While rickets is primarily thought to be a disease of industrialization, there was an earlier spike in prevalence especially within Europe. Rickets is primarily due to lack of exposure to ultraviolet B rays, caused by lack of sun exposure, poor environmental conditions or bad nutrition. The early post-modern period in Europe was plagued by low sunspot activity and freezing temperatures, both leading to increased numbers of rickets for everyone. Rickets was first systematically described by medical professionals in the mid-17th century, although some they note that it had been present and epidemic for most first half of the century. The first medical exposition on rickets was written by Daniel Whistler in 1645; which describes symptoms such as swelling of the abdomen, ribs and joints, “flaccid and enervated legs” unable to support the body, late eruption of dentition, and a narrow chest (Smerdon, 1950, p402). All described this new disease as primarily causing softness in the bones and narrowing of the chest. In 1676, Graunt observed that “the rickets were never more numberous [sic] than now, and they are still increasing” (Bollett, 2004, p80). Sir John Floyer observed in 1706 that “no distemper is more frequent in infants than the rickets” and that few families could escape the epidemic.
Even powerful families were not able to prevent their children from suffering from this deficiency. The Medici was one of the most powerful families during the Italian Renaissance. Members of the family were buried underneath the crypt floors of the Basilica of San Lorenzo in Florence. Excavations of the crypt were started during the ‘Medici Project’ in 2004 and results were recently published by Giuffra et al. (2013). The goal was to unearth individuals belonging to the family branch of the Grand Dukes of Tuscany starting in 1526 with the death of John of the Black Bands (1498–1526) and ending in 1737 with the burial of Giangastone (1671–1737). During the excavation of this final duke of the family, a number of small coffins were discovered. These remains had been badly disturbed during a floor in the 1960’s, and there is no context to determine who these children were.
A total of 9 sub-adults were identified from the Medici crypt and date from the 16th to 17th centuries. Individuals were aged from newborn to 5 years old: 2 individuals were 5 years old, 2 were around 1.5 years old, 3 were around 6 months, and one was a newborn. Using documentary and archival information, Giuffra et al. (2013) were able to come up with potential identifications of the deceased. All of the children present at least three indicators of vitamin D deficiency including bending of the long bones and growth of new periosteal bone. All children were actively affected by the deficiency, and showed varying signs of rickets based on their ages. Those who were younger had bending more present in the upper long bones due to crawling pressure, and the older ones had bent lower long bones due to walking pressure.
Giuffra et al. (2013) hypothesize that the high prevalence of rickets was due to the long length of weaning and lack of nutritious sources of vitamins. Weaning didn’t occur until the child was over two years old during this period; it was a sign of status that parents could afford to provide a wet nurse for so long. However, mother’s milk at that stage wouldn’t provide the necessary nutrients, and foods used to supplement breatmilk did not contain vitamin D. Historical sources also state that the children did not get much outdoor time and were unhealthy. The practice of swaddling would have further prevented infants from getting enough sun exposure. Given the presence of rickets even within the newborns, it is likely that vitamin D deficiency was also experienced by the birth mothers and wet nurses.
They conclude that rickets was highly prevalent during this time period due to poor nutrition and cultural habits. Due to practices like swaddling, keeping sick children indoors, and heavy clothing would have prevented children, and their birth mothers, from getting adequate sun exposure. Further, a lack of nutritious food and adherence to long breast feeding terms would have made this worse. The study is interesting because it combines archival and bioarchaeological evidence to create an integrated conclusion.
Giuffra, V., Vitiello, A., Caramella, D., Fornaciari, A., Giustini, D., & Fornaciari, G. (2013). Rickets in a High Social Class of Renaissance Italy: The Medici Children International Journal of Osteoarchaeology DOI: 10.1002/oa.2324