THE EARLIEST accounts of childhood rickets describe thoracic deformities and mention respiratory difficulty in severe cases.1 A more specific description of the respiratory consequences appears in an early edition of Cecil's2 text:
Thoracic deformities... functional embarrassment which attends severe rickets may actually endanger life. The thoracic cage instead of expanding with each downward excursion of the diaphragm may actually become more constricted;... respiration is rapid and difficult and a relatively mild infection may have a fatal termination.
A similar thread runs through the literature of renal osteodystrophy. In the first report of the association of rachitic deformity with renal disease, Lucas3 tentatively includes curvature of the spine and pigeon chest in the syndrome. Further definition of the entity by Barber4 dwells on growth retardation, renal dwarfism, and the few photographs accompanying his earlier case reports show, at the most, mild pigeon chest and thoracic margin sulcus.