I am grateful to Thacher et al. for their comments and for drawing attention to the recent paper by Swinburne,(1) which appeared while my Perspective was in press. Two of Swinburne's observations especially interested me.

The first was finding records of early recipes for treating rickets in the handwritten papers of the Fairfax family, dated February 25, 1632. These can be seen in a facsimile reproduction(2) published in 1890 and were written before the word “rickets” appeared in print in the Bills of Mortality for 1634.

The second was locating and translating from Dutch a description of the Ailment of St Willibrord studied by Monna,(3) who had examined a short manuscript, which is written in Dutch and still exists in the archives of the Diocese of 's-Hertogenbosch, from 1614. The description of the ailment of St Willibrord reads:

“The children get little knobs on their ribs, like pinheads or rosary beads, or of similar size.”

The size of the pinheads or rosary beads at that time is not known, but Monna(3) suggested, reasonably, that this might be rickets. The text that is quoted is part of a report to the Bishop of 's-Hertogenbosch, which was commissioned because of concerns about the conduct of pilgrimages in that part of Holland. The text was based on the statement of a Hermitess, supported by her predecessor in the hermitage. They also gave the features of the Ailment of St Machutus, which were that the lower limbs appeared as though they were sitting cross-legged together with swelling of the abdomen. The Ailment of St Machutus apparently was often accompanied by the Ailment of St Willibrord. Despite concerns on religious grounds, the pilgrimages continued for many years, and presumably her successors in the Hermitage took over the diagnosis and the treatment, which involved using water from a well in Diessen, 30 km away, and a religious routine. It should be said that whether they were actually dealing with rickets, at that time, must be debatable.

Thakker et al. are right in saying that wet-nursing should be considered among the possible causes of rickets. Whistler(4) actually did that in 1645, in the first full description of rickets, writing:

“The disease is most frequent in the ranks of the highest citizens, next amongst the dregs of the populace, least amongst those of moderate means. The cause in the first group I take to be the intemperance of the parents and the fact that the infants are entrusted to the care of hired wet nurses.”

Whistler went on to offer a variety of other explanations (including “mistakes in diet”) for the occurrence of rickets in his second group, indicating that wet nursing was not responsible for rickets in that group of children. The problem continued to be a cause of concern, and Baynard,(5) a physician, wrote in 1706:

“As to the Rickets, it was a distemper in England, almost worn out, but now it becomes in play again. But in the time of King Charles 1,” (who lived 1600–49) “it was almost epidemical, few families escaping it; especially those who were rich and opulent, and put their children out to nurse…. These nurses spoil and destroy…. two thirds of the poor children entrusted to their care.”

He also referred to “drunken nurses” being particularly bad. If his word “destroy” means that the children died, the situation was dreadful. In this context, the paper to which Thakker et al. refer, by Fildes,(6) gives information about burials of “nurse-children” in a part of England. The proportion that died cannot be deduced from the paper to compare with Baynard's apparently very high estimate, nor are the causes of death determinable. Likewise, it is not possible to compare the mortality associated with wet nursing and the prevailing infant mortality rate then.

After nearly four centuries, we cannot establish the cause of rickets at that time, so it is feasible only to suggest possibilities, and the significance of vitamin D deficiency and calcium deficiency will remain speculative.


  1. Top of page
  2. Acknowledgements

I am grateful to Drs Layinka Swinburne, Adriaan Monna, and Olav Bijvoet for help, especially in locating and translating manuscripts.


  1. Top of page
  2. Acknowledgements
  • 1
    Swinburne LM 2006 Rickets and the Fairfax family receipt books. J R Soc Med 99: 391395.
  • 2
    Weddell G 1891 Arcana Fairfaxiana Manuscripta. Mawson, Swan, & Morgan, Newcastle on Tyne, UK.
  • 3
    Monna ADA 1998 In: MargryPJ and CaspersC (eds.) “Bedevaartplaatsen in Nederland,” 1998, vol. 2, “Hertogenbosch, H. Willibrord,” pp. 429430, and “Vught, H. Machutus,” pp. 906–912, Meertens Institute, Amsterdam ISBN deel 2 90-6550-567-9. See also web publications: 's-Hertogenbosch, H. Willibrord in: http://www.meertens.knaw,nl/bol/fulltext_detail.php? id=1153 and Vught, H. Machutus in:
  • 4
    Whistler D 1645 ]see Smerdon GT 1950[ Daniel Whistler and the English disease. A translation and biographical note. J Hist Med 5: 97414.
  • 5
    Baynard E (Floyer J, Baynard E) 1706 The History of Cold Bathing, Both Ancient and Modern, 2nd ed. Walford, London, UK.
  • 6
    Fildes V 1988 The English wet-nurse and her role in infant care 1538–1800. Med Hist 32: 142173.