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  • Rickets

    Here's an interesting one with quite a complex story behind it.

    I had thought that this condition only emerged with industrialisation - because people were then indoors for much of the day and, therefore, lacked sufficient exposure to sunlight to make enough vitamin D.

    Like much of what one reads, this is both historically fallacious and a gross simplification. (It's amazing how much bad information there is out there in print.) Anyway, it turns out rickets are first much commented on in the medical literature in the early seventeenth century, mostly by English doctors, and probably occurred in Northern Europe, at times, long before this. It was known at one time as "The English disease" but it's not clear why that is - it may be because English doctors had first described and tried to categorise it, or it may be because it was prevalent in England at one time. However, on the latter point, English sources also mention it as occurring in Ireland, and some German and Dutch paintings from the fifteenth century show infants with bowed legs and characteristically distorted heads. It could be that what's seen in the paintings is a stylistic feature; however, it seems equally likely that it was a depiction of what was often seen and not thought of as remarkable. One Dutch doctor - Leyden was the leading university for medicine in Europe for a very long period - used to take in children for "straightening" from all over the country and abroad (over a 1000). He strapped them into iron and leather stays and let them out once a week to change their shirts. Verney's son was under his "care" sent from England and when asked to let him out more often the doctor replied that he didn't have time to attend to special requests as regarded individual children.


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    I wondered at this point at the popularity of stays for quite a long period in the early modern world. I think it's often assumed that they were mostly about looking slim, but one wonders if they also were to do with worries about growing straight, or an attempt by some who were not to straighten more. But that's by the by.
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    To recap, it seems likely that the condition was probably around, at times, for quite some time back. However, it also seems that there may have been an increase in England at around 1620 for a while. It seems that it was first turning up in Dorset and Somerset and from there "spread" east and north.

    We know from problems with this in animals that it appears when the calcium : phosphorous ratio in the diet is out of balance. When either mineral is too high, or too low, it can appear. Adjusting the diet to supply more of the mineral that's deficient resolves the condition. However, supply of sunlight, or ultra-violet light, can also resolve the condition, because a large enough amount of vitamin D allows mineralisation even when the calcium : phosphorous balance is not right.

    Around the date mentioned above, enclosures had begun to be a problem:

    Enclosure - Wikipedia, the free encyclopedia

    This meant that peasant families might have lost the land on which they had previously kept a cow. For people in medieval and Tudor/Stuart England what they called "white meat" - dairy products and eggs - were a particularly important part of the diet. Sometimes (flesh) meat was fairly abundant, and the English were often noted by foreign visitors as eating a lot of it. But at times, further down the social scale, it was "white meat" that largely supplied people's protein needs. Now it so happens that wholemeal bread together with milk - staples of the peasant diet in Northern Europe - results in a diet that has an almost ideal calcium : phosphorous balance. If milk went short for these people, they had to make up the calorific deficit with more bread. That put their calcium : phosphorous balance out of whack. Under these circumstances, the amount of calcium dropped sharply but the amount of phosphorous [EDIT : did not fall near so much]


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    It is, by the way, interesting that one survey of medieval skulls in Denmark found that only 6% of teeth were carious. (Skulls from Hythe churchyard dating from c. 1250 to c. 1650 similarly show good teeth.) Tooth decay seems to be linked to mineralisation problems - as researchers in the 1930s and 40s often seem to have been aware, even if people have forgotten since - and only became rampant when refined carbohydrate became available. Doesn't the USDA "My Plate" - how outdated putting that hypocoristic
    "My" in is, by the way, even Microsoft no longer does that: "My Documents" has become "Documents"! - think one can get away with half the very large carbohydrate allowance they recommend as refined carbohydrate?
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    This would seem to be the root of it. In pre-modern times any time the supply of milk went short, for whatever reasons, that mineral balance was affected. That mightn't have mattered if people's level of vitamin D was high enough; however, in Northern Europe in the winter likely it very often wasn't.

    Interestingly, there's some evidence that rickets was more of a problem among the wealthy than among the poor. This seems counterintuitive. However, wealthy women often put their children out to nurse, and if the wet-nurse's diet was inadequate so would her milk have been. In addition, educated people at this time still tended to believe in old Greek texts and had formed the opinion, based upon the theory of the "humours", that milk was a suitable food for babies and for the elderly but not for people of any ages in between. Consequently, the children of the wealthy seem often not to have been given milk after weaning. The poor
    did at any rate drink milk when they could get it.

    Furthermore, if a rich man had consulted a doctor about his child's rickets he would also probably have been told that it was a "cold and moist" condition and that "cold and moist" food should be avoided. This would, unfortunately, have included fish, which as one of the best available food-sources of vitamin D would probably have helped had it been eaten.

    Country people in Norfolk, apparently, said that a cure for a ricketty child was to kill a raven and eat its liver. This sounds quite plausible, although it's not known what the level of vitamin D in ravens' livers is. Perhaps it would have been better in those days to take an opinion from a simple country person than from a medical doctor!

    There are also, interestingly, indications that xerophthalmia and orther eye problems were more common among the wealthy in 17th century England than among the poor. It's thought this may have been caused by a diet that was very high in protein but lacking vitamin A. (The Weston A. Price Foundation has, by the way, criticised both the Zone Diet and the Paleo Diet in the past on the grounds of what look to be rather high protein levels and rather low vitamin A levels. See for example

    Adventures in Macro-Nutrient Land | Weston A Price

    - an article which is worth reading in its entirety anyway.)

    Wealthy people in medieval England and through into much later periods may have eaten as much as 200g to 300g of protein a day. Readers may recall the passage in Fielding's 18th century novel Tom Jones:

    Our heroe received the enemy's attack with the most undaunted intrepidity, and his bosom resounded with the blow. This he presently returned with no less violence, aiming likewise at the parson's breast; but he dexterously drove down the fist of Jones, so that it reached only his belly, where two pounds of beef and as many of pudding were then deposited, and whence consequently no hollow sound could proceed.
    The History of Tom Jones, a Foundling, by Henry Fielding

    One group of anthroplogists say that a young male Maasai, at the time they visited, would eat up to 300g of protein a day. However, the Maasai diet was very rich in vitamin A. In 17th century England the wealthy seem to have only used butter in cooking and not at table, despising it as a "poor man's food". The poor, by contrast, ate as much butter as they could get. At this time, too, the upper class (and possibly other classes) tended to avoid vegetables, since they believed that they gave you wind. (There are, of course, precursors to vitamin A, in some vegetable foods, which allow you to make A provided you can do the conversion efficiently.)
    Last edited by Vainamoinen; 03-31-2015, 02:46 AM.

  • #2
    I don't think I've ever heard of rickets being described in terms of calciumhosphorous ratio before. Interesting idea. I have heard (but not really researched) that rickets is on the rise again in the US - I wonder if there is a link between that possible historic scenario and postulated modern increases in the disease?

    Perhaps it would have been better in those days to take an opinion from a simple country person than from a medical doctor!
    Unfortunate how doctrine can sometimes cloud judgement like that. You have reminded me of this article: https://medium.com/war-is-boring/eat...y-f985772c81a6

    TL;DNR: Navy gave out free white rice to ship crews but charged for all other foods. Most crew were poor country boys who, culturally, held white rice to be "premo" stuff due to its relative cost and urban image back home. Result: Lots of beri beri. Country-educated-come-university-educated doc comes along and tries to cure it like they did back in the 'sticks' (brown rice, greens, etc - linking it to nutrition), but spends years getting shut down because that's just "bumpkin bullshit".

    M.

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    • #3
      I was taught decades ago that rickets was primarily a disease caused by lack of sunshine. Later on, they added lack of fish oils and fish to the causes, because rickets didn't affect coastal fish eaters. Back in the mists of antiquity, I remember my mother giving us our daily cod liver oil. Hmmm, maybe my mother was ahead of the research!.

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      • #4
        Originally posted by Paysan View Post
        I was taught decades ago that rickets was primarily a disease caused by lack of sunshine. Later on, they added lack of fish oils and fish to the causes, because rickets didn't affect coastal fish eaters. Back in the mists of antiquity, I remember my mother giving us our daily cod liver oil. Hmmm, maybe my mother was ahead of the research!.
        Yes, that's what many people used to do till more recently. It's maybe a shame they tend not to now. Cod liver oil was actually part of the ration for children in Britain in WWII - along with orange juice to supply vitamin C.

        (Maybe this is the origin of the mystique around fruit juices? Historically, it was a "protective food" in the jargon of the day. But then again people weren't drinking ten fluid ounce glasses of it, and the whole fruit wasn't easily available under the conditions of the war, so that a small ration of orange juice for kids made sense. People nowadays haven't really twigged that you can have too much of a good thing.)

        Cod liver oil has been known about for some time. At first it was recommended for joint pains - Parson Woodeforde mentions someone giving a bottle to him for his sister:

        Diary of a Country Parson, 1758-1802: James Woodforde: 9781853113116: Amazon.com: Books

        Then later it was tried for rickets. They'd found it would cure rickets before they even knew of the existence of vitamin A. It seems that some scientists even thought that it might be iodine that helped, but it was realised that was wrong when it was found that adding iodine to other oils did not make them effective.

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        • #5
          Originally posted by MEversbergII View Post

          TL;DNR: Navy gave out free white rice to ship crews but charged for all other foods. Most crew were poor country boys who, culturally, held white rice to be "premo" stuff due to its relative cost and urban image back home. Result: Lots of beri beri. Country-educated-come-university-educated doc comes along and tries to cure it like they did back in the 'sticks' (brown rice, greens, etc - linking it to nutrition), but spends years getting shut down because that's just "bumpkin bullshit".

          M.
          That's interesting.

          There were deficiency diseases appearing in Allied forces at the siege of Kut al Amara in the First World War which are quite interesting.

          Siege of Kut - Wikipedia, the free encyclopedia

          These were British and Indian troops, and the striking thing is that the British troops tended to be troubled with beri-beri and the Indian troops with scurvy.

          The rations for the British troops were a pound and a quarter of horseflesh and bread. I don't think there was much else. The Indian troops refused the meat ration on religious grounds, and their rations were mostly barley, ghee and dates. Since there's enough vitamin C in fresh meat, if it isn't overcooked, for at any rate overt signs of scurvy not to become evident, the British troops were OK there, but some of the Indian troops came down with that. By contrast the white bread the British soldiers were eating meant they were deficient in thiamine (B1) and tended to suffer from beri-beri, whereas the whole barley of the Indian soldiers protected them from that.

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