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