Editors: Samuel M. Wishik, M.D..
Cultural Factors: While working in Hawaii some years ago, I was surprised to encounter a number of cases of rickets. This surely did not seem logical in the land of sunshine. When I questioned the mothers on whether or not they took the baby outdoors, they replied in the negative because they were afraid that they and the babies would become too dark-complexioned. Since they were members of non-Caucasian races, it was clear that a cultural situation (in the absence of vitamin D supplementation because of the year-round sunshine) contributed to the development of rickets.
The Hawaiian experience illustrates the importance of looking even beyond the "whole child" to consideration of him as a member of his community and of his culture.