RICKETS AND THE REST - CHILD-CARE, DIET AND THE INFECTIOUS CHILDRENS DISEASES, 1850-1914

In the late nineteenth century, death rates for infants remained high while those for children began to decline. Infant diarrhoea helped to maintain high death-rates among children under one year, but the reduction in fatality of several of the major infectious diseases of childhood improved prospects for older children. Paradoxically, death-rates for whooping cough, which is most fatal to infants under one, began to fall after I870, whereas those for measles, most fatal in the second year of life, remained high. In an attempt to elucidate the paradox, this paper focuses on the influence of rickets, a specific deficiency disease, in determining the different patterns of the two diseases. Rickets is primarily a disease of weanlings, and was recognized by contemporary observers to influence the outcome of infections. The factors which influenced the prevalence and severity of rickets are examined, and the contribution of the disease to fatality in whooping cough and measles assessed. It is suggested that a small reduction in the prevalence or severity of rickets could have been critical in producing the downturn in whooping cough fatality, and that this was achieved less through dietary improvement than through changing childcare practices.