Rachitis, not arthritis, in Caravaggio's sleeping child

Vitamin D: part I; from plankton and calcified skeletons (500 million years ago) to rickets

The vitamin D history started early in the evolution of life (billion years ago) as a photochemical reaction producing an inert molecule. During the early evolution of vertebrates, this molecule became essential for calcium and bone homeostasis of terrestrial animals and arrived to the status of hormone. Phytoplankton, zooplankton, and most plants and animals that are exposed to sunlight have the capacity to make vitamin D. Vitamin D is critically important for the development, growth, and maintenance of a healthy skeleton from birth until death. The major function of vitamin D is to maintain calcium homeostasis. It accomplishes this by increasing the efficiency of the intestine to absorb dietary calcium. When there is inadequate calcium in the diet to satisfy the body's calcium requirement, vitamin D communicates to the osteoblasts that signal osteoclast precursors to mature and dissolve the calcium stored in the bone. The typical "vitamin D-deficiency" disorder was observed for growing children in the west and south of England in the early 1600s. This disease was described by Glisson and named "rickets" (known also as "the English disease") and was observed with epidemic proportions in northern Europe and North America. The corrections of deformities of rickets were at the origin of the name "orthopedia" and of the technique of osteotomies.

Improving the use of historical written sources in paleopathology

The texts written by the people of past societies can provide key information that enhances our understanding of disease in the past. Written sources and art can describe cultural contexts that not only help us interpret lesions in excavated human remains, but also provide evidence for past disease events themselves. However, in recent decades many biohistorical articles have been published that claim to diagnose diseases present in past celebrities or well known individuals, often using less than scholarly methodology. This article aims to help researchers use historical written sources and artwork responsibly, thus improving our understanding of health and disease in the past. It explores a broad range of historical sources, from medical texts and histories to legal documents and tax records, and it highlights how the key to interpreting any past text is to understand who wrote it, when it was written, and why it was written. Case studies of plague epidemics, crucifixion, and the spinal deformity of King Richard III are then used to highlight how we might better integrate archaeological and historical evidence. When done well, integrating evidence from both archaeological and historical sources increases the probability of a complete and well-balanced understanding of disease in past societies.

"English Disease": Historical Notes on Rickets, the Bone-Lung Link and Child Neglect Issues

Nutritional or classical rickets (here labeled as "rickets") is a worldwide disease involving mostly infants and young children having inadequate sunlight exposure, often associated with a low dietary intake of Vitamin D. Rickets targets all layers of society independently of economic status with historical information spanning more than two millennia. Vitamin D is critical for the absorption of calcium and prevention of rickets in children as well as osteomalacia in adults. The initial and misleading paradigm of the 19th and 20th centuries that rickets may have been the consequence of infection has been, indeed, reversed following the identification of the Vitamin D molecule's important role in the function of the immune system. Although traditionally considered limited to osteopathology, Vitamin D deficiency is now known to be linked to infection, inflammation, and carcinogenesis. In this review, we consider the key historical (Whistler, pre-Whistler and post-Whistler descriptors) and social facts around rickets; highlight the osteo-pathological features of rickets and the pathology of the upper and lower respiratory tract, stressing the fact that lungs remain the main secondary organ affected by Vitamin D deficiency; and emphasize the public health role in identifying the cases of child neglect or abuse based on the evaluation of the costochondral region.