International Journal of Paleopathology 32 (2021) 41–49 Available online 1 December 2020 1879-9817/© 2020 Elsevier Inc. All rights reserved. A joint medico-historical and paleopathological perspective on vitamin D defciency prevalence in post-Medieval Netherlands Barbara Veselka a, b, *, Megan B. Brickley c , Andrea L. Waters-Rist b, d a Vrije Universiteit Brussel, Department of Art, Sciences, and Archaeology, Maritime Cultures Research Institute, Belgium b Leiden University, Faculty of Archaeology, Human Osteology Laboratory, the Netherlands c McMaster University, Faculty of Social Sciences, Department of Anthropology, Canada d The University of Western Ontario, Social Science Centre, Department of Anthropology, Canada A R T I C L E INFO Keywords: Rickets Residual rickets Socioeconomic Status Division of activities Child labor Western Europe ABSTRACT Objective: : By applying a joint medico-historical and paleopathological perspective, this paper aims to improve our understanding of factors infuencing past vitamin D defciency in ten Dutch 17th to 19th-century commu- nities of varying socioeconomic status and settlement type. Materials: : Vitamin D defciency is evaluated in 733 individuals of both sexes and all age groups: Silvolde (n = 16), Rotterdam (n = 23), Rhenen (n = 24), Noordwijkerhout (n = 27), Gouda1and 2 (n = 40; n = 59), Roo- sendaal (n = 51), Den Haag (n = 93), Hattem (n = 113), and Beemster (n = 287). Methods: : Rickets and residual rickets are macroscopically assessed using established criteria. Hypotheses formulated based on medico-historical texts are investigated via multivariate statistical analysis of vitamin D defciency prevalence. Results: : Vitamin D defciency prevalence ranges from 13.7 % (7/51) in Roosendaal to 48.1 % (13/27) in Noordwijkerhout, with an onset of < 4 years, and higher rates in cities, conforming to medico-historical texts. Patterns of child labor are likely key. In contrast, socioeconomic status did not statistically signifcantly infuence vitamin D defciency prevalence rates. Conclusion: : Systematically collected paleopathological data enabled evaluation of medico-historical texts and provided insights into the role that socioeconomic status and settlement type played on the prevalence of vitamin D defciency. Signifcance: : Combining medico-historical texts and large-scale paleopathological data enables disease patterning to be embedded in a comprehensive biocultural perspective. Limitations: : Comparisons may be limited by the small sample size of high socioeconomic status nonadults and some of the collections. Suggestions for future research: : Analysis of more individuals and sites would improve our understanding of disease patterns. 1. Introduction Medico-historical texts can be of great value when assessing patho- logical conditions in the past. They provide information about the perception of diseases over time and how different conditions affected daily life. They may identify important causal factors. However, most historical texts present the knowledge of a single practitioner, based on personal experience and opinion, and are thus simply ‘arguments from authority’ (Mays, 2018; Mitchell, 2017). The data in these texts may not be accurate or complete, but paleopathologists can use the information to formulate hypotheses that can be investigated in contemporaneous skeletal material (Mays, 2018). This approach will be followed herein, for the investigation of vitamin D defciency in post-Medieval Netherlands. Rickets caught the attention of the English medical community in the 17th century and became known as the “English disease” (Zeehandelaar, 1911). It was characterised by crooked bones and swollen joints, following the clear clinical descriptions of this disease’s symptoms by Daniel Whistler, Arnoldus Boot, and Francis Glisson ([Whistler, 1645; Boot, 1649; Glisson et al., 1650] in Zeehandelaar, 1911). Glisson * Corresponding author at: Pleinlaan 2, 1050 Brussels, Belgium. E-mail address: barbara.veselka@vub.be (B. Veselka). Contents lists available at ScienceDirect International Journal of Paleopathology journal homepage: www.elsevier.com/locate/ijpp https://doi.org/10.1016/j.ijpp.2020.10.010 Received 2 May 2020; Received in revised form 30 October 2020; Accepted 31 October 2020