The Uses of Rickets: Race, Technology, and the Politics of Preventive Medicine in the Early Twentieth Century

by Arwady, M. Allison

Rickets, the bone disease classically caused by Vitamin D deficiency, was one of the most common diseases of children 100 years ago. It has been recognized as a disease of urban living and linked to issues of race and culture for generations. This paper uses unpublished patient records from 1904 to 1909 and archival and published materials from multiple community-based trials, including the New Haven Rickets Study (1923-1926), to explore how the definition, diagnosis, and treatment of rickets shifted in the first decades of the twentieth century in the United States. Before 1910, as evidenced by patient records, neither the diagnosis nor the treatment of rickets had been standardized. The disease was frequently presented as a disease of African- Americans or Italian immigrants and used to reinforce racial stereotypes, to promote the assimilation of immigrants into majority cultures, and to call for behavioral change. In the second and third decades of the twentieth century, as clinicians and scientists unraveled the twin roles of diet and sunlight exposure in the diseases etiology, both diagnosis and treatment became more standardized. But this standardizationincluding exchanging bedside diagnosis for X-ray technology and promoting general preventive measuresaltered the perceived prevalence and even the definition of the disease. By the mid-1920s, rickets was promoted as universal, at times invisible to non-experts, but present to some degree in nearly every young child regardless of race or class. It was thus used to promote the young disciplines of preventive medicine, pediatrics, and public health. Rickets therefore provides an excellent window into the early politics of preventive health in the United States and a relevant historical counterpoint for current debates over the role of race and ethnicity as risk factors for disease; the use of diagnostic technology in defining disease; and the promotion of targeted interventions for todays so-called lifestyle diseases.