Rickets and the industrial revolution in France: The example of Provence

This article aims to estimate the prevalence of rickets and its development during the Industrial Revolution in southeastern France through the study of a large skeletal collection from two recently excavated sites in La Ciotat and Marseille. In total, 790 individuals were selected based on their state of preservation: 556 adults and 234 nonadults. All individuals were systematically examined for macroscopic paleopathological evidence of rickets, based on 13 features indicative of vitamin D deficiency. Rickets was rare in our population, with only 3% of the sample showing signs of the disease. Individuals who died during childhood were more likely to present lesions associated with rickets: 7.7% of the nonadult population show signs of rickets against 1.1% of the adult one (Fisher's exact test: p < 0.001). Moreover, these lesions generally indicated early stages with mechanical bowing of long bones being particularly rare, unlike metaphyseal deformities. Far from the expected increase described by medico-historical literature, incidence was low and showed no change from the 16th to the 20th century. Furthermore, an increase in residual cases in adults results suggest better survival of vitamin D deficiency, which could reflect better handling of the disease. This is the first study dealing with rickets during the Industrial Revolution in France, and based on osteological material, forthcoming analyses should now focus on the incorporation of radiographic and microscopic criteria to further validate our cases and working hypotheses. Additionally, future research could benefit from the inclusion of a broader sample of individuals from early and late modern contexts, but also from the consideration of local medieval contexts providing a detailed overview that could highlight secular changes over a long period.