What causes Rickets - 1919

By Nancy Walsh, MedPage Today: May 06, 2013

This past weekend I covered the annual meeting of the Pediatric Endocrine Society in Washington, and in preparation I was looking through the abstracts available online. This one caught my eye:

"Dr. Mellanby's Puppies: The Discovery of Dietary Vitamin D in Edwardian England," by V. Houston and C. Michie of Ealing Hospital in London.

The authors wrote, "By the later 1800s the majority of English and American children living in poverty suffered rickets. Proposed causes included confinement, infection, and sunlight deficiency." The disease likely was an important contributor to child mortality at the time, with affected children developing characteristic skeletal deformities, bone pain and softening, and weakness.

Apparently, in 1914 the medical research committee at King's College for Women in London asked young researcher Edward Mellanby to investigate the cause of rickets. Suspecting a nutritional cause, Mellanby spent the next 5 years performing dietary elimination experiments on some 400 puppies. He first found that by feeding the dogs a diet consisting exclusively of oat porridge, they developed rickets. The animals also had been deprived of sunlight, having been kept indoors throughout the experiments.

In Houston and Michie's abstract, they noted that when Mellanby added certain oils and animal fats such as butter the puppies didn't develop the bone abnormalities. In fact, those animals given linseed or cod liver oil were found to have 21% to 28% more calcium in their bones.

By 1919, Mellanby had concluded that rickets was a disease of malnutrition that was curable with regular doses of cod liver oil. Writing in the Lancet, he stated, "Rickets is a deficiency disease which develops in consequence of the absence of some accessory food factor or factors. It therefore seems probable that the cause of rickets is a diminished intake of an anti-rachitic factor."

A decade later German chemist Adolf Windaus was awarded the Nobel prize in chemistry for his work on vitamins, particularly vitamin D and sunlight.
Mellanby's experiments and those who followed him during the 1920s apparently had a dramatic impact on the prevention and treatment of rickets in England, because when a trial for a commercial preparation of vitamin D was planned in the 1930s, there were no children with rickets to be found in London.

I was happy to find the poster at the meeting this weekend and see it for myself.

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See also VitaminDWiki

• Overview of Rickets and Vitamin D
• Vitamin D, Cod-Liver Oil, Sunlight, and Rickets: A Historical Perspective – 2003 brings the history of Rickets back to 1650
• Rickets can be suspected below 36 ng of vitamin D – Oct 2012
• Rickets in Humans and domestic animals - March 2011
• Rare Nutritional Rickets increased 10X in 20 years – Feb 2013
• Black Sudanese children 350X more likely to have rickets than other Australians – April 2012
• All items in category Rickets and vitamin D 127 items
• All items in category Infants/children and vitamin D 854 items
• Why are so many Victorian killer illnesses making a comeback - Nov 2012 4X increase in UK Rickets in past 15 years
• Many reasons why vitamin D deficiency has become epidemic
  Indoors as much as 100 years ago, more dark skinned children in the UK, more obese children, soft drinks,
  animials rarely in the sunlight in the weeks before slaughter, increased salt consumption, less Magnesium in foods,