Rickets, or "the English disease", may have emerged around Dorset and
Somerset in the early 17th century. Some remarks made on this topic by
myself, Martha Sherwood at the Dept of Ecology and Evolution, University of
Oregon, and by the historian Thomas Jackson may be of interest to some of
our readers. Perhaps any of you has something to add or time enough to
check up some of the suggested lines.

-------------------------------------I wrote to a listserv on the history
of England and Wales:

IN BRIEF
Rickets is a disease of infancy and childhood which causes marked skeletal
changes that can easily be identified by osteologists. The disease is rare
or absent in preagricultural human skeletons, while the prevalence seems to
have increased during medieval urbanization, at least in some cities, and
then to have exploded shortly before industrialization starting in
southwestern England in the early 17th century. In the year 1900 more than
80 per cent of Northern European children may have been affected.
        This dramatic increase can hardly be explained only in terms of
decreasing exposure to sunlight (which is important for the activation of
vitamin D), not even after considering descreased length of breast-feeding
(milk is a good source of vitamin D). Another possible contributing factor
is an increasing inhibition of calcium absorption by phytate from cereals
since their intake increased during the Middle Ages, and since old methods
of reducing phytate from cereals (dampening, heat treatment, sourdough
baking etc) appear to have been lost during the emergence of yeast baking
and large-scale cereal processing.

IN DETAIL
The first adequate description of rickets is attributed to Soranus of
Ephesus (A.D. 98-138), who observed more cases in the neighborhood of Rome
than in other places including Egypt. He specifically stated that it did
not affect Greek children.
Apparently, the term rickets was first mentioned in the mortuary tables of
London in 1634, when 14 of 10,900 persons were reported to have died from
rickets.
        Shortly before 1645, Dr. Francis Glisson (1597-1677), who was born
in the village of Rampisham in Dorset, reported to the College of
Physicians about the disease. In 1650, after more than five years of
discussions within the college he wrote a book on the subject, entitled De
Rachitide sive Morbo Puerili qui Vulgo The Rickets Dicitur (On rachitis or
a disease which ordinary people call the rickets). One year later Glisson
and two others stated that "This disease became first known as near as we
could gather from the relation of others, after sedulous inquiry, about
thirty years since, in the counties of Dorset and Somerset Š since which
time the observation of it hath been derived unto all the southern and
western parts of the Kingdom".
        At about the same time, and possibly without knowledge of the
mentioned discussions, Thomas Fuller (1608-1661) a divine living in Exeter,
noted that "There is a disease of infants .... having scarcely as yet
gotten a proper name in Latin, called the rickets; wherein the head waxeth
too great, whilst the legs and lower parts wane too little".
        Shortly thereafter the disease had spread to other parts of England
and later throughout Europe.
        It cannot be excluded that the spread was slightly earlier,
considering that Floyer in 1706 wrote that, "In the time of King Charles"
(who was born in 1600 and was king from 1625 until his execution in 1649)
rickets "was almost epidemical, few families escaping it".
        From what I have gathered, in the 1600s it was mainly the children
in the high and middle ranks of society who appear to were affected, while
two centuries later it was rather those of the lowest ranks.
        Scrutinizing cereals is not as far fetched as it may seem. Cereals
and other seeds have in their shells phytic acid which strongly binds to
minerals like calcium, iron, zinc and magnesium to form insoluble salts,
phytates. It is well known that whole meal cereals by this mechanism
decrease the absorption of such minerals. There is apparently no adaptation
to a habitual high intake of phytic acid, why this is an important
contributing cause of iron deficiency in third world countries. It is also
an important cause of mineral deficiency in vegetarians.
        Mellanby found back in the 30s that young dogs got rickets when
they were fed oatmeal. He was made aware of the calcium-binding effect of
phytate and showed that phytate was the dietary factor responsible for
inhibition of calcium absorption by oatmeal as well as the induction of
rickets in dogs. McCance and Widdowson found adverse effects of bread
prepared from high-extraction wheat flour on retention of essential metals
by humans. They also showed that destruction of phytate improved retention
of calcium. Substantial evidence have later firmly established this
negative impact of phytate. Contemporary Asian Indians are at high risk of
rickets which can be healed or prevented by removal of chapatti bread from
the diet. Not even rats seem to be fully adapted to graminivorous diets
since phytate adversely affects mineral absorption in them as well.
        Accordingly, in addition to lower intake of meat, fish and dairy
products (which are important sources of vitamin D) during and after the
Middle Ages, as well as decreased exposure to sunlight and earlier weaning
during industrialization, a possible contributing cause of rickets is thus
a secular trend of increasing intake of phytate. This could be the case if
cereal intake increased during the Middle Ages and if old methods of
reducing the phytate content such as malting, soaking, scalding,
fermentation, germination and sourdough baking were lost by the emergence
of large-scale cereal processing and the introduction of yeast baking. The
mentioned methods reduce the amount of phytic acid by use of phytases,
enzymes which are also present in cereals and which are easily destroyed
during industrial cereal processing.
        So, what happened in Dorset and Somerset in the early 17th century
and later in the rest of England? Since my knowledge of history may be less
than that of your worst students of history, it may be rather daring when I
propose that the practice of using beer-yeast in bread baking was first
introduced from France to Dorset, where Dorchester was apparently once
famous for its breweries. Nor do I know when and where enclosure first
became widespread and what impact such a spread would have on the
availibility of small game and fish to common people.
        Finally, what conclusions can be drawn from the fact that between
1500 and 1650 the purchasing power of wage rates decreased by more than 50
per cent while the price of agricultural products increased by 700 per cent
after both had been stable for at least 50 years? Would this imply that
poverty was increasing and that access to milk, cheese and meat declined
markedly while common people had to rely ever more on cereals?
        I should mention another possible contributing dietary factor:
salt. Urinary excretion of calcium is directly related to sodium intake
which accordingly theoretically may deprive the body of calcium from the
skeleton. However, I would expect salt intake to have increased much
earlier than 1600.
        Any relevant information is most welcome.

REFERENCES
Caprez A, Fairweather TS. The effect of heat treatment and particle size of
bran on mineral absorption in rats. Br J Nutr 1982; 48: 467-75.
Thirsk J (Ed). Chapters from the Agrarian History of England and Wales. Vol
1-5. Cambridge Univ Press 1990.
Gibbs D. Rickets and the crippled child: an historical perspective. J R Soc
Med 1994; 87: 729-32 [Comment by Black J in J R Soc Med 1995; 88: 363-4].
Gibson RS. Content and bioavailability of trace elements in vegetarian
diets. Am J Clin Nutr 1994; 59(5 Suppl): 1223S-1232S.
Harrison D, Mellanby E. Phytic acid and the rickets-producing action of
cereals. Biochem J 1934; 28: 517-28.
Hernigou P. Historical overview of rickets, osteomalacia, and vitamin D.
Rev Rhum Engl Ed 1995; 62: 261-70.
McCance R, Edgecombe C, Widdowson E. Mineral metabolism of dephytinized
bread. J Physiol 1942; 101:
Mellanby E. A story of nutrition research. Baltimore: Williams & Wilkins
Co, 1950
Pettifor JM. Privational rickets: a modern perspective. J R Soc Med 1994;
87: 723-5.
Sandberg AS. The effect of food processing on phytate hydrolysis and
availability of iron and zinc. Adv Exp Med Biol 1991; 289: 499-508.
Sandstead HH. Fiber, phytates, and mineral nutrition. Nutr Rev 1992; 50: 30-1.
Stuart-Macadam PL. Nutritional deficiency diseases: a survey of scurvy,
rickets, and iron-deficiency anemia. In: Iscan MY, Kennedy KAR, eds.
Reconstruction of life from the human skeleton.  New York: Wiley-Liss,
1989: 201-22.

-------------------------------------Martha Sherwood wrote:
I found your posting on the English History list most interesting. Two
things that might be relevant, both anecdotal:
        An observation one runs across frequently in travel literature from the
late 18th-early 19th century is the surprisingly good health of the Irish
peasantry, despite their extreme poverty.  One would expect a population
that relied on potatoes as a starch base to have a lower incidence of
rickets than one which relied on grains.  The incidence of dental caries
also seems to follow the sort of pattern you are describing.
        I ran across something in a literary source that suggested that
rickets was
epidemic in the children of people exiled to northern regions of the Soviet
Union in the 30's and 40's, though not particularly common in the regions
these people had come from or among native peoples of Siberia.  This would
have been a population forced by extreme poverty to rely on a diet
consisting almost entirely of grain.  Middle-aged people in Russia in
general have very poor teeth, again probably ascribable to childhood
calcium deficiency.
From: [log in to unmask] (Martha Sherwood)

-------------------------------------Thomas Jackson wrote:
This is not my topic, I am a local historian living in the North of England
but I found the question interesting as I used to work in the food
industry.
Have you looked at a book called Food in England by Dorothy Hartley, I do
not have a copy but it may have something which is relevant.
Have you looked at the timing of mortality crisis in the SW of England in
Wrigley and Schofield The population history of England 1541-1871 in case
harvest failures could have caused diet changes?
Could there have been a reduction in the milk intake of Dorset children due
to increased demand for cheese outside the county, Dorset blue vinney is a
famous English cheese.
Could a reduction of the use of salted meat as cattle began to be fed on
winter forage during the 17th century make the addition of salt directly to
food at higher concentrations more likely.
Dorothy George in her book London life in the 18th Century, says that in
London the number of deaths from ricketts in the Bills of Mortality
declined steadily which was attributed to the more maternal attention to
the suckling and rearing of children.
 Do you know there is a local history list on mailbase in the UK, it is not
very active but it might get an answer from someone in Dorset.
From: Thomas Jackson <[log in to unmask]>

-------------------------------------Martha Sherwood also wrote:
I had some more thoughts, very general and not fully formed, on the subject
of phytate sequestration of essential minerals in heavily graniverous
populations.
(1).  Did Greeks and Romans have different techniques for baking bread?  I
read somewhere that the teeth of Greek skeletons were in significantly
better shape than contemporary Romans.  Were the Greeks and Egyptians more
likely to be processing grain at home?
(2).  Does alkalai neutralize phytate? Soaking in alkalai is practiced by
many traditional American cultures as a means of processing corn.  Also, in
the type of oven used throughout the mideast until comparatively recently
and in Europe in the Middle Ages, bread is baked in flat loaves in ashes in
the fire chamber, which results in an alkaline ash-impregnated crust.
Would switching to an oven with a separate fire chamber increase exposure
to phytates?  This would I think be consistent historically with the
pattern that is observed in England for rickets.  Maybe also consistent
with what is observed in India, where chapati and nan  used to be baked in
tandoori ovens, which work on the same principle, but are now more likely
to be baked on kerosene-fired grills.
(3).  A sketchy survey of the anthropological literature reveals what looks
like a short-lived phase in the growh of agricultural communities where
there is a high incidence of bone abnormalities  and dental caries, does
this correspond to a period where burgeoning population decreased people's
access to game and livestock, but a usable technique for reducing phytate
intake had not yet been discovered by trial and error.
(4).  Childhood rickets is a contributing cause to high infant and
childbirth mortality.  Is it possible that our picture of the prevalence of
these in the past is skewed by much of the hard data coming from the early
modern period in England?  Another thing comes to mind, re previous
communication.  Those healthy Irish potato eaters underwent a population
explosion in the latter eighteenth century.  It would be interesting to get
hold of records from representative parishes of the period and calculate
things like infant mortality and life expectancy, comparing them with
England.
(5).  I think this may have a bearing on a question that has been puzzling
me for years.  Grain eaters from high latitudes have a notorious
prediliction for preferring to consume their starch base in fermented form.
The increase in rickets in England does correlate with the rise of
puritanism, in attitudes such as frowning on children drinking beer for
breakfast.  The people responsible for the "disease theory of alcoholism"
account for the latitudinal variation in rates of alcoholism (which depends
more on where your ancestors came from than where you were born and raised)
by postulating that since people in mediterranean cultures have had many
more generations over which their ancestors had access to alcohol, so the
trait has been selected against in their populations.  I reasoned that one
cannot acount for a high-frequency deleterious hereditary trait solely on
the basis that it has not in the past been selected against; there has to
have been some compensatory advantage.  If the beer drinkers suffered fewer
skeletal defects and thus had better reproductive success than the
teetotalers, one would have a situation where a taste for beer was selected
for.  Before widespread access to distilled liquor, it would have been
uncommon in any case for people to drink enough to suffer really adverse
health effects before they reached the end of their reproductive years.
Hogarth's prints, "Beer alley" and "gin lane" come to mind, the beer
drinkers are depicted as being in robust good health and the gin drinkers
as wallowing in misery.  Beer drinking was considered in 18th century
England to be particularly beneficial for nursing mothers; contracts for
wet nurses often specified a generous beer allowance.
(6).  Natives of northern Russia and Siberia are fond of kvas, made of
fermented rye bread.  In an area of northwestern China the preferred way of
preparing maize, the dietary staple, is to steam cornmeal mush and then
allow it to ferment (the fungal fermentation used produced carcinogens,
which only became a problem when the average life expectancy in the area
increased under Communism).
(7).  Heavy taxation of the rural peasantry to finance development in Meiji
Japan led to increased reliance on rice bran and seeds of wild grasses as a
food source; one sees an increase in mineral deficiency diseases associated
with it.
I'll let you know what else I come up with.

-------------------------------------My comment:
Optimal pH for degradation of phytic acid by phytases is 5.15. Accordingly
alkali would not be of any help.
A more probable reason why traditional populations have treated cereals or
maize with alkali is to prevent pellagra. Read more about this and other
cereal issues in a very, very interesting review by
- the one and only - Loren Cordain: Cereal Grains: Humanity's Double Edged
Sword. World Rev Nutr Diet 1998, in press.

-------------------------------------Thomas Jackson also wrote:
Have you looked at Norman Moore' The history of the first treatise on
rickets'?
He also wrote Cause and Treatment of rickets, and probably wrote the account
in the DNB of Francis Glisson. That is where I got those references, he
implies that while Glisson may have described the disease on observations
in his native Dorset, that the disease had always occurred where infants
were fed solid food during suckling. This is written in 1885 before the
work on vitamin D. This may mean there is no factor unique to Dorset which
can be related back to Glisson's initial work .
I used to be an information officer in industry so find it difficult to get
out of the habit of searching.

-------------------------------------

Any further comments?

Best regards

Staffan

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Staffan Lindeberg M.D. Ph.D. Dept of Community Health Sciences, Lund
University, Mailing address: Dr Staffan Lindeberg, Primary Health Care
Centre, Sjobo, S-22738 Sweden, +46 416 28140, Fax +46 416 18395
<[log in to unmask]> http://www.panix.com/~paleodiet/lindeberg/
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