Growth and Vitamin D Deficiency in a Population from 19(th) Century Birmingham, England

The West Midlands of England were the cradle of the Industrial Revolution. The 19(th) century AD skeletal remains from St Martin's Church, Birmingham, West Midlands, provided an important opportunity to assess the health of an urban, working-class population at this key point in British history. The purpose of this study is to investigate the effect of rickets on growth in this population. Modern clinical data suggest that those with vitamin D deficiency may be retarded in growth, but this has, to our knowledge, yet to be demonstrated in an archaeological population. We investigate the hypothesis that in Birmingham, subadults with rickets showed deficient growth compared with those lacking bony signs of the disease. Age at death was estimated using dental calcification; long-bone lengths were used as measures of endochondral bone growth. Results showed that for subadults aged 2-6 years, bones in those with signs of rickets tended to be short for their ages, and the deficit in bone length was more marked toward the upper end of the 2-6 year age group, Analysis of the data indicated that deficiency in bone length in rickets primarily reflects deficiency of endochondral bone growth, but for the femur, bending deformity was probably an additional factor reducing the overall length in rickets compared with those without the disease. It was previously suggested (Mays et al., 2006) that in this population rickets may have been a recurrent disease, probably on a seasonal (winter) basis. If this is accepted, a reason why older children with rickets show a greater deficit in long-bone growth than younger ones is that they are more likely to have had multiple episodic vitamin D deficiency than younger children who have experienced fewer vitamin D deficient winter seasons. Multiple episodes or prolonged vitamin D deficiency disease may be necessary to cause growth deficit sufficient to be detectable in skeletal samples. Copyright (C) 2008 John Wiley & Sons, Ltd.