What did Tiny Tim of "Christmas Carol" suffer from?

Harrisburg, Pennsylvania; December 22, 2010

Whether as a book, a movie, or television production, "A Christmas Carol" has been a beloved part of Christmas since Charles Dickens penned it in 1843.

Its basic message of good will to all mankind has been translated into dozens of languages, including those of many nations thay do not celebrate Christmas.

But it contains a mystery never answered by Dickens - what exactly was wrong with Bob Cratchit's son, Tiny Tim? And why was it so important he get prompt medical attention.

The staff of the Pennsylvania Medical Society recently offered some thoughts in this release:

The symptoms

Thanks to the Ghost of Christmas Present, we know that Tiny Tim would soon die. We know that Tiny Tim used a crutch, was very small, and very sick. We also know that Bob Cratchit carried his son periodically, possibly a signal of muscle fatigue. From the Ghost of Christmas Yet to Come, we see the Cratchit house without Tiny Tim, and thus we assume that this confirmed the prediction made by the Ghost of Christmas Present.

Financially, we know that Scrooge didn't pay Bob Cratchit enough money. His meager salary was not enough to buy good food and medicine for Tiny Tim. Plus the Cratchit house was very small.

Historically, we know that Tiny Tim was growing up in London in the mid-1800s.

But, as all three ghosts, along with Scrooge's deceased partner, Jacob Marley, help Scrooge turn from a miser to a kind and generous man, fans of A Christmas Carol are also led to believe that the kind pay raise that Scrooge gave Bob Cratchit helped to save Tiny Tim. Bob would be able to afford good food and medicine.

A quick Internet search brings up several theories on what ailed Tiny Tim. According to Daniel J. Glunk, M.D., past president of the Pennsylvania Medical Society and a practicing internist from Williamsport, Pa., all the theories have a certain degree of merit in making this literary diagnosis.

Could it be RTA?

The first theory is that Tiny Tim suffered from renal tubular acidosis (RTA), a kidney disease that makes blood too acidic.

"Tiny Tim is small, has malformed limbs, and periods of weakness," says Dr. Glunk. "These all can be the result of RTA. Plus, the fact that Tiny Tim's condition is fatal if left untreated, but reversible if proper medicine is used, helps to guide medical sleuths to RTA."

According to Dr. Glunk, RTA occurs when the kidneys fail to excrete acids into the urine. This causes a person's blood to remain too acidic. The result can be growth retardation, kidney stones, bone disease, and progressive renal failure.

"Doctors today can diagnose RTA by checking the acid-base balance in blood and urine samples," says Dr. Glunk. "Back then, when our fictional patient lived, they didn't have the tests we have today to determine this. But, they did know that his symptoms could be treated with alkaline solutions. With appropriate care at the time, Tiny Tim could have managed the condition we know today as RTA."

Dr. Glunk adds that doctors today have identified three types of RTA. Frequent doses of alkali, either as a bicarbonate or something that the body converts into a bicarbonate, are used to treat the disease. The long-term outlook for a child diagnosed with RTA, if not linked to another kidney disease, is positive. Many outgrow the disease, while others who aren't as fortunate simply manage their disease through medications and the help of a doctor. Provided they take their medications as prescribed by their doctors, they remain healthy.


Other Internet medical sleuths suggest that Tiny Tim could have suffered from a Vitamin D deficiency, commonly known as rickets.

Rickets was a widespread problem in locations with heavy smog and industry in the late 1800s and early 1900s. Since sunlight is a major source of Vitamin D, smog could play a role in the deficiency. And, we know that Tiny Tim lived in London, a city that can naturally be gloomy but also had problems with smog as England became industrialized.

According to Dr. Glunk, some signs of Vitamin D deficiency include soft bones, muscular weakness, osteoporosis, and joint pain. Without Vitamin D, the body can't absorb calcium, and thus has difficulty building and maintaining strong bones. That may be why Tiny Tim needed a crutch.

"Knowing London's environmental conditions at that time and knowing Tiny Tim used a crutch, it's reasonable to consider this disease, despite the fact that Vitamin D wasn't discovered until the early 20th Century, well after the time period used by Dickens in the story," said Dr. Glunk. "At the time, they could have unknowingly treated this condition through better foods that Scrooge helped to buy."

Although there have been advancements in medicine, Dr. Glunk says we shouldn't believe we've conquered this disease. "It doesn't occur often these days, but there are occasional reports that rickets still exists," said Dr. Glunk. "A person's diet may not be as good as it should, and with the fear of skin cancer, people are more aware of using sunblock."

Dr. Glunk doesn't recommend dropping sunblock from the beach list to fight a Vitamin D deficiency. In fact, sunblock is too important in fighting skin cancer, he says. Instead, he suggests drinking fortified milk and taking a Vitamin D supplement to prevent the disease. If a person were diagnosed with the disease, stronger dosages of Vitamin D would be used and diet changes probably would be recommended.

A Dickens conspiracy?

Finally, some Internet sleuths believe a conspiracy theory exists and that something other than a disease could have caused Tiny Tim's death. After all, the Ghost of Christmas Yet to Come only showed the Cratchit House without Tiny Tim and never said how he died. Fans of the classic story are only led to believe Tiny Tim died of what ailed him, but are not provided positive proof. Could it be a Dickens literary trick?

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