As a parent of an infant, I am familiar with contemporary medical emphasis on the importance of vitamin D to healthy childhood growth. Health visitors, midwives and NHS general medical practitioners have all provided vitamin D supplements for us to give our wean, and breakfast provides the backdrop for a daily game of ‘how many drops before you notice your food is now an oily mess’.
This routine – and its medical architecture – was frequently at the forefront of my mind as I read Starved for Light. Christian Warren explores a long history of childhood rickets and vitamin D deficiency, and the steps taken by American medical professionals, public-health practitioners, parents, consumers and industry to address it. In so doing, he engagingly and lucidly unpacks how anglophonic understandings of rickets have shifted since the sixteenth century, and how forms of supplementation replaced exposure to sunlight as the ‘modern’ means for securing the vitamin D required for health.
Starved for Light makes two interconnected arguments. First, Warren proposes that manifestations of vitamin D deficiency (and its clinical, childhood, manifestations as rickets) have largely been rooted in historical changes to the built environment: increasing urban density, proliferating industrial pollutants and self-contained housing provide the most notable culprits for reducing human exposure to sunlight. As explored in Chapters 1 and 2 (and again in Chapter 8), Warren’s position sits in stark contrast to dominant explanations for rickets that have long emphasized deficient cultural practices, ignorant dietary ‘choices’ or racial susceptibility. Moreover, where diet or other social factors have historically produced rickets, Warren makes plain the roles of economic exploitation, social marginalization and racism in structuring the dietary intake (and broader living conditions) patterning rickets and vitamin D deficiency since at least the seventeenth century.
Second, Warren argues that rickets’ overt inscription on human bones became an increasingly salient cultural touchstone in America during the nineteenth century (Chapter 2), and rickets become a major focus of scientific and commercial activity over the first half of the twentieth century (Chapters 3–6). During a period of Vitamania (to borrow from Rima Apple’s, Vitamania: Vitamins and American Culture, (1996)), medical researchers intensely investigated the mechanics of vitamin D’s action – and the potential causes of its insufficiency – while competition for ‘magic-bullet’ preventives (heliotherapy, cod liver oil, irradiated foods) accelerated. As became increasingly common under ‘modern’ medicine, industrial ‘solutions’ were sought to a painful social and environmental problem. In the case of rickets, however, medicalization was driven not only by academic medicine, policymakers and pharmaceutical companies, but also by dairy producers. Furthermore, the knowledge and products emerging from this research were entangled with alarming research practices: most disturbingly through the racially ordered use of institutionalized infants and children as (often unwitting) test subjects.
The book’s final chapters (7–8) take up rickets’ ‘disappearance’ since the 1950s and draws these two strands of investigation together. Over the later twentieth century, Warren argues, a conquest narrative emerged in American medical and cultural texts as rickets-related mortality and hospital admissions declined. Yet cases of rickets did not completely disappear. The slow violences of racism and poverty continued to manifest in clinical and subclinical vitamin D deficiency, but the resulting harms often went unregistered in public-health statistics unable to account for systemic exclusions from US health care. In the twenty-first century, high-profile media cases and an expansion of population testing have returned vitamin D deficiency to medical and cultural salience. Yet, despite frameworks of race and culture continuing to shape rickets discourse, mass testing has also begun to destabilize any consensus over universally applicable criteria for ‘sufficiency’ (and, by implication, ‘deficiency’).
As becomes clear over the work’s opening pages, the historical analysis that Starved for Light offers to the study of rickets complicates any straightforward narrative of medical and social ‘progress’. Pharmaceuticalization of vitamin D is firmly grounded within ingrained medical racism and exploitative clinical experimentation, as well as being connected to the broader masking of structural ills generating disease. In tracing this history, Warren draws on an impressive array of materials (from bioarcheological studies to dairy advertising campaigns) and weaves together a remarkably diverse set of biological, cultural, economic, medical and social histories. Following the work’s grand sweep, we take in everything from evolutionary pressures shaping skin colour to the metabolic violence of enslavement, from the historic structures of cod-fishing societies to the sporting and fashion histories of ‘knock-knees’ (via John Wilkes-Booth’s legs), and beyond.
At points, this sheer reach can detract slightly from the book’s central narrative arcs. Chapter 7, for instance, somewhat awkwardly bolts together a discussion of rickets after the Second World War with fascinating reflections on rickets and obstetrics in Britain and the United States since the 1700s. The latter was undoubtedly deserving of its own chapter, yet as introduced feels like a sharp left turn. Similarly, historians’ mileage may vary on some of the ‘deep historical’ work on climate, migration and evolution in Chapters 2 and 8, which are certainly more speculative than the grounded archival studies of clinical trials, patenting and corporate promotion.
Yet this drive for interdisciplinary synthesis often invigorates the text and distinguishes it from a more straightforward study of framing or constructing disease. Equally, connecting its fine-detailed examination of rickets research to broader social and political histories also enhances the value of Starved for Light for scholars of subjects beyond histories of rickets or vitamins. Students and researchers of, for instance, America’s ‘Golden Age’ of medicine, racialized medical experimentation or the complexities of medicalization will gain from the work, and the book would serve well as a case for introducing students to the social history of medicine.
Ultimately, Starved for Light is an enriching and entertaining study that will benefit a wide readership, from undergraduate novitiates to subject specialists. Carers for small children might also be unable to look at a box of vitamin D drops in the same way again.
