January 26, 2026 • 40 mins
Nutritional rickets is caused by a vitamin D deficiency, and people figured out two ways to treat it before we even knew what vitamin D was.
Research:
- “Oldest UK case of rickets in Neolithic Tiree skeleton.” 9/10/2015. https://www.bbc.com/news/uk-scotland-glasgow-west-34208976
- Carpenter, Kenneth J. “Harriette Chick and the Problem of Rickets.” The Journal of Nutrition, Volume 138, Issue 5, 827 – 832
- Chesney, Russell W. “New thoughts concerning the epidemic of rickets: was the role of alum overlooked?.” Pediatric Nephrology. (2012) 27:3–6. DOI 10.1007/s00467-011-2004-9.
- Craig, Wallace and Morris Belkin. “The Prevention and Cure of Rickets.” The Scientific Monthly , May, 1925, Vol. 20, No. 5 (May, 1925). Via JSTOR. https://www.jstor.org/stable/7260
- Davidson, Tish. "Rickets." The Gale Encyclopedia of Medicine, edited by Jacqueline L. Longe, 6th ed., vol. 7, Gale, 2020, pp. 4485-4487. Gale OneFile: Health and Medicine, link.gale.com/apps/doc/CX7986601644/GPS?u=mlin_n_melpub&sid=bookmark-GPS&xid=811f7e02. Accessed 7 Jan. 2026.
- Friedman, Aaron. “A brief history of rickets.” Pediatric Nephrology (2020) 35:1835–1841. https://doi.org/10.1007/s00467-019-04366-9
- Hawkes, Colin P, and Michael A Levine. “A painting of the Christ Child with bowed legs: Rickets in the Renaissance.” American journal of medical genetics. Part C, Seminars in medical genetics vol. 187,2 (2021): 216-218. doi:10.1002/ajmg.c.31894
- Ihde, Aaron J. “Studies on the History of Rickets. I: Recognition of Rickets as a Deficiency Disease.” Pharmacy in History, 1974, Vol. 16, No. 3 (1974). https://www.jstor.org/stable/41108858
- Ihde, Aaron J. “Studies on the History of Rickets. II : The Roles of Cod Liver Oil and Light.” Pharmacy in History, 1975, Vol. 17, No. 1 (1975). https://www.jstor.org/stable/41108885
- Newton, Gil. “Diagnosing Rickets in Early Modern England: Statistical Evidence and Social Response.” Social History of Medicine Vol. 35, No. 2 pp. 566–588. https://academic.oup.com/shm/article/35/2/566/6381535
- O'Riordan, Jeffrey L H, and Olav L M Bijvoet. “Rickets before the discovery of vitamin D.” BoneKEy reports vol. 3 478. 8 Jan. 2014, doi:10.1038/bonekey.2013.212.
- Palm, T. “Etiology of Rickets.” Br Med J 1888; 2 doi: https://doi.org/10.1136/bmj.2.1457.1247 (Published 01 December 1888)
- Rajakumar, Kumaravel and Stephen B. Thomas. “Reemerging Nutritional Rickets: A Historical Perspective.” Arch Pediatr Adolesc Med. Published Online: April 2005 2005;159;(4):335-341. doi:10.1001/archpedi.159.4.335
- Swinburne, Layinka M. “Rickets and the Fairfax family receipt books.” Journal of the Royal Society of Medicine. Vol. 99. August 2006.
- Tait, H. P.. “Daniel Whistler and His Contribution to Pædiatrics.” Edinburgh Medical Journal vol. 53,6 (1946): 325–330.
- Warren, Christian. “No Magic Bolus: What the History of Rickets and Vitamin D Can Teach Us About Setting Standards.” Journal of Adolescent Health. 66 (2020) 379e380. https://www.jahonline.org/article/S1054-139X(20)30038-0/pdf
- Wheeler, Benjamin J et al. “A Brief History of Nutritional Rickets.” Frontiers in endocrinology vol. 10 795. 14 Nov. 2019, doi:10.3389/fendo.2019.00795
- World Health Organization. “The Magnitude and Distribution of Nutritoinal Rickets: Disease Burden in Infants, Children, and Adolescents.” 2019. Via JSTOR. https://www.jstor.org/stable/resrep27899.7
- Zhang, M., Shen, F., Petryk, A., Tang, J., Chen, X., & Sergi, C. (2016). “English Disease”: Historical Notes on Rickets, the Bone–Lung Link and Child Neglect Issues. Nutrients, 8(11), 722. https://doi.org/10.3390/nu8110722
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Stuff You Missed in History Class, a production
of iHeartRadio.
Speaker 2 (00:12):
Hello and welcome to the podcast. I'm Tracy V. Wilson
and I'm Holly Fry. Once again, I'm returning to the
realm of nutritional deficiency diseases. I just find them very interesting,
especially because people have really figured out how to treat them,
way before they figured out exactly what was causing them,
which has not always been the case with other diseases.
(00:34):
Like scurvy is caused by vitamin SED efficiency, and people
had figured out that some foods, including citrus fruit, could
prevent scurvy by the seventeenth century. So today we know
that these foods are good sources of vitamin C. But
people made the connection between the food and the scurvy
well over a century before Casimir Funk even coined the
(00:56):
word vitamin, and that also happened before any individual vitamin
had been identified and named. We have an episode on scarvey,
and then last year we also did an episode on pelagra,
which is caused by niasin deficiency. People were similarly treating
pelagra with brewers yeast decades before we knew what niasin
(01:21):
was or that Brewer's yeast has a lot of it
in there. The discovery and identification of specific vitamins grew
in part from people trying to figure out what exactly
people were missing with that missing substance making them sick.
Nutritional rickets is caused by a vitamin D deficiency, and
(01:43):
people figured out two ways to treat it before we
even knew what vitamin D was. So it's a fun
word to say, but we don't really know where the
word rickets even comes from. English physician Daniel Whistler wrote
a thesis on rickets in sixteen forty five aimed that
it had been named for someone who had supposedly tried
(02:03):
to cure it, or from the term to rocket, which
he said was used in parts of England to mean
to breathe with difficulty. While there were people whose surname
was Rickett, there's really no evidence of any of them
trying to cure this disease, and it's also not clear
whether there is any merit to that rocket idea. Another
possibility is that it comes from German or Swedish words
(02:26):
meaning twisting or swaying. Yeah, I went down a big
rabbit hole trying to figure out if in sixteen forty five,
people in parts of England were using the word to rucket.
This way did not find a good answer. In the
seventeenth century, ricketts was also called rachitis, and that came
from Latin and Greek words to describe disorders or inflammations
(02:50):
of the spinal column. The symptoms of rickets can include
spinal pain and unusual spinal curvatures. So it's possible that
writing in the Latin use the word rachitis because of
these symptoms, and then lay people shifted that pronunciation to rickets,
But again that is all very speculative. Rickets affects growing animals,
(03:14):
not only human beings. In the body, vitamin D is
converted into a hormone that affects the way calcium is
absorbed in the digestive system, and it has other effects
on calcium in the body. To put it really really, basically,
without enough vitamin D, the body cannot absorb the calcium
needed for bones to mineralize properly. Rickets usually affects animals
(03:36):
during infancy, childhood, and adolescence when their bones are growing
and mineralizing, especially during growth spurts. A similar vitamin D
deficiency in adults is called Osteomalaysia. Animals get vitamin D
from two primary sources, their food and exposure to the sun.
Foods that are naturally high and vitamin D include egg
(03:59):
yolks and various types of fish like salmon, tuna, and sardines.
Wild mushrooms can also be high in vitamin D, but
commercially grown mushrooms that are raised in the dark typically aren't.
They aren't getting that sun exposure themselves to have vitamin D.
Speaker 1 (04:16):
Today, some foods are also fortified with added vitamin D,
although which foods, whether fortification is voluntary or mandatory for manufacturers,
and weather foods are fortified at all, depends on where
you live. In the United States, foods that are most
likely to be fortified with vitamin D include dairy and
non dairy milks, orange juice, and breakfast cereals, all of
(04:40):
which are associated, of course, with children's diets. In terms
of sun exposure, again very very basically, UVB radiation converts
cholesterol in the skin to kulic house for all, which
is the more formal name for vitamin D three.
Speaker 2 (04:59):
This requires direct exposure to the sun because UVB is
blocked by things like glass and clothing. Can also be
blocked or at least reduced by things like fog and
air pollution. UVB radiation is also affected by the Earth's
atmosphere and the angle at which sunlight reaches the surface.
Speaker 1 (05:18):
Of the Earth. Areas of very high latitudes get a
lot less UVB light than the tropics do, and since
melanin protects the body from UV light, the amount of
vitamin D that a person's own body can synthesize is
affected by how much melanin they have in their skin.
People with more melanin, meaning people who are darker skinned,
(05:40):
need more sun exposure to be able to synthesize enough
vitamin D than people with lighter skin.
Speaker 2 (05:46):
We don't really know whether ricketts was a widespread problem
during early human history, but it might not have been.
Early hunters and gatherers, and then later on early farmers
would have been spending a lot of time outside in
the sun. In the tropics, where in the long ago
past more people had more melanin in their skin. The
(06:09):
sun was also a lot more direct, so they would
have been getting more UVB exposure. Of course, those things
are interconnected, the UV light and the melanin. Conversely, in
the far north, for example, people had less exposure to
sunlight since even during the long days of the summer,
the sun's rays just aren't as direct, and people also
(06:30):
tended to wear more clothing because it was colder. But
these indigenous peoples have also historically had a diet that
is rich in vitamin D. People still living in the
same places that their ancestors did, following the same traditions
and lifeways, are probably getting a lot of their vitamin
D these same ways today. At the same time, it
(06:51):
is possible and maybe even likely, that people around the
world did historically go through periods when they weren't getting
enough vitamin D actually in the winter or during times
of famine, but this might not have been an ongoing
problem since most people would have been spending more time
outside again in the spring. One big exception here, at
(07:12):
least in theory, is babies. Because breast milk alone does
not provide infants with enough vitamin D. It would take
a lot of vitamin D supplementation for a person to
produce breast milk that was really rich in vitamin D
like way beyond what someone would get through ordinary food
(07:33):
and sunlight. So throughout history, babies who were breastfed and
then also swaddled or covered up or kept out of
the sun could be susceptible to rickets. Today, various health
organizations around the world recommend that breastfed babies be given
a vitamin D supplement, especially if they are exclusively breastfed.
Speaker 1 (07:56):
We do have some evidence of rickets in the archaeological record.
In twenty thirteen, archaeologists in Scotland announced the discovery of
a five thousand year old skeleton that showed evidence of rickets.
That is the oldest example discovered so far. Prior to
this discovery, the oldest skeletons known to have signs of
rickets were from the Roman Era, and there's some evidence
(08:18):
to suggest that it may have been more widespread in
the Roman Empire. For example, in twenty eighteen, researchers from
Historic England and McMaster University in Canada surveyed Roman Era
skeletons from cemeteries from what's now northern England down to
southern Spain, and they found evidence of rickets in more
than one in twenty. Children with babies most often affected.
Speaker 2 (08:43):
What may be the earliest written description of rickets also
comes from the Roman Era. Serranus of Ephesus wrote a
treatise on gynecology around the first or second century CE.
It includes a section about the care of newborns. The section,
he advises loosening a baby's swaddling clothes only after their
(09:05):
body has become reasonably firm, so that it does not
become distorted. Serranus also recommends not letting babies try to
sit up too early or for too long, because that
could cause them to become hunchbacked, and he says if
a baby is allowed to try to walk too early,
their legs can become distorted. Bow legs and spinal curvatures
(09:29):
are two of the most recognizable symptoms of rickets, so
this is often interpreted as a description of the condition.
There is some debate about whether that's really what he's
talking about, but Siranis is generally more accepted as the
first description of rickets than some earlier but even more
vague possibilities. Yes, sometimes it's a brief sentence that sort
(09:53):
of seems like maybe someone's leg was growing in a
strange way.
Speaker 1 (09:58):
Could that have been rickets? Maybe?
Speaker 2 (10:01):
Of course, rickets is definitely not caused by unswaddling a
baby too early. It is not caused by letting babies
try to stand up too soon after they're born. And
we really don't have any way to know if what
Serranus is describing in this passage is something that he
also would have recognized in the children from that twenty
(10:21):
eighteen study we mentioned, or if the children in that
study were seen as having some kind of illness or
condition relating to their bones while they were alive.
Speaker 1 (10:31):
Ricketts was not recognized as a disease with a name
until the early modern period, and we're going to get
into that after we pause for a sponsor break.
Speaker 2 (10:49):
Rickets seems to have been a more widespread problem in
parts of Europe in the sixteenth and seventeenth centuries, or
at least that is when it seems to start showing
up more in artwork and in written records. In fifteen
oh nine, German painter Hans Borkmeyer the Elder painted a
version of the Virgin and Child in which the infant
(11:10):
Jesus appears to have bowed legs and other possible signs
of rickets. In fifteen thirty two, German physician Hieronymous Roisner
described a disease that occurred only in children whose symptoms
included weakness, bowed legs, and chest malformations. Roisner said this
disease was common in Holland and Switzerland.
Speaker 1 (11:33):
In fifteen fifty four, Theodosius of Bologna described a child
who was very pale and had an unusual spinal curvature
which could have been rickets. Other accounts in the late
sixteenth century described children whose bones were bent and who
seemed to have some kind of wasting disease. In sixteen fourteen,
(11:53):
a visitor to a monastery in the Netherlands, which was
at the time part of the Dutch Republic, described children
being treated with water from a well dedicated to Saint Willibrard.
These children were described as having Saint Willibard's infirmity or
the ailment of Saint Willibrard. One of the symptoms was a.
Speaker 2 (12:15):
Series of knobs on the children's ribs, described as being
like pinheads or rosary beads, or something of a similar size.
Some of these children were also described as having the
ailment of Saint Macketus, in which their legs appeared as
though they were sitting cross legged. It was possible for
a child to have both of these ailments at once.
(12:38):
As we said earlier, bowed legs are one of the
most recognizable signs of rickets. Another is called richitic rosary.
These are knobs that develop where each rib connects to
the costal cartilage on the front of a person's rib cage,
and they're named for their resemblance to a string of
rosary beads. So it seems likely that at least some
(12:59):
of these children that Tracy was just shoying about had rickets.
There were also other Willibrard wells and springs around the Netherlands,
and their water was similarly used to try to treat
children who had these conditions. The first known use of
the word rickets and writing was a couple of decades
after this visitor report. Unlike most of the first uses
(13:22):
and writing we've talked about before, this was not in
published material. It was a handwritten receipt book belonging to
the Fairfax family of Yorkshire, England. People used to call
recipes receipts, and the word receipt could also apply specifically
to the ingredients and methods used to make medicinal preparations.
(13:43):
This particular receipt book had belonged to Mary Chumley, who
married the Reverend Henry Fairfax in sixteen twenty six. The
book remained in the family, with people recording recipes for
things like foods, medicines, and household preparations into the late
eighteenth century. Some of the entries were attributed to well
known physicians of the day, and others came from relatives
(14:05):
or friends. An entry for February twenty fifth, sixteen thirty
two includes five remedies for rickets in children, attributed to
the reverend's cousin, Lady Fairfax of Steaton. There are also
various recipes labeled for the rickets, and one marked for
a child that is weak or lame in her joints.
(14:27):
None of these remedies would have been effective in treating rickets.
They included things like ointments made of herbs minced into butter,
and drinks being made of things like herbs or dried
fruit boiled in water or ale. But this suggests that
by the first quarter of the seventeenth century, people in
England knew about a disease that they were calling rickets,
(14:48):
and that they were trying to figure out ways to
treat it. The first use of the word rickets in
published material was in the Annual Bill of Mortality of
the City of London in sixteen thirty four. This was
only the fifth year that the Annual Bill of Mortality
included causes of death. This information was gathered by people
(15:08):
called searchers, who were described as elderly matrons. Made a
lot of sense for older women to be doing this job,
since they were typically involved in laying out the dead
and preparing people's bodies for burial. Good fit for them
to also be the people determining cause of death. Since
older women often cared for sick people. People also thought
(15:31):
they might have some protection from whatever illness a person
might have died of, and that experience could also theoretically
help them identify and describe a person's cause of death.
At the same time, these women typically didn't have access
to a formal education. Most of them could not read
or write, so they gave their reports to the clerk orly,
(15:54):
and that means we don't have any details or notes
about how they determined the causes of death.
Speaker 1 (16:00):
So at the time, these searchers were seen as knowledgeable
and respected members of their community who were doing important work,
but today their reports are not really seen as an
accurate accounting of what people were dying of.
Speaker 2 (16:13):
All of that said, in sixteen thirty four, the annual
Bill of Mortality of the City of London reported that
fourteen people died of ricketts out of almost eleven thousand
total deaths in the city. And while no English medical
treatises have been unearthed that mention rickets before this point,
(16:34):
it seems like it must have been something the medical
community would have been aware of, otherwise how would it
be reported as a cause of death in this official document.
The first known clinical description of ricketts was written by
Daniel Whistler in his MD thesis at the University of
Leyten in the Netherlands, that is where a lot of
people from Britain and Ireland went to study medicine. And
(16:57):
this was written in Latin and its title translation to
concerning the Disease of English Children, which in English it
is called rickets. Whistler defended this thesis on October eighteenth,
sixteen forty five, and he would eventually go on to
be the President of the College of Physicians. In this work,
Whistler described rickets as common in England. He listed a
(17:21):
series of symptoms, including enlargements at the ends of the bones, weakness,
deformities of the limbs, unusually flexible joints, delayed emergence of
the teeth, decay in the teeth once they had emerged,
and chest malformations. All of these very physically recognizable signs
(17:41):
of rickets. He also listed some other symptoms that were
not related to the skeletal system, like cough, fever, irregular pulse,
and digestive distress. Some of these can occur in severe
cases of rickets. He speculated that rickets was caused when
blood clots form in the viscer, and he said that
the disease was often fatal, especially in children who were
(18:05):
affected with it from birth. Whistler also described rickets as
something that was most frequent in England's wealthiest people, with
the next most affected group being the poor. He thought
that as.
Speaker 1 (18:18):
A group, people in the middle were the least affected
by ricketts. He attributed the rate of ricketts among the
wealthy to the use of wet nurses, and when it
came to poor people, he blamed quote the intemperance of parents.
Other works on ricketts soon followed. One was a book
chapter by Arnold boot which was printed as part of
(18:39):
a book on medicine that came out in sixteen forty nine.
Boot was born in Holland and practiced medicine in Ireland.
Then in sixteen fifty English physician Francis Glisson printed the
longest and best known seventeenth century treatise on rickets. Its
title translated to a Treatise of the rickets being a
(19:00):
disease common to children. Glisson's work was so influential that
some people started calling rickets glistens disease, and in some
other parts of Europe it was known as English disease.
All these works were written in Latin, which was the
shared language of the European medical community, but most of
them used the English word rickets for the name of
(19:22):
the disease. Most of the people writing about rickets in
the mid seventeenth century thought it was a new disease
that had only been seen for the previous couple of decades.
It's possible that this was just.
Speaker 2 (19:36):
Connected to growing awareness and more doctors starting to look
for this disease, but it's also possible that rickets was
becoming a bigger issue. This was during the period of
regional cooling known as the Little Ice Age, when parts
of the world, including parts of Europe, were generally cooler
and wetter and cloudier. This could have affected how much
(19:59):
sunlike people. It also led to poor harvests and food
shortages that could have led to other nutrient deficiencies that
people might have mistaken for rickets, and it's also possible
that in major cities air pollution was becoming a factor.
London in particular, was described as being blanketed in a
cloud of smog that could be seen from miles away.
(20:23):
We will be talking about that more in a future episode.
It is likely that people were experiencing rickets in other
parts of the world as well, but most of the
writing about it is from northern and western Europe, and
at this point there was no effective treatment being used
in Europe. The idea of four humors was still a
very big part of medicine, so most of the proposed
(20:46):
treatments were influenced by that. In general, they did not
include any vitamin D.
Speaker 1 (20:52):
No. We will get to.
Speaker 2 (20:54):
The first effective treatments for rickets after a sponsor break.
The first effective treatment for rickets was cod liver oil,
which we know today is high in vitamin D. As
(21:16):
that name suggests, this is an oil made from the
liver of Atlantic cod. An Atlantic cod live in coastal
waters in the Northern Atlantic Ocean. By the seventeen hundreds,
people who lived in areas that were home to a
lot of cod fishing had started using cod liver oil
for a range of medicinal purposes, including as a treatment
(21:37):
for arthritis, sciatica, tuberculosis, and scropula, which is a swelling
of the lymph nodes in the neck that is typically
caused by tuberculosis. The discovery of cod liver oil as
a rickets treatment may have been an accident. A lot
of children who had rickets also had other conditions, such
as tuberculosis, and some were more generally manourished. So in
(22:01):
the eighteenth century, doctors and hospitals were using cod liver
oil to treat a range of ailments and as a
source of fat and calories for malnourished children. And people
started noticing improvements in children who were recognized as having rickets,
and children who weren't diagnosed with rickets but were just
seen as small and sick started growing more and faster
(22:23):
than could be explained simply by getting more food to eat.
By the early nineteenth century, another proposed treatment for rickets
was sunlight. Polish physician yed Rej Sniodeki proposed sunlight as
a cure for rickets as early as eighteen twenty two.
He wrote a book whose title translates to on the
(22:44):
Physical Education of Children, and it had a chapter on
the English disease. In that chapter, he said that if
parents were financially able, they should take their children to
the country to keep them in the dry, open air.
And he said it was particular important that they be
in the sun because the sun's action on the body
(23:05):
was one of the most efficient methods for the prevention
and cure of rickets. I do not know how he
came to that conclusion, but it was correct. It may
have just been that general fresh air and the great
outdoors is good for kids. There was a lot of
fresh air and sunlight focused, so it just might have
(23:25):
been that Snandeki cited densely populated English towns as places
where rickets was common. He described such towns as having
narrow streets and poorly lit dwellings, places where people would
not get a lot of sun and starting in the
eighteenth century in the UK and in other parts of
the world, more and more people.
Speaker 1 (23:46):
Were living this way. In the wake of the Industrial Revolution,
more people were moving from the country to towns and
cities and were working indoors in factories, and this included children.
The air pollution problems that it are already been observed
back in the seventeenth century, we're also getting worse because
many of those factories were powered by burning coal. Soon
(24:09):
ricketts was being associated with the urban poor, particularly in
the UK, but in other industrialized nations as well.
Speaker 2 (24:17):
It's possible that there may have also been some dietary
changes involved in this as people moved to the cities,
especially for example, they moved from the coast, where they
were eating a lot of fish, to somewhere farther inland
where they were not. One potential factor in London was
also the use of alum to whiten poor quality flour.
(24:39):
Physician John Snow, most famous today for tracing the source
of a cholera outbreak in London, understood that rickets was
a disease that affected the mineralization of bone. In eighteen
fifty seven, he published a paper arguing that alam was
binding to phosphorus in the intestines of people who ate
a lot of cheap bread and that kept their bones
(25:02):
for mineralizing. People did already know what phosphorus was. Hennig
Brand had figured that out after boiling huge amounts of urine.
Just enormous amounts of urine way back in sixteen sixty nine.
We have scheduled that as an upcoming Saturday classic. I
got a fifteen hundred gallons a year and advised the
(25:24):
Piaga workshop you want to come see. In the nineteenth century,
people also started noticing rickets in other animals, including animals
that were living in the gardens of the London Zoological Society.
For example, surgeon John Bland Sutton described rickets as extremely
frequent in the monkeys living in the garden. In eighteen
(25:45):
eighty three, he wrote a paper titled on the Diseases
of Monkeys in the Society's Gardens, in which he said
nearly half of the monkeys in the gardens die rickety
that is his direct quote, and that healthy monkeys that
arrived in the gardens were dead of rickets within four months.
These monkeys lived in a fully glassed in enclosure that
(26:05):
would have blocked the UV light. By the late eighteen nineties,
two schools of thought had evolved around rickets, one that
it could be cured with cod liver oil and the
other that it could be cured with sunlight, and a
lot of doctors really thought it was one or the other,
not both, or they focused mainly on one and not
(26:27):
on the other. For example, physician Theobald Adrian Palm wrote
a letter to the British Medical Journal in eighteen eighty
eight in response to a report on rickets that had
made the quote want of light sound unimportant. Palm was
objecting to that dismissiveness. He had worked in Japan for
(26:49):
almost ten years and described rickets there as quote conspicuous
by its absence. He attributed this to Japan's abundant sunshine.
He speculated that a worldwide study would find that rickets
is directly related to an absence of sunshine. He advocated
(27:10):
the use of sun baths as treatment. He did, not,
at least in this piece, seemed to make any connection
with cod liver oil and the fact that the Japanese
diet included a lot of fish. Meanwhile, advocates of cod
liver oil and other fish oils were bolstered by the
work of Casimir Funk in nineteen twelve he coined the
(27:32):
term vital amines or vitamins to describe compounds necessary for life.
He theorized that a lack of vital amines could cause
what he called deficiency diseases, including scurvy, pelagra, and rickets.
The first vitamin to be isolated and named was vitamin
A a few years later, followed by vitamins B and C.
(27:55):
They were named that because that's the order of the alphabet.
The search for vitamins was partly rooted in a search
for nutrients that could prevent these diseases. When it came
to vitamin C, that disease was, of course scurvy, and
the search was for a substance with anti scorbutic properties,
meaning the ability to fight off scurvy. So with these developments,
(28:19):
researchers were also looking for a compound with anti rickets
properties when cod liver oil was found to be a
good source of vitamin A. After vitamin A was isolated,
people started wondering if that was the anti rocritic component,
and this led to some confusion and some kind of
overlapping research about why exactly cod liver oil was an
(28:43):
effective treatment for rickets. As that vitamin research was going
on there were also ongoing efforts to study the use
of both UV light and cod liver oil to treat rickets.
In nineteen eighteen and nineteen nineteen, a doctor Holdshinsky successfully
demon treated the use of UV lamps to treat rickets
in children. He also noted that using the UV lamp
(29:06):
on one arm treated rickets in both arms, and he
speculated that the UV light was causing the synthesis of
some kind of compound that could then circulate all throughout
the body. At around the same time, American doctors Alfred
Hesse and Lester Unger were testing cod liver oil as
a treatment and preventative for scurvy in black children in
(29:29):
New York City. As we noted earlier, people with darker
skin are at greater risk for rickets because of the
amount of melanin in their skin compared to the strength
of the sun at that latitude. Not as much direct
sunlight in New York than in parts of Africa, for example,
cod liver oil treatments either prevented the onset of rickets
(29:53):
or led to its resolution. In ninety two percent of
infants who were treated for six months, and in more
than and half of the infants who were treated for
four months. Sixteen infants in the control group were not
given any cod liver oil, and nearly all of them
had rickets by the end of six months.
Speaker 1 (30:13):
Today, this study would not be viewed as ethical, since
other studies had already established that cod liver oil could
be used to treat rickets. What wasn't as well established
was whether cod liver oil could prevent rickets, not just
treat it, and this study was the first to show
that it could. The Henry Street Settlement House, which was
(30:34):
involved with this study, also became a rickets screening and
treatment center for the community more broadly as it was
going on. Also, we should take a moment to note
that the prevalence of rickets among black people living in
North America was used to justify racism, with racists arguing
that it signaled some kind of inherent weakness in their bodies. This,
(30:56):
again was just about melanin, and the vitamin D was
isolated and named not long after this study. Multiple people
contributed to its discovery, some of them through their previous
work on vitamin A. In nineteen nineteen, Edward Mellanbee wrote
about a fourth vitamin the absence of which could cause rickets,
(31:19):
concluding that it was either vitamin A or another fat
soluble vitamin that's found in a lot of the same
foods as vitamin A. Elmer McCollum, who had helped discover
vitamin A, differentiated the two and he was the one
who coined the name vitamin D.
Speaker 2 (31:35):
In nineteen twenty two, bacteriologist Harriet Chick of the Lister
Institute of Preventive Medicine in London led a team from
the British Medical Research Council to Vienna to study ricketts there.
They had been invited by Charles Perku, director of the
University of Vienna's Kinder Clinic. This was an unusual research
(31:57):
team for the time because most of its members, including Chick,
were women. They divided the babies into two groups. Group
one continued on the Kinder clinics regular diet, which included
local cow's milk and sucrose, while Group two had full
cream dried milk with some added sugar supplemented with cod
liver oil. They assessed the babies for rickets using X rays.
(32:22):
Half of the babies in Group one developed rickets, while
none of the babies in group two did this study
took place over the course of nineteen twenty one and
nineteen twenty two, and the results were different based on
the season. Babies in Group one, who had showed signs
of rickets early in the year seemed to improve in
(32:43):
the spring and summer, so the team did further research
to narrow down whether this had something to do with
the quality of the local milk changing seasonally, or if
it was the fact that the babies were being placed
outside on balconies as soon as the weather was warm enough.
Eleven babies from Group one were kept strictly indoors for
(33:05):
about three months and developed rickets, and they all rapidly
improved after being brought outdoors when the weather allowed it.
Babies also improved after being exposed to light from a
mercury vapor lamp. The babies in group one who had
developed rickets also rapidly improved once cod liver oil was
added to their food. This study helped establish that rickets
(33:29):
could be treated with both cod liver oil and sunlight.
This was not the one or the other situation that
a lot of researchers had been thinking that it was.
By nineteen twenty five, this was generally accepted within the
medical community, and then over the nineteen twenties and thirties,
researchers figured out how to produce vitamin D, allowing it
(33:51):
to be added to things like infant formula and other
food that led to a sharp decline in rates of
rickets in some parts of the world. Continues to be
an ongoing issue, though in addition to the things that
we've talked about, people who have other conditions that affect
their absorption of nutrients can certainly develop rickets. This includes
(34:12):
coeliac disease, inflammatory bowel disease, and cystic fibrosis.
Speaker 1 (34:16):
Among others.
Speaker 2 (34:18):
In more recent years, there have also been concerns that
advice to wear sunblock to prevent skin cancer has led
to a rise in rickets. This seems to be complicated
in lab studies. Unquestionably, sunblock keeps the skin from being
able to synthesize vitamin D, but in real world situations
(34:41):
it is not nearly as clear. Most people just don't
apply sunblock perfectly or often enough, or use enough of
the product, so at least some sun exposure is still happening.
It's possible that a bigger factor than wearing sunblock is
just the fact that some people don't go outside much
(35:03):
at all. Like if a child is being driven to
school and then does not have recess at school and
then comes back home and reads and plays video games
and goes to bed, not a lot of opportunity there
for direct sun exposure.
Speaker 1 (35:18):
Yeah, having a flashback to our episode where we talked
about sunscreens, I'm not knocking reading and playing video games.
Speaker 2 (35:25):
Those are two of my favorite pastor. I am an
advocate of sunscreened.
Speaker 1 (35:33):
All of these things are important, but you must get
vitamin D. Do you have listener mail for us? I
do have listener mail. This is from Charylyn, who wrote, Hi, both,
I've been listening for over a decade. My now ex
wife used to refer to you as the Ladies because
(35:55):
you were and still are my food prep companions. Appreciate
the years of company, as well as the reflective and
sometimes self reflective way you addressed your work. I grew
up half an hour south of Boston, so hearing bits
of Tracy's life is like fragments from home. I now
live in Wales, and my first bit of Welsh history
(36:18):
from you years before I moved here. It was the
Abravan disaster and living in the Welsh valleys as I do,
understanding the mining history is an important culture point. I
have been to the graves of the children who died
in the Abravan disaster, which is absolutely heartbreaking. I almost
took this last line out because I cried writing it,
(36:39):
and I can picture Holly trying not to cry reading it.
But the personal connection to history and this bridge this
podcast has been is part of the point on two
iguanadons in between Boston and Wales. In between Boston and Wales,
I lived not far from Crystal Palace, which is an
area of London in addition to a park, so I
(37:00):
really enjoyed hearing about the creation of the park. My
shorthand for the statues has always been what the Victorian's
thought dinosaurs looked like, so it was interesting to hear
the background to them. I too was sad to think
of the people working on it seeing them already be
incorrect because of new discoveries. But they are still fun
to visit. I recommend them to anyone wanting something a
(37:21):
little more offbeat in London. The larger park is also lovely,
and the train station is now part of the Tube network.
It was also interesting to hear that they demolished the
Pinge mansion for the park, as Pinge is now an
area down the road slash Hill for a pet tax
I've attached my eight year old cat, Willow. Her pet
sitter got this scratching pad for Christmas, and he was
(37:44):
instantly appreciative. Thank you for all you do, especially as
it gets harder to access resources. You are my podcast
staple and the one I most often recommend to others.
Speaker 2 (37:53):
All the best, Charlyn.
Speaker 1 (37:55):
We have a.
Speaker 2 (37:56):
Picture of a black cat. Computer does not want to
open it at full skies at the moment, but oh,
there we go. As soon as I said that and
tried to close the window, it appeared we have a
black cat on Christmas tree shaped one of those cardboard
like scratching pads.
Speaker 1 (38:18):
Super cute. I in my house have.
Speaker 2 (38:23):
A cardboard Halloween house that was bought at the pet
store on impulse a couple of years ago and became
one of Opal's favorite things. It is still in good
enough shape to still be in the house. I'm always
wondering how much longer though, until like the bottom is
all the way shredded through. How I don't know even
(38:48):
the right word for a person's first bit of Welsh
history before moving to Wales being the Abervan Disaster one
of the saddest episodes we have ever done.
Speaker 1 (38:58):
Listen well, while you were reading, I was hoping she
was going to say it was the Mary Lloyd.
Speaker 2 (39:04):
It was going to be.
Speaker 1 (39:05):
Poor skeletons of the holidays, but no, Alas no.
Speaker 2 (39:09):
Yeah. Now, it's so sad that I kind of erased
it from my memory for a while after we recorded it.
And when someone asked about what are some of the
saddest episodes you've ever done? I didn't mention it, and
somebody else was like, what about the Abravant Well, I
blocked it out of my head.
Speaker 1 (39:28):
Is that's what hard? Same? I had some that we
had talked about that were really harrowing come up in
recent research, and I was like, I forgot we did these.
I think my brain did that on purpose.
Speaker 2 (39:38):
Yeah, can only hold so much. So thank you again,
Chrilyn for this lovely email. I'm glad you enjoyed visiting
the Crystal Palace Park. Perhaps one day I will make
it and see them myself. If you would like to
send us some notes, Our email addresses History Podcast at
iHeartRadio dot com, and you can subscribe to the show
(40:00):
on the iHeartRadio app or anywhere else you'd like to
get your podcasts. Stuff you Missed in History Class is
a production of iHeartRadio. For more podcasts from iHeartRadio, visit
the iHeartRadio app, Apple Podcasts, or wherever you listen to
your favorite shows.
Welcome to Stuff You Missed in History Class, a production
of iHeartRadio.
Speaker 2 (00:12):
Hello and welcome to the podcast. I'm Tracy V. Wilson
and I'm Holly Fry. Once again, I'm returning to the
realm of nutritional deficiency diseases. I just find them very interesting,
especially because people have really figured out how to treat them,
way before they figured out exactly what was causing them,
which has not always been the case with other diseases.
(00:34):
Like scurvy is caused by vitamin SED efficiency, and people
had figured out that some foods, including citrus fruit, could
prevent scurvy by the seventeenth century. So today we know
that these foods are good sources of vitamin C. But
people made the connection between the food and the scurvy
well over a century before Casimir Funk even coined the
(00:56):
word vitamin, and that also happened before any individual vitamin
had been identified and named. We have an episode on scarvey,
and then last year we also did an episode on pelagra,
which is caused by niasin deficiency. People were similarly treating
pelagra with brewers yeast decades before we knew what niasin
(01:21):
was or that Brewer's yeast has a lot of it
in there. The discovery and identification of specific vitamins grew
in part from people trying to figure out what exactly
people were missing with that missing substance making them sick.
Nutritional rickets is caused by a vitamin D deficiency, and
(01:43):
people figured out two ways to treat it before we
even knew what vitamin D was. So it's a fun
word to say, but we don't really know where the
word rickets even comes from. English physician Daniel Whistler wrote
a thesis on rickets in sixteen forty five aimed that
it had been named for someone who had supposedly tried
(02:03):
to cure it, or from the term to rocket, which
he said was used in parts of England to mean
to breathe with difficulty. While there were people whose surname
was Rickett, there's really no evidence of any of them
trying to cure this disease, and it's also not clear
whether there is any merit to that rocket idea. Another
possibility is that it comes from German or Swedish words
(02:26):
meaning twisting or swaying. Yeah, I went down a big
rabbit hole trying to figure out if in sixteen forty five,
people in parts of England were using the word to rucket.
This way did not find a good answer. In the
seventeenth century, ricketts was also called rachitis, and that came
from Latin and Greek words to describe disorders or inflammations
(02:50):
of the spinal column. The symptoms of rickets can include
spinal pain and unusual spinal curvatures. So it's possible that
writing in the Latin use the word rachitis because of
these symptoms, and then lay people shifted that pronunciation to rickets,
But again that is all very speculative. Rickets affects growing animals,
(03:14):
not only human beings. In the body, vitamin D is
converted into a hormone that affects the way calcium is
absorbed in the digestive system, and it has other effects
on calcium in the body. To put it really really, basically,
without enough vitamin D, the body cannot absorb the calcium
needed for bones to mineralize properly. Rickets usually affects animals
(03:36):
during infancy, childhood, and adolescence when their bones are growing
and mineralizing, especially during growth spurts. A similar vitamin D
deficiency in adults is called Osteomalaysia. Animals get vitamin D
from two primary sources, their food and exposure to the sun.
Foods that are naturally high and vitamin D include egg
(03:59):
yolks and various types of fish like salmon, tuna, and sardines.
Wild mushrooms can also be high in vitamin D, but
commercially grown mushrooms that are raised in the dark typically aren't.
They aren't getting that sun exposure themselves to have vitamin D.
Speaker 1 (04:16):
Today, some foods are also fortified with added vitamin D,
although which foods, whether fortification is voluntary or mandatory for manufacturers,
and weather foods are fortified at all, depends on where
you live. In the United States, foods that are most
likely to be fortified with vitamin D include dairy and
non dairy milks, orange juice, and breakfast cereals, all of
(04:40):
which are associated, of course, with children's diets. In terms
of sun exposure, again very very basically, UVB radiation converts
cholesterol in the skin to kulic house for all, which
is the more formal name for vitamin D three.
Speaker 2 (04:59):
This requires direct exposure to the sun because UVB is
blocked by things like glass and clothing. Can also be
blocked or at least reduced by things like fog and
air pollution. UVB radiation is also affected by the Earth's
atmosphere and the angle at which sunlight reaches the surface.
Speaker 1 (05:18):
Of the Earth. Areas of very high latitudes get a
lot less UVB light than the tropics do, and since
melanin protects the body from UV light, the amount of
vitamin D that a person's own body can synthesize is
affected by how much melanin they have in their skin.
People with more melanin, meaning people who are darker skinned,
(05:40):
need more sun exposure to be able to synthesize enough
vitamin D than people with lighter skin.
Speaker 2 (05:46):
We don't really know whether ricketts was a widespread problem
during early human history, but it might not have been.
Early hunters and gatherers, and then later on early farmers
would have been spending a lot of time outside in
the sun. In the tropics, where in the long ago
past more people had more melanin in their skin. The
(06:09):
sun was also a lot more direct, so they would
have been getting more UVB exposure. Of course, those things
are interconnected, the UV light and the melanin. Conversely, in
the far north, for example, people had less exposure to
sunlight since even during the long days of the summer,
the sun's rays just aren't as direct, and people also
(06:30):
tended to wear more clothing because it was colder. But
these indigenous peoples have also historically had a diet that
is rich in vitamin D. People still living in the
same places that their ancestors did, following the same traditions
and lifeways, are probably getting a lot of their vitamin
D these same ways today. At the same time, it
(06:51):
is possible and maybe even likely, that people around the
world did historically go through periods when they weren't getting
enough vitamin D actually in the winter or during times
of famine, but this might not have been an ongoing
problem since most people would have been spending more time
outside again in the spring. One big exception here, at
(07:12):
least in theory, is babies. Because breast milk alone does
not provide infants with enough vitamin D. It would take
a lot of vitamin D supplementation for a person to
produce breast milk that was really rich in vitamin D
like way beyond what someone would get through ordinary food
(07:33):
and sunlight. So throughout history, babies who were breastfed and
then also swaddled or covered up or kept out of
the sun could be susceptible to rickets. Today, various health
organizations around the world recommend that breastfed babies be given
a vitamin D supplement, especially if they are exclusively breastfed.
Speaker 1 (07:56):
We do have some evidence of rickets in the archaeological record.
In twenty thirteen, archaeologists in Scotland announced the discovery of
a five thousand year old skeleton that showed evidence of rickets.
That is the oldest example discovered so far. Prior to
this discovery, the oldest skeletons known to have signs of
rickets were from the Roman Era, and there's some evidence
(08:18):
to suggest that it may have been more widespread in
the Roman Empire. For example, in twenty eighteen, researchers from
Historic England and McMaster University in Canada surveyed Roman Era
skeletons from cemeteries from what's now northern England down to
southern Spain, and they found evidence of rickets in more
than one in twenty. Children with babies most often affected.
Speaker 2 (08:43):
What may be the earliest written description of rickets also
comes from the Roman Era. Serranus of Ephesus wrote a
treatise on gynecology around the first or second century CE.
It includes a section about the care of newborns. The section,
he advises loosening a baby's swaddling clothes only after their
(09:05):
body has become reasonably firm, so that it does not
become distorted. Serranus also recommends not letting babies try to
sit up too early or for too long, because that
could cause them to become hunchbacked, and he says if
a baby is allowed to try to walk too early,
their legs can become distorted. Bow legs and spinal curvatures
(09:29):
are two of the most recognizable symptoms of rickets, so
this is often interpreted as a description of the condition.
There is some debate about whether that's really what he's
talking about, but Siranis is generally more accepted as the
first description of rickets than some earlier but even more
vague possibilities. Yes, sometimes it's a brief sentence that sort
(09:53):
of seems like maybe someone's leg was growing in a
strange way.
Speaker 1 (09:58):
Could that have been rickets? Maybe?
Speaker 2 (10:01):
Of course, rickets is definitely not caused by unswaddling a
baby too early. It is not caused by letting babies
try to stand up too soon after they're born. And
we really don't have any way to know if what
Serranus is describing in this passage is something that he
also would have recognized in the children from that twenty
(10:21):
eighteen study we mentioned, or if the children in that
study were seen as having some kind of illness or
condition relating to their bones while they were alive.
Speaker 1 (10:31):
Ricketts was not recognized as a disease with a name
until the early modern period, and we're going to get
into that after we pause for a sponsor break.
Speaker 2 (10:49):
Rickets seems to have been a more widespread problem in
parts of Europe in the sixteenth and seventeenth centuries, or
at least that is when it seems to start showing
up more in artwork and in written records. In fifteen
oh nine, German painter Hans Borkmeyer the Elder painted a
version of the Virgin and Child in which the infant
(11:10):
Jesus appears to have bowed legs and other possible signs
of rickets. In fifteen thirty two, German physician Hieronymous Roisner
described a disease that occurred only in children whose symptoms
included weakness, bowed legs, and chest malformations. Roisner said this
disease was common in Holland and Switzerland.
Speaker 1 (11:33):
In fifteen fifty four, Theodosius of Bologna described a child
who was very pale and had an unusual spinal curvature
which could have been rickets. Other accounts in the late
sixteenth century described children whose bones were bent and who
seemed to have some kind of wasting disease. In sixteen fourteen,
(11:53):
a visitor to a monastery in the Netherlands, which was
at the time part of the Dutch Republic, described children
being treated with water from a well dedicated to Saint Willibrard.
These children were described as having Saint Willibard's infirmity or
the ailment of Saint Willibrard. One of the symptoms was a.
Speaker 2 (12:15):
Series of knobs on the children's ribs, described as being
like pinheads or rosary beads, or something of a similar size.
Some of these children were also described as having the
ailment of Saint Macketus, in which their legs appeared as
though they were sitting cross legged. It was possible for
a child to have both of these ailments at once.
(12:38):
As we said earlier, bowed legs are one of the
most recognizable signs of rickets. Another is called richitic rosary.
These are knobs that develop where each rib connects to
the costal cartilage on the front of a person's rib cage,
and they're named for their resemblance to a string of
rosary beads. So it seems likely that at least some
(12:59):
of these children that Tracy was just shoying about had rickets.
There were also other Willibrard wells and springs around the Netherlands,
and their water was similarly used to try to treat
children who had these conditions. The first known use of
the word rickets and writing was a couple of decades
after this visitor report. Unlike most of the first uses
(13:22):
and writing we've talked about before, this was not in
published material. It was a handwritten receipt book belonging to
the Fairfax family of Yorkshire, England. People used to call
recipes receipts, and the word receipt could also apply specifically
to the ingredients and methods used to make medicinal preparations.
(13:43):
This particular receipt book had belonged to Mary Chumley, who
married the Reverend Henry Fairfax in sixteen twenty six. The
book remained in the family, with people recording recipes for
things like foods, medicines, and household preparations into the late
eighteenth century. Some of the entries were attributed to well
known physicians of the day, and others came from relatives
(14:05):
or friends. An entry for February twenty fifth, sixteen thirty
two includes five remedies for rickets in children, attributed to
the reverend's cousin, Lady Fairfax of Steaton. There are also
various recipes labeled for the rickets, and one marked for
a child that is weak or lame in her joints.
(14:27):
None of these remedies would have been effective in treating rickets.
They included things like ointments made of herbs minced into butter,
and drinks being made of things like herbs or dried
fruit boiled in water or ale. But this suggests that
by the first quarter of the seventeenth century, people in
England knew about a disease that they were calling rickets,
(14:48):
and that they were trying to figure out ways to
treat it. The first use of the word rickets in
published material was in the Annual Bill of Mortality of
the City of London in sixteen thirty four. This was
only the fifth year that the Annual Bill of Mortality
included causes of death. This information was gathered by people
(15:08):
called searchers, who were described as elderly matrons. Made a
lot of sense for older women to be doing this job,
since they were typically involved in laying out the dead
and preparing people's bodies for burial. Good fit for them
to also be the people determining cause of death. Since
older women often cared for sick people. People also thought
(15:31):
they might have some protection from whatever illness a person
might have died of, and that experience could also theoretically
help them identify and describe a person's cause of death.
At the same time, these women typically didn't have access
to a formal education. Most of them could not read
or write, so they gave their reports to the clerk orly,
(15:54):
and that means we don't have any details or notes
about how they determined the causes of death.
Speaker 1 (16:00):
So at the time, these searchers were seen as knowledgeable
and respected members of their community who were doing important work,
but today their reports are not really seen as an
accurate accounting of what people were dying of.
Speaker 2 (16:13):
All of that said, in sixteen thirty four, the annual
Bill of Mortality of the City of London reported that
fourteen people died of ricketts out of almost eleven thousand
total deaths in the city. And while no English medical
treatises have been unearthed that mention rickets before this point,
(16:34):
it seems like it must have been something the medical
community would have been aware of, otherwise how would it
be reported as a cause of death in this official document.
The first known clinical description of ricketts was written by
Daniel Whistler in his MD thesis at the University of
Leyten in the Netherlands, that is where a lot of
people from Britain and Ireland went to study medicine. And
(16:57):
this was written in Latin and its title translation to
concerning the Disease of English Children, which in English it
is called rickets. Whistler defended this thesis on October eighteenth,
sixteen forty five, and he would eventually go on to
be the President of the College of Physicians. In this work,
Whistler described rickets as common in England. He listed a
(17:21):
series of symptoms, including enlargements at the ends of the bones, weakness,
deformities of the limbs, unusually flexible joints, delayed emergence of
the teeth, decay in the teeth once they had emerged,
and chest malformations. All of these very physically recognizable signs
(17:41):
of rickets. He also listed some other symptoms that were
not related to the skeletal system, like cough, fever, irregular pulse,
and digestive distress. Some of these can occur in severe
cases of rickets. He speculated that rickets was caused when
blood clots form in the viscer, and he said that
the disease was often fatal, especially in children who were
(18:05):
affected with it from birth. Whistler also described rickets as
something that was most frequent in England's wealthiest people, with
the next most affected group being the poor. He thought
that as.
Speaker 1 (18:18):
A group, people in the middle were the least affected
by ricketts. He attributed the rate of ricketts among the
wealthy to the use of wet nurses, and when it
came to poor people, he blamed quote the intemperance of parents.
Other works on ricketts soon followed. One was a book
chapter by Arnold boot which was printed as part of
(18:39):
a book on medicine that came out in sixteen forty nine.
Boot was born in Holland and practiced medicine in Ireland.
Then in sixteen fifty English physician Francis Glisson printed the
longest and best known seventeenth century treatise on rickets. Its
title translated to a Treatise of the rickets being a
(19:00):
disease common to children. Glisson's work was so influential that
some people started calling rickets glistens disease, and in some
other parts of Europe it was known as English disease.
All these works were written in Latin, which was the
shared language of the European medical community, but most of
them used the English word rickets for the name of
(19:22):
the disease. Most of the people writing about rickets in
the mid seventeenth century thought it was a new disease
that had only been seen for the previous couple of decades.
It's possible that this was just.
Speaker 2 (19:36):
Connected to growing awareness and more doctors starting to look
for this disease, but it's also possible that rickets was
becoming a bigger issue. This was during the period of
regional cooling known as the Little Ice Age, when parts
of the world, including parts of Europe, were generally cooler
and wetter and cloudier. This could have affected how much
(19:59):
sunlike people. It also led to poor harvests and food
shortages that could have led to other nutrient deficiencies that
people might have mistaken for rickets, and it's also possible
that in major cities air pollution was becoming a factor.
London in particular, was described as being blanketed in a
cloud of smog that could be seen from miles away.
(20:23):
We will be talking about that more in a future episode.
It is likely that people were experiencing rickets in other
parts of the world as well, but most of the
writing about it is from northern and western Europe, and
at this point there was no effective treatment being used
in Europe. The idea of four humors was still a
very big part of medicine, so most of the proposed
(20:46):
treatments were influenced by that. In general, they did not
include any vitamin D.
Speaker 1 (20:52):
No. We will get to.
Speaker 2 (20:54):
The first effective treatments for rickets after a sponsor break.
The first effective treatment for rickets was cod liver oil,
which we know today is high in vitamin D. As
(21:16):
that name suggests, this is an oil made from the
liver of Atlantic cod. An Atlantic cod live in coastal
waters in the Northern Atlantic Ocean. By the seventeen hundreds,
people who lived in areas that were home to a
lot of cod fishing had started using cod liver oil
for a range of medicinal purposes, including as a treatment
(21:37):
for arthritis, sciatica, tuberculosis, and scropula, which is a swelling
of the lymph nodes in the neck that is typically
caused by tuberculosis. The discovery of cod liver oil as
a rickets treatment may have been an accident. A lot
of children who had rickets also had other conditions, such
as tuberculosis, and some were more generally manourished. So in
(22:01):
the eighteenth century, doctors and hospitals were using cod liver
oil to treat a range of ailments and as a
source of fat and calories for malnourished children. And people
started noticing improvements in children who were recognized as having rickets,
and children who weren't diagnosed with rickets but were just
seen as small and sick started growing more and faster
(22:23):
than could be explained simply by getting more food to eat.
By the early nineteenth century, another proposed treatment for rickets
was sunlight. Polish physician yed Rej Sniodeki proposed sunlight as
a cure for rickets as early as eighteen twenty two.
He wrote a book whose title translates to on the
(22:44):
Physical Education of Children, and it had a chapter on
the English disease. In that chapter, he said that if
parents were financially able, they should take their children to
the country to keep them in the dry, open air.
And he said it was particular important that they be
in the sun because the sun's action on the body
(23:05):
was one of the most efficient methods for the prevention
and cure of rickets. I do not know how he
came to that conclusion, but it was correct. It may
have just been that general fresh air and the great
outdoors is good for kids. There was a lot of
fresh air and sunlight focused, so it just might have
(23:25):
been that Snandeki cited densely populated English towns as places
where rickets was common. He described such towns as having
narrow streets and poorly lit dwellings, places where people would
not get a lot of sun and starting in the
eighteenth century in the UK and in other parts of
the world, more and more people.
Speaker 1 (23:46):
Were living this way. In the wake of the Industrial Revolution,
more people were moving from the country to towns and
cities and were working indoors in factories, and this included children.
The air pollution problems that it are already been observed
back in the seventeenth century, we're also getting worse because
many of those factories were powered by burning coal. Soon
(24:09):
ricketts was being associated with the urban poor, particularly in
the UK, but in other industrialized nations as well.
Speaker 2 (24:17):
It's possible that there may have also been some dietary
changes involved in this as people moved to the cities,
especially for example, they moved from the coast, where they
were eating a lot of fish, to somewhere farther inland
where they were not. One potential factor in London was
also the use of alum to whiten poor quality flour.
(24:39):
Physician John Snow, most famous today for tracing the source
of a cholera outbreak in London, understood that rickets was
a disease that affected the mineralization of bone. In eighteen
fifty seven, he published a paper arguing that alam was
binding to phosphorus in the intestines of people who ate
a lot of cheap bread and that kept their bones
(25:02):
for mineralizing. People did already know what phosphorus was. Hennig
Brand had figured that out after boiling huge amounts of urine.
Just enormous amounts of urine way back in sixteen sixty nine.
We have scheduled that as an upcoming Saturday classic. I
got a fifteen hundred gallons a year and advised the
(25:24):
Piaga workshop you want to come see. In the nineteenth century,
people also started noticing rickets in other animals, including animals
that were living in the gardens of the London Zoological Society.
For example, surgeon John Bland Sutton described rickets as extremely
frequent in the monkeys living in the garden. In eighteen
(25:45):
eighty three, he wrote a paper titled on the Diseases
of Monkeys in the Society's Gardens, in which he said
nearly half of the monkeys in the gardens die rickety
that is his direct quote, and that healthy monkeys that
arrived in the gardens were dead of rickets within four months.
These monkeys lived in a fully glassed in enclosure that
(26:05):
would have blocked the UV light. By the late eighteen nineties,
two schools of thought had evolved around rickets, one that
it could be cured with cod liver oil and the
other that it could be cured with sunlight, and a
lot of doctors really thought it was one or the other,
not both, or they focused mainly on one and not
(26:27):
on the other. For example, physician Theobald Adrian Palm wrote
a letter to the British Medical Journal in eighteen eighty
eight in response to a report on rickets that had
made the quote want of light sound unimportant. Palm was
objecting to that dismissiveness. He had worked in Japan for
(26:49):
almost ten years and described rickets there as quote conspicuous
by its absence. He attributed this to Japan's abundant sunshine.
He speculated that a worldwide study would find that rickets
is directly related to an absence of sunshine. He advocated
(27:10):
the use of sun baths as treatment. He did, not,
at least in this piece, seemed to make any connection
with cod liver oil and the fact that the Japanese
diet included a lot of fish. Meanwhile, advocates of cod
liver oil and other fish oils were bolstered by the
work of Casimir Funk in nineteen twelve he coined the
(27:32):
term vital amines or vitamins to describe compounds necessary for life.
He theorized that a lack of vital amines could cause
what he called deficiency diseases, including scurvy, pelagra, and rickets.
The first vitamin to be isolated and named was vitamin
A a few years later, followed by vitamins B and C.
(27:55):
They were named that because that's the order of the alphabet.
The search for vitamins was partly rooted in a search
for nutrients that could prevent these diseases. When it came
to vitamin C, that disease was, of course scurvy, and
the search was for a substance with anti scorbutic properties,
meaning the ability to fight off scurvy. So with these developments,
(28:19):
researchers were also looking for a compound with anti rickets
properties when cod liver oil was found to be a
good source of vitamin A. After vitamin A was isolated,
people started wondering if that was the anti rocritic component,
and this led to some confusion and some kind of
overlapping research about why exactly cod liver oil was an
(28:43):
effective treatment for rickets. As that vitamin research was going
on there were also ongoing efforts to study the use
of both UV light and cod liver oil to treat rickets.
In nineteen eighteen and nineteen nineteen, a doctor Holdshinsky successfully
demon treated the use of UV lamps to treat rickets
in children. He also noted that using the UV lamp
(29:06):
on one arm treated rickets in both arms, and he
speculated that the UV light was causing the synthesis of
some kind of compound that could then circulate all throughout
the body. At around the same time, American doctors Alfred
Hesse and Lester Unger were testing cod liver oil as
a treatment and preventative for scurvy in black children in
(29:29):
New York City. As we noted earlier, people with darker
skin are at greater risk for rickets because of the
amount of melanin in their skin compared to the strength
of the sun at that latitude. Not as much direct
sunlight in New York than in parts of Africa, for example,
cod liver oil treatments either prevented the onset of rickets
(29:53):
or led to its resolution. In ninety two percent of
infants who were treated for six months, and in more
than and half of the infants who were treated for
four months. Sixteen infants in the control group were not
given any cod liver oil, and nearly all of them
had rickets by the end of six months.
Speaker 1 (30:13):
Today, this study would not be viewed as ethical, since
other studies had already established that cod liver oil could
be used to treat rickets. What wasn't as well established
was whether cod liver oil could prevent rickets, not just
treat it, and this study was the first to show
that it could. The Henry Street Settlement House, which was
(30:34):
involved with this study, also became a rickets screening and
treatment center for the community more broadly as it was
going on. Also, we should take a moment to note
that the prevalence of rickets among black people living in
North America was used to justify racism, with racists arguing
that it signaled some kind of inherent weakness in their bodies. This,
(30:56):
again was just about melanin, and the vitamin D was
isolated and named not long after this study. Multiple people
contributed to its discovery, some of them through their previous
work on vitamin A. In nineteen nineteen, Edward Mellanbee wrote
about a fourth vitamin the absence of which could cause rickets,
(31:19):
concluding that it was either vitamin A or another fat
soluble vitamin that's found in a lot of the same
foods as vitamin A. Elmer McCollum, who had helped discover
vitamin A, differentiated the two and he was the one
who coined the name vitamin D.
Speaker 2 (31:35):
In nineteen twenty two, bacteriologist Harriet Chick of the Lister
Institute of Preventive Medicine in London led a team from
the British Medical Research Council to Vienna to study ricketts there.
They had been invited by Charles Perku, director of the
University of Vienna's Kinder Clinic. This was an unusual research
(31:57):
team for the time because most of its members, including Chick,
were women. They divided the babies into two groups. Group
one continued on the Kinder clinics regular diet, which included
local cow's milk and sucrose, while Group two had full
cream dried milk with some added sugar supplemented with cod
liver oil. They assessed the babies for rickets using X rays.
(32:22):
Half of the babies in Group one developed rickets, while
none of the babies in group two did this study
took place over the course of nineteen twenty one and
nineteen twenty two, and the results were different based on
the season. Babies in Group one, who had showed signs
of rickets early in the year seemed to improve in
(32:43):
the spring and summer, so the team did further research
to narrow down whether this had something to do with
the quality of the local milk changing seasonally, or if
it was the fact that the babies were being placed
outside on balconies as soon as the weather was warm enough.
Eleven babies from Group one were kept strictly indoors for
(33:05):
about three months and developed rickets, and they all rapidly
improved after being brought outdoors when the weather allowed it.
Babies also improved after being exposed to light from a
mercury vapor lamp. The babies in group one who had
developed rickets also rapidly improved once cod liver oil was
added to their food. This study helped establish that rickets
(33:29):
could be treated with both cod liver oil and sunlight.
This was not the one or the other situation that
a lot of researchers had been thinking that it was.
By nineteen twenty five, this was generally accepted within the
medical community, and then over the nineteen twenties and thirties,
researchers figured out how to produce vitamin D, allowing it
(33:51):
to be added to things like infant formula and other
food that led to a sharp decline in rates of
rickets in some parts of the world. Continues to be
an ongoing issue, though in addition to the things that
we've talked about, people who have other conditions that affect
their absorption of nutrients can certainly develop rickets. This includes
(34:12):
coeliac disease, inflammatory bowel disease, and cystic fibrosis.
Speaker 1 (34:16):
Among others.
Speaker 2 (34:18):
In more recent years, there have also been concerns that
advice to wear sunblock to prevent skin cancer has led
to a rise in rickets. This seems to be complicated
in lab studies. Unquestionably, sunblock keeps the skin from being
able to synthesize vitamin D, but in real world situations
(34:41):
it is not nearly as clear. Most people just don't
apply sunblock perfectly or often enough, or use enough of
the product, so at least some sun exposure is still happening.
It's possible that a bigger factor than wearing sunblock is
just the fact that some people don't go outside much
(35:03):
at all. Like if a child is being driven to
school and then does not have recess at school and
then comes back home and reads and plays video games
and goes to bed, not a lot of opportunity there
for direct sun exposure.
Speaker 1 (35:18):
Yeah, having a flashback to our episode where we talked
about sunscreens, I'm not knocking reading and playing video games.
Speaker 2 (35:25):
Those are two of my favorite pastor. I am an
advocate of sunscreened.
Speaker 1 (35:33):
All of these things are important, but you must get
vitamin D. Do you have listener mail for us? I
do have listener mail. This is from Charylyn, who wrote, Hi, both,
I've been listening for over a decade. My now ex
wife used to refer to you as the Ladies because
(35:55):
you were and still are my food prep companions. Appreciate
the years of company, as well as the reflective and
sometimes self reflective way you addressed your work. I grew
up half an hour south of Boston, so hearing bits
of Tracy's life is like fragments from home. I now
live in Wales, and my first bit of Welsh history
(36:18):
from you years before I moved here. It was the
Abravan disaster and living in the Welsh valleys as I do,
understanding the mining history is an important culture point. I
have been to the graves of the children who died
in the Abravan disaster, which is absolutely heartbreaking. I almost
took this last line out because I cried writing it,
(36:39):
and I can picture Holly trying not to cry reading it.
But the personal connection to history and this bridge this
podcast has been is part of the point on two
iguanadons in between Boston and Wales. In between Boston and Wales,
I lived not far from Crystal Palace, which is an
area of London in addition to a park, so I
(37:00):
really enjoyed hearing about the creation of the park. My
shorthand for the statues has always been what the Victorian's
thought dinosaurs looked like, so it was interesting to hear
the background to them. I too was sad to think
of the people working on it seeing them already be
incorrect because of new discoveries. But they are still fun
to visit. I recommend them to anyone wanting something a
(37:21):
little more offbeat in London. The larger park is also lovely,
and the train station is now part of the Tube network.
It was also interesting to hear that they demolished the
Pinge mansion for the park, as Pinge is now an
area down the road slash Hill for a pet tax
I've attached my eight year old cat, Willow. Her pet
sitter got this scratching pad for Christmas, and he was
(37:44):
instantly appreciative. Thank you for all you do, especially as
it gets harder to access resources. You are my podcast
staple and the one I most often recommend to others.
Speaker 2 (37:53):
All the best, Charlyn.
Speaker 1 (37:55):
We have a.
Speaker 2 (37:56):
Picture of a black cat. Computer does not want to
open it at full skies at the moment, but oh,
there we go. As soon as I said that and
tried to close the window, it appeared we have a
black cat on Christmas tree shaped one of those cardboard
like scratching pads.
Speaker 1 (38:18):
Super cute. I in my house have.
Speaker 2 (38:23):
A cardboard Halloween house that was bought at the pet
store on impulse a couple of years ago and became
one of Opal's favorite things. It is still in good
enough shape to still be in the house. I'm always
wondering how much longer though, until like the bottom is
all the way shredded through. How I don't know even
(38:48):
the right word for a person's first bit of Welsh
history before moving to Wales being the Abervan Disaster one
of the saddest episodes we have ever done.
Speaker 1 (38:58):
Listen well, while you were reading, I was hoping she
was going to say it was the Mary Lloyd.
Speaker 2 (39:04):
It was going to be.
Speaker 1 (39:05):
Poor skeletons of the holidays, but no, Alas no.
Speaker 2 (39:09):
Yeah. Now, it's so sad that I kind of erased
it from my memory for a while after we recorded it.
And when someone asked about what are some of the
saddest episodes you've ever done? I didn't mention it, and
somebody else was like, what about the Abravant Well, I
blocked it out of my head.
Speaker 1 (39:28):
Is that's what hard? Same? I had some that we
had talked about that were really harrowing come up in
recent research, and I was like, I forgot we did these.
I think my brain did that on purpose.
Speaker 2 (39:38):
Yeah, can only hold so much. So thank you again,
Chrilyn for this lovely email. I'm glad you enjoyed visiting
the Crystal Palace Park. Perhaps one day I will make
it and see them myself. If you would like to
send us some notes, Our email addresses History Podcast at
iHeartRadio dot com, and you can subscribe to the show
(40:00):
on the iHeartRadio app or anywhere else you'd like to
get your podcasts. Stuff you Missed in History Class is
a production of iHeartRadio. For more podcasts from iHeartRadio, visit
the iHeartRadio app, Apple Podcasts, or wherever you listen to
your favorite shows.
Stuff You Missed in History Class News
Hosts And Creators
Holly Frey
Tracy Wilson
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