Rickets, the childhood disease that once caused an epidemic of bowed legs and curved spines during the Victorian era, is making a shocking comeback in 21-century Britain.

Rickets results from a severe deficiency of vitamin D, which helps the body absorb calcium. Rickets was historically considered to be a disease of poverty among children who toiled in factories during the Industrial Revolution, and some experts have hypothesized it afflicted literary characters like Tiny Tim in Charles Dickens’ “A Christmas Carol.”

Last month, Britain’s Chief Medical Officer Dr. Sally Davies described the return of rickets as “appalling.” She proposed the country give free vitamins to all children under five and asked the country’s independent health watchdog to study if that would be worthwhile.

Most people get vitamin D from the sun, oily fish, eggs or dairy products. Rickets largely disappeared from Britain in the 1950s, when the country embarked on mass programmes to give children cod liver oil. But in the last 15 years, the number of reported cases of rickets in hospitalized children has increased fourfold from 183 cases in 1995 to 762 cases in 2011. Experts said the actual number is probably even higher since there’s no official surveillance system and it’s unknown whether the disease has peaked.

“It’s very surprising to see this,” said Dr. Mitch Blair, an officer for health promotion at the Royal College of Paediatrics and Child Health. “Children come in with bendy legs, swollen wrists and sometimes swollen ribs,” he said. “This is not something we should be seeing because it’s completely preventable.” He said the condition was reversible once children start getting enough vitamin D, usually in tablets or injections.

Keywords: RicketsUK