The first descriptions of a condition that is very likely what is now referred to as scabies, of the infestation by Sarcoptes scabiei mites has been made by Aristotle who called the parasites 'lice of the flesh' and mentioned that it is possible to remove them physically. Presence of the mites has also been reported by the ancient and medieval physicians, such as Ibn Zahr (Avenzoar) but the causal link between the mites and the characteristic dermal lesions and pruritic symptoms has been made only in the late 1680s by Giovanni Bonomo and Giacinto Cestoni who, after microscopic examination of the mite specimen present within the discharge from a dermal lesion noticed that the the mites are animals that reproduce via laying eggs and thus are most likely parasites. This was not a commonly accepted idea at the time, as many known parasites, especially those of microscopic size were though to be generated within the patients body because of a some pathological state (e.g. imbalance of humours), and thus their presence was a result of a pre-existent condition rather than a direct cause. This was especially prevalent idea in the case of scabies, as the mites responsible burrow within the upper layer of the skin (and thus 'inside') rather than on the surface of the body like fleas or lice. The exact cause of the scabies were only described in length by Ferdinand von Hebra in 1844 and then became commonly accepted, although it took more than a century for an effective medicines to be developed.

It should be noted however, that ancient and medieval medical terminology was not standardized by any means and various conditions with similar symptoms could have been described by one name, e.g. 'leprosy' could have meant actual leprosy or any other conditions characterized by dermal ulcers or scales. Thus, we can't be really certain whether 'scabies' meant actual scabies or any other pruritic skin diseases, such as lichen, urticaria or atopic dermatitis.

In one of his letters to Giovanni Bocaccio, Francesco Petrarca observed:

I had and I still have, and I do not know how long it will torment me, a ugly and dry scabies, which is troublesome at all ages, but it is also dangerous at our age. Since five months, this illness oppresses me so much that the hands are prevented to use the pen and to take the food, but they serve only to scratch and scrape it.

Petrarca's statement that the scabies are dangerous at his age (he was 61 when writing an aforementioned letter) was later corroborated by the medical examination, as the infection, especially when accompanied by frequent scratching can lead to the formation of open sores that are quite susceptible to further infection by pathogens such as staphylococci or streptococci that could have been quite dangerous for people with already compromised immune system that was weakened by an old age, especially in the age when the antibiotics were not consciously used. Modern examinations suggest that neglected scabies, even though not dangerous directly, can lead to serious complications caused by pathogens, including lymphadenopathy, post-streptococcal glomerulonephritis (bacterial inflamation of kidneys), sepsis or rheumatic fever.

Modern organic medicines, show relatively high cure rate. For topically used benzyl benzoate, one of the most common treatments for scabies, it usually reaches 50%. It has potential neurotoxic side effects though and thus has been withdrawn from use in European Union. Permethrin and crotamiton is similarly or more effective, although in recent decades a rising resistance to that drug has been observed, potentially limiting its usage in the long run. Orally administered ivermectine usually shows high cure rate, usually reaching 70% after a single dose and 90% after several doses, although it is generally administered only when topical treatment is shown to be inefficient and even then it is used sparingly due to potential severe side effects. But even then, ivermectin shows poor effect on young parasites and little to no ovicidal effect, further limiting its effectiveness in general treatment.

As we can see, even modern treatments seem to be moderately effective, so what relief could patient count on in the past? Well, as usual, various people tried to address this millennia-old problem (the latest written sources allowing to identify this condition with a decent probability come from 5th century BCE) more or less effectively.

Celsus suggested topical application of myrrh, sulfur, pitch or copper for any sort of pruritic condition of the skin, what could have been efficient in case of bacterial infections, but rather useless in case of real scabies. Galen, on the other hand, being a strong proponent of humoral theory, advocated both topical and oral administration of e.g. sulfur to 'decrease the level of black bile' that was considered by him to be a leading cause of the skin lesions.

Hildegard of Bingen noted that 'scabies' is a skin disease that develops between the outer layer of skin and deeper tissues caused by 'small animals' that is transmitted by direct contact, including sexual one, what pretty well corresponds to actual scabies mite infestation. In her Causae et curae she recommends application of the ointments consisting largely of mercury or sulphur, that were commonly used in various dermal conditions, most likely to some effect, as both elements show bactericidal properties (5% solution of ammoniated mercury is also used today). In addition, she also advised to use plant-based preparations that included common polypody (Polypodium vulgare), tumble mustard (Sisymbrium altissimum) or and chervil (Anthriscus silvestris). All these plants have moderate antibacterial properties, so they could have been useful in various skin conditions, but they would have had no effect on scabies, with the exception of the decreased chance for infection of the sores.

Some physicians also recommended bloodletting (phlebotomy), like they did in case of other conditions. Sigismundus Albicus, archbishop of Prague, physician and a lecturer at the Prague University in the first two decades of 15th century, mentioned in his Practica Medicinalis that drawing blood from the vein in the palate help in alleviation of facial pustules and scabies. Similar measures were also advocated by Kristian of Prachatice, another Czech physician and an author of a bloodletting treatise De sanguinis minucione.

Another quite typical medieval medicine was the new invention of strong alcoholic distillates that was often labeled as a kind of panaceum, whether alone or as the base for various herbal macerates. For example, Taddeo Alderotti, a 13th-century physician wrote in his Concillium CLXXX that aqua vitae (judging from a description in the same source, it could have been a brandy consisting of 75% alcohol by volume) administered orally and topically 'prevents grey hair, preserves youth, cures tinea, sores of the head and every sort of scabies'.

These methods, were continued well into 19th century. Around that time, one of the most popular treatment for various skin conditions was Wilkinson's Ointment, developed in mid-19th century and containing 15% sulphur, 15% wood tar, 10% calcium carbonate, 30% lard and 30% soft soap. This preparation could have been somewhat effective due to the properties of sulfur and tar, although the effects could have been palliative at best, as the ingredients were very unlikely to influence eggs laid by mites and thus the itch was very likely to return after the initial relief, requiring frequent re-application.

Thus, it was very unlikely that before the invention of the antiparasitic agents in the second half of the 20th century people had any working curative for actual scabies. Medical sources suggest that until 19th century scabies was generally treated like any other skin condition and treated with medicines designed to treat the latter which must have been inefficient given completely different etiology of the condition. So, with no good acaricides around, scabies seemed to be more or less permanent condition, although its actual prevalence in the past is very hard to measure.

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Grant, E. (Ed.), A Source Book of Medieval Science, Harvard University Press, Cambridge 1974.

Heukelbach J., Mazigo H., Ugbomoiko U., Impact of scabies in resource-poor communities, in: Current Opinion in Infectious Diseases, 2013, 26(2), pp. 127-132.

I know in the 50s they used to use DDT, before it was banned.