X-ray of rickets

© Wellcome Images

Anaemia

© Wellcome Images

What were her medical achievements?

Rickets

Rickets is caused by a deficiency of calcium in the bone, which is caused by inadequate levels of calcium and Vitamin D in the diet, and by inadequate exposure to sunlight, which the body needs in order to absorb Vitamin D. Rickets causes children’s bones to soften, causing bending of the spine, bowing of the legs, and malformations of the jaw, which become permanent once the child has finished growing. Rickets was a very common condition in the early 20th century, especially amongst poor urban children who, as well as having inadequate diets, were often deprived of sunlight while they worked long shifts in enclosed factories, returning home to overcrowded and polluted streets. Once the link with sunlight deprivation had been discovered, charitable organisations began to organise trips for such urban children to the countryside in the summer. It is an indication of dietary improvement over the last generation or two that the deformities of rickets, still common well within living memory, are no longer seen in Hackney. Mackay’s groundbreaking research established the link between diet and rickets, and led to a new understanding of its prevention and cure. She showed that cod liver oil and sunlight were effective treatments for the disease.

Anaemia

Anaemia is a very serious health problem if left untreated among children. Chronic anaemia can cause serious neurological and developmental damage, as well as other symptoms like extreme tiredness, poor concentration and behavioural problems. Mackay was aware of the frequent occurrence of anaemia among newborn babies and she wanted to understand how it was caused. Her work did three extremely important things: it showed conclusively that iron deficiency was the most common cause, it illustrated how it affected children, and it led to a new awareness about how it could be prevented. She studied her infant patients at the Mothers’ between 1925 and 1927. She found the condition to be very widespread, with the vast majority of children in the East End being deficient in iron. As part of her research she established what were the normal haemoglobin levels for different stages of infant development, which had not been done before. After studying the haemoglobin levels of breastfed and bottle-fed babies she concluded that breast milk lessened iron deficiency. She found that while 50% of the iron in human breast milk was absorbed by the infant, only 10% of the iron in cow’s milk was. She concluded that babies who were not being breastfed should be given supplementary iron, and this is still received wisdom today.

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