speaking of people who have survived the burns and are less vital afterwards, resulting in earlier death due to the “impervious” skin. A 2017 study of critically ill burn survivors showed just the opposite to be true. The surprising finding of this study showed that of those who survived the acute phase of widespread burns, those who had the greatest amount of surface area affected, lived longer after getting out of the hospital than those who had a smaller amount of surface area burned (Nitzschke, 2017). The caveat is that these patients were also younger. The thought behind why this was observed is that in order for the patient to survive the critical, acute phase of the severe burn, they had to have a significant reserve of health prior to the burn (which is more likely in younger patients). Those who didn’t have good health prior to the burn would be more likely to die in the acute phase with the equivalent amount of surface area affected than someone who was healthier (and younger). My conclusion is that there are more important aspects to health than the amount of scarring a person has. However, extensive scarring could have socioeconomic implications, as scarring leads to decreased range of motion (possibly fewer employment options due to disability) and can also lead to depression due to social isolation.

Although it may seem like the topic of scarring has no practical application, consider this. Scars can often be the source of chronic pain and itch, even at bodily sites distant to the scar (Bruno, 2014). Why is this practical? This comes into play in elective surgery. For example, I often have patients come to my office wanting to have a perfectly benign mole removed because they don’t like the way it looks. While most people do fine symptomatically after removal, a subset of patients will have chronic pain and itch from this and other elective procedures that cut into the skin.

Perspiration

The blood receives and gets rid of the waste of the tissues, and one of the most important agents by means of which it does this necessary scavenger’s work is the skin. (Home Education, p. 35)

Mason stakes the claim that sweating is an important means of getting rid of tissue waste. There are four organs that the human body uses to rid itself of waste: lungs (primarily CO2 when we exhale), kidneys (from the blood, which includes metabolites of toxins biotransformed by the liver), the large intestine (stool), and finally, the skin via sweat. Of the four listed, the skin is probably the least important. Pigs and dogs (and many animals for that matter) have very few sweat glands compared to humans, but they definitely have lungs, kidneys, and bowels. This often begs the question, is pork unsafe to eat because pigs have excess toxins from lack of sweating? Whether or not pork is a safe food to eat I will not address now, but I will say that cows also do not sweat significantly (Ford, 2015). The lack of sweating may affect their ability to remove toxins, but since God designed them this way, it’s safe to say that in normal, natural environments, the inability for them to sweat does not affect their ability to get rid of the waste of the tissues. However, just because sweating is probably fourth in importance out of our four excretory organs, that does not mean it is not useful.

But this claim of Mason’s is not without controversy. A recent article in National Geographic (Engelhaupt, 2018) claims that people cannot sweat out toxins. The article goes on to say how scientists have been screaming for years that it is a myth that sweat is used to detoxify the body. The primary target of the article appears to be the “sweat-detox” industry in an apparent effort to warn consumers. However, the article was based on very little science and in fact ignored much evidence to the contrary. A 2012 article published by the Journal of Environmental Public Health (whose target audience is scientists) looked at many studies done over the years and came to the opposite conclusion as the National Geographic article. They discovered that certain heavy metals (cadmium, arsenic, mercury, and lead) were in higher concentration in the sweat than in the blood and in most cases were also higher in concentration than in the urine (considered to be the primary excretory pathway). Other articles have shown sweating to be an important mechanism of eliminating persistent flame retardants, bisphenol-A and other Persistent Organic Pollutants (POPs). Elimination through sweat can also be enhanced by consuming other nutrients such as zinc and Vitamin E (Sears, 2012). Detoxification aside, there certainly seem to be other health benefits to sweating which may or may not be related to elimination of bodily waste. Sauna use, which can be used scientifically as a surrogate for sweating, shows many health benefits, such as lower strokes, lower risk of dementia, and heart attacks (Zaccardi, 2017; Laukkanen, 2015; Laukkanen, 2017).

My conclusions are that, although sweating is not the most important route of tissue waste elimination in the body, it potentially provides for a preferred avenue of elimination for certain toxicants, contrary to what many mainstream scientists may claim. There is plenty of evidence that shows certain non-beneficial elements that can be found in the body (such as heavy metals and Persistent Organic Pollutants that are primarily the results of industrial processing by humans) are readily and perhaps most effectively eliminated by sweating. This can be especially helpful for those of us who have been exposed to a great amount of such toxins or have a genetic predisposition leading to negative health effects from such exposure.

Vigorous Skin Rubbing

… [of] the necessity for the daily bath, followed by vigorous rubbing of the skin, it is needless to say a word here. (Home Education, p. 36)

You remember how a popular American poet sat on a gate in the sun after his bath, using his flesh-brushes by the hour, until he was the colour of a boiled lobster. He might have been more seemly employed, but his joy was greater than if daily telegrams had brought him word of new editions of his poems. Well, if due action of the skin be a means to a joyous life, to health and a genial temper, what mother is there who would not secure these for her child? (Formation of Character, pp. 139-140) [1]

This is perhaps the most offensive health advice to dermatologists. From early in our dermatology training, we are taught that any heat, friction, or energy added to the skin will lead to itchy skin. We continually counsel our patients that hot showers and scratching (rubbing is not an acceptable alternative) will make their itchy skin worse. This is good advice for a dermatologist to a patient. But it also introduces the concept of referral bias. The reason the advice not to scrub skin is good for dermatologists to give their patients is that the patients that are referred to dermatologists have itchy skin to begin with! The principle of why your mom told you not to scratch the mosquito bite applies here: itchy skin leads to scratching which leads to more itchy skin. It’s called the itch-scratch-itch cycle and it is an example of a positive feedback control system. But what if a person is not prone to itchy skin to begin with? Is it possible that there could be benefit to regular use of Mason’s flesh brush? Searching the internet will lead to numerous health benefits listed for scrubbing the skin. The modern term is called “dry skin brushing.” Here is a list of purported health claims for dry skin brushing that I acquired from a representative website (Dr. Mercola):

  1. Stimulates your lymphatic system, thereby stimulating your immune system
  2. Exfoliates the skin leading to healthier appearing skin that can “breathe”
  3. Increases Circulation aiding in detoxification
  4. Reduces cellulite
  5. Stress Relief
  6. Improve Digestion and Kidney Function
  7. It’s invigorating

Although Mercola typically backs up his claims with evidence from the medical literature, he did not do so in the case of dry skin brushing. In fact, the only article that he cited was from the Huffington Post (popular on-line news site, not a medical journal), whose author agreed that it worked to “smooth away less-than-perfect spots on your legs.” I am not surprised that Dr. Mercola didn’t cite any studies to back up his claims, because when I conducted a search of the medical literature for dry skin brushing, I found no articles in the English language. The only articles that came up were two articles in the German literature (Hoffman, 1952; Henke, 2000). Fortunately, we have a German au pair who was willing to translate the two articles. Neither of these articles were able to cite any particular study that demonstrated efficacy in any of the purported claims but instead also made similar claims without evidence. So without any direct evidence, it is hard to recommend this practice for people who do not have itchy skin normally. However, I can address several of the claims indirectly based on surrogate interventions. For example, skin exfoliation is frequently performed by dermatologists in the form of chemical peels (Humphreys 1996) or by using a topical retinoid (Bagatin, 2018). Not only can this form of exfoliation result in younger looking skin, it has also been shown to reduce the number of precancers on sun exposed skin (Weinstock, 2012). However, this is typically reserved for the face rather than other parts of the body, so the principle is not necessarily transferrable to whole body skin brushing. Furthermore, the depth of the exfoliation is likely greater in a chemical peel than it would be with skin brushing. At least with respect to skin cancer prevention, the depth of the peel makes a difference (Sumita, 2018).

What about the purported benefit of increasing circulation with dry brushing? It seems clear that dry brushing increases the circulation in the skin, especially when done until the skin is red from increased blood flow, but such an increase in blood flow to the skin also means that the blood has to be diverted from elsewhere in the body (for example, gut for digestion or brain for mentation). While common sense may say that the redness induced by dry skin brushing is inflammatory in nature resulting in negative health effects associated with inflammation, a recent study showed that gua sha (traditional Chinese medicine involving the scraping of the skin often resulting in bruising) has been shown to decrease inflammatory markers (Yuen, 2017).

Is it possible that dry skin brushing can improve lymphatic flow and the immune system? One study on mice that received a vaccination followed by gua sha had a better response to the vaccine than those mice that did not have a gua sha treatment (Chen 2016) indicating that it may stimulate the immune system. Another purported benefit of gua sha is improved digestion (Marion, 2018) although I could find no literature to support this. But keep in mind, I am using gua sha as a surrogate for dry skin brushing, which may not be accurate, especially since the gua sha technique involves bruising of the skin, something typically not achieved (I hope) with the use of a flesh brush.

As far as the other purported benefits of dry skin brushing are concerned, I cannot comment on its ability to improve kidney function or reduce cellulite, although I have no doubt that it is invigorating (see Mason’s quote about the American poet). Stress relief is a reasonable benefit, although once again, I must caution the itchy patient who may have increased stress due to increased itchiness from dry skin brushing. Finally, assuming that dry skin brushing increases blood flow to the skin and therefore increases the chance that toxins will be transferred to the sweat glands, it is possible that dry skin brushing can play a role in detoxification (see section on perspiration).

In summary, although there are many purported benefits to dry skin brushing, or as Mason puts it, “vigorous skin rubbing with a flesh-brush,” none of these are supported by the medical literature. Although I would like to design a study to investigate the claims, most of them would be hard to prove (except for maybe the cellulite) through a typical clinical trial. As a dermatologist, I cannot recommend it to people with eczema or generally itchy skin. For those who don’t suffer from itchy skin, it will probably not do much harm, and may be beneficial—I myself admit that I like my hot showers and back scratches and feel like a hypocrite every time I advise against such practices to my patients.

Wool

The children cannot be better dressed throughout than in loosely woven woollen garments… Wool is a bad conductor, and therefore does not allow of the too free escape of the animal heat; and it is absorbent, and therefore relieves the skin of the clammy sensations which follow sensible perspiration. (Home Education, p. 36-37)

Wool has traditionally been used as cold weather clothing in the harshest environments. For example, Earnest Shackleton’s team in their expedition to the South Pole (which occurred towards the end of Mason’s lifetime) wore wool. The story is about an expedition of 27 men who were trapped for one and a half years on the coldest continent in the world, exposed to a winter that makes Minnesota winters seem tropical in comparison. The fact that they survived wearing wool should be the biggest endorsement you could give for the warmth of this fabric. But most of the time we’re not stepping out into a negative 60 degrees Fahrenheit climate. Certainly this wasn’t the climate in Mason’s England. So why was she so big on wool? It’s related to her thoughts that healthy skin (and therefore a healthy body) is skin that can breathe freely.

There certainly are a number of studies published in textile journals (peer reviewed and scientifically validated, it would appear to me) that seem to support the superior breathability (Barnes, 1996), temperature and moisture buffering qualities of wool over other fabrics (Holmer, 1985; Li, 1992). Indeed breathability is important with respect to skin disease. For example, there is a disease known as miliaria rubra/crystillina, which we can see in bed-ridden patients. When the sweat glands are blocked, little red, often itchy bumps form. (This is also known as “prickly heat rash.”) Usually this disease occurs in areas on which the patient bears weight without moving over long periods of time, such as the back when lying down in a bed. Although Mason promotes the use of wool as bed sheeting, it is unlikely that sheets made of wool would prevent the development of a prickly heat rash, unless the bedcoverings were made of wool and the mattress underneath of a breathable material as well. Acne/folliculitis can also be a disease of occlusion (lack of skin breathability). We see this in athletes who wear helmets or chin straps that block the pores. We also see this on the backs of some patients who exercise frequently. I would love to do a study on such patients to see if their skin would improve with superfine wool workout clothing because none has been done to date as far as I know. So Mason’s claim that it is important for skin to breathe and that wool is probably the most breathable fabric available seems to be a valid claim. But there are other concerns about wool.

One of the assumptions about wool is that it is itchy. Indeed this can certainly be the case, and most likely was the case for most wool worn in Mason’s era. In fact, dermatology text books specifically list wearing wool as a risk factor for worsening eczema (James, 2016). However, thankfully, for those of us traumatized by our childhood wool experiences when our parents made us wear thick wool sweaters with coarse, itchy fibers, there are plenty of options available today of softer, non-itchy wool garments. One study was performed that demonstrated a therapeutic benefit in infants when changing from cotton to superfine merino wool. These patients showed less itch and required less topical anti-itch cream. This benefit was lost when going back to wearing cotton (Su, 2017). The explanation for the superiority of wool likely lies not in its softness or non-itchiness. Superfine wool is not necessarily softer than cotton (and I, as a frequent superfine wool wearer do occasionally notice a twinge of a fiber, more so than with cotton). The best explanation for wool’s superior performance is in its ability to buffer temperature and moisture that I mentioned previously. One of the main reasons that eczema patients are itchy is that they have dry skin. Their skin, as a barrier to microbes and preventing water loss, malfunctions resulting in inflammation and itchiness. One theory is that wool acts as a second skin (much like it probably does in sheep), preventing the water loss in eczema patients and the subsequent inflammation and itching that ensues.

Most dermatologists are not aware of these qualities of wool. Not only are dermatologists taught that wool can worsen eczema because of its itchy barbs, we’re also taught that wool has lanolin residue which can cause an allergic reaction and more skin itching. Indeed lanolin is a substance known to cause itchy skin but a recent study (Zallman, 2017) was done that looked at the data over the last 100 years, to put it in their terms, “debunking the myth of wool allergy.” Their conclusion was that modern processing of wool does not result in significant amounts of allergens in the fabric, eliminating the concern of allergic skin reactions in those who wear wool.

Another purported benefit of wool is that it is less odoriferous. Please let me share a personal testimony about this. About half or more of what I wear is wool. I even wear wool workout garments. Shortly after I started doing CrossFit, I did an experiment. After wearing the same 100% wool t-shirt for eight CrossFit workouts in a row (letting it air out in between), I had two of my colleagues perform a sniff test on the shirt (without telling them that I had worn it eight times!). Neither of them suspected the shirt’s prior (excessive) use after shoving it to their nostrils and giving it a big whiff. Obviously, my experiment has little scientific validity. However, there are studies to support the fact that wool is odor resistant because it is bacteriostatic—likely a property at least in part due to the ability to wick away moisture (McQueen, 2007; McQueen, 2008).

Since the Smartwool company started producing modern wool clothing in the mid-1990s, there has been a surge in the number of superfine wool clothing manufacturers. Many of them market themselves as being organic, sustainable, and natural with all the well-known properties of traditional wool without the itchiness that comes from coarser and shorter fibers. The type of sheep from which the wool comes plays the biggest role in its itchiness (merino is the prototypical non-itchy breed, but there are other merino-like breeds that also produce a similar fiber). But there’s a secret that most of these superfine wool clothing manufacturers don’t want consumers to know because it would damage their organic, all-natural fiber reputation. Let me ask a question of those of you who own superfine wool clothing. Have you ever seen moth holes in them like you would see in traditional wool (if you don’t keep them in a cedar drawer)? If not, why not? Do moths only like traditional wool and not merino wool? I have several items of superfine merino wool clothing that have no moth-eaten holes despite being stored in containers without cedar. I had to ask why. This is where the manufacturing secret comes into play.

I wrote to one of the bigger name superfine wool clothing manufacturers and this is how they described their fabric processing to make their products machine-washable: chlorination, anti-chlorination, alkaline neutralisation, rinsing, polymer application, softener/lubrication application, drying, and polymer curing. In case you missed it in the list of manufacturing jargon, the wool is coated in plastic (polymer resin) to prevent them from shrinking in the washing machine. Additionally, many of these manufacturers wrap the wool fibers around a nylon core to make them more durable. There are several obvious problems with these manufacturing practices. The first question that comes to my mind, is that by literally changing the very core of the fiber and by coating it with a synthetic substance how do we know that the performance characteristics of the wool have not changed? I asked this question to all of the major superfine wool clothing manufacturers and none of them had performance data on their altered fabric (and in the case of some manufacturers, they didn’t respond to my inquiries).

When these corporations make broad claims about their products’ performance qualities, they are making the huge assumption that their processing does not change the performance characteristics of the fabric significantly. I don’t know if that is an accurate assumption. The second concern about the chemical modification of the wool that I have is that this synthetic material (plastic coating) clearly makes contact with the skin. Why is this a problem? Because skin is designed to both absorb and release. The principle of absorbing a substance through the skin to have a systemic effect on the body is used when medications are delivered “transdermally” via a patch, like testosterone, or lidocaine, for example. The assumption that many physicians (and perhaps clothing manufacturers) make is that most of the materials/chemicals that come in contact with our skin is in such a small quantity that it cannot make a difference systemically or in the general health of a person. Although there is no denying that many man-made chemicals are easily measured within the blood (from skin and lung absorption), the logic mainstream healthcare practitioners use to minimize its impact on health is the fact that the quantities of these substances are so minute that they are measured in pmol/L compared to cholesterol, for example, which is measured in mmol/L. But this logic doesn’t hold up when you consider that thyroid and estrogen hormones are also measured in pmol/L in the blood! So to claim that trace chemicals should have no health effect simply because they are found in the blood at quantities measured in pmol/L is to say that the hormones that our bodies naturally produce have no health effect either, which we know is not true.

Although it is hard to determine what specific amount of a given chemical is required to have a given effect, the functional medicine approach is that systemic effects occur based on the total toxic load of all the numerous chemicals we are exposed to in our daily lives (adding up all the pmol/L of synthetic substances), of which the chemicals we put on our skin (whether lotions, medications, or chemically treated clothing) are just one component. Having said that, I have no evidence that treated clothing, or even synthetic clothing is significantly absorbed by our skin into the systemic circulation, so it may be that modern treated fabrics are completely safe from that respect. But the question remains, and there are plenty of studies on the negative health effects of industrial chemicals that our bodies carry in our modern age, most of which Mason knew nothing about (Fry, 2017; de Tata, 2014). On a bright note, there were two brands of superfine wool (out of six that I own) that did develop holes in them after being stored in non-cedar lined containers, indicating that they were at least natural enough for moths to enjoy them (who ever thought moth holes would be a positive thing?!)

In summary, Mason hits the nail on the head with her promotion of wool for all of the above reasons: wool breathes better, is better for the skin, resists bacterial growth and therefore is odor resistant, and can be used in very cold and even warm environments. However, caution should be taken with respect to the manufacturing process in the modern-day superfine wool industry. Let the buyer beware of possible alterations of the fiber which may or may not affect performance, and which may also have a systemic effect by adding to the total toxic burden of industrial pollutants to our bodies. However, although the eczema study I mentioned earlier did not disclose the brand or manufacturing process, the study did use superfine merino wool. This fact gives me at least some reassurance that the performance characteristics may be somewhat preserved. And in full disclosure, I myself still wear all my superfine wool clothing despite my own caution.

Conclusion

In my initial exploration of Mason’s health claims, limited to the skin, I would say that she is on the right track and her advice is good. Sunshine and kids, along with outdoor activity is the right prescription for our generation, and one that is desperately needed in our gaming, indoor culture. But as a skin doctor and father of three red heads, I can’t recommend uninhibited sun exposure on vulnerable skin. While I certainly don’t recommend intentional scarring (not that Mason did either!), accidents do happen, and when they do, it does not appear that scars are a major hindrance towards good health. Consideration should be made with respect to elective surgery that results in scarring, as some people experience unexpected chronic discomfort from their scars. Perspiration appears to have many health benefits, not the least of which is related to the way most of us in the United States initiate perspiration via exercise (not covered in this article), but also seems to have benefits when performed to remove modern day industrial exposures that may have accumulated in our bodies—although I recognize not every house comes with an adjacent sauna room as they do in Scandinavia. The flesh brush and vigorous skin brushing is probably not as bad as your average dermatologist would make it out to be, and it may have more benefits than we have verified scientifically. However, I would advise caution for people with itchy skin, and if your skin starts to become itchy, I would take a break. Finally, wool, good enough for Mason, Earnest Shackleton, and the Handfield family, comes highly recommended, especially in today’s finer weave. Just be cautious about further processing to the wool fabric which may require some investigation on the consumer’s part.

As I close this first installment of investigating Mason’s health claims, I will give my own disclaimer. When I was in medical school, more than 15 years ago, I distinctly remember one of our professors saying, “Half of what we are teaching you is wrong. The only problem is we don’t know which half!” Since that time, I have seen medical “truths” one-by-one fall by the wayside, overtaken by new studies and new discoveries. In my opinion, Charlotte Mason gets some things right, and some things wrong with respect to her health claims. But I hesitate to render final judgment on any topic in medicine because of the mutability of the medical literature. The only literature that I can point to confidently as truth, standing the test of time, is also a person, or the Word of God made flesh—the Bible. Jesus declared Himself to be the truth, which is the only claim that I can fully and confidently endorse. To me, Christ is the standard by which everything is compared, and He is the beacon of light that guides me in my health care and all other life decisions. As I am sure Mason would as well, I defer all final judgment to Him.

Look for future articles at Charlotte Mason Poetry covering other controversial topics from Mason’s writings such as fresh air (including night air), food, and exercise.

Endnotes

[1] This paragraph occurs in quotation marks in the original as part of a narrative, and so it is difficult to determine precisely how it relates to Mason’s own views.

References

Sunshine

Adamson, J.W. Regulation of red blood cell production. Am J Med. 1996 Aug 26; 101(2A):4S-6S.

Aldrich, N., Gerstenblith, M., Fu P., Tuttle, M.S., Varma, P., Gotow E., Cooper, K.D., Mann, M., & Popkin, D.L. Genetic vs Environmental Factors That Correlate With Rosacea: A Cohort-Based Survey of Twins. JAMA Dermatol. 2015 Nov; 151(11):1213-9.

Egeberg, A., Hansen, P.R., Gislason, G.H., & Thyssen, J.P. Clustering of autoimmune diseases in patients with rosacea. J Am Acad Dermatol. 2016 Apr; 74(4):667-72.

Janjua, N.R., Mogensen, B., Andersson, A.M., Petersen, J.H., Henriksen, M., Skakkebaek, N.E., & Wulf, H.C. Systemic absorption of the sunscreens benzophenone-3, octyl-methoxycinnamate, and 3-(4-methyl-benzylidene) camphor after whole-body topical application and reproductive hormone levels in humans. J Invest Dermatol. 2004 Jul; 123(1):57-61.

Landers, M., Law, S., & Storrs, F.J. Contact urticaria, allergic contact dermatitis, and photoallergic contact dermatitis from oxybenzone. Am J Contact Dermat. 2003 Mar; 14(1):33-4.

Lindqvist, P.G., Epstein, E., Nielsen, K., Landin-Olsson, M., Ingvar, C., & Olsson, H. Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the Melanoma in Southern Sweden cohort. J Intern Med. 2016 Oct; 280(4):375-87.

Rainer, B.M., Fischer, A.H., Luz Felipe da Silva, D., Kang, S., & Chien, A.L. Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: results of a case-control study. J Am Acad Dermatol. 2015 Oct; 73(4):604-8.

Sim et al. Vitamin D deficiency and anemia: a cross-sectional study. Ann Hematol. 2010 May; 89(5):447–452.

Scarring

Bordoni, Bruno, & Emiliano Zanier. Skin, fascias, and scars: symptoms and systemic connections. J Multidiscip Healthc. 2014; 7:11–24.

Kunii, T., Hirao, T., Kikuchi, K., & Tagami, H. Stratum corneum lipid profile and maturation pattern of corneocytes in the outermost layer of fresh scars: the presence of immature corneocytes plays a much more important role in the barrier dysfunction than do changes in intercellular lipids. Br J Dermatol. 2003 Oct; 149(4):749-56.

Nitzschke, S. Long term mortality in critically ill burn survivors. Burns. 2017 Sep; 43(6):1155-1162.

Shapiro, Y., Epstein, Y., Ben-Simchon, C., & Tsur, H. Thermoregulatory responses of patients with extensive healed burns. J Appl Physiol Respir Environ Exerc Physiol. 1982 Oct; 53(4):1019-22.

Suetake, T., Sasai, S., Zhen, Y.X. et al. Functional analyses of the stratum corneum in scars. Sequential studies after injury and comparison among keloids, hypertrophic scars, and atrophic scars. Arch Dermatol 1996; 132:1453–8.

Perspiration

Engelhaupt, Erika. https://news.nationalgeographic.com/2018/04/sweating-toxins-myth-detox-facts-saunas-pollutants-science/

Ford, Kreutzer. Oxen, engines of the overland emigration. Overland Journal, Vol 33, Number 1, Spring, 2015.

Laukkanen et al. Association between sauna bathing and fatal cardiovascular and all-cause mortality events. JAMA Intern Med. 2015 Apr; 175(4):542-8.

Laukkanen et al. Sauna bathing is inversely associated with dementia and Alzheimer’s disease in middle-aged Finnish men. Age Ageing. 2017 Mar 1; 46(2):245-249.

Zaccardi et al. Sauna Bathing and Incident Hypertension: A Prospective Cohort Study. Am J Hypertens. 2017 Nov 1; 30(11):1120-1125.

Flesh brush

Bagatin, E., Gonçalves, H.S., Sato, M., Almeida, L.M.C., & Miot, H.A. Comparable efficacy of adapalene 0.3% gel and tretinoin 0.05% cream as treatment for cutaneous photoaging. Eur J Dermatol. 2018 Jun 1; 28(3):343-350.

Chen, T., Liu, N., Liu, J., Zhang, X., Huang, Z., Zang, Y., Chen, J., Dong, L., Zhang, J., & Ding, Z. Gua Sha, a press-stroke treatment of the skin, boosts the immune response to intradermal vaccination. PeerJ. 2016 Sep 14; 4:e2451.

Henke F.  [Alternative skin care: fit and revitalized with the aid of dry brushing]. [Article in German] Pflege Z. 2000 Feb; 53(2):95-6.

Hoffmann, K.F. [Skin massage, skin brushing (dry type), a means to maintain health]. [Article in German] Dtsch Zahnarztl Z. 1952 Aug 1; 7(15):880-1.

Humphreys, T.R., Werth, V., Dzubow, L., & Kligman. A Treatment of photodamaged skin with trichloroacetic acid and topical tretinoin. J Am Acad Dermatol. 1996 Apr; 34(4):638-44.

Marion, T., Cao, K., & Roman, J. Gua Sha, or Coining Therapy. JAMA Dermatol. 2018 Jul 1; 154(7):788. doi:10.1001/jamadermatol.2018.0615.

Sumita JM, Miot HA, Soares JLM, Raminelli ACP, Pereira SM, Ogawa MM, Picosse FR, Guadanhim LRS, Enokihara MMSS, Leonardi GR, Bagatin E. Tretinoin (0.05% cream vs. 5% peel) for photoaging and field cancerization of the forearms: randomized, evaluator-blinded, clinical trial. J Eur Acad Dermatol Venereol. 2018 Oct;32(10):1819-1826.

Weinstock, M.A., Bingham, S.F., Digiovanna, J.J., Rizzo, A.E., Marcolivio, K., Hall, R., Eilers, D., Naylor, M., Kirsner, R., Kalivas, J., Cole, G., & Vertrees, J.E.; Veterans Affairs Topical Tretinoin Chemoprevention Trial Group. Tretinoin and the prevention of keratinocyte carcinoma (Basal and squamous cell carcinoma of the skin): a veterans affairs randomized chemoprevention trial. J Invest Dermatol. 2012 Jun; 132(6):1583-90

Yuen, J.W.M., Tsang, W.W.N., Tse, S.H.M., Loo, W.T.Y., Chan, S.T., Wong, D.L.Y., Chung, H.H.Y., Tam, J.K.K., Choi, T.K.S., & Chiang, V.C.L. The effects of Gua sha on symptoms and inflammatory biomarkers associated with chronic low back pain: A randomized active-controlled crossover pilot study in elderly. Complement Ther Med. 2017 Jun; 32:25-32.

Wool

Barnes and Holcombe. Moisture Sorption and transport in clothing during wear. Textile Research Journal, 1996, 77-786.

De Tata V. Association of dioxin and other persistent organic pollutants (POPs) with diabetes: epidemiological evidence and new mechanisms of beta cell dysfunction. Int J Mol Sci. 2014; 15:7787–7811.

Fry and Power. Persistent organic pollutants and mortality in the United States, NHANES 1999–2011. Environ Health. 2017; 16:105.

Holmer, I. Heat Exchange and Thermal Insulation Compared in Woolen and Nylon Garments During Wear Trials. Textile Research Journal, 1985, 512-518.

James, William, et al. Andrews Diseases of the skin, 12thed. 2016.

Li, Y, Holcombe, B.V., and Apcar. Moisture Buffering Behaviour of Hygroscopic Fabric During Wear. Text Res J, 1992, Vol 62, 619-627.

McQueen, R.H., Laing, R.M., Brooks, H.J.L, and Niven, B.E. Odour intensity in apparel fabrics and the link with bacterial populations. 2007, Textile Research Journal, 77, 449.

McQueen et al. Retention of axillary odour on apparel fabrics, Journal of the Textile Institute. 2008, Vol 99, No 6, 518.

Su, J.C., Dailey, R., Zallmann, M., Leins, E., Taresch, L., Donath, S., Heah, S.S., & Lowe, A.J. Determining Effects of Superfine Sheep wool in INfantile Eczema (DESSINE): a randomized paediatric crossover study. Br J Dermatol. 2017 Jul; 177(1):125-133.

Zallmann, M., Smith, P.K., Tang, M.L.K., Spelman, L.J., Cahill, J.L., Wortmann, G., Katelaris, C.H., Allen, K.J., & Su, J.C. Debunking the Myth of Wool Allergy: Reviewing the Evidence for Immune and Non-immune Cutaneous Reactions. Acta Derm Venereol. 2017 Aug 31; 97(8):906-915.

Dr. Kent Handfield is a board-certified dermatologist who received his MD from Vanderbilt University. He has also passed the board certification exam administered by the Institute for Functional Medicine. Kent and his wife Nicole home school four energetic children in the Washington, DC area. They also host the In a Large Room Retreat every February.

©2019 Kent Handfield

14 Replies to “A Physician’s Look at Charlotte Mason’s Views”

  1. Kent.. I’m sorry sorry to have missed In a large room this year( hubby had back surgery) yet am so grateful to read your article informative article!

  2. I truly enjoyed this fascinating and highly readable article. Thank you, Dr. Handfield, for taking the time to share your knowledge with the Charlotte Mason community. I look forward to the further installments.

    1. You’re most welcome! I am glad you felt the article was readable – I know it is very long and wasn’t sure if it would be hard to get through it all.

  3. Thank you for putting so much hard work into this thorough, balanced article! Looking forward to the next article in the series!

    1. It’s a relief to hear that you felt my article was balanced. That’s what I was aiming for. As for the thoroughness, I felt I barely scratched the surface, especially with respect to the wool – there is so much more to look into it can be overwhelming!

  4. Being a nurse with a father who is a family physician I get to converse with a medically critically thinking mind similar to this podcast and so I LOVED this article! Regarding flesh brushing…made me think of the use of my Norwex body cloth which exfoliates skin. It, along with my heated shower, does what CM says, invigorates and brings a certain joy in life and definitely, no doubt about it, a more even-keel, cordial temper the days I GET to shower and use my Norwex body cloth with “vigorous rubbing of the skin”. (Oh Mason…who would have thought from your volumes over a hundred years ago we would relate your writings to our showers and the care of our skin!) Can I also say, I love your common sense discussion on sun exposure and sunscreen! I feel sunscreen and protection is SO overdone these days. Lathering children in sunscreen just to go out for an hour nature walk. Some may need it but it’s not always a necessity! Just like education, and so much else, it should be individualized! Thank you for sharing with other like-minded medical brains in the CM world and for your common sense doctoring!

    1. You’re welcome. The sun and dermatologists make strange bedfellows, but not only do we dermatologists accuse the sun of evil to our patients, but we also use ultraviolet light boxes (which is kind of a euphemism for a dermatologist approved tanning bed) to treat many diseases. At our dermatology residency program, we chose the sun as the symbol to represent our specialty for this very reason. The sun is both skin disease inducing and skin disease curing. It takes some wisdom (we also included the lamp of knowledge as part of the symbol) and common sense to know how it all works.

  5. Thank you, Dr. Handfield, for taking the time from your medical practice to provide such an interesting, thorough and well-researched presentation. Your cogent, insightful discussion offers an objective, empirical, and timely analysis of Charlotte Mason’s approach to health and home education.

  6. Oh! I am so happy to find this! My field is neuroscience and so I’ve always wanted somebody sciencey to dive into the literature and investigate all of Mason’s health claims! I am always annoyed I don’t have time to do it myself. Thanks again! I will be looking forward to more 🙂

  7. I just wanted to point out that, although this does not apply to the general population, dry skin brushing is recommended by occupational therapists and therapists, for children with sensory processing issues.

    1. Thanks for the tip, Robyn. As a matter of fact, this was recommended for my son, who has special needs, but it wasn’t effective for him. I just briefly did a literature search for this, but again nothing came up. If you know of any such studies, I would appreciate the references.

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