Nutrition - Other

The History of Rickets Scurvy and other Nutritional Deficiencies



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Most of us today understand nutrition sufficiently to prevent diseases caused by nutritional deficiencies, such as rickets and scurvy. However, such was not always the case.

Nutritional deficiencies have been recorded since ancient times. Unfortunately, they were not always defined as nutritional deficiencies, and were often regarded as resulting from other factors, such as poor hygiene and lack of exercise. Ignorance often caused the imagination to run wild, and as a result things like witchcraft, spontaneous generation, bad "humors" and irate gods have throughout history often been determined as the causes of these diseases. Quackery and mysticism reigned supreme in the medical profession. When trying to determine the cause of illness, many doctors looked to the system used by the ancients such as Hippocrates and Galen, which stated that the body was made up of four humors; blood, phlegm, black bile and yellow bile. They believed that blood was the most dominant humor, and thus needed to be controlled. This system maintained its popularity well through the nineteenth century. It didn't see a definitive end until 1858, when German doctor and anthropologist Rudolf Virchow published the book Cellularpathologie which established a cellular rather than a humorous basis for pathology.

It wasn't until the twentieth century that we really began to fully understand nutrition, and what disease processes can take place when proper nutrition isn't observed. In previous centuries, many people remained attached to the old ways of viewing nutrition and diseases, even though the technology to understand them already existed.

The Roman physician Soranus reported deformation of the bones in infants as early as the first and second centuries AD. He attributed these deformities as resulting from the failure of Roman mothers to properly nurture and clean their children, but didn't directly implicate poor diet in the condition.

Rickets wasn't defined as a specific medical condition until 1645, when an English physical named Daniel Whistler gave the earliest known description of the disease while still studying medicine. Later, in 1650, a treatise on rickets was published by Francis Glisson, a physician at Cambridge. Glisson's work, unlike others during the period, is based on observation. Although unable to determine the cause of the disease, Glisson was sure that the disease was not contagious, nor was it passed down from parent to child. Despite his writing, no real advances were made in the study of rickets for almost two centuries.

Rickets was very common in industrialized cities around the turn of the twentieth century, both in the United States and in Europe. It was most common among the poorer, less privileged people and often affected infants. Still, there was not a complete understanding that the condition was caused by poor nutrition, although it was considered a potential cause, along with lack of fresh air and sunshine.

In the late nineteenth century, strides had been made toward finding a cure for rickets. At the London Zoo in 1889, lion cubs were fed a diet of boneless lean meat. When some cubs developed florid rickets, they were treated by the addition of cod liver oil and crushed bones to their meals, and made a full recovery.

The discovery of vitamins took place in the early part of the twentieth century, primarily between the years of 1911 and 1922. Until this time, thanks to the work of Louis Pasteur, diseases of nutritional insufficiency such as rickets, scurvy, beri-beri and pellagra were still sometimes thought of as being caused by infection.

In 1919, a deficiency of vitamin A was implicated as a cause of the disease. Furthermore, it was found that foods rich in vitamin A prevented rickets. Again, cod liver oil surfaced as an anti-rachitic factor.

Similarly, scurvy was a very destructive disease in ancient Egypt, Rome and Greece, but was typically regarded as a "plague" rather than as a nutritional deficiency. The cause of the disease, whose symptoms include muscle weakness, fatigue, joint and muscle pain, bleeding gums, loose teeth, hemorrhage and rashes, was a mystery to its sufferers. All that was known was that men on long sea voyages suffered from this often-deadly condition far more than the general population, and was well known for depleting the military strength of countries which depended on a strong navy for their well-being. Because of a poor understanding of nutrition, fresh fruits and vegetables were not considered an important commodity on long voyages.

The condition was apparently familiar to natives of Newfoundland, since they were able to provide a remedy to French explorer Jacques Cartier and his men in 1536. The remedy contained spruce tree needles; little did they know that their treatment was a nutritional supplement rather than an actual medicine.

One of the most important steps toward a cure for scurvy took place in 1742 when James Lind, a commander and surgeon in the British navy, recommended that lemons and limes be made available on sea voyages. He had discovered the cure by accident, when on a very long voyage with an unusually high level of deaths from scurvy, lemon juice had affected a miracle cure. Nevertheless, Lind's advice was ignored for more than sixty years, when a Captain James Cook managed to prevent scurvy altogether by providing lime juice on three different sea voyages. It is because of this fact that we often refer to British people as "limeys."

In the 1920s Albert Szent-Gyrgyi did experiments on citrus plants which resulted in the discovery of what he termed "hexuronic acid." Later, in the 1930s, he worked in concert with American chemist J. L. Svirbely doing experiments on guinea pigs. One group, which was fed boiled food, developed symptoms of scurvy and died. Another group of animals, whose food was fortified with this hexuronic acid, thrived in excellent health. The substance was renamed ascorbic acid for its properties of preventing and curing the symptoms of scurvy.

Anemia is another nutritional deficiency which has been historically misunderstood and poorly recognized. As late as 1855, the English doctor Thomas Addison identified what he termed as "idiopathic anemia." The name was later changed to "pernicious anemia" by Anton Biermer, a German physician. The cause was unidentified, but later George Whipple, director of the Hooper Foundation for Medical Research at the University of California, found that raw liver was effective in curing the disease. It wasn't until 1948 that a deficiency of cobalamin, named vitamin B12, was responsible for the condition. It was caused by a defect in the gastro-intestinal system, in which a lack of proper stomach acid prevented digestion of the nutrient.

Thomas Sydenham, who lived between 1624 and 1689 in England, was the first ever to treat iron deficiency anemia with iron. However, like most physic ans in his day, he was an advocate of bloodletting. Bloodletting was a common and popular practice which was practiced by the ancient Greeks, Mesopotamians and Egyptians. The practice remained popular up through the nineteenth century, although in England after the eighteenth century the value of this "treatment" was hotly debated. It's very likely that throughout history, the practice of bloodletting has been a cause or a complication of anemia.

The first reported cases of beriberi was observed in 1642 by Bontius and in 1652 by Nicolaas Tulp. Tulp's case was of a Dutchman who had begun to suffer from lameness in the East Indes. Beriberi, which means, "I can't, I can't," in Singhalese, was often seen in combination with kidney disease and pernicious anemia, and yet nutritional deficiency still was not suspected. It wasn't until 1880 that diet was implicated in the disease.

The common diet in the East Indes consisted largely of polished white rice. Unlike unpolished brown rice, polished white rice is deficient in thiamine or vitamin B1. However, this was not generally known until the early twentieth century. Before then, in Norway, there was debate between Dr. Christiaan Eijkman who thought beriberi was caused by an infection, and Dr. Evart van Dieren who thought it was caused by a poison. Even after Eijkman proved that unpolished rice cured beriberi, he still believed that the nutritional deficiency was just a predisposing factor which made one more susceptible to infection.

Pellagra has historically been a disease of poverty. The first recorded observation is by Don Gasper Casal, a physician of the Spanish court, who observed the disease in the poor peasants in the Spanish province of Asturias in 1735. The term, which means "rough skin," described the thickened skin which was a symptom of the disease. The condition was common in the American south in the early twentieth century, where the typical diet consisted of corn bread, molasses and pork fat.

Pellagra is caused by a deficiency of niacin or vitamin B3. The disease was first identified as a nutritional deficiency by an American chemist named Conrad A. Elvehjem in 1937. After niacin was discovered, many foods were fortified with the vitamin, helping to eliminate pellagra as an epidemic in the United States.

More about this author: Jennifer Claerr

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