WEBVTT - Rickets 0:00:01.320 --> 0:00:04.240 Welcome to Stuff You Missed in History Class, a production 0:00:04.400 --> 0:00:08.719 of iHeartRadio. 0:00:12.000 --> 0:00:15.240 Hello and welcome to the podcast. I'm Tracy V. Wilson 0:00:15.400 --> 0:00:19.160 and I'm Holly Fry. Once again, I'm returning to the 0:00:19.200 --> 0:00:23.520 realm of nutritional deficiency diseases. I just find them very interesting, 0:00:24.360 --> 0:00:28.080 especially because people have really figured out how to treat them, 0:00:28.480 --> 0:00:31.760 way before they figured out exactly what was causing them, 0:00:31.800 --> 0:00:34.720 which has not always been the case with other diseases. 0:00:34.880 --> 0:00:38.960 Like scurvy is caused by vitamin SED efficiency, and people 0:00:38.960 --> 0:00:42.360 had figured out that some foods, including citrus fruit, could 0:00:42.400 --> 0:00:45.519 prevent scurvy by the seventeenth century. So today we know 0:00:45.560 --> 0:00:48.280 that these foods are good sources of vitamin C. But 0:00:48.440 --> 0:00:51.760 people made the connection between the food and the scurvy 0:00:52.720 --> 0:00:56.760 well over a century before Casimir Funk even coined the 0:00:56.800 --> 0:01:02.200 word vitamin, and that also happened before any individual vitamin 0:01:02.440 --> 0:01:08.000 had been identified and named. We have an episode on scarvey, 0:01:08.120 --> 0:01:11.160 and then last year we also did an episode on pelagra, 0:01:11.360 --> 0:01:16.600 which is caused by niasin deficiency. People were similarly treating 0:01:16.760 --> 0:01:21.280 pelagra with brewers yeast decades before we knew what niasin 0:01:21.640 --> 0:01:24.080 was or that Brewer's yeast has a lot of it 0:01:24.319 --> 0:01:29.559 in there. The discovery and identification of specific vitamins grew 0:01:29.640 --> 0:01:33.119 in part from people trying to figure out what exactly 0:01:33.240 --> 0:01:38.040 people were missing with that missing substance making them sick. 0:01:39.040 --> 0:01:43.040 Nutritional rickets is caused by a vitamin D deficiency, and 0:01:43.040 --> 0:01:46.360 people figured out two ways to treat it before we 0:01:46.440 --> 0:01:50.240 even knew what vitamin D was. So it's a fun 0:01:50.280 --> 0:01:52.160 word to say, but we don't really know where the 0:01:52.160 --> 0:01:56.760 word rickets even comes from. English physician Daniel Whistler wrote 0:01:56.800 --> 0:02:00.360 a thesis on rickets in sixteen forty five aimed that 0:02:00.400 --> 0:02:03.280 it had been named for someone who had supposedly tried 0:02:03.320 --> 0:02:07.040 to cure it, or from the term to rocket, which 0:02:07.040 --> 0:02:09.040 he said was used in parts of England to mean 0:02:09.120 --> 0:02:13.280 to breathe with difficulty. While there were people whose surname 0:02:13.560 --> 0:02:16.240 was Rickett, there's really no evidence of any of them 0:02:16.280 --> 0:02:18.799 trying to cure this disease, and it's also not clear 0:02:19.240 --> 0:02:22.880 whether there is any merit to that rocket idea. Another 0:02:23.000 --> 0:02:26.360 possibility is that it comes from German or Swedish words 0:02:26.400 --> 0:02:30.359 meaning twisting or swaying. Yeah, I went down a big 0:02:30.480 --> 0:02:33.800 rabbit hole trying to figure out if in sixteen forty five, 0:02:33.960 --> 0:02:36.960 people in parts of England were using the word to rucket. 0:02:37.720 --> 0:02:41.680 This way did not find a good answer. In the 0:02:41.720 --> 0:02:46.280 seventeenth century, ricketts was also called rachitis, and that came 0:02:46.280 --> 0:02:50.120 from Latin and Greek words to describe disorders or inflammations 0:02:50.160 --> 0:02:54.760 of the spinal column. The symptoms of rickets can include 0:02:54.840 --> 0:02:59.760 spinal pain and unusual spinal curvatures. So it's possible that 0:03:00.639 --> 0:03:04.040 writing in the Latin use the word rachitis because of 0:03:04.080 --> 0:03:08.320 these symptoms, and then lay people shifted that pronunciation to rickets, 0:03:08.320 --> 0:03:14.040 But again that is all very speculative. Rickets affects growing animals, 0:03:14.080 --> 0:03:17.920 not only human beings. In the body, vitamin D is 0:03:17.960 --> 0:03:21.200 converted into a hormone that affects the way calcium is 0:03:21.280 --> 0:03:24.520 absorbed in the digestive system, and it has other effects 0:03:24.520 --> 0:03:27.960 on calcium in the body. To put it really really, basically, 0:03:28.160 --> 0:03:31.480 without enough vitamin D, the body cannot absorb the calcium 0:03:31.560 --> 0:03:36.640 needed for bones to mineralize properly. Rickets usually affects animals 0:03:36.720 --> 0:03:40.760 during infancy, childhood, and adolescence when their bones are growing 0:03:40.800 --> 0:03:45.920 and mineralizing, especially during growth spurts. A similar vitamin D 0:03:46.000 --> 0:03:51.440 deficiency in adults is called Osteomalaysia. Animals get vitamin D 0:03:51.680 --> 0:03:55.680 from two primary sources, their food and exposure to the sun. 0:03:56.560 --> 0:03:59.560 Foods that are naturally high and vitamin D include egg 0:03:59.640 --> 0:04:04.280 yolks and various types of fish like salmon, tuna, and sardines. 0:04:05.080 --> 0:04:08.400 Wild mushrooms can also be high in vitamin D, but 0:04:08.560 --> 0:04:12.480 commercially grown mushrooms that are raised in the dark typically aren't. 0:04:12.520 --> 0:04:16.080 They aren't getting that sun exposure themselves to have vitamin D. 0:04:16.760 --> 0:04:20.599 Today, some foods are also fortified with added vitamin D, 0:04:20.760 --> 0:04:26.279 although which foods, whether fortification is voluntary or mandatory for manufacturers, 0:04:26.720 --> 0:04:29.760 and weather foods are fortified at all, depends on where 0:04:29.760 --> 0:04:33.359 you live. In the United States, foods that are most 0:04:33.400 --> 0:04:36.680 likely to be fortified with vitamin D include dairy and 0:04:36.760 --> 0:04:40.880 non dairy milks, orange juice, and breakfast cereals, all of 0:04:40.920 --> 0:04:44.960 which are associated, of course, with children's diets. In terms 0:04:45.000 --> 0:04:50.640 of sun exposure, again very very basically, UVB radiation converts 0:04:50.760 --> 0:04:55.640 cholesterol in the skin to kulic house for all, which 0:04:55.800 --> 0:04:58.320 is the more formal name for vitamin D three. 0:04:59.120 --> 0:05:03.200 This requires direct exposure to the sun because UVB is 0:05:03.320 --> 0:05:07.359 blocked by things like glass and clothing. Can also be 0:05:07.440 --> 0:05:10.200 blocked or at least reduced by things like fog and 0:05:10.320 --> 0:05:14.880 air pollution. UVB radiation is also affected by the Earth's 0:05:14.920 --> 0:05:18.840 atmosphere and the angle at which sunlight reaches the surface. 0:05:18.480 --> 0:05:22.080 Of the Earth. Areas of very high latitudes get a 0:05:22.120 --> 0:05:25.840 lot less UVB light than the tropics do, and since 0:05:25.920 --> 0:05:29.159 melanin protects the body from UV light, the amount of 0:05:29.240 --> 0:05:32.720 vitamin D that a person's own body can synthesize is 0:05:32.760 --> 0:05:35.400 affected by how much melanin they have in their skin. 0:05:36.360 --> 0:05:40.080 People with more melanin, meaning people who are darker skinned, 0:05:40.320 --> 0:05:43.320 need more sun exposure to be able to synthesize enough 0:05:43.400 --> 0:05:46.000 vitamin D than people with lighter skin. 0:05:46.839 --> 0:05:50.760 We don't really know whether ricketts was a widespread problem 0:05:50.920 --> 0:05:54.480 during early human history, but it might not have been. 0:05:55.040 --> 0:05:59.000 Early hunters and gatherers, and then later on early farmers 0:05:59.040 --> 0:06:01.880 would have been spending a lot of time outside in 0:06:02.000 --> 0:06:05.719 the sun. In the tropics, where in the long ago 0:06:05.880 --> 0:06:09.000 past more people had more melanin in their skin. The 0:06:09.080 --> 0:06:11.400 sun was also a lot more direct, so they would 0:06:11.400 --> 0:06:15.200 have been getting more UVB exposure. Of course, those things 0:06:15.240 --> 0:06:20.039 are interconnected, the UV light and the melanin. Conversely, in 0:06:20.080 --> 0:06:23.839 the far north, for example, people had less exposure to 0:06:23.920 --> 0:06:27.080 sunlight since even during the long days of the summer, 0:06:27.120 --> 0:06:30.159 the sun's rays just aren't as direct, and people also 0:06:30.440 --> 0:06:33.599 tended to wear more clothing because it was colder. But 0:06:33.680 --> 0:06:37.240 these indigenous peoples have also historically had a diet that 0:06:37.400 --> 0:06:41.160 is rich in vitamin D. People still living in the 0:06:41.200 --> 0:06:44.560 same places that their ancestors did, following the same traditions 0:06:44.600 --> 0:06:47.640 and lifeways, are probably getting a lot of their vitamin 0:06:47.680 --> 0:06:51.360 D these same ways today. At the same time, it 0:06:51.440 --> 0:06:54.880 is possible and maybe even likely, that people around the 0:06:54.920 --> 0:06:58.360 world did historically go through periods when they weren't getting 0:06:58.440 --> 0:07:02.120 enough vitamin D actually in the winter or during times 0:07:02.120 --> 0:07:05.120 of famine, but this might not have been an ongoing 0:07:05.200 --> 0:07:08.040 problem since most people would have been spending more time 0:07:08.080 --> 0:07:12.800 outside again in the spring. One big exception here, at 0:07:12.880 --> 0:07:17.080 least in theory, is babies. Because breast milk alone does 0:07:17.120 --> 0:07:21.360 not provide infants with enough vitamin D. It would take 0:07:21.640 --> 0:07:25.240 a lot of vitamin D supplementation for a person to 0:07:25.480 --> 0:07:28.920 produce breast milk that was really rich in vitamin D 0:07:29.560 --> 0:07:33.200 like way beyond what someone would get through ordinary food 0:07:33.320 --> 0:07:38.560 and sunlight. So throughout history, babies who were breastfed and 0:07:38.600 --> 0:07:41.720 then also swaddled or covered up or kept out of 0:07:41.760 --> 0:07:46.080 the sun could be susceptible to rickets. Today, various health 0:07:46.160 --> 0:07:50.280 organizations around the world recommend that breastfed babies be given 0:07:50.320 --> 0:07:55.400 a vitamin D supplement, especially if they are exclusively breastfed. 0:07:56.120 --> 0:07:59.960 We do have some evidence of rickets in the archaeological record. 0:08:00.480 --> 0:08:04.320 In twenty thirteen, archaeologists in Scotland announced the discovery of 0:08:04.360 --> 0:08:08.520 a five thousand year old skeleton that showed evidence of rickets. 0:08:08.720 --> 0:08:12.800 That is the oldest example discovered so far. Prior to 0:08:12.840 --> 0:08:15.920 this discovery, the oldest skeletons known to have signs of 0:08:15.960 --> 0:08:18.840 rickets were from the Roman Era, and there's some evidence 0:08:18.880 --> 0:08:21.720 to suggest that it may have been more widespread in 0:08:21.760 --> 0:08:26.160 the Roman Empire. For example, in twenty eighteen, researchers from 0:08:26.280 --> 0:08:30.560 Historic England and McMaster University in Canada surveyed Roman Era 0:08:30.640 --> 0:08:34.640 skeletons from cemeteries from what's now northern England down to 0:08:34.720 --> 0:08:38.120 southern Spain, and they found evidence of rickets in more 0:08:38.160 --> 0:08:42.160 than one in twenty. Children with babies most often affected. 0:08:43.240 --> 0:08:47.600 What may be the earliest written description of rickets also 0:08:47.679 --> 0:08:51.640 comes from the Roman Era. Serranus of Ephesus wrote a 0:08:51.679 --> 0:08:55.760 treatise on gynecology around the first or second century CE. 0:08:56.800 --> 0:09:00.440 It includes a section about the care of newborns. The section, 0:09:00.600 --> 0:09:05.280 he advises loosening a baby's swaddling clothes only after their 0:09:05.360 --> 0:09:08.640 body has become reasonably firm, so that it does not 0:09:08.720 --> 0:09:14.080 become distorted. Serranus also recommends not letting babies try to 0:09:14.240 --> 0:09:17.679 sit up too early or for too long, because that 0:09:17.720 --> 0:09:21.199 could cause them to become hunchbacked, and he says if 0:09:21.200 --> 0:09:23.680 a baby is allowed to try to walk too early, 0:09:23.960 --> 0:09:29.120 their legs can become distorted. Bow legs and spinal curvatures 0:09:29.160 --> 0:09:32.640 are two of the most recognizable symptoms of rickets, so 0:09:32.720 --> 0:09:35.800 this is often interpreted as a description of the condition. 0:09:36.800 --> 0:09:39.840 There is some debate about whether that's really what he's 0:09:39.880 --> 0:09:43.440 talking about, but Siranis is generally more accepted as the 0:09:43.480 --> 0:09:47.480 first description of rickets than some earlier but even more 0:09:47.559 --> 0:09:53.440 vague possibilities. Yes, sometimes it's a brief sentence that sort 0:09:53.440 --> 0:09:57.160 of seems like maybe someone's leg was growing in a 0:09:57.200 --> 0:09:57.840 strange way. 0:09:58.080 --> 0:10:00.160 Could that have been rickets? Maybe? 0:10:01.120 --> 0:10:05.080 Of course, rickets is definitely not caused by unswaddling a 0:10:05.120 --> 0:10:08.720 baby too early. It is not caused by letting babies 0:10:08.760 --> 0:10:12.040 try to stand up too soon after they're born. And 0:10:12.080 --> 0:10:14.679 we really don't have any way to know if what 0:10:14.880 --> 0:10:18.000 Serranus is describing in this passage is something that he 0:10:18.280 --> 0:10:21.199 also would have recognized in the children from that twenty 0:10:21.240 --> 0:10:24.320 eighteen study we mentioned, or if the children in that 0:10:24.480 --> 0:10:27.280 study were seen as having some kind of illness or 0:10:27.320 --> 0:10:30.559 condition relating to their bones while they were alive. 0:10:31.440 --> 0:10:34.440 Ricketts was not recognized as a disease with a name 0:10:34.679 --> 0:10:37.240 until the early modern period, and we're going to get 0:10:37.240 --> 0:10:39.680 into that after we pause for a sponsor break. 0:10:49.320 --> 0:10:52.760 Rickets seems to have been a more widespread problem in 0:10:52.800 --> 0:10:55.480 parts of Europe in the sixteenth and seventeenth centuries, or 0:10:55.520 --> 0:10:58.280 at least that is when it seems to start showing 0:10:58.360 --> 0:11:02.360 up more in artwork and in written records. In fifteen 0:11:02.360 --> 0:11:06.720 oh nine, German painter Hans Borkmeyer the Elder painted a 0:11:06.840 --> 0:11:10.200 version of the Virgin and Child in which the infant 0:11:10.280 --> 0:11:14.440 Jesus appears to have bowed legs and other possible signs 0:11:14.440 --> 0:11:19.680 of rickets. In fifteen thirty two, German physician Hieronymous Roisner 0:11:19.720 --> 0:11:24.400 described a disease that occurred only in children whose symptoms 0:11:24.400 --> 0:11:29.640 included weakness, bowed legs, and chest malformations. Roisner said this 0:11:29.760 --> 0:11:32.599 disease was common in Holland and Switzerland. 0:11:33.280 --> 0:11:37.079 In fifteen fifty four, Theodosius of Bologna described a child 0:11:37.160 --> 0:11:41.079 who was very pale and had an unusual spinal curvature 0:11:41.200 --> 0:11:44.720 which could have been rickets. Other accounts in the late 0:11:44.760 --> 0:11:48.320 sixteenth century described children whose bones were bent and who 0:11:48.400 --> 0:11:53.559 seemed to have some kind of wasting disease. In sixteen fourteen, 0:11:53.800 --> 0:11:56.840 a visitor to a monastery in the Netherlands, which was 0:11:56.880 --> 0:12:00.680 at the time part of the Dutch Republic, described children 0:12:00.960 --> 0:12:05.280 being treated with water from a well dedicated to Saint Willibrard. 0:12:06.200 --> 0:12:10.640 These children were described as having Saint Willibard's infirmity or 0:12:10.679 --> 0:12:15.160 the ailment of Saint Willibrard. One of the symptoms was a. 0:12:15.120 --> 0:12:19.120 Series of knobs on the children's ribs, described as being 0:12:19.280 --> 0:12:24.440 like pinheads or rosary beads, or something of a similar size. 0:12:24.480 --> 0:12:27.439 Some of these children were also described as having the 0:12:27.600 --> 0:12:31.400 ailment of Saint Macketus, in which their legs appeared as 0:12:31.400 --> 0:12:34.800 though they were sitting cross legged. It was possible for 0:12:34.880 --> 0:12:37.600 a child to have both of these ailments at once. 0:12:38.400 --> 0:12:40.920 As we said earlier, bowed legs are one of the 0:12:40.960 --> 0:12:45.840 most recognizable signs of rickets. Another is called richitic rosary. 0:12:46.600 --> 0:12:49.520 These are knobs that develop where each rib connects to 0:12:49.559 --> 0:12:52.640 the costal cartilage on the front of a person's rib cage, 0:12:53.160 --> 0:12:55.400 and they're named for their resemblance to a string of 0:12:55.520 --> 0:12:59.200 rosary beads. So it seems likely that at least some 0:12:59.280 --> 0:13:02.520 of these children that Tracy was just shoying about had rickets. 0:13:03.200 --> 0:13:07.400 There were also other Willibrard wells and springs around the Netherlands, 0:13:07.480 --> 0:13:10.000 and their water was similarly used to try to treat 0:13:10.080 --> 0:13:14.640 children who had these conditions. The first known use of 0:13:14.679 --> 0:13:17.960 the word rickets and writing was a couple of decades 0:13:18.040 --> 0:13:22.280 after this visitor report. Unlike most of the first uses 0:13:22.320 --> 0:13:24.720 and writing we've talked about before, this was not in 0:13:24.800 --> 0:13:29.200 published material. It was a handwritten receipt book belonging to 0:13:29.240 --> 0:13:33.400 the Fairfax family of Yorkshire, England. People used to call 0:13:33.520 --> 0:13:37.880 recipes receipts, and the word receipt could also apply specifically 0:13:37.960 --> 0:13:42.400 to the ingredients and methods used to make medicinal preparations. 0:13:43.040 --> 0:13:46.680 This particular receipt book had belonged to Mary Chumley, who 0:13:46.720 --> 0:13:50.680 married the Reverend Henry Fairfax in sixteen twenty six. The 0:13:50.720 --> 0:13:53.960 book remained in the family, with people recording recipes for 0:13:54.040 --> 0:13:58.320 things like foods, medicines, and household preparations into the late 0:13:58.360 --> 0:14:02.480 eighteenth century. Some of the entries were attributed to well 0:14:02.520 --> 0:14:05.719 known physicians of the day, and others came from relatives 0:14:05.800 --> 0:14:09.880 or friends. An entry for February twenty fifth, sixteen thirty 0:14:09.880 --> 0:14:15.320 two includes five remedies for rickets in children, attributed to 0:14:15.360 --> 0:14:19.240 the reverend's cousin, Lady Fairfax of Steaton. There are also 0:14:19.400 --> 0:14:23.320 various recipes labeled for the rickets, and one marked for 0:14:23.480 --> 0:14:26.359 a child that is weak or lame in her joints. 0:14:27.200 --> 0:14:31.040 None of these remedies would have been effective in treating rickets. 0:14:31.200 --> 0:14:35.000 They included things like ointments made of herbs minced into butter, 0:14:35.640 --> 0:14:38.800 and drinks being made of things like herbs or dried 0:14:38.880 --> 0:14:42.640 fruit boiled in water or ale. But this suggests that 0:14:42.680 --> 0:14:45.280 by the first quarter of the seventeenth century, people in 0:14:45.400 --> 0:14:48.400 England knew about a disease that they were calling rickets, 0:14:48.480 --> 0:14:50.480 and that they were trying to figure out ways to 0:14:50.520 --> 0:14:53.600 treat it. The first use of the word rickets in 0:14:53.680 --> 0:14:56.880 published material was in the Annual Bill of Mortality of 0:14:56.920 --> 0:15:00.520 the City of London in sixteen thirty four. This was 0:15:00.600 --> 0:15:03.520 only the fifth year that the Annual Bill of Mortality 0:15:03.640 --> 0:15:08.560 included causes of death. This information was gathered by people 0:15:08.760 --> 0:15:14.040 called searchers, who were described as elderly matrons. Made a 0:15:14.080 --> 0:15:17.000 lot of sense for older women to be doing this job, 0:15:17.640 --> 0:15:20.600 since they were typically involved in laying out the dead 0:15:20.720 --> 0:15:24.640 and preparing people's bodies for burial. Good fit for them 0:15:24.640 --> 0:15:28.200 to also be the people determining cause of death. Since 0:15:28.280 --> 0:15:31.920 older women often cared for sick people. People also thought 0:15:31.960 --> 0:15:35.400 they might have some protection from whatever illness a person 0:15:35.480 --> 0:15:39.720 might have died of, and that experience could also theoretically 0:15:39.760 --> 0:15:43.040 help them identify and describe a person's cause of death. 0:15:43.960 --> 0:15:47.360 At the same time, these women typically didn't have access 0:15:47.520 --> 0:15:50.880 to a formal education. Most of them could not read 0:15:50.920 --> 0:15:53.640 or write, so they gave their reports to the clerk orly, 0:15:54.400 --> 0:15:57.120 and that means we don't have any details or notes 0:15:57.160 --> 0:15:59.760 about how they determined the causes of death. 0:16:00.240 --> 0:16:03.320 So at the time, these searchers were seen as knowledgeable 0:16:03.360 --> 0:16:06.880 and respected members of their community who were doing important work, 0:16:07.000 --> 0:16:10.080 but today their reports are not really seen as an 0:16:10.080 --> 0:16:12.440 accurate accounting of what people were dying of. 0:16:13.920 --> 0:16:17.640 All of that said, in sixteen thirty four, the annual 0:16:17.680 --> 0:16:21.000 Bill of Mortality of the City of London reported that 0:16:21.120 --> 0:16:25.000 fourteen people died of ricketts out of almost eleven thousand 0:16:25.120 --> 0:16:29.360 total deaths in the city. And while no English medical 0:16:29.400 --> 0:16:33.680 treatises have been unearthed that mention rickets before this point, 0:16:34.200 --> 0:16:37.000 it seems like it must have been something the medical 0:16:37.000 --> 0:16:40.800 community would have been aware of, otherwise how would it 0:16:40.840 --> 0:16:43.880 be reported as a cause of death in this official document. 0:16:44.760 --> 0:16:47.760 The first known clinical description of ricketts was written by 0:16:47.840 --> 0:16:51.080 Daniel Whistler in his MD thesis at the University of 0:16:51.160 --> 0:16:53.680 Leyten in the Netherlands, that is where a lot of 0:16:53.720 --> 0:16:57.120 people from Britain and Ireland went to study medicine. And 0:16:57.160 --> 0:17:00.320 this was written in Latin and its title translation to 0:17:00.840 --> 0:17:04.480 concerning the Disease of English Children, which in English it 0:17:04.560 --> 0:17:09.320 is called rickets. Whistler defended this thesis on October eighteenth, 0:17:09.359 --> 0:17:12.359 sixteen forty five, and he would eventually go on to 0:17:12.359 --> 0:17:16.920 be the President of the College of Physicians. In this work, 0:17:17.000 --> 0:17:21.040 Whistler described rickets as common in England. He listed a 0:17:21.040 --> 0:17:25.959 series of symptoms, including enlargements at the ends of the bones, weakness, 0:17:26.200 --> 0:17:32.560 deformities of the limbs, unusually flexible joints, delayed emergence of 0:17:32.600 --> 0:17:36.080 the teeth, decay in the teeth once they had emerged, 0:17:36.400 --> 0:17:41.200 and chest malformations. All of these very physically recognizable signs 0:17:41.200 --> 0:17:44.600 of rickets. He also listed some other symptoms that were 0:17:44.640 --> 0:17:48.840 not related to the skeletal system, like cough, fever, irregular pulse, 0:17:48.920 --> 0:17:53.240 and digestive distress. Some of these can occur in severe 0:17:53.320 --> 0:17:57.840 cases of rickets. He speculated that rickets was caused when 0:17:57.920 --> 0:18:01.080 blood clots form in the viscer, and he said that 0:18:01.119 --> 0:18:05.240 the disease was often fatal, especially in children who were 0:18:05.280 --> 0:18:09.800 affected with it from birth. Whistler also described rickets as 0:18:09.800 --> 0:18:14.000 something that was most frequent in England's wealthiest people, with 0:18:14.119 --> 0:18:17.760 the next most affected group being the poor. He thought 0:18:17.760 --> 0:18:18.280 that as. 0:18:18.160 --> 0:18:21.080 A group, people in the middle were the least affected 0:18:21.119 --> 0:18:24.240 by ricketts. He attributed the rate of ricketts among the 0:18:24.280 --> 0:18:27.320 wealthy to the use of wet nurses, and when it 0:18:27.359 --> 0:18:31.359 came to poor people, he blamed quote the intemperance of parents. 0:18:32.440 --> 0:18:36.080 Other works on ricketts soon followed. One was a book 0:18:36.160 --> 0:18:39.440 chapter by Arnold boot which was printed as part of 0:18:39.480 --> 0:18:42.560 a book on medicine that came out in sixteen forty nine. 0:18:43.240 --> 0:18:46.800 Boot was born in Holland and practiced medicine in Ireland. 0:18:47.760 --> 0:18:52.159 Then in sixteen fifty English physician Francis Glisson printed the 0:18:52.320 --> 0:18:57.360 longest and best known seventeenth century treatise on rickets. Its 0:18:57.440 --> 0:19:00.879 title translated to a Treatise of the rickets being a 0:19:00.960 --> 0:19:05.760 disease common to children. Glisson's work was so influential that 0:19:05.800 --> 0:19:09.720 some people started calling rickets glistens disease, and in some 0:19:09.840 --> 0:19:12.640 other parts of Europe it was known as English disease. 0:19:13.560 --> 0:19:16.280 All these works were written in Latin, which was the 0:19:16.320 --> 0:19:19.959 shared language of the European medical community, but most of 0:19:19.960 --> 0:19:22.639 them used the English word rickets for the name of 0:19:22.640 --> 0:19:26.639 the disease. Most of the people writing about rickets in 0:19:26.680 --> 0:19:29.760 the mid seventeenth century thought it was a new disease 0:19:30.160 --> 0:19:33.200 that had only been seen for the previous couple of decades. 0:19:34.040 --> 0:19:36.000 It's possible that this was just. 0:19:36.000 --> 0:19:40.440 Connected to growing awareness and more doctors starting to look 0:19:40.480 --> 0:19:44.399 for this disease, but it's also possible that rickets was 0:19:44.480 --> 0:19:48.439 becoming a bigger issue. This was during the period of 0:19:48.520 --> 0:19:51.480 regional cooling known as the Little Ice Age, when parts 0:19:51.520 --> 0:19:54.760 of the world, including parts of Europe, were generally cooler 0:19:54.880 --> 0:19:59.000 and wetter and cloudier. This could have affected how much 0:19:59.080 --> 0:20:03.520 sunlike people. It also led to poor harvests and food 0:20:03.560 --> 0:20:07.199 shortages that could have led to other nutrient deficiencies that 0:20:07.240 --> 0:20:11.200 people might have mistaken for rickets, and it's also possible 0:20:11.240 --> 0:20:14.720 that in major cities air pollution was becoming a factor. 0:20:15.240 --> 0:20:19.000 London in particular, was described as being blanketed in a 0:20:19.040 --> 0:20:22.520 cloud of smog that could be seen from miles away. 0:20:23.320 --> 0:20:26.160 We will be talking about that more in a future episode. 0:20:27.240 --> 0:20:30.480 It is likely that people were experiencing rickets in other 0:20:30.520 --> 0:20:33.000 parts of the world as well, but most of the 0:20:33.080 --> 0:20:36.480 writing about it is from northern and western Europe, and 0:20:36.560 --> 0:20:39.440 at this point there was no effective treatment being used 0:20:39.440 --> 0:20:42.960 in Europe. The idea of four humors was still a 0:20:43.119 --> 0:20:46.000 very big part of medicine, so most of the proposed 0:20:46.000 --> 0:20:49.800 treatments were influenced by that. In general, they did not 0:20:50.040 --> 0:20:51.600 include any vitamin D. 0:20:52.720 --> 0:20:54.920 No. We will get to. 0:20:54.880 --> 0:20:58.600 The first effective treatments for rickets after a sponsor break. 0:21:08.160 --> 0:21:12.240 The first effective treatment for rickets was cod liver oil, 0:21:12.480 --> 0:21:16.440 which we know today is high in vitamin D. As 0:21:16.480 --> 0:21:19.000 that name suggests, this is an oil made from the 0:21:19.040 --> 0:21:23.320 liver of Atlantic cod. An Atlantic cod live in coastal 0:21:23.440 --> 0:21:28.280 waters in the Northern Atlantic Ocean. By the seventeen hundreds, 0:21:28.320 --> 0:21:30.720 people who lived in areas that were home to a 0:21:30.760 --> 0:21:33.920 lot of cod fishing had started using cod liver oil 0:21:34.000 --> 0:21:37.680 for a range of medicinal purposes, including as a treatment 0:21:37.760 --> 0:21:43.320 for arthritis, sciatica, tuberculosis, and scropula, which is a swelling 0:21:43.440 --> 0:21:45.840 of the lymph nodes in the neck that is typically 0:21:45.920 --> 0:21:50.800 caused by tuberculosis. The discovery of cod liver oil as 0:21:50.800 --> 0:21:54.000 a rickets treatment may have been an accident. A lot 0:21:54.040 --> 0:21:57.280 of children who had rickets also had other conditions, such 0:21:57.280 --> 0:22:01.359 as tuberculosis, and some were more generally manourished. So in 0:22:01.400 --> 0:22:04.720 the eighteenth century, doctors and hospitals were using cod liver 0:22:04.760 --> 0:22:07.479 oil to treat a range of ailments and as a 0:22:07.520 --> 0:22:11.760 source of fat and calories for malnourished children. And people 0:22:11.800 --> 0:22:16.280 started noticing improvements in children who were recognized as having rickets, 0:22:16.720 --> 0:22:19.600 and children who weren't diagnosed with rickets but were just 0:22:19.600 --> 0:22:23.480 seen as small and sick started growing more and faster 0:22:23.600 --> 0:22:26.880 than could be explained simply by getting more food to eat. 0:22:27.480 --> 0:22:31.160 By the early nineteenth century, another proposed treatment for rickets 0:22:31.280 --> 0:22:37.399 was sunlight. Polish physician yed Rej Sniodeki proposed sunlight as 0:22:37.400 --> 0:22:40.480 a cure for rickets as early as eighteen twenty two. 0:22:41.480 --> 0:22:44.520 He wrote a book whose title translates to on the 0:22:44.520 --> 0:22:47.639 Physical Education of Children, and it had a chapter on 0:22:47.920 --> 0:22:51.800 the English disease. In that chapter, he said that if 0:22:51.840 --> 0:22:54.879 parents were financially able, they should take their children to 0:22:54.960 --> 0:22:57.920 the country to keep them in the dry, open air. 0:22:58.600 --> 0:23:01.320 And he said it was particular important that they be 0:23:01.359 --> 0:23:05.000 in the sun because the sun's action on the body 0:23:05.200 --> 0:23:08.160 was one of the most efficient methods for the prevention 0:23:08.359 --> 0:23:12.119 and cure of rickets. I do not know how he 0:23:12.240 --> 0:23:16.680 came to that conclusion, but it was correct. It may 0:23:16.680 --> 0:23:19.640 have just been that general fresh air and the great 0:23:19.720 --> 0:23:22.800 outdoors is good for kids. There was a lot of 0:23:22.840 --> 0:23:25.359 fresh air and sunlight focused, so it just might have 0:23:25.480 --> 0:23:30.760 been that Snandeki cited densely populated English towns as places 0:23:30.800 --> 0:23:34.520 where rickets was common. He described such towns as having 0:23:34.600 --> 0:23:38.600 narrow streets and poorly lit dwellings, places where people would 0:23:38.600 --> 0:23:41.320 not get a lot of sun and starting in the 0:23:41.359 --> 0:23:44.320 eighteenth century in the UK and in other parts of 0:23:44.320 --> 0:23:46.520 the world, more and more people. 0:23:46.240 --> 0:23:49.040 Were living this way. In the wake of the Industrial Revolution, 0:23:50.119 --> 0:23:52.760 more people were moving from the country to towns and 0:23:52.840 --> 0:23:57.520 cities and were working indoors in factories, and this included children. 0:23:58.320 --> 0:24:00.920 The air pollution problems that it are already been observed 0:24:00.960 --> 0:24:04.080 back in the seventeenth century, we're also getting worse because 0:24:04.440 --> 0:24:08.639 many of those factories were powered by burning coal. Soon 0:24:09.000 --> 0:24:12.720 ricketts was being associated with the urban poor, particularly in 0:24:12.760 --> 0:24:16.320 the UK, but in other industrialized nations as well. 0:24:17.200 --> 0:24:20.560 It's possible that there may have also been some dietary 0:24:20.720 --> 0:24:23.640 changes involved in this as people moved to the cities, 0:24:24.359 --> 0:24:27.560 especially for example, they moved from the coast, where they 0:24:27.560 --> 0:24:30.600 were eating a lot of fish, to somewhere farther inland 0:24:30.680 --> 0:24:34.960 where they were not. One potential factor in London was 0:24:35.040 --> 0:24:38.800 also the use of alum to whiten poor quality flour. 0:24:39.640 --> 0:24:43.480 Physician John Snow, most famous today for tracing the source 0:24:43.480 --> 0:24:47.720 of a cholera outbreak in London, understood that rickets was 0:24:47.720 --> 0:24:51.959 a disease that affected the mineralization of bone. In eighteen 0:24:52.040 --> 0:24:55.600 fifty seven, he published a paper arguing that alam was 0:24:55.680 --> 0:24:58.879 binding to phosphorus in the intestines of people who ate 0:24:58.960 --> 0:25:02.520 a lot of cheap bread and that kept their bones 0:25:02.520 --> 0:25:08.360 for mineralizing. People did already know what phosphorus was. Hennig 0:25:08.440 --> 0:25:12.600 Brand had figured that out after boiling huge amounts of urine. 0:25:12.680 --> 0:25:16.760 Just enormous amounts of urine way back in sixteen sixty nine. 0:25:17.200 --> 0:25:21.480 We have scheduled that as an upcoming Saturday classic. I 0:25:21.520 --> 0:25:24.520 got a fifteen hundred gallons a year and advised the 0:25:24.560 --> 0:25:28.680 Piaga workshop you want to come see. In the nineteenth century, 0:25:28.760 --> 0:25:33.080 people also started noticing rickets in other animals, including animals 0:25:33.080 --> 0:25:36.639 that were living in the gardens of the London Zoological Society. 0:25:37.320 --> 0:25:41.400 For example, surgeon John Bland Sutton described rickets as extremely 0:25:41.480 --> 0:25:44.960 frequent in the monkeys living in the garden. In eighteen 0:25:45.000 --> 0:25:47.800 eighty three, he wrote a paper titled on the Diseases 0:25:47.840 --> 0:25:51.080 of Monkeys in the Society's Gardens, in which he said 0:25:51.119 --> 0:25:54.879