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Presidential Practice of Dermatology

Presidential Practice of Dermatology Lyndon Johnson, the 36th President of the United States, had many careers en route to the White House (schoolteacher, local administrator, naval officer, and elected public official), but his brief stint as an amateur dermatologist is generally overlooked. Johnson’s unorthodox approach to treating severe facial acne was first tried while he was an undergraduate at Southwest Texas State Teachers’ College. A classmate who witnessed the episode is quoted verbatim in the first volume of Robert Caro’s monumental biography of Johnson1: One student, a Bohemian farm boy, was generally immune from practical jokes because he was so “slow” and gullible—some students believed he might be slightly retarded—as to be too defenseless a target. This student had a severe case of acne, and one evening, talking with Johnson, … he said girls wouldn’t go out with him because of it. Lyndon said to him that the cure was to get fresh cow manure and put it on your face. He said, “Oh, go on,” and Lyndon said, “Didn’t you ever turn over a cow pile and see how white the grass was underneath, how the manure bleached the grass?”… Lyndon tells him to take a towel and cut eyeholes in it and wrap it around his face. He…came into our room and asked how it was, and Lyndon said, “You don’t have enough on to do any good.” He made him put more on. In the morning, he smelled so bad, you couldn’t go near him. On the one hand, we do not have long-term follow-up of Johnson’s initial patient, and, as with many n-of-1 clinical trials, we lack adequate data on safety and efficacy on which to base further recommendations. Interest in alternative interventions for severe acne waned greatly with the success of systemic retinoids. Furthermore, use of topical bovine excrement would certainly test the limits of acceptability for today’s discerning patients, even with a marketing strategy that touts its natural origins. On the other hand, medicinal formulations of equine urine, porcine digestive hormones, bovine bile, and other below-the-diaphragm excretions are regularly used in medicine and generally accepted by the wider public. Human feces, in the form of an allogeneic transplant, is now an accepted treatment for Clostridium difficile enteritis.2 Evidence of the microbiome’s role in healthy and diseased skin, and its potential manipulation in therapy, is piling up. Kang et al3 have shown that some human fecal enterococci have in vitro activity against Proprionobacterium acnes, which suggests further exploration of fecotherapy in dermatology. Back to top Article Information Corresponding Author: Loren Zech, MD, PhD, Department of Dermatology, Georgetown University Hospital, Washington Hospital Center, 110 Irving St NW, Room 2B-44, Washington, DC 20010 (loren.zech@medstar.net; loren.zech@gmail.com). References 1. Caro RA. The Path to Power: The Years of Lyndon Johnson.Vol 1. New York, NY: Vintage Press; 1990:191-192. 2. van Nood E, Vrieze A, Nieuwdorp M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013;368(5):407-415.PubMedGoogle ScholarCrossref 3. Kang BS, Seo JG, Lee GS, et al. Antimicrobial activity of enterocins from Enterococcus faecalis SL-5 against Propionibacterium acnes, the causative agent in acne vulgaris, and its therapeutic effect. J Microbiol. 2009;47(1):101-109.PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Dermatology American Medical Association

Presidential Practice of Dermatology

JAMA Dermatology , Volume 149 (9) – Sep 1, 2013

Presidential Practice of Dermatology

Abstract

Lyndon Johnson, the 36th President of the United States, had many careers en route to the White House (schoolteacher, local administrator, naval officer, and elected public official), but his brief stint as an amateur dermatologist is generally overlooked. Johnson’s unorthodox approach to treating severe facial acne was first tried while he was an undergraduate at Southwest Texas State Teachers’ College. A classmate who witnessed the episode is quoted verbatim in the first volume...
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Publisher
American Medical Association
Copyright
Copyright © 2013 American Medical Association. All Rights Reserved.
ISSN
2168-6068
eISSN
2168-6084
DOI
10.1001/jamadermatol.2013.4912
Publisher site
See Article on Publisher Site

Abstract

Lyndon Johnson, the 36th President of the United States, had many careers en route to the White House (schoolteacher, local administrator, naval officer, and elected public official), but his brief stint as an amateur dermatologist is generally overlooked. Johnson’s unorthodox approach to treating severe facial acne was first tried while he was an undergraduate at Southwest Texas State Teachers’ College. A classmate who witnessed the episode is quoted verbatim in the first volume of Robert Caro’s monumental biography of Johnson1: One student, a Bohemian farm boy, was generally immune from practical jokes because he was so “slow” and gullible—some students believed he might be slightly retarded—as to be too defenseless a target. This student had a severe case of acne, and one evening, talking with Johnson, … he said girls wouldn’t go out with him because of it. Lyndon said to him that the cure was to get fresh cow manure and put it on your face. He said, “Oh, go on,” and Lyndon said, “Didn’t you ever turn over a cow pile and see how white the grass was underneath, how the manure bleached the grass?”… Lyndon tells him to take a towel and cut eyeholes in it and wrap it around his face. He…came into our room and asked how it was, and Lyndon said, “You don’t have enough on to do any good.” He made him put more on. In the morning, he smelled so bad, you couldn’t go near him. On the one hand, we do not have long-term follow-up of Johnson’s initial patient, and, as with many n-of-1 clinical trials, we lack adequate data on safety and efficacy on which to base further recommendations. Interest in alternative interventions for severe acne waned greatly with the success of systemic retinoids. Furthermore, use of topical bovine excrement would certainly test the limits of acceptability for today’s discerning patients, even with a marketing strategy that touts its natural origins. On the other hand, medicinal formulations of equine urine, porcine digestive hormones, bovine bile, and other below-the-diaphragm excretions are regularly used in medicine and generally accepted by the wider public. Human feces, in the form of an allogeneic transplant, is now an accepted treatment for Clostridium difficile enteritis.2 Evidence of the microbiome’s role in healthy and diseased skin, and its potential manipulation in therapy, is piling up. Kang et al3 have shown that some human fecal enterococci have in vitro activity against Proprionobacterium acnes, which suggests further exploration of fecotherapy in dermatology. Back to top Article Information Corresponding Author: Loren Zech, MD, PhD, Department of Dermatology, Georgetown University Hospital, Washington Hospital Center, 110 Irving St NW, Room 2B-44, Washington, DC 20010 (loren.zech@medstar.net; loren.zech@gmail.com). References 1. Caro RA. The Path to Power: The Years of Lyndon Johnson.Vol 1. New York, NY: Vintage Press; 1990:191-192. 2. van Nood E, Vrieze A, Nieuwdorp M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013;368(5):407-415.PubMedGoogle ScholarCrossref 3. Kang BS, Seo JG, Lee GS, et al. Antimicrobial activity of enterocins from Enterococcus faecalis SL-5 against Propionibacterium acnes, the causative agent in acne vulgaris, and its therapeutic effect. J Microbiol. 2009;47(1):101-109.PubMedGoogle ScholarCrossref

Journal

JAMA DermatologyAmerican Medical Association

Published: Sep 1, 2013

Keywords: dermatology

References