Rickets returns

Today, we have a guest post written by one of our project volunteers, David Lamb.


Earlier this month, the Royal College of Paediatrics and Child Health released guidance for healthcare staff on identifying the symptoms of rickets. This is in response to the rise in rickets, a condition common in Victorian times, but that had largely disappeared through the 20th century. Rickets is a bone-deforming disease caused by vitamin D deficiency, stunting growth and inhibiting walking.

Hospital admissions with rickets in England increased from 561 in 2008/09 to 702 last year. January and February are the worst months because of the low levels of UV light. Observations suggest a link with some children not playing outside. The issue was covered recently in the [London] Evening Standard (13.1.14).

Over 5% of the children who passed through The Children’s Society’s care between 1881 and 1917 had rickets recorded in their case files. Below are extracts from various cases to illustrate the situation in which rickets developed and a range of its impacts.

Three year old Lydia “lives in unhealthy street (in Hackney), and never goes out during the last three months I have known it. She sits with her feet under her, not attempting to walk, and seems to require nourishment and care. The room constantly is so close and smelly it is not conducive to the child’s health, and the mother is too deformed to do her own scrubbing. I think it one of the saddest cases I have ever known”.

The medical certificate for Annie aged six records rickets resulting in bowed legs and curvature of the spine, but “with proper care she is said to be curable”. Almost ten years on, boarded out in Suffolk, she is not considered “capable of carrying heavy weights or doing much hard work. … She takes great pleasure in, and does needlework nicely”.

With six year old Allan from Teesdale, rickets in both legs and wrists had left him “hopelessly crippled unless the deformity is corrected by operation”. The file does not record whether he had that operation. After seven years in Bradstock Lockett Home in Southport, he returned to his mother.

Some children did have their ‘rickety’ condition alleviated by surgery, as in this case below. (Like all the images in this blog, click on the image below to see a larger version.)

Letter from case file 9953, mentioning proposed treatments for two children with rickets at St Thomas' Hospital, London, 1903

Others required special medical or ‘surgical’ appliances, for which funding had to be secured, as in this Welsh case:

Letter from case file 7207, discussing the funding required for a medical boot and leg support for a child with rickets, 1911

Lily from Richmond, Surrey had genu valgum [knock knees] resulting from rickets when younger.

Another rickets case, Sarah, originally from Beverley, Yorkshire was “close upon 15 – but no bigger than a child of 8 – and thus quite debarred from domestic service as she is almost a dwarf”.

With Margaret from Oxfordshire, her rickets developed soon after birth deformities, such that as an eight year old she could not use her legs beyond standing a little. However, she could use her arms well and do needlework. At nearly 16, “she is deformed, height 4ft 3in – not a girl suitable for service – does housework very nicely but her height and limbs are very much against her. She has been through our laundry, but complains of her legs hurting her, after standing or walking far.”

Hopefully, raising the alert about rickets will avoid our generation of children any of the pain, discomfort and disabilities suffered in Victorian and Edwardian times.

Lotions, ointments and eczema

Thomas’ father died from congestion of the lungs in 1891 when Thomas was 7 years old, leaving a widow and four young children. The family lived in Islington in London and the situation must have been hard for Thomas’ mother who was a cleaner, earning 4 shillings per week, which equates to only around £12 per week in today’s money.

With an extended family who couldn’t afford to help, the only option for Thomas’ mother was for her to place her children into care so that she would be able to work full-time in domestic service.

That year, Thomas’ case was accepted by The Children’s Society (then known as the Waifs and Strays Society) and he went to live in the recently-opened St Michael’s Home for Boys in Lyme Regis.

A medical form completed when Thomas entered St Michael’s home suggests that Thomas was suffering from a ‘condition’. The exact nature of this condition isn’t stated on the form, although the doctor’s opinion was that it wouldn’t need medical treatment.

Everything becomes clearer in the following letter from St Michael’s home to The Society’s head office, dated 1893:

Letter from case file 2965, mentioning the benefit of inland air for eczema, 1893

Letter from case file 2965, mentioning the benefit of inland air for eczema, 1893

Dear Mr. Rudolf.-

Mr. Peek is much vexed at the
intrusion of the 21st. for which I enclose
a cheque from The Hone. [Honourable] Mrs. Cuthbert Peek
for £5. I must therefore ask you as
soon as possible find a vacancy for
Thomas [surname]. He is a sharp
boy. & would do well in learning
an industry such as printing or carpentering

& is not of the sort to make a
good indoor servant. I am truly
grieved to part with any of them
just yet. for they are all doing
well in every respect. Thomas
[surname] suffers constitutionally
from excima [sic] & perhaps inland
air would be better for him than
sea. for these two reasons I decide
on asking you to make arrangements
for his being received elsewhere.
I will send you the tax papers
early in the week. you will be aware
of course that I have not received
a cheque from you since Oct 11th.

I remain
Yours very truly
J Waring

From this letter, we see that Thomas was suffering from eczema. For a reason that is not entirely clear, it appears that one or more boys had to leave the home. In particular, it was thought that living near the coast wasn’t helping Thomas’ condition and that the air found further inland might be better for him.

Instead of moving inland, however, we find next that Thomas was moved to another home on the South Coast; this time to Bognor Home for Boys in Sussex. Sadly, no correspondence about this move survives, so we don’t know if this move to another costal home was due to conflicting medical advice or not.

Thomas was still having problems with eczema in 1895 when he would have been 11 years old. In order to help him, he was sent to the Hospital for Skin Diseases at Blackfriars in London.

After staying in hospital for two weeks, Thomas was discharged back to the Bognor Home. A letter from the hospital states that he was ‘quite cured’.

Sadly, this prognosis appears to have been overly-optimistic, as two months later there is the following note from the Bognor home:

Could lotion & ointment used
by [Thomas’ surname] in “Skin Hospital”
be sent us?

In response, Thomas returned to London to be seen by the doctor who had treated him at the hospital. We don’t know the exact outcome of this visit, but it is possible that the doctor gave Thomas a prescription for more medicine.

The next year, when Thomas was 13 years old, he was transferred to the Diocesan Home for Boys in Cambridge, which had recently been taken over by The Society. While he was in this home, a letter tells us that he was visiting hospital once a fortnight for treatment for his eczema, which was described as ‘getting better’.

Thomas was now of an age where he could begin to learn a trade. It was thought that Thomas would be well-suited to farm work and so in 1897 he was sent to Standon Farm Home for Boys in Staffordshire, which specialised in agricultural teaching. His training appears to have gone well as just over a year later, when Thomas was 15 years old, he went to work for a farmer in Market Drayton in Shropshire.

Thomas stayed in this job for one year, then left to go live with his mother who had moved to Huddersfield. Whether he was still continuing his hospital visits at this time, we don’t know.

This case, like so many of those that mention medical treatment, is tantalisingly vague. We know that Thomas was visiting hospital and that he had been given lotion and ointment to help with his eczema, but we don’t know exactly what those lotions, ointments and hospital treatments were.

Most intriguing for me is the fact that sea air was thought to be bad for eczema. In the late-19th Century so many diseases and conditions were treated with exposure to fresh sea air that it seems strange to find a case where it was recommended that sea air be avoided. If you know why this recommendation might have been made, I’d be really interested to hear your thoughts.

(The records of the Hospital for Skin Diseases at Blackfriars are held at London Metropolitan Archives. Click here for more information.)