Fish oil capsules and omega-3 supplements that are common today can trace their origins to the infamous cod liver oil of yesteryear, often given to children by well intentioned adults to combat the debilitating diseases caused by vitamin D deficiency, including rickets (a disease marked by soft and deformed bones, typically resulting in bowed legs). According to the Science History Institute, “Even the most steadfast proponents of cod-liver oil admitted that the highly disagreeable taste and smell presented a significant hurdle to its use. In 1873, Alfred B. Scott came to New York City and, along with partner Samuel W. Bowne, began experimenting to produce a less nauseating preparation of cod-liver oil. Three years later they established the firm of Scott and Bowne, and began marketing their product as Scott’s Emulsion.
According to the Smithsonian magazine, “Vitamin D, which is made in the body when the skin is exposed to sunlight, is vital to human health. It helps the gastrointestinal tract absorb calcium and phosphorous, which in turn ensures the normal mineralization of bones. When children don’t get enough vitamin D, they wind up with rickets. Their bones become soft and weak, leading to stunted growth and deformities like bowed legs.” While rickets is most often associated with Industrial cities in the 19th and early 20th centuries, new archaeological research shows it to have been a public health problem as early as the Roman empire.
“Roman physician Soranus was one of the first to remark upon “bony deformities” in infants in the first and second century. To find out just how prevalent the disease was, researchers from Historic England and McMaster University in Canada studied 2,787 skeletons from across the Roman Empire, dating from the first to sixth centuries A.D. The researchers found evidence of rickets in more than one in 20 ancient children. Overall, the rate of rickets in children was 5.7 percent and residual rickets was seen in the remains of 3.2 percent of adults.”
Dr Kumaravel Rajakumar writes in the journal Pediatrics about the medical evolution rickets, how its links to vitamin D were discovered, and how cod liver oil because its first effective cure.
“Rickets, although rare, is still diagnosed in the United States. Individuals with dark skin pigmentation who reside in northern latitudes or those with poor sun exposure are most at risk. Breast milk is a poor source of vitamin D and dark-skinned infants are at risk for rickets if they are exclusively breastfed beyond 6 months without vitamin D supplementation.
“Daniel Whistler, an English physician, is credited with the earliest description of rickets, when in 1645, he published a monograph titled “Inaugural medical disputation on the disease of English children which is popularly termed the rickets”. Then in 1650, Francis Glisson, a Cambridge physician, published “De Rachitide.” Glisson’s observation of rickets is based on clinical and postmortem experience. Glisson’s writing reflects the transitional phase in medical thinking as he describes the clinical features of rickets in a scientific tone, but lapses into medieval mysticism while discussing the etiology of rickets. Glisson ascribed the etiology of rickets to “cold distemper, that is moist and consisting of penury or paucity of and stupefaction of sprits.” Glisson’s suggested treatments for rickets included: cautery, incisions to draw out bad humors, blistering, and ligature of soft wool around the limb to retard the return of blood. For correction of bony deformities, Glisson proposed splinting and artificial suspension of the affected infant.
“There were no new advances in the study of rickets for nearly 2 centuries after the Glissonian era. At the turn of the 20th century, rickets was rampant among the underprivileged infants residing in industrialized cities of North in the United States and several polluted cities in Europe. In 1909, among infants 18 months or less who had died, Schmorl found histopathological evidence of rickets in 96% (214 of 221) at autopsy, highlighting the pervasive nature of rickets during that era. Despite its common occurrence, the exact cause remained elusive. Deficient diet, faulty environment (poor hygiene, lack of fresh air and sunshine), and lack of exercise were all implicated in its etiology.”
As Dr. Rajakumar explains, it was animal studies that showed the connection between deficiencies of diet and rickets, and how supplementing diets could cure and prevent rickets. Studies of lions, dogs and rats clearly established the role of diet in the cause of rickets, and later, how newly discovered vitamins could be supplemented to prevent rickets.
“Elmer McCollum, a nutritional biochemist at Wisconsin College of Agriculture, perfected the art of “biological method of analysis” of nutritive value of foods using rats as an animal model. Rats fed restricted diets of single cereal grains or mixtures of several grains ceased to grow, reflecting the nutritional inadequacy of the corresponding diets. The physiologic response of such animals to single and multiple purified nutritional supplements helped clarify their nutritional requirements. Eventually it was the perfection of this technique of “biological analysis of foods,” which helped McCollum discover vitamin D.”
“Among people living in coastal areas, folklore has had a long-standing appreciation of the medical benefit of cod-liver oil. The earliest recorded medical use of cod-liver oil dates to 1789, and is credited to Dr Darbey of Manchester Infirmary, where he used it for treating rheumatism. The recognition of cod-liver oil as a remedy against rickets was noted in 1824 in the German medical literature. In 1861, Trousseau of France ventured to state that rickets was caused by lack of sun exposure and a faulty diet, and cod-liver oil could effectively cure it. In 1890, Theobald Palm studied the relationship between incidence of rickets and its geographical distribution, and concluded that rickets was caused by lack of exposure to sunlight and he recommended “systematic use of sun-baths as a preventive and therapeutic measure in rickets.”
“The fact that both sunlight exposure and ingestion of cod-liver oil could cure or prevent rickets was perplexing. Clinical studies performed by Dr Harriette Chick in Vienna in 1919, were able to confirm the preventive and therapeutic value of cod-liver oil and sunlight against rickets in young infants. The seasonal variation in the incidence of rickets, the role of skin pigmentation in exacerbation of rickets during the winter months, the role of diet and appreciation of the fact that breast milk was not an adequate source of vitamin D were understood. The bridging of the knowledge that photosynthesized vitamin D and vitamin D in cod-liver oil were similar was responsible for the eventual conquest of rickets. By the 1930s, the use of cod-liver oil in the treatment and prevention of rickets became common place. The eventual public health prevention initiative of fortification of milk with vitamin D led to eradication of rickets in the United States.”
“Northern European fishing communities used cod-liver oil for generations to restore health and alleviate aches and pains before the doctors and chemists of 19th-century Europe began to take an interest. Its manufacture was simple: cut out the fish livers (with gallbladders), throw them into barrels, and let them decompose. “In those days,” wrote pharmacist F. Peckel Möller in his 1895 monograph Cod Liver Oil and Chemistry, “cod-liver oil was not a desirable article of consumption; indeed, to put the matter plainly, it was an abomination, and no one could have taken it willingly, even once, not to speak of day after day and month after month. Nevertheless many people did take it, and the only reasonable explanation is that the oil must have given strikingly favorable results.”
“Edinburgh physician John Hughes Bennett played a part in introducing cod-liver oil to the English-speaking medical community. In 1841 he published his Treatise on the Oleum Jecoris Aselli, or Cod Liver Oil, after spending some years in Germany observing its use for the treatment of rickets, rheumatism, gout, and scrofula (a form of tuberculosis). Bennett’s publication spawned further research, resulting in the growth of a large cod-liver-oil industry in New England by mid-century.
“Ludovicus Josephus de Jongh of the Netherlands produced the first extensive chemical analysis of cod liver in 1843. In 1846 de Jongh traveled to Norway to procure the purest oil available. By the 1850s “Dr. de Jongh’s Light Brown Cod Liver Oil” was marketed throughout Europe and exported to the United States. Advertising emphasized de Jongh’s credentials as a physician and chemist and included testimonials from other men of science and medicine.”
Among a sea of false claims, narcotic snake oils and adulterated nostrums for sale in the 19th century, cod liver oil was a simple medicine that could prevent disease if taken regularly, especially for the very young. And yet, it was the foul taste of cod liver oil was the primary barrier to the wide use of this rare efficacious 19th century patent medicine. The medicine needed a champion who could help it overcome this fatal flaw and bring it to the masses. Motivated by financial opportunity if not medical altruism, Alfred B. Scott, with partner Samuel W. Bowne, enter the scene. According to Wendt: