JMS Pearce
Hull, England

Today, few Western doctors have seen children suffering from rickets, an extremely common crippling scourge of children recorded since the second century AD. Whistler, Boot, and Glisson in the seventeenth century described the clinical features. Its cause was a mystery.

In a letter written around 1664, Sir Thomas Browne (1605–1682) describing rooks/crows, recorded “the young ones commonly eaten, sometimes sold in Norwich markets, and many killed for their livers in order to cure rickets.”¹ Seventeenth-century folklore and eighteenth-century physicians commended cod liver oil for rheumatism and rickets, and Sniadecki in 1822 had recognized the value of sunlight in its prevention and treatment,² but how they worked was unknown. There was no suspicion that an antirachitic factor was a constituent of foodstuffs or was stimulated by ultraviolet light.

Sir Edward Mellanby GBE KCB FRS FRCP, who held chairs in London and Sheffield, in 1921 reported the “antirachitic accessory factor in Experimental rickets” to the Medical Research Council. Present in fish oils, when deficient in the diet of dogs it caused rickets, which was reversed by its administration.

Mellanby also uncovered an important and original clinical investigation that had never appeared in a medical journal:

In examining school children at Leeds, Dr. William Hall was much interested in the great difference in general nutrition, and more especially in the teeth of Jewish and Gentile children, the financial position and housing of whose families were comparable. The results of his investigations were described at a Health Congress in Leeds in 1902, and his general observations and conclusions are so concordant with my experimental results that I should like to record them. The following table represents a few of these results:³

The great difference between these two classes of people, more especially in the poor schools, is very striking. It will be further observed that the condition of the poorest Jewish children is better than that of the country children.

Hall then proceeded to investigate the cause of the above described differences and finally decided that only the dieting could be held responsible. From his analysis of the diets, which he found very different in the two classes of the community examined, I take the following points:

1. The Jewish families used large quantities of oil in cooking—even in making bread. Fish were generally fried in oil. Potatoes were not boiled in water; if boiled, it was usually in milk; otherwise cooked in oil. In making broth, butter and oil were added to it. …
2. The normal beverage was cocoa made with milk. This was usually drunk three times a day, except on the days when meat was eaten.
3. An analysis of the eggs eaten by the Jewish families showed the large number consumed.
4. Fruit and vegetables were used abundantly.
5. The Jewish mothers combined to buy large quantities of the cheaper fish in the market. Herrings were commonly eaten.

Dr. Hall concluded that it was purely a dietetic problem. My researches on animals are in complete agreement with the outcome of these investigations… Nearly all the substances mentioned by Hall contain an abundance of antirachitic accessory factor.

Mellanby reasoned: “the production of rickets depends on a relative insufficiency in the diet of the antirachitic accessory factor, the best sources of which are fish oils, animal fats except lard, milk, and eggs.” McCollum and colleagues⁴ named Vitamin D as Mellanby’s antirachitic factor.⁵

William Hall (1834–1923) was in general practice in Burmantofts, a deprived area in Leeds, and held the lowly state of lecturer in midwifery at the school of medicine. He campaigned tirelessly against children’s exploitation in sweatshops, poor diet, and hygiene. He received woefully scant notice in the British Medical Journal.⁶ The only accounts I have unearthed are in the Yorkshire Post newspaper (March–May 1903), and in an excellent comprehensive article in the Lawnswood cemetery newsletter: “The Friend of Poor Children.”⁷

References

1. Browne T (1663). The works of Sir Thomas Browne 1931. In: Keynes G (ed). Notes on the natural history of Norfolk, chiefly birds and fishes, circa. vol 5. Faber and Faber, London, p. 385. Cited by Hernigou, P., Auregan, J.C. & Dubory, A. in “Vitamin D: part II; cod liver oil, ultraviolet radiation, and eradication of rickets.” International Orthopaedics (SICOT) 2019;43, 735–749.
2. Sniadecki J. “Jerdrzej Sniadecki (1768–1838) on the cure of rickets.” (1840) Cited by W. Mozolowski. Nature. 1939;143:121–124.
3. Mellanby E. “Accessory food factors (vitamines) in the feeding of infants. “ The Lancet 1920;1:856-862.
4. McCollum EV, Simmonds N, Becker JE, Shipley PG. “Studies on experimental rickets XXI. An experimental demonstration of the existence of a vitamin which promotes calcium deposition.” Journal of Biological Chemistry 1922;53:293–312.
5. Mellanby E. “The fat-soluble vitamins: their significance in nutrition.” Edinburgh Medical journal 1933;40:197-222.
6. The Late Dr. William Hall of Leeds. Br Med J 1923; 2:952.
7. Janet Douglas. The Friend of Poor Children’: Dr William Hall 1834-1923. Friends of the Lawnswood Cemetery. https://friendsoflawnswoodcemetery.org.uk/dr-william-hall-1834-1923/