1 00:00:01,320 --> 00:00:04,240 Speaker 1: Welcome to Stuff You Missed in History Class, a production 2 00:00:04,400 --> 00:00:08,719 Speaker 1: of iHeartRadio. 3 00:00:12,000 --> 00:00:15,240 Speaker 2: Hello and welcome to the podcast. I'm Tracy V. Wilson 4 00:00:15,400 --> 00:00:19,160 Speaker 2: and I'm Holly Fry. Once again, I'm returning to the 5 00:00:19,200 --> 00:00:23,520 Speaker 2: realm of nutritional deficiency diseases. I just find them very interesting, 6 00:00:24,360 --> 00:00:28,080 Speaker 2: especially because people have really figured out how to treat them, 7 00:00:28,480 --> 00:00:31,760 Speaker 2: way before they figured out exactly what was causing them, 8 00:00:31,800 --> 00:00:34,720 Speaker 2: which has not always been the case with other diseases. 9 00:00:34,880 --> 00:00:38,960 Speaker 2: Like scurvy is caused by vitamin SED efficiency, and people 10 00:00:38,960 --> 00:00:42,360 Speaker 2: had figured out that some foods, including citrus fruit, could 11 00:00:42,400 --> 00:00:45,519 Speaker 2: prevent scurvy by the seventeenth century. So today we know 12 00:00:45,560 --> 00:00:48,280 Speaker 2: that these foods are good sources of vitamin C. But 13 00:00:48,440 --> 00:00:51,760 Speaker 2: people made the connection between the food and the scurvy 14 00:00:52,720 --> 00:00:56,760 Speaker 2: well over a century before Casimir Funk even coined the 15 00:00:56,800 --> 00:01:02,200 Speaker 2: word vitamin, and that also happened before any individual vitamin 16 00:01:02,440 --> 00:01:08,000 Speaker 2: had been identified and named. We have an episode on scarvey, 17 00:01:08,120 --> 00:01:11,160 Speaker 2: and then last year we also did an episode on pelagra, 18 00:01:11,360 --> 00:01:16,600 Speaker 2: which is caused by niasin deficiency. People were similarly treating 19 00:01:16,760 --> 00:01:21,280 Speaker 2: pelagra with brewers yeast decades before we knew what niasin 20 00:01:21,640 --> 00:01:24,080 Speaker 2: was or that Brewer's yeast has a lot of it 21 00:01:24,319 --> 00:01:29,559 Speaker 2: in there. The discovery and identification of specific vitamins grew 22 00:01:29,640 --> 00:01:33,119 Speaker 2: in part from people trying to figure out what exactly 23 00:01:33,240 --> 00:01:38,040 Speaker 2: people were missing with that missing substance making them sick. 24 00:01:39,040 --> 00:01:43,040 Speaker 2: Nutritional rickets is caused by a vitamin D deficiency, and 25 00:01:43,040 --> 00:01:46,360 Speaker 2: people figured out two ways to treat it before we 26 00:01:46,440 --> 00:01:50,240 Speaker 2: even knew what vitamin D was. So it's a fun 27 00:01:50,280 --> 00:01:52,160 Speaker 2: word to say, but we don't really know where the 28 00:01:52,160 --> 00:01:56,760 Speaker 2: word rickets even comes from. English physician Daniel Whistler wrote 29 00:01:56,800 --> 00:02:00,360 Speaker 2: a thesis on rickets in sixteen forty five aimed that 30 00:02:00,400 --> 00:02:03,280 Speaker 2: it had been named for someone who had supposedly tried 31 00:02:03,320 --> 00:02:07,040 Speaker 2: to cure it, or from the term to rocket, which 32 00:02:07,040 --> 00:02:09,040 Speaker 2: he said was used in parts of England to mean 33 00:02:09,120 --> 00:02:13,280 Speaker 2: to breathe with difficulty. While there were people whose surname 34 00:02:13,560 --> 00:02:16,240 Speaker 2: was Rickett, there's really no evidence of any of them 35 00:02:16,280 --> 00:02:18,799 Speaker 2: trying to cure this disease, and it's also not clear 36 00:02:19,240 --> 00:02:22,880 Speaker 2: whether there is any merit to that rocket idea. Another 37 00:02:23,000 --> 00:02:26,360 Speaker 2: possibility is that it comes from German or Swedish words 38 00:02:26,400 --> 00:02:30,359 Speaker 2: meaning twisting or swaying. Yeah, I went down a big 39 00:02:30,480 --> 00:02:33,800 Speaker 2: rabbit hole trying to figure out if in sixteen forty five, 40 00:02:33,960 --> 00:02:36,960 Speaker 2: people in parts of England were using the word to rucket. 41 00:02:37,720 --> 00:02:41,680 Speaker 2: This way did not find a good answer. In the 42 00:02:41,720 --> 00:02:46,280 Speaker 2: seventeenth century, ricketts was also called rachitis, and that came 43 00:02:46,280 --> 00:02:50,120 Speaker 2: from Latin and Greek words to describe disorders or inflammations 44 00:02:50,160 --> 00:02:54,760 Speaker 2: of the spinal column. The symptoms of rickets can include 45 00:02:54,840 --> 00:02:59,760 Speaker 2: spinal pain and unusual spinal curvatures. So it's possible that 46 00:03:00,639 --> 00:03:04,040 Speaker 2: writing in the Latin use the word rachitis because of 47 00:03:04,080 --> 00:03:08,320 Speaker 2: these symptoms, and then lay people shifted that pronunciation to rickets, 48 00:03:08,320 --> 00:03:14,040 Speaker 2: But again that is all very speculative. Rickets affects growing animals, 49 00:03:14,080 --> 00:03:17,920 Speaker 2: not only human beings. In the body, vitamin D is 50 00:03:17,960 --> 00:03:21,200 Speaker 2: converted into a hormone that affects the way calcium is 51 00:03:21,280 --> 00:03:24,520 Speaker 2: absorbed in the digestive system, and it has other effects 52 00:03:24,520 --> 00:03:27,960 Speaker 2: on calcium in the body. To put it really really, basically, 53 00:03:28,160 --> 00:03:31,480 Speaker 2: without enough vitamin D, the body cannot absorb the calcium 54 00:03:31,560 --> 00:03:36,640 Speaker 2: needed for bones to mineralize properly. Rickets usually affects animals 55 00:03:36,720 --> 00:03:40,760 Speaker 2: during infancy, childhood, and adolescence when their bones are growing 56 00:03:40,800 --> 00:03:45,920 Speaker 2: and mineralizing, especially during growth spurts. A similar vitamin D 57 00:03:46,000 --> 00:03:51,440 Speaker 2: deficiency in adults is called Osteomalaysia. Animals get vitamin D 58 00:03:51,680 --> 00:03:55,680 Speaker 2: from two primary sources, their food and exposure to the sun. 59 00:03:56,560 --> 00:03:59,560 Speaker 2: Foods that are naturally high and vitamin D include egg 60 00:03:59,640 --> 00:04:04,280 Speaker 2: yolks and various types of fish like salmon, tuna, and sardines. 61 00:04:05,080 --> 00:04:08,400 Speaker 2: Wild mushrooms can also be high in vitamin D, but 62 00:04:08,560 --> 00:04:12,480 Speaker 2: commercially grown mushrooms that are raised in the dark typically aren't. 63 00:04:12,520 --> 00:04:16,080 Speaker 2: They aren't getting that sun exposure themselves to have vitamin D. 64 00:04:16,760 --> 00:04:20,599 Speaker 1: Today, some foods are also fortified with added vitamin D, 65 00:04:20,760 --> 00:04:26,279 Speaker 1: although which foods, whether fortification is voluntary or mandatory for manufacturers, 66 00:04:26,720 --> 00:04:29,760 Speaker 1: and weather foods are fortified at all, depends on where 67 00:04:29,760 --> 00:04:33,359 Speaker 1: you live. In the United States, foods that are most 68 00:04:33,400 --> 00:04:36,680 Speaker 1: likely to be fortified with vitamin D include dairy and 69 00:04:36,760 --> 00:04:40,880 Speaker 1: non dairy milks, orange juice, and breakfast cereals, all of 70 00:04:40,920 --> 00:04:44,960 Speaker 1: which are associated, of course, with children's diets. In terms 71 00:04:45,000 --> 00:04:50,640 Speaker 1: of sun exposure, again very very basically, UVB radiation converts 72 00:04:50,760 --> 00:04:55,640 Speaker 1: cholesterol in the skin to kulic house for all, which 73 00:04:55,800 --> 00:04:58,320 Speaker 1: is the more formal name for vitamin D three. 74 00:04:59,120 --> 00:05:03,200 Speaker 2: This requires direct exposure to the sun because UVB is 75 00:05:03,320 --> 00:05:07,359 Speaker 2: blocked by things like glass and clothing. Can also be 76 00:05:07,440 --> 00:05:10,200 Speaker 2: blocked or at least reduced by things like fog and 77 00:05:10,320 --> 00:05:14,880 Speaker 2: air pollution. UVB radiation is also affected by the Earth's 78 00:05:14,920 --> 00:05:18,840 Speaker 2: atmosphere and the angle at which sunlight reaches the surface. 79 00:05:18,480 --> 00:05:22,080 Speaker 1: Of the Earth. Areas of very high latitudes get a 80 00:05:22,120 --> 00:05:25,840 Speaker 1: lot less UVB light than the tropics do, and since 81 00:05:25,920 --> 00:05:29,159 Speaker 1: melanin protects the body from UV light, the amount of 82 00:05:29,240 --> 00:05:32,720 Speaker 1: vitamin D that a person's own body can synthesize is 83 00:05:32,760 --> 00:05:35,400 Speaker 1: affected by how much melanin they have in their skin. 84 00:05:36,360 --> 00:05:40,080 Speaker 1: People with more melanin, meaning people who are darker skinned, 85 00:05:40,320 --> 00:05:43,320 Speaker 1: need more sun exposure to be able to synthesize enough 86 00:05:43,400 --> 00:05:46,000 Speaker 1: vitamin D than people with lighter skin. 87 00:05:46,839 --> 00:05:50,760 Speaker 2: We don't really know whether ricketts was a widespread problem 88 00:05:50,920 --> 00:05:54,480 Speaker 2: during early human history, but it might not have been. 89 00:05:55,040 --> 00:05:59,000 Speaker 2: Early hunters and gatherers, and then later on early farmers 90 00:05:59,040 --> 00:06:01,880 Speaker 2: would have been spending a lot of time outside in 91 00:06:02,000 --> 00:06:05,719 Speaker 2: the sun. In the tropics, where in the long ago 92 00:06:05,880 --> 00:06:09,000 Speaker 2: past more people had more melanin in their skin. The 93 00:06:09,080 --> 00:06:11,400 Speaker 2: sun was also a lot more direct, so they would 94 00:06:11,400 --> 00:06:15,200 Speaker 2: have been getting more UVB exposure. Of course, those things 95 00:06:15,240 --> 00:06:20,039 Speaker 2: are interconnected, the UV light and the melanin. Conversely, in 96 00:06:20,080 --> 00:06:23,839 Speaker 2: the far north, for example, people had less exposure to 97 00:06:23,920 --> 00:06:27,080 Speaker 2: sunlight since even during the long days of the summer, 98 00:06:27,120 --> 00:06:30,159 Speaker 2: the sun's rays just aren't as direct, and people also 99 00:06:30,440 --> 00:06:33,599 Speaker 2: tended to wear more clothing because it was colder. But 100 00:06:33,680 --> 00:06:37,240 Speaker 2: these indigenous peoples have also historically had a diet that 101 00:06:37,400 --> 00:06:41,160 Speaker 2: is rich in vitamin D. People still living in the 102 00:06:41,200 --> 00:06:44,560 Speaker 2: same places that their ancestors did, following the same traditions 103 00:06:44,600 --> 00:06:47,640 Speaker 2: and lifeways, are probably getting a lot of their vitamin 104 00:06:47,680 --> 00:06:51,360 Speaker 2: D these same ways today. At the same time, it 105 00:06:51,440 --> 00:06:54,880 Speaker 2: is possible and maybe even likely, that people around the 106 00:06:54,920 --> 00:06:58,360 Speaker 2: world did historically go through periods when they weren't getting 107 00:06:58,440 --> 00:07:02,120 Speaker 2: enough vitamin D actually in the winter or during times 108 00:07:02,120 --> 00:07:05,120 Speaker 2: of famine, but this might not have been an ongoing 109 00:07:05,200 --> 00:07:08,040 Speaker 2: problem since most people would have been spending more time 110 00:07:08,080 --> 00:07:12,800 Speaker 2: outside again in the spring. One big exception here, at 111 00:07:12,880 --> 00:07:17,080 Speaker 2: least in theory, is babies. Because breast milk alone does 112 00:07:17,120 --> 00:07:21,360 Speaker 2: not provide infants with enough vitamin D. It would take 113 00:07:21,640 --> 00:07:25,240 Speaker 2: a lot of vitamin D supplementation for a person to 114 00:07:25,480 --> 00:07:28,920 Speaker 2: produce breast milk that was really rich in vitamin D 115 00:07:29,560 --> 00:07:33,200 Speaker 2: like way beyond what someone would get through ordinary food 116 00:07:33,320 --> 00:07:38,560 Speaker 2: and sunlight. So throughout history, babies who were breastfed and 117 00:07:38,600 --> 00:07:41,720 Speaker 2: then also swaddled or covered up or kept out of 118 00:07:41,760 --> 00:07:46,080 Speaker 2: the sun could be susceptible to rickets. Today, various health 119 00:07:46,160 --> 00:07:50,280 Speaker 2: organizations around the world recommend that breastfed babies be given 120 00:07:50,320 --> 00:07:55,400 Speaker 2: a vitamin D supplement, especially if they are exclusively breastfed. 121 00:07:56,120 --> 00:07:59,960 Speaker 1: We do have some evidence of rickets in the archaeological record. 122 00:08:00,480 --> 00:08:04,320 Speaker 1: In twenty thirteen, archaeologists in Scotland announced the discovery of 123 00:08:04,360 --> 00:08:08,520 Speaker 1: a five thousand year old skeleton that showed evidence of rickets. 124 00:08:08,720 --> 00:08:12,800 Speaker 1: That is the oldest example discovered so far. Prior to 125 00:08:12,840 --> 00:08:15,920 Speaker 1: this discovery, the oldest skeletons known to have signs of 126 00:08:15,960 --> 00:08:18,840 Speaker 1: rickets were from the Roman Era, and there's some evidence 127 00:08:18,880 --> 00:08:21,720 Speaker 1: to suggest that it may have been more widespread in 128 00:08:21,760 --> 00:08:26,160 Speaker 1: the Roman Empire. For example, in twenty eighteen, researchers from 129 00:08:26,280 --> 00:08:30,560 Speaker 1: Historic England and McMaster University in Canada surveyed Roman Era 130 00:08:30,640 --> 00:08:34,640 Speaker 1: skeletons from cemeteries from what's now northern England down to 131 00:08:34,720 --> 00:08:38,120 Speaker 1: southern Spain, and they found evidence of rickets in more 132 00:08:38,160 --> 00:08:42,160 Speaker 1: than one in twenty. Children with babies most often affected. 133 00:08:43,240 --> 00:08:47,600 Speaker 2: What may be the earliest written description of rickets also 134 00:08:47,679 --> 00:08:51,640 Speaker 2: comes from the Roman Era. Serranus of Ephesus wrote a 135 00:08:51,679 --> 00:08:55,760 Speaker 2: treatise on gynecology around the first or second century CE. 136 00:08:56,800 --> 00:09:00,440 Speaker 2: It includes a section about the care of newborns. The section, 137 00:09:00,600 --> 00:09:05,280 Speaker 2: he advises loosening a baby's swaddling clothes only after their 138 00:09:05,360 --> 00:09:08,640 Speaker 2: body has become reasonably firm, so that it does not 139 00:09:08,720 --> 00:09:14,080 Speaker 2: become distorted. Serranus also recommends not letting babies try to 140 00:09:14,240 --> 00:09:17,679 Speaker 2: sit up too early or for too long, because that 141 00:09:17,720 --> 00:09:21,199 Speaker 2: could cause them to become hunchbacked, and he says if 142 00:09:21,200 --> 00:09:23,680 Speaker 2: a baby is allowed to try to walk too early, 143 00:09:23,960 --> 00:09:29,120 Speaker 2: their legs can become distorted. Bow legs and spinal curvatures 144 00:09:29,160 --> 00:09:32,640 Speaker 2: are two of the most recognizable symptoms of rickets, so 145 00:09:32,720 --> 00:09:35,800 Speaker 2: this is often interpreted as a description of the condition. 146 00:09:36,800 --> 00:09:39,840 Speaker 2: There is some debate about whether that's really what he's 147 00:09:39,880 --> 00:09:43,440 Speaker 2: talking about, but Siranis is generally more accepted as the 148 00:09:43,480 --> 00:09:47,480 Speaker 2: first description of rickets than some earlier but even more 149 00:09:47,559 --> 00:09:53,440 Speaker 2: vague possibilities. Yes, sometimes it's a brief sentence that sort 150 00:09:53,440 --> 00:09:57,160 Speaker 2: of seems like maybe someone's leg was growing in a 151 00:09:57,200 --> 00:09:57,840 Speaker 2: strange way. 152 00:09:58,080 --> 00:10:00,160 Speaker 1: Could that have been rickets? Maybe? 153 00:10:01,120 --> 00:10:05,080 Speaker 2: Of course, rickets is definitely not caused by unswaddling a 154 00:10:05,120 --> 00:10:08,720 Speaker 2: baby too early. It is not caused by letting babies 155 00:10:08,760 --> 00:10:12,040 Speaker 2: try to stand up too soon after they're born. And 156 00:10:12,080 --> 00:10:14,679 Speaker 2: we really don't have any way to know if what 157 00:10:14,880 --> 00:10:18,000 Speaker 2: Serranus is describing in this passage is something that he 158 00:10:18,280 --> 00:10:21,199 Speaker 2: also would have recognized in the children from that twenty 159 00:10:21,240 --> 00:10:24,320 Speaker 2: eighteen study we mentioned, or if the children in that 160 00:10:24,480 --> 00:10:27,280 Speaker 2: study were seen as having some kind of illness or 161 00:10:27,320 --> 00:10:30,559 Speaker 2: condition relating to their bones while they were alive. 162 00:10:31,440 --> 00:10:34,440 Speaker 1: Ricketts was not recognized as a disease with a name 163 00:10:34,679 --> 00:10:37,240 Speaker 1: until the early modern period, and we're going to get 164 00:10:37,240 --> 00:10:39,680 Speaker 1: into that after we pause for a sponsor break. 165 00:10:49,320 --> 00:10:52,760 Speaker 2: Rickets seems to have been a more widespread problem in 166 00:10:52,800 --> 00:10:55,480 Speaker 2: parts of Europe in the sixteenth and seventeenth centuries, or 167 00:10:55,520 --> 00:10:58,280 Speaker 2: at least that is when it seems to start showing 168 00:10:58,360 --> 00:11:02,360 Speaker 2: up more in artwork and in written records. In fifteen 169 00:11:02,360 --> 00:11:06,720 Speaker 2: oh nine, German painter Hans Borkmeyer the Elder painted a 170 00:11:06,840 --> 00:11:10,200 Speaker 2: version of the Virgin and Child in which the infant 171 00:11:10,280 --> 00:11:14,440 Speaker 2: Jesus appears to have bowed legs and other possible signs 172 00:11:14,440 --> 00:11:19,680 Speaker 2: of rickets. In fifteen thirty two, German physician Hieronymous Roisner 173 00:11:19,720 --> 00:11:24,400 Speaker 2: described a disease that occurred only in children whose symptoms 174 00:11:24,400 --> 00:11:29,640 Speaker 2: included weakness, bowed legs, and chest malformations. Roisner said this 175 00:11:29,760 --> 00:11:32,599 Speaker 2: disease was common in Holland and Switzerland. 176 00:11:33,280 --> 00:11:37,079 Speaker 1: In fifteen fifty four, Theodosius of Bologna described a child 177 00:11:37,160 --> 00:11:41,079 Speaker 1: who was very pale and had an unusual spinal curvature 178 00:11:41,200 --> 00:11:44,720 Speaker 1: which could have been rickets. Other accounts in the late 179 00:11:44,760 --> 00:11:48,320 Speaker 1: sixteenth century described children whose bones were bent and who 180 00:11:48,400 --> 00:11:53,559 Speaker 1: seemed to have some kind of wasting disease. In sixteen fourteen, 181 00:11:53,800 --> 00:11:56,840 Speaker 1: a visitor to a monastery in the Netherlands, which was 182 00:11:56,880 --> 00:12:00,680 Speaker 1: at the time part of the Dutch Republic, described children 183 00:12:00,960 --> 00:12:05,280 Speaker 1: being treated with water from a well dedicated to Saint Willibrard. 184 00:12:06,200 --> 00:12:10,640 Speaker 1: These children were described as having Saint Willibard's infirmity or 185 00:12:10,679 --> 00:12:15,160 Speaker 1: the ailment of Saint Willibrard. One of the symptoms was a. 186 00:12:15,120 --> 00:12:19,120 Speaker 2: Series of knobs on the children's ribs, described as being 187 00:12:19,280 --> 00:12:24,440 Speaker 2: like pinheads or rosary beads, or something of a similar size. 188 00:12:24,480 --> 00:12:27,439 Speaker 2: Some of these children were also described as having the 189 00:12:27,600 --> 00:12:31,400 Speaker 2: ailment of Saint Macketus, in which their legs appeared as 190 00:12:31,400 --> 00:12:34,800 Speaker 2: though they were sitting cross legged. It was possible for 191 00:12:34,880 --> 00:12:37,600 Speaker 2: a child to have both of these ailments at once. 192 00:12:38,400 --> 00:12:40,920 Speaker 2: As we said earlier, bowed legs are one of the 193 00:12:40,960 --> 00:12:45,840 Speaker 2: most recognizable signs of rickets. Another is called richitic rosary. 194 00:12:46,600 --> 00:12:49,520 Speaker 2: These are knobs that develop where each rib connects to 195 00:12:49,559 --> 00:12:52,640 Speaker 2: the costal cartilage on the front of a person's rib cage, 196 00:12:53,160 --> 00:12:55,400 Speaker 2: and they're named for their resemblance to a string of 197 00:12:55,520 --> 00:12:59,200 Speaker 2: rosary beads. So it seems likely that at least some 198 00:12:59,280 --> 00:13:02,520 Speaker 2: of these children that Tracy was just shoying about had rickets. 199 00:13:03,200 --> 00:13:07,400 Speaker 2: There were also other Willibrard wells and springs around the Netherlands, 200 00:13:07,480 --> 00:13:10,000 Speaker 2: and their water was similarly used to try to treat 201 00:13:10,080 --> 00:13:14,640 Speaker 2: children who had these conditions. The first known use of 202 00:13:14,679 --> 00:13:17,960 Speaker 2: the word rickets and writing was a couple of decades 203 00:13:18,040 --> 00:13:22,280 Speaker 2: after this visitor report. Unlike most of the first uses 204 00:13:22,320 --> 00:13:24,720 Speaker 2: and writing we've talked about before, this was not in 205 00:13:24,800 --> 00:13:29,200 Speaker 2: published material. It was a handwritten receipt book belonging to 206 00:13:29,240 --> 00:13:33,400 Speaker 2: the Fairfax family of Yorkshire, England. People used to call 207 00:13:33,520 --> 00:13:37,880 Speaker 2: recipes receipts, and the word receipt could also apply specifically 208 00:13:37,960 --> 00:13:42,400 Speaker 2: to the ingredients and methods used to make medicinal preparations. 209 00:13:43,040 --> 00:13:46,680 Speaker 2: This particular receipt book had belonged to Mary Chumley, who 210 00:13:46,720 --> 00:13:50,680 Speaker 2: married the Reverend Henry Fairfax in sixteen twenty six. The 211 00:13:50,720 --> 00:13:53,960 Speaker 2: book remained in the family, with people recording recipes for 212 00:13:54,040 --> 00:13:58,320 Speaker 2: things like foods, medicines, and household preparations into the late 213 00:13:58,360 --> 00:14:02,480 Speaker 2: eighteenth century. Some of the entries were attributed to well 214 00:14:02,520 --> 00:14:05,719 Speaker 2: known physicians of the day, and others came from relatives 215 00:14:05,800 --> 00:14:09,880 Speaker 2: or friends. An entry for February twenty fifth, sixteen thirty 216 00:14:09,880 --> 00:14:15,320 Speaker 2: two includes five remedies for rickets in children, attributed to 217 00:14:15,360 --> 00:14:19,240 Speaker 2: the reverend's cousin, Lady Fairfax of Steaton. There are also 218 00:14:19,400 --> 00:14:23,320 Speaker 2: various recipes labeled for the rickets, and one marked for 219 00:14:23,480 --> 00:14:26,359 Speaker 2: a child that is weak or lame in her joints. 220 00:14:27,200 --> 00:14:31,040 Speaker 2: None of these remedies would have been effective in treating rickets. 221 00:14:31,200 --> 00:14:35,000 Speaker 2: They included things like ointments made of herbs minced into butter, 222 00:14:35,640 --> 00:14:38,800 Speaker 2: and drinks being made of things like herbs or dried 223 00:14:38,880 --> 00:14:42,640 Speaker 2: fruit boiled in water or ale. But this suggests that 224 00:14:42,680 --> 00:14:45,280 Speaker 2: by the first quarter of the seventeenth century, people in 225 00:14:45,400 --> 00:14:48,400 Speaker 2: England knew about a disease that they were calling rickets, 226 00:14:48,480 --> 00:14:50,480 Speaker 2: and that they were trying to figure out ways to 227 00:14:50,520 --> 00:14:53,600 Speaker 2: treat it. The first use of the word rickets in 228 00:14:53,680 --> 00:14:56,880 Speaker 2: published material was in the Annual Bill of Mortality of 229 00:14:56,920 --> 00:15:00,520 Speaker 2: the City of London in sixteen thirty four. This was 230 00:15:00,600 --> 00:15:03,520 Speaker 2: only the fifth year that the Annual Bill of Mortality 231 00:15:03,640 --> 00:15:08,560 Speaker 2: included causes of death. This information was gathered by people 232 00:15:08,760 --> 00:15:14,040 Speaker 2: called searchers, who were described as elderly matrons. Made a 233 00:15:14,080 --> 00:15:17,000 Speaker 2: lot of sense for older women to be doing this job, 234 00:15:17,640 --> 00:15:20,600 Speaker 2: since they were typically involved in laying out the dead 235 00:15:20,720 --> 00:15:24,640 Speaker 2: and preparing people's bodies for burial. Good fit for them 236 00:15:24,640 --> 00:15:28,200 Speaker 2: to also be the people determining cause of death. Since 237 00:15:28,280 --> 00:15:31,920 Speaker 2: older women often cared for sick people. People also thought 238 00:15:31,960 --> 00:15:35,400 Speaker 2: they might have some protection from whatever illness a person 239 00:15:35,480 --> 00:15:39,720 Speaker 2: might have died of, and that experience could also theoretically 240 00:15:39,760 --> 00:15:43,040 Speaker 2: help them identify and describe a person's cause of death. 241 00:15:43,960 --> 00:15:47,360 Speaker 2: At the same time, these women typically didn't have access 242 00:15:47,520 --> 00:15:50,880 Speaker 2: to a formal education. Most of them could not read 243 00:15:50,920 --> 00:15:53,640 Speaker 2: or write, so they gave their reports to the clerk orly, 244 00:15:54,400 --> 00:15:57,120 Speaker 2: and that means we don't have any details or notes 245 00:15:57,160 --> 00:15:59,760 Speaker 2: about how they determined the causes of death. 246 00:16:00,240 --> 00:16:03,320 Speaker 1: So at the time, these searchers were seen as knowledgeable 247 00:16:03,360 --> 00:16:06,880 Speaker 1: and respected members of their community who were doing important work, 248 00:16:07,000 --> 00:16:10,080 Speaker 1: but today their reports are not really seen as an 249 00:16:10,080 --> 00:16:12,440 Speaker 1: accurate accounting of what people were dying of. 250 00:16:13,920 --> 00:16:17,640 Speaker 2: All of that said, in sixteen thirty four, the annual 251 00:16:17,680 --> 00:16:21,000 Speaker 2: Bill of Mortality of the City of London reported that 252 00:16:21,120 --> 00:16:25,000 Speaker 2: fourteen people died of ricketts out of almost eleven thousand 253 00:16:25,120 --> 00:16:29,360 Speaker 2: total deaths in the city. And while no English medical 254 00:16:29,400 --> 00:16:33,680 Speaker 2: treatises have been unearthed that mention rickets before this point, 255 00:16:34,200 --> 00:16:37,000 Speaker 2: it seems like it must have been something the medical 256 00:16:37,000 --> 00:16:40,800 Speaker 2: community would have been aware of, otherwise how would it 257 00:16:40,840 --> 00:16:43,880 Speaker 2: be reported as a cause of death in this official document. 258 00:16:44,760 --> 00:16:47,760 Speaker 2: The first known clinical description of ricketts was written by 259 00:16:47,840 --> 00:16:51,080 Speaker 2: Daniel Whistler in his MD thesis at the University of 260 00:16:51,160 --> 00:16:53,680 Speaker 2: Leyten in the Netherlands, that is where a lot of 261 00:16:53,720 --> 00:16:57,120 Speaker 2: people from Britain and Ireland went to study medicine. And 262 00:16:57,160 --> 00:17:00,320 Speaker 2: this was written in Latin and its title translation to 263 00:17:00,840 --> 00:17:04,480 Speaker 2: concerning the Disease of English Children, which in English it 264 00:17:04,560 --> 00:17:09,320 Speaker 2: is called rickets. Whistler defended this thesis on October eighteenth, 265 00:17:09,359 --> 00:17:12,359 Speaker 2: sixteen forty five, and he would eventually go on to 266 00:17:12,359 --> 00:17:16,920 Speaker 2: be the President of the College of Physicians. In this work, 267 00:17:17,000 --> 00:17:21,040 Speaker 2: Whistler described rickets as common in England. He listed a 268 00:17:21,040 --> 00:17:25,959 Speaker 2: series of symptoms, including enlargements at the ends of the bones, weakness, 269 00:17:26,200 --> 00:17:32,560 Speaker 2: deformities of the limbs, unusually flexible joints, delayed emergence of 270 00:17:32,600 --> 00:17:36,080 Speaker 2: the teeth, decay in the teeth once they had emerged, 271 00:17:36,400 --> 00:17:41,200 Speaker 2: and chest malformations. All of these very physically recognizable signs 272 00:17:41,200 --> 00:17:44,600 Speaker 2: of rickets. He also listed some other symptoms that were 273 00:17:44,640 --> 00:17:48,840 Speaker 2: not related to the skeletal system, like cough, fever, irregular pulse, 274 00:17:48,920 --> 00:17:53,240 Speaker 2: and digestive distress. Some of these can occur in severe 275 00:17:53,320 --> 00:17:57,840 Speaker 2: cases of rickets. He speculated that rickets was caused when 276 00:17:57,920 --> 00:18:01,080 Speaker 2: blood clots form in the viscer, and he said that 277 00:18:01,119 --> 00:18:05,240 Speaker 2: the disease was often fatal, especially in children who were 278 00:18:05,280 --> 00:18:09,800 Speaker 2: affected with it from birth. Whistler also described rickets as 279 00:18:09,800 --> 00:18:14,000 Speaker 2: something that was most frequent in England's wealthiest people, with 280 00:18:14,119 --> 00:18:17,760 Speaker 2: the next most affected group being the poor. He thought 281 00:18:17,760 --> 00:18:18,280 Speaker 2: that as. 282 00:18:18,160 --> 00:18:21,080 Speaker 1: A group, people in the middle were the least affected 283 00:18:21,119 --> 00:18:24,240 Speaker 1: by ricketts. He attributed the rate of ricketts among the 284 00:18:24,280 --> 00:18:27,320 Speaker 1: wealthy to the use of wet nurses, and when it 285 00:18:27,359 --> 00:18:31,359 Speaker 1: came to poor people, he blamed quote the intemperance of parents. 286 00:18:32,440 --> 00:18:36,080 Speaker 1: Other works on ricketts soon followed. One was a book 287 00:18:36,160 --> 00:18:39,440 Speaker 1: chapter by Arnold boot which was printed as part of 288 00:18:39,480 --> 00:18:42,560 Speaker 1: a book on medicine that came out in sixteen forty nine. 289 00:18:43,240 --> 00:18:46,800 Speaker 1: Boot was born in Holland and practiced medicine in Ireland. 290 00:18:47,760 --> 00:18:52,159 Speaker 1: Then in sixteen fifty English physician Francis Glisson printed the 291 00:18:52,320 --> 00:18:57,360 Speaker 1: longest and best known seventeenth century treatise on rickets. Its 292 00:18:57,440 --> 00:19:00,879 Speaker 1: title translated to a Treatise of the rickets being a 293 00:19:00,960 --> 00:19:05,760 Speaker 1: disease common to children. Glisson's work was so influential that 294 00:19:05,800 --> 00:19:09,720 Speaker 1: some people started calling rickets glistens disease, and in some 295 00:19:09,840 --> 00:19:12,640 Speaker 1: other parts of Europe it was known as English disease. 296 00:19:13,560 --> 00:19:16,280 Speaker 1: All these works were written in Latin, which was the 297 00:19:16,320 --> 00:19:19,959 Speaker 1: shared language of the European medical community, but most of 298 00:19:19,960 --> 00:19:22,639 Speaker 1: them used the English word rickets for the name of 299 00:19:22,640 --> 00:19:26,639 Speaker 1: the disease. Most of the people writing about rickets in 300 00:19:26,680 --> 00:19:29,760 Speaker 1: the mid seventeenth century thought it was a new disease 301 00:19:30,160 --> 00:19:33,200 Speaker 1: that had only been seen for the previous couple of decades. 302 00:19:34,040 --> 00:19:36,000 Speaker 1: It's possible that this was just. 303 00:19:36,000 --> 00:19:40,440 Speaker 2: Connected to growing awareness and more doctors starting to look 304 00:19:40,480 --> 00:19:44,399 Speaker 2: for this disease, but it's also possible that rickets was 305 00:19:44,480 --> 00:19:48,439 Speaker 2: becoming a bigger issue. This was during the period of 306 00:19:48,520 --> 00:19:51,480 Speaker 2: regional cooling known as the Little Ice Age, when parts 307 00:19:51,520 --> 00:19:54,760 Speaker 2: of the world, including parts of Europe, were generally cooler 308 00:19:54,880 --> 00:19:59,000 Speaker 2: and wetter and cloudier. This could have affected how much 309 00:19:59,080 --> 00:20:03,520 Speaker 2: sunlike people. It also led to poor harvests and food 310 00:20:03,560 --> 00:20:07,199 Speaker 2: shortages that could have led to other nutrient deficiencies that 311 00:20:07,240 --> 00:20:11,200 Speaker 2: people might have mistaken for rickets, and it's also possible 312 00:20:11,240 --> 00:20:14,720 Speaker 2: that in major cities air pollution was becoming a factor. 313 00:20:15,240 --> 00:20:19,000 Speaker 2: London in particular, was described as being blanketed in a 314 00:20:19,040 --> 00:20:22,520 Speaker 2: cloud of smog that could be seen from miles away. 315 00:20:23,320 --> 00:20:26,160 Speaker 2: We will be talking about that more in a future episode. 316 00:20:27,240 --> 00:20:30,480 Speaker 2: It is likely that people were experiencing rickets in other 317 00:20:30,520 --> 00:20:33,000 Speaker 2: parts of the world as well, but most of the 318 00:20:33,080 --> 00:20:36,480 Speaker 2: writing about it is from northern and western Europe, and 319 00:20:36,560 --> 00:20:39,440 Speaker 2: at this point there was no effective treatment being used 320 00:20:39,440 --> 00:20:42,960 Speaker 2: in Europe. The idea of four humors was still a 321 00:20:43,119 --> 00:20:46,000 Speaker 2: very big part of medicine, so most of the proposed 322 00:20:46,000 --> 00:20:49,800 Speaker 2: treatments were influenced by that. In general, they did not 323 00:20:50,040 --> 00:20:51,600 Speaker 2: include any vitamin D. 324 00:20:52,720 --> 00:20:54,920 Speaker 1: No. We will get to. 325 00:20:54,880 --> 00:20:58,600 Speaker 2: The first effective treatments for rickets after a sponsor break. 326 00:21:08,160 --> 00:21:12,240 Speaker 2: The first effective treatment for rickets was cod liver oil, 327 00:21:12,480 --> 00:21:16,440 Speaker 2: which we know today is high in vitamin D. As 328 00:21:16,480 --> 00:21:19,000 Speaker 2: that name suggests, this is an oil made from the 329 00:21:19,040 --> 00:21:23,320 Speaker 2: liver of Atlantic cod. An Atlantic cod live in coastal 330 00:21:23,440 --> 00:21:28,280 Speaker 2: waters in the Northern Atlantic Ocean. By the seventeen hundreds, 331 00:21:28,320 --> 00:21:30,720 Speaker 2: people who lived in areas that were home to a 332 00:21:30,760 --> 00:21:33,920 Speaker 2: lot of cod fishing had started using cod liver oil 333 00:21:34,000 --> 00:21:37,680 Speaker 2: for a range of medicinal purposes, including as a treatment 334 00:21:37,760 --> 00:21:43,320 Speaker 2: for arthritis, sciatica, tuberculosis, and scropula, which is a swelling 335 00:21:43,440 --> 00:21:45,840 Speaker 2: of the lymph nodes in the neck that is typically 336 00:21:45,920 --> 00:21:50,800 Speaker 2: caused by tuberculosis. The discovery of cod liver oil as 337 00:21:50,800 --> 00:21:54,000 Speaker 2: a rickets treatment may have been an accident. A lot 338 00:21:54,040 --> 00:21:57,280 Speaker 2: of children who had rickets also had other conditions, such 339 00:21:57,280 --> 00:22:01,359 Speaker 2: as tuberculosis, and some were more generally manourished. So in 340 00:22:01,400 --> 00:22:04,720 Speaker 2: the eighteenth century, doctors and hospitals were using cod liver 341 00:22:04,760 --> 00:22:07,479 Speaker 2: oil to treat a range of ailments and as a 342 00:22:07,520 --> 00:22:11,760 Speaker 2: source of fat and calories for malnourished children. And people 343 00:22:11,800 --> 00:22:16,280 Speaker 2: started noticing improvements in children who were recognized as having rickets, 344 00:22:16,720 --> 00:22:19,600 Speaker 2: and children who weren't diagnosed with rickets but were just 345 00:22:19,600 --> 00:22:23,480 Speaker 2: seen as small and sick started growing more and faster 346 00:22:23,600 --> 00:22:26,880 Speaker 2: than could be explained simply by getting more food to eat. 347 00:22:27,480 --> 00:22:31,160 Speaker 2: By the early nineteenth century, another proposed treatment for rickets 348 00:22:31,280 --> 00:22:37,399 Speaker 2: was sunlight. Polish physician yed Rej Sniodeki proposed sunlight as 349 00:22:37,400 --> 00:22:40,480 Speaker 2: a cure for rickets as early as eighteen twenty two. 350 00:22:41,480 --> 00:22:44,520 Speaker 2: He wrote a book whose title translates to on the 351 00:22:44,520 --> 00:22:47,639 Speaker 2: Physical Education of Children, and it had a chapter on 352 00:22:47,920 --> 00:22:51,800 Speaker 2: the English disease. In that chapter, he said that if 353 00:22:51,840 --> 00:22:54,879 Speaker 2: parents were financially able, they should take their children to 354 00:22:54,960 --> 00:22:57,920 Speaker 2: the country to keep them in the dry, open air. 355 00:22:58,600 --> 00:23:01,320 Speaker 2: And he said it was particular important that they be 356 00:23:01,359 --> 00:23:05,000 Speaker 2: in the sun because the sun's action on the body 357 00:23:05,200 --> 00:23:08,160 Speaker 2: was one of the most efficient methods for the prevention 358 00:23:08,359 --> 00:23:12,119 Speaker 2: and cure of rickets. I do not know how he 359 00:23:12,240 --> 00:23:16,680 Speaker 2: came to that conclusion, but it was correct. It may 360 00:23:16,680 --> 00:23:19,640 Speaker 2: have just been that general fresh air and the great 361 00:23:19,720 --> 00:23:22,800 Speaker 2: outdoors is good for kids. There was a lot of 362 00:23:22,840 --> 00:23:25,359 Speaker 2: fresh air and sunlight focused, so it just might have 363 00:23:25,480 --> 00:23:30,760 Speaker 2: been that Snandeki cited densely populated English towns as places 364 00:23:30,800 --> 00:23:34,520 Speaker 2: where rickets was common. He described such towns as having 365 00:23:34,600 --> 00:23:38,600 Speaker 2: narrow streets and poorly lit dwellings, places where people would 366 00:23:38,600 --> 00:23:41,320 Speaker 2: not get a lot of sun and starting in the 367 00:23:41,359 --> 00:23:44,320 Speaker 2: eighteenth century in the UK and in other parts of 368 00:23:44,320 --> 00:23:46,520 Speaker 2: the world, more and more people. 369 00:23:46,240 --> 00:23:49,040 Speaker 1: Were living this way. In the wake of the Industrial Revolution, 370 00:23:50,119 --> 00:23:52,760 Speaker 1: more people were moving from the country to towns and 371 00:23:52,840 --> 00:23:57,520 Speaker 1: cities and were working indoors in factories, and this included children. 372 00:23:58,320 --> 00:24:00,920 Speaker 1: The air pollution problems that it are already been observed 373 00:24:00,960 --> 00:24:04,080 Speaker 1: back in the seventeenth century, we're also getting worse because 374 00:24:04,440 --> 00:24:08,639 Speaker 1: many of those factories were powered by burning coal. Soon 375 00:24:09,000 --> 00:24:12,720 Speaker 1: ricketts was being associated with the urban poor, particularly in 376 00:24:12,760 --> 00:24:16,320 Speaker 1: the UK, but in other industrialized nations as well. 377 00:24:17,200 --> 00:24:20,560 Speaker 2: It's possible that there may have also been some dietary 378 00:24:20,720 --> 00:24:23,640 Speaker 2: changes involved in this as people moved to the cities, 379 00:24:24,359 --> 00:24:27,560 Speaker 2: especially for example, they moved from the coast, where they 380 00:24:27,560 --> 00:24:30,600 Speaker 2: were eating a lot of fish, to somewhere farther inland 381 00:24:30,680 --> 00:24:34,960 Speaker 2: where they were not. One potential factor in London was 382 00:24:35,040 --> 00:24:38,800 Speaker 2: also the use of alum to whiten poor quality flour. 383 00:24:39,640 --> 00:24:43,480 Speaker 2: Physician John Snow, most famous today for tracing the source 384 00:24:43,480 --> 00:24:47,720 Speaker 2: of a cholera outbreak in London, understood that rickets was 385 00:24:47,720 --> 00:24:51,959 Speaker 2: a disease that affected the mineralization of bone. In eighteen 386 00:24:52,040 --> 00:24:55,600 Speaker 2: fifty seven, he published a paper arguing that alam was 387 00:24:55,680 --> 00:24:58,879 Speaker 2: binding to phosphorus in the intestines of people who ate 388 00:24:58,960 --> 00:25:02,520 Speaker 2: a lot of cheap bread and that kept their bones 389 00:25:02,520 --> 00:25:08,360 Speaker 2: for mineralizing. People did already know what phosphorus was. Hennig 390 00:25:08,440 --> 00:25:12,600 Speaker 2: Brand had figured that out after boiling huge amounts of urine. 391 00:25:12,680 --> 00:25:16,760 Speaker 2: Just enormous amounts of urine way back in sixteen sixty nine. 392 00:25:17,200 --> 00:25:21,480 Speaker 2: We have scheduled that as an upcoming Saturday classic. I 393 00:25:21,520 --> 00:25:24,520 Speaker 2: got a fifteen hundred gallons a year and advised the 394 00:25:24,560 --> 00:25:28,680 Speaker 2: Piaga workshop you want to come see. In the nineteenth century, 395 00:25:28,760 --> 00:25:33,080 Speaker 2: people also started noticing rickets in other animals, including animals 396 00:25:33,080 --> 00:25:36,639 Speaker 2: that were living in the gardens of the London Zoological Society. 397 00:25:37,320 --> 00:25:41,400 Speaker 2: For example, surgeon John Bland Sutton described rickets as extremely 398 00:25:41,480 --> 00:25:44,960 Speaker 2: frequent in the monkeys living in the garden. In eighteen 399 00:25:45,000 --> 00:25:47,800 Speaker 2: eighty three, he wrote a paper titled on the Diseases 400 00:25:47,840 --> 00:25:51,080 Speaker 2: of Monkeys in the Society's Gardens, in which he said 401 00:25:51,119 --> 00:25:54,879 Speaker 2: nearly half of the monkeys in the gardens die rickety 402 00:25:55,200 --> 00:25:58,119 Speaker 2: that is his direct quote, and that healthy monkeys that 403 00:25:58,200 --> 00:26:01,280 Speaker 2: arrived in the gardens were dead of rickets within four months. 404 00:26:02,160 --> 00:26:05,639 Speaker 2: These monkeys lived in a fully glassed in enclosure that 405 00:26:05,720 --> 00:26:10,760 Speaker 2: would have blocked the UV light. By the late eighteen nineties, 406 00:26:10,880 --> 00:26:15,240 Speaker 2: two schools of thought had evolved around rickets, one that 407 00:26:15,320 --> 00:26:17,919 Speaker 2: it could be cured with cod liver oil and the 408 00:26:17,960 --> 00:26:21,040 Speaker 2: other that it could be cured with sunlight, and a 409 00:26:21,160 --> 00:26:23,720 Speaker 2: lot of doctors really thought it was one or the other, 410 00:26:24,520 --> 00:26:27,560 Speaker 2: not both, or they focused mainly on one and not 411 00:26:27,680 --> 00:26:32,560 Speaker 2: on the other. For example, physician Theobald Adrian Palm wrote 412 00:26:32,560 --> 00:26:35,640 Speaker 2: a letter to the British Medical Journal in eighteen eighty 413 00:26:35,680 --> 00:26:39,000 Speaker 2: eight in response to a report on rickets that had 414 00:26:39,080 --> 00:26:44,359 Speaker 2: made the quote want of light sound unimportant. Palm was 415 00:26:44,800 --> 00:26:49,040 Speaker 2: objecting to that dismissiveness. He had worked in Japan for 416 00:26:49,080 --> 00:26:54,320 Speaker 2: almost ten years and described rickets there as quote conspicuous 417 00:26:54,400 --> 00:27:00,800 Speaker 2: by its absence. He attributed this to Japan's abundant sunshine. 418 00:27:01,440 --> 00:27:05,040 Speaker 2: He speculated that a worldwide study would find that rickets 419 00:27:05,240 --> 00:27:10,040 Speaker 2: is directly related to an absence of sunshine. He advocated 420 00:27:10,080 --> 00:27:14,080 Speaker 2: the use of sun baths as treatment. He did, not, 421 00:27:14,280 --> 00:27:16,920 Speaker 2: at least in this piece, seemed to make any connection 422 00:27:17,560 --> 00:27:21,399 Speaker 2: with cod liver oil and the fact that the Japanese 423 00:27:21,440 --> 00:27:25,600 Speaker 2: diet included a lot of fish. Meanwhile, advocates of cod 424 00:27:25,600 --> 00:27:28,520 Speaker 2: liver oil and other fish oils were bolstered by the 425 00:27:28,560 --> 00:27:32,240 Speaker 2: work of Casimir Funk in nineteen twelve he coined the 426 00:27:32,320 --> 00:27:37,560 Speaker 2: term vital amines or vitamins to describe compounds necessary for life. 427 00:27:38,320 --> 00:27:41,520 Speaker 2: He theorized that a lack of vital amines could cause 428 00:27:41,520 --> 00:27:46,800 Speaker 2: what he called deficiency diseases, including scurvy, pelagra, and rickets. 429 00:27:47,520 --> 00:27:50,560 Speaker 2: The first vitamin to be isolated and named was vitamin 430 00:27:50,640 --> 00:27:54,119 Speaker 2: A a few years later, followed by vitamins B and C. 431 00:27:55,760 --> 00:27:59,200 Speaker 2: They were named that because that's the order of the alphabet. 432 00:28:01,080 --> 00:28:04,040 Speaker 2: The search for vitamins was partly rooted in a search 433 00:28:04,119 --> 00:28:07,520 Speaker 2: for nutrients that could prevent these diseases. When it came 434 00:28:07,520 --> 00:28:10,679 Speaker 2: to vitamin C, that disease was, of course scurvy, and 435 00:28:10,720 --> 00:28:15,000 Speaker 2: the search was for a substance with anti scorbutic properties, 436 00:28:15,080 --> 00:28:19,720 Speaker 2: meaning the ability to fight off scurvy. So with these developments, 437 00:28:19,800 --> 00:28:23,920 Speaker 2: researchers were also looking for a compound with anti rickets 438 00:28:23,920 --> 00:28:27,959 Speaker 2: properties when cod liver oil was found to be a 439 00:28:28,000 --> 00:28:31,399 Speaker 2: good source of vitamin A. After vitamin A was isolated, 440 00:28:31,440 --> 00:28:35,240 Speaker 2: people started wondering if that was the anti rocritic component, 441 00:28:36,119 --> 00:28:39,400 Speaker 2: and this led to some confusion and some kind of 442 00:28:39,480 --> 00:28:43,280 Speaker 2: overlapping research about why exactly cod liver oil was an 443 00:28:43,320 --> 00:28:47,480 Speaker 2: effective treatment for rickets. As that vitamin research was going 444 00:28:47,480 --> 00:28:50,680 Speaker 2: on there were also ongoing efforts to study the use 445 00:28:50,720 --> 00:28:54,080 Speaker 2: of both UV light and cod liver oil to treat rickets. 446 00:28:54,680 --> 00:28:59,600 Speaker 2: In nineteen eighteen and nineteen nineteen, a doctor Holdshinsky successfully 447 00:28:59,680 --> 00:29:03,000 Speaker 2: demon treated the use of UV lamps to treat rickets 448 00:29:03,000 --> 00:29:06,680 Speaker 2: in children. He also noted that using the UV lamp 449 00:29:06,800 --> 00:29:09,680 Speaker 2: on one arm treated rickets in both arms, and he 450 00:29:09,800 --> 00:29:13,440 Speaker 2: speculated that the UV light was causing the synthesis of 451 00:29:13,480 --> 00:29:16,959 Speaker 2: some kind of compound that could then circulate all throughout 452 00:29:17,000 --> 00:29:22,160 Speaker 2: the body. At around the same time, American doctors Alfred 453 00:29:22,200 --> 00:29:25,720 Speaker 2: Hesse and Lester Unger were testing cod liver oil as 454 00:29:25,760 --> 00:29:29,920 Speaker 2: a treatment and preventative for scurvy in black children in 455 00:29:29,960 --> 00:29:33,800 Speaker 2: New York City. As we noted earlier, people with darker 456 00:29:33,880 --> 00:29:36,680 Speaker 2: skin are at greater risk for rickets because of the 457 00:29:36,720 --> 00:29:39,800 Speaker 2: amount of melanin in their skin compared to the strength 458 00:29:39,880 --> 00:29:43,520 Speaker 2: of the sun at that latitude. Not as much direct 459 00:29:43,520 --> 00:29:47,560 Speaker 2: sunlight in New York than in parts of Africa, for example, 460 00:29:48,840 --> 00:29:53,040 Speaker 2: cod liver oil treatments either prevented the onset of rickets 461 00:29:53,240 --> 00:29:56,760 Speaker 2: or led to its resolution. In ninety two percent of 462 00:29:56,800 --> 00:29:59,760 Speaker 2: infants who were treated for six months, and in more 463 00:29:59,840 --> 00:30:02,280 Speaker 2: than and half of the infants who were treated for 464 00:30:02,360 --> 00:30:06,520 Speaker 2: four months. Sixteen infants in the control group were not 465 00:30:06,560 --> 00:30:09,920 Speaker 2: given any cod liver oil, and nearly all of them 466 00:30:10,040 --> 00:30:12,479 Speaker 2: had rickets by the end of six months. 467 00:30:13,320 --> 00:30:16,680 Speaker 1: Today, this study would not be viewed as ethical, since 468 00:30:16,720 --> 00:30:20,400 Speaker 1: other studies had already established that cod liver oil could 469 00:30:20,400 --> 00:30:24,360 Speaker 1: be used to treat rickets. What wasn't as well established 470 00:30:24,400 --> 00:30:27,880 Speaker 1: was whether cod liver oil could prevent rickets, not just 471 00:30:27,960 --> 00:30:30,800 Speaker 1: treat it, and this study was the first to show 472 00:30:30,880 --> 00:30:34,400 Speaker 1: that it could. The Henry Street Settlement House, which was 473 00:30:34,440 --> 00:30:38,080 Speaker 1: involved with this study, also became a rickets screening and 474 00:30:38,120 --> 00:30:41,080 Speaker 1: treatment center for the community more broadly as it was 475 00:30:41,120 --> 00:30:44,520 Speaker 1: going on. Also, we should take a moment to note 476 00:30:44,520 --> 00:30:47,640 Speaker 1: that the prevalence of rickets among black people living in 477 00:30:47,680 --> 00:30:52,520 Speaker 1: North America was used to justify racism, with racists arguing 478 00:30:52,520 --> 00:30:56,760 Speaker 1: that it signaled some kind of inherent weakness in their bodies. This, 479 00:30:56,840 --> 00:31:02,360 Speaker 1: again was just about melanin, and the vitamin D was 480 00:31:02,440 --> 00:31:07,400 Speaker 1: isolated and named not long after this study. Multiple people 481 00:31:07,480 --> 00:31:10,920 Speaker 1: contributed to its discovery, some of them through their previous 482 00:31:10,920 --> 00:31:15,280 Speaker 1: work on vitamin A. In nineteen nineteen, Edward Mellanbee wrote 483 00:31:15,280 --> 00:31:19,160 Speaker 1: about a fourth vitamin the absence of which could cause rickets, 484 00:31:19,360 --> 00:31:22,560 Speaker 1: concluding that it was either vitamin A or another fat 485 00:31:22,600 --> 00:31:25,400 Speaker 1: soluble vitamin that's found in a lot of the same 486 00:31:25,480 --> 00:31:29,400 Speaker 1: foods as vitamin A. Elmer McCollum, who had helped discover 487 00:31:29,520 --> 00:31:32,880 Speaker 1: vitamin A, differentiated the two and he was the one 488 00:31:32,880 --> 00:31:35,160 Speaker 1: who coined the name vitamin D. 489 00:31:35,800 --> 00:31:39,760 Speaker 2: In nineteen twenty two, bacteriologist Harriet Chick of the Lister 490 00:31:39,920 --> 00:31:44,280 Speaker 2: Institute of Preventive Medicine in London led a team from 491 00:31:44,320 --> 00:31:48,560 Speaker 2: the British Medical Research Council to Vienna to study ricketts there. 492 00:31:49,280 --> 00:31:52,560 Speaker 2: They had been invited by Charles Perku, director of the 493 00:31:52,680 --> 00:31:57,520 Speaker 2: University of Vienna's Kinder Clinic. This was an unusual research 494 00:31:57,560 --> 00:32:00,800 Speaker 2: team for the time because most of its members, including Chick, 495 00:32:00,880 --> 00:32:05,680 Speaker 2: were women. They divided the babies into two groups. Group 496 00:32:05,760 --> 00:32:09,440 Speaker 2: one continued on the Kinder clinics regular diet, which included 497 00:32:09,480 --> 00:32:13,200 Speaker 2: local cow's milk and sucrose, while Group two had full 498 00:32:13,280 --> 00:32:17,240 Speaker 2: cream dried milk with some added sugar supplemented with cod 499 00:32:17,240 --> 00:32:21,560 Speaker 2: liver oil. They assessed the babies for rickets using X rays. 500 00:32:22,280 --> 00:32:25,400 Speaker 2: Half of the babies in Group one developed rickets, while 501 00:32:25,520 --> 00:32:29,200 Speaker 2: none of the babies in group two did this study 502 00:32:29,200 --> 00:32:31,760 Speaker 2: took place over the course of nineteen twenty one and 503 00:32:31,880 --> 00:32:35,600 Speaker 2: nineteen twenty two, and the results were different based on 504 00:32:35,720 --> 00:32:39,760 Speaker 2: the season. Babies in Group one, who had showed signs 505 00:32:39,800 --> 00:32:43,320 Speaker 2: of rickets early in the year seemed to improve in 506 00:32:43,360 --> 00:32:46,840 Speaker 2: the spring and summer, so the team did further research 507 00:32:46,960 --> 00:32:49,520 Speaker 2: to narrow down whether this had something to do with 508 00:32:49,600 --> 00:32:54,160 Speaker 2: the quality of the local milk changing seasonally, or if 509 00:32:54,200 --> 00:32:57,040 Speaker 2: it was the fact that the babies were being placed 510 00:32:57,080 --> 00:33:00,960 Speaker 2: outside on balconies as soon as the weather was warm enough. 511 00:33:01,760 --> 00:33:05,360 Speaker 2: Eleven babies from Group one were kept strictly indoors for 512 00:33:05,360 --> 00:33:09,440 Speaker 2: about three months and developed rickets, and they all rapidly 513 00:33:09,480 --> 00:33:12,440 Speaker 2: improved after being brought outdoors when the weather allowed it. 514 00:33:13,160 --> 00:33:16,280 Speaker 2: Babies also improved after being exposed to light from a 515 00:33:16,320 --> 00:33:19,960 Speaker 2: mercury vapor lamp. The babies in group one who had 516 00:33:19,960 --> 00:33:24,040 Speaker 2: developed rickets also rapidly improved once cod liver oil was 517 00:33:24,080 --> 00:33:29,120 Speaker 2: added to their food. This study helped establish that rickets 518 00:33:29,200 --> 00:33:33,120 Speaker 2: could be treated with both cod liver oil and sunlight. 519 00:33:33,880 --> 00:33:36,920 Speaker 2: This was not the one or the other situation that 520 00:33:37,120 --> 00:33:40,000 Speaker 2: a lot of researchers had been thinking that it was. 521 00:33:40,720 --> 00:33:43,920 Speaker 2: By nineteen twenty five, this was generally accepted within the 522 00:33:43,960 --> 00:33:47,000 Speaker 2: medical community, and then over the nineteen twenties and thirties, 523 00:33:47,120 --> 00:33:51,080 Speaker 2: researchers figured out how to produce vitamin D, allowing it 524 00:33:51,120 --> 00:33:53,960 Speaker 2: to be added to things like infant formula and other 525 00:33:54,040 --> 00:33:57,360 Speaker 2: food that led to a sharp decline in rates of 526 00:33:57,440 --> 00:34:01,240 Speaker 2: rickets in some parts of the world. Continues to be 527 00:34:01,280 --> 00:34:04,600 Speaker 2: an ongoing issue, though in addition to the things that 528 00:34:04,640 --> 00:34:07,760 Speaker 2: we've talked about, people who have other conditions that affect 529 00:34:07,760 --> 00:34:12,160 Speaker 2: their absorption of nutrients can certainly develop rickets. This includes 530 00:34:12,239 --> 00:34:17,040 Speaker 2: coeliac disease, inflammatory bowel disease, and cystic fibrosis. 531 00:34:16,480 --> 00:34:17,560 Speaker 1: Among others. 532 00:34:18,480 --> 00:34:21,799 Speaker 2: In more recent years, there have also been concerns that 533 00:34:22,000 --> 00:34:25,919 Speaker 2: advice to wear sunblock to prevent skin cancer has led 534 00:34:25,960 --> 00:34:30,680 Speaker 2: to a rise in rickets. This seems to be complicated 535 00:34:31,719 --> 00:34:37,439 Speaker 2: in lab studies. Unquestionably, sunblock keeps the skin from being 536 00:34:37,480 --> 00:34:41,800 Speaker 2: able to synthesize vitamin D, but in real world situations 537 00:34:41,840 --> 00:34:45,320 Speaker 2: it is not nearly as clear. Most people just don't 538 00:34:45,360 --> 00:34:50,200 Speaker 2: apply sunblock perfectly or often enough, or use enough of 539 00:34:50,320 --> 00:34:55,400 Speaker 2: the product, so at least some sun exposure is still happening. 540 00:34:56,239 --> 00:35:00,279 Speaker 2: It's possible that a bigger factor than wearing sunblock is 541 00:35:00,800 --> 00:35:03,080 Speaker 2: just the fact that some people don't go outside much 542 00:35:03,120 --> 00:35:06,640 Speaker 2: at all. Like if a child is being driven to 543 00:35:06,719 --> 00:35:09,640 Speaker 2: school and then does not have recess at school and 544 00:35:09,680 --> 00:35:13,160 Speaker 2: then comes back home and reads and plays video games 545 00:35:13,200 --> 00:35:16,560 Speaker 2: and goes to bed, not a lot of opportunity there 546 00:35:16,600 --> 00:35:18,239 Speaker 2: for direct sun exposure. 547 00:35:18,680 --> 00:35:22,000 Speaker 1: Yeah, having a flashback to our episode where we talked 548 00:35:22,000 --> 00:35:25,840 Speaker 1: about sunscreens, I'm not knocking reading and playing video games. 549 00:35:25,880 --> 00:35:30,799 Speaker 2: Those are two of my favorite pastor. I am an 550 00:35:30,840 --> 00:35:32,280 Speaker 2: advocate of sunscreened. 551 00:35:33,280 --> 00:35:35,839 Speaker 1: All of these things are important, but you must get 552 00:35:35,960 --> 00:35:41,799 Speaker 1: vitamin D. Do you have listener mail for us? I 553 00:35:42,120 --> 00:35:49,400 Speaker 1: do have listener mail. This is from Charylyn, who wrote, Hi, both, 554 00:35:49,760 --> 00:35:52,719 Speaker 1: I've been listening for over a decade. My now ex 555 00:35:52,760 --> 00:35:55,680 Speaker 1: wife used to refer to you as the Ladies because 556 00:35:55,719 --> 00:36:00,719 Speaker 1: you were and still are my food prep companions. Appreciate 557 00:36:00,800 --> 00:36:03,520 Speaker 1: the years of company, as well as the reflective and 558 00:36:03,600 --> 00:36:08,200 Speaker 1: sometimes self reflective way you addressed your work. I grew 559 00:36:08,280 --> 00:36:10,719 Speaker 1: up half an hour south of Boston, so hearing bits 560 00:36:10,760 --> 00:36:14,200 Speaker 1: of Tracy's life is like fragments from home. I now 561 00:36:14,280 --> 00:36:17,960 Speaker 1: live in Wales, and my first bit of Welsh history 562 00:36:18,400 --> 00:36:22,160 Speaker 1: from you years before I moved here. It was the 563 00:36:22,200 --> 00:36:26,000 Speaker 1: Abravan disaster and living in the Welsh valleys as I do, 564 00:36:26,280 --> 00:36:30,560 Speaker 1: understanding the mining history is an important culture point. I 565 00:36:30,600 --> 00:36:32,839 Speaker 1: have been to the graves of the children who died 566 00:36:32,840 --> 00:36:36,600 Speaker 1: in the Abravan disaster, which is absolutely heartbreaking. I almost 567 00:36:36,600 --> 00:36:39,080 Speaker 1: took this last line out because I cried writing it, 568 00:36:39,120 --> 00:36:41,680 Speaker 1: and I can picture Holly trying not to cry reading it. 569 00:36:41,760 --> 00:36:44,600 Speaker 1: But the personal connection to history and this bridge this 570 00:36:44,680 --> 00:36:49,040 Speaker 1: podcast has been is part of the point on two 571 00:36:49,080 --> 00:36:55,080 Speaker 1: iguanadons in between Boston and Wales. In between Boston and Wales, 572 00:36:55,120 --> 00:36:57,960 Speaker 1: I lived not far from Crystal Palace, which is an 573 00:36:58,000 --> 00:37:00,520 Speaker 1: area of London in addition to a park, so I 574 00:37:00,560 --> 00:37:03,799 Speaker 1: really enjoyed hearing about the creation of the park. My 575 00:37:03,920 --> 00:37:06,879 Speaker 1: shorthand for the statues has always been what the Victorian's 576 00:37:06,960 --> 00:37:09,399 Speaker 1: thought dinosaurs looked like, so it was interesting to hear 577 00:37:09,400 --> 00:37:12,520 Speaker 1: the background to them. I too was sad to think 578 00:37:12,560 --> 00:37:15,160 Speaker 1: of the people working on it seeing them already be 579 00:37:15,400 --> 00:37:18,560 Speaker 1: incorrect because of new discoveries. But they are still fun 580 00:37:18,600 --> 00:37:21,799 Speaker 1: to visit. I recommend them to anyone wanting something a 581 00:37:21,840 --> 00:37:25,760 Speaker 1: little more offbeat in London. The larger park is also lovely, 582 00:37:25,800 --> 00:37:28,600 Speaker 1: and the train station is now part of the Tube network. 583 00:37:28,920 --> 00:37:31,759 Speaker 1: It was also interesting to hear that they demolished the 584 00:37:31,800 --> 00:37:34,480 Speaker 1: Pinge mansion for the park, as Pinge is now an 585 00:37:34,520 --> 00:37:38,120 Speaker 1: area down the road slash Hill for a pet tax 586 00:37:38,160 --> 00:37:41,040 Speaker 1: I've attached my eight year old cat, Willow. Her pet 587 00:37:41,080 --> 00:37:44,239 Speaker 1: sitter got this scratching pad for Christmas, and he was 588 00:37:44,320 --> 00:37:47,640 Speaker 1: instantly appreciative. Thank you for all you do, especially as 589 00:37:47,640 --> 00:37:50,280 Speaker 1: it gets harder to access resources. You are my podcast 590 00:37:50,400 --> 00:37:53,840 Speaker 1: staple and the one I most often recommend to others. 591 00:37:53,880 --> 00:37:54,840 Speaker 2: All the best, Charlyn. 592 00:37:55,640 --> 00:37:56,160 Speaker 1: We have a. 593 00:37:56,080 --> 00:38:01,279 Speaker 2: Picture of a black cat. Computer does not want to 594 00:38:01,320 --> 00:38:05,080 Speaker 2: open it at full skies at the moment, but oh, 595 00:38:05,120 --> 00:38:06,960 Speaker 2: there we go. As soon as I said that and 596 00:38:07,040 --> 00:38:10,759 Speaker 2: tried to close the window, it appeared we have a 597 00:38:10,800 --> 00:38:15,640 Speaker 2: black cat on Christmas tree shaped one of those cardboard 598 00:38:15,719 --> 00:38:18,399 Speaker 2: like scratching pads. 599 00:38:18,440 --> 00:38:23,000 Speaker 1: Super cute. I in my house have. 600 00:38:23,280 --> 00:38:27,960 Speaker 2: A cardboard Halloween house that was bought at the pet 601 00:38:28,000 --> 00:38:31,280 Speaker 2: store on impulse a couple of years ago and became 602 00:38:31,280 --> 00:38:34,520 Speaker 2: one of Opal's favorite things. It is still in good 603 00:38:34,600 --> 00:38:38,480 Speaker 2: enough shape to still be in the house. I'm always 604 00:38:38,560 --> 00:38:41,360 Speaker 2: wondering how much longer though, until like the bottom is 605 00:38:41,440 --> 00:38:48,479 Speaker 2: all the way shredded through. How I don't know even 606 00:38:48,520 --> 00:38:51,800 Speaker 2: the right word for a person's first bit of Welsh 607 00:38:51,840 --> 00:38:56,200 Speaker 2: history before moving to Wales being the Abervan Disaster one 608 00:38:56,239 --> 00:38:58,760 Speaker 2: of the saddest episodes we have ever done. 609 00:38:58,920 --> 00:39:01,880 Speaker 1: Listen well, while you were reading, I was hoping she 610 00:39:01,960 --> 00:39:03,359 Speaker 1: was going to say it was the Mary Lloyd. 611 00:39:04,480 --> 00:39:05,239 Speaker 2: It was going to be. 612 00:39:05,560 --> 00:39:08,920 Speaker 1: Poor skeletons of the holidays, but no, Alas no. 613 00:39:09,200 --> 00:39:14,440 Speaker 2: Yeah. Now, it's so sad that I kind of erased 614 00:39:14,480 --> 00:39:17,040 Speaker 2: it from my memory for a while after we recorded it. 615 00:39:17,080 --> 00:39:18,880 Speaker 2: And when someone asked about what are some of the 616 00:39:18,920 --> 00:39:22,840 Speaker 2: saddest episodes you've ever done? I didn't mention it, and 617 00:39:22,920 --> 00:39:26,279 Speaker 2: somebody else was like, what about the Abravant Well, I 618 00:39:26,400 --> 00:39:27,760 Speaker 2: blocked it out of my head. 619 00:39:28,000 --> 00:39:31,480 Speaker 1: Is that's what hard? Same? I had some that we 620 00:39:31,520 --> 00:39:33,560 Speaker 1: had talked about that were really harrowing come up in 621 00:39:33,600 --> 00:39:35,960 Speaker 1: recent research, and I was like, I forgot we did these. 622 00:39:36,080 --> 00:39:37,600 Speaker 1: I think my brain did that on purpose. 623 00:39:38,160 --> 00:39:42,880 Speaker 2: Yeah, can only hold so much. So thank you again, 624 00:39:43,120 --> 00:39:46,480 Speaker 2: Chrilyn for this lovely email. I'm glad you enjoyed visiting 625 00:39:46,520 --> 00:39:50,200 Speaker 2: the Crystal Palace Park. Perhaps one day I will make 626 00:39:50,239 --> 00:39:53,480 Speaker 2: it and see them myself. If you would like to 627 00:39:53,520 --> 00:39:56,839 Speaker 2: send us some notes, Our email addresses History Podcast at 628 00:39:56,840 --> 00:40:00,000 Speaker 2: iHeartRadio dot com, and you can subscribe to the show 629 00:40:00,360 --> 00:40:02,840 Speaker 2: on the iHeartRadio app or anywhere else you'd like to 630 00:40:02,880 --> 00:40:10,680 Speaker 2: get your podcasts. Stuff you Missed in History Class is 631 00:40:10,719 --> 00:40:15,080 Speaker 2: a production of iHeartRadio. For more podcasts from iHeartRadio, visit 632 00:40:15,120 --> 00:40:18,560 Speaker 2: the iHeartRadio app, Apple Podcasts, or wherever you listen to 633 00:40:18,600 --> 00:40:19,440 Speaker 2: your favorite shows.