As we emerge from the wettest winter on record most of us are looking forward to the summer and the chance to maybe get out into some sunlight. The pleasures associated with lying on a beach, going for a bike ride, or having an alfresco drink are immeasurably enhanced by the presence of sunlight. Yet as with so much today we are told that pleasure today may lead to pain tomorrow – in this case skin cancer (non-melanoma skin cancer or malignant melanoma). We are used to being told that activities that are ‘normal’ and fun may actually be harmful. But what is less obvious is that our attitudes to sunlight have undergone dramatic and unparalleled flip-flops over the last hundred years.
Currently the health warnings on sun exposure are far from straight forward. Indeed these seem to be an heroic attempt to manage an impossible contradiction. Lack of vitamin D, which is most easily acquired via sunlight exposure, is implicated in a whole range of health problems. Yet exposure to sunlight is still the major risk factor for skin cancers. The latest advice suggests we should allow short periods (10-15 minutes) of unprotected exposure during the summer. But anyone concerned about vitamin D, or skin cancer, would quickly realise that unless they were a standard age and skin colour that they may need to modify this prescription without any clear guidance about how much they need to adjust this, upwards or downwards depending upon their concern.
If we were to turn back the clock a hundred years then warnings about sunlight were less ambiguous and recommended solar avoidance. In a UK context, for those serving the needs of Empire overseas, sunlight was thought to lead to ill health, sunstroke, madness and death. It was Julius Jeffreys (1800-1877), a physician with the Bengal Medical Corps in the mid-nineteenth century who thought that prevention of sunstroke was only possible if the head, neck, spine and even the abdomen were shielded from the sun. He suggested that a ‘metallized curtain’ be incorporated into clothing. He was also widely credited with inventing the pith helmet – the ever present icon of British colonial rule and the protector against the dangers of the ‘midday sun’ in ‘foreign’ lands.
Closer to home there were frequent warnings in medical journals about the dangers of unregulated exposure of the body to the sunlight and how this may lead to sunstroke. A typical account appeared in the 1896 August edition of the British Medical Journal where a GP writes about the death of a child from ‘sunstroke’ after ‘paddling’ in the sea:
This is but an example of the evil effects of a practice which can be seen in full swing every day at any of our seaside watering places – little children ‘paddling’ with their clothes tucked up, their feet chilled, and their heads exposed to the blazing sun
Women were a particular target of warnings about the dangers of sunlight with a ‘sun tan’ evoking undesirable social origins as well as being dangerous. Vogue (1903) carried the following warning: ‘The nut brown maid may look the picture of health, but unfortunately tan and sunburn are anything but poetical in real life being, on the contrary, often a great detriment to comfort as well as personal appearance’. Throughout the first two decades of the twentieth century Vogue was still recommending that its female readers should adopt a pale or white complexion whenever possible and if by accident a tan was acquired then it should be removed by the use of skin bleach.
In the period after the First World War these attitudes began to change. There was increasing interest in the use of sunlight as a therapy in the treatment of rickets and tuberculosis. The debate about the use of sunlight (and sunlamps) to treat rickets became politicised between those who advocated changes to people’s diets and those who recommended exposure to sunlight. At a time when slums were still widespread, if lack of adequate food was a factor in causing rickets it implied that poverty also contributed to ill-health. Conservative medics, such as Noel Paton and Leonard Findlay, preferred to argue that there was no need to address poverty if children could be exposed to sunlight. Indeed they said in a special report for the MRC (1926) that a ‘simple increase of income would [not] be followed by improvements in the condition of the children. Bad parents irrespective of income tend to select bad houses as the money is often spent on other things’.
In the same era sunlight was being used to treat the victims of tuberculosis in Britain, Europe and North America. Tuberculosis, though in decline, still affected large numbers of people. One idea about its treatment held that the body could cure itself, if the right conditions were set up – an extension of the concept of vis medicatrix naturaeor or “the healing power of nature”. This idea underpinned the sanatoria movement where patients were removed to isolated country locations where they could rest and recuperate. It was a logical extension to add exposure to sunlight as part of this therapy.
The use of sunlight in the treatment of rickets and tuberculosis led to the idea that sunlight was a potent tonic which would benefit all bodies (sick and healthy). During the 1920s and 1930s sunlight was increasingly promoted as conferring health benefits on the population in its own right. Organisations with their foundations in the social hygiene and eugenics movements, such as the People’s League of Health and the New Health Society, began actively promoting sunlight exposure for the masses. In 1924 an organisation dedicated to the advancement of sunlight exposure in people’s homes, workplaces, schools and leisure time was established – the Sunlight League. Their founding manifesto states:
We declare war against the powers of darkness… our new houses must be placed so as to receive the sun… no man or woman shall be stricken with disease for lack of knowledge of the light that heals… it is ours to better the environment, and bring forth a fitter race for humanity’s high purposes
It was these movements and medical therapies that established the powerful idea that sunlight confers health and acts as a tonic on the body. In the post war era the increase in workers leisure time and disposable income meant that a good fit was being established between mass tourism and these ideas established earlier about the health giving properties of sunlight. But as mass tourism became a multi-billion dollar industry involving the international movement of millions of people to sunlit locations it became noticeable to dermatologists, and later epidemiologists, that rates of skin cancer were increasing dramatically. It seemed that the health tonic of sunlight might be doing more harm than good. Suddenly health educators were telling people that any exposure to sunlight was dangerous and should be avoided.
In many ways the oscillations between sunlight being ‘good’ or ‘bad’ seem to be getting closer together. In 1999, just as the health educators seemed to be at the peak of their warnings about the dangers of sunlight, a paper appeared in the British Medical Journal entitled ‘Are we really dying for a tan?’ While acknowledging the overall increases in skin cancers it asked if avoidance of sunlight might have had a negative impact on overall mortality. Published just before the hottest weekend of the year it caused a media sensation with typical headlines like ‘sunbathing is healthy say experts’ (Daily Telegraph, 9 July 1999) appearing and a spoof article in Private Eye. The ongoing debates about the benefits or risks of the sun are not likely to be answered soon but they tell us a lot about changing social attitudes to one of the most prominent natural features in our world. Unfortunately that doesn’t help us any in planning our holidays!
You can read a more detailed history of sunlight in this book.