What
Was Ailing Tiny Tim?
By
Andrea Thompson, LiveScience Staff Writer
Ebenezer
Scrooge may be the most memorable character from Charles Dickens' "A Christmas
Carol," with his "Bah, humbug!" and stingy ways. But medical sleuths
are more interested in the book's biggest unanswered question: What exactly was
wrong with Tiny Tim, Bob Cratchit's sickly son?
Online
detectives have been debating this question for years, using clues taken from
the book to form possible diagnoses.
Internist
Dr. Daniel J. Glunk, president-elect of the Pennsylvania Medical Society, has
examined all of these theories and determined that many seem to have merit in
identifying Tiny Tim's ailment.
The
symptoms
We
know that Tiny Tim was growing up in London in the mid-1800s, a time when heavy
smog lay thick in the air, blocking sunlight.
From
Dickens' descriptions of the lad, we know he was very small, used a crutch and
was very sick. Because Scrooge was a well-known, well, scrooge, it is clear Cratchit's
meager salary was not enough to buy good food and medicine for his son. From the
scenes Scrooge sees while being visited by the ghosts, we see Cratchit carrying
Tiny Tim from time to time, a possible sign of muscle fatigue. We also learn through
Scrooge's time travels that Tiny Tim would soon die.
At
the end of the book, readers are led to believe that the pay raise the changed
Scrooge gives Bob Cratchit helps to save Tiny Tim.
Kidney
disease
One
theory floating around the Web is that Tiny Tim suffered from renal tubular acidosis
(RTA), a kidney disease that makes blood too acidic.
According
to Glunk, RTA occurs when the kidneys fail to excrete acids into the urine, cause
the acid to build up in the blood. The result can be growth retardation, kidney
stones, bone disease and progressive renal failure—symptoms that seem to
match some of Tiny Tim's.
"Tiny
Tim is small, has malformed limbs and periods of weakness," Glunk said. "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."
While
19th century doctors wouldn't have been able to test for the disease or even put
a name on it, they did know the symptoms and how to treat them, Glunk said. Frequent
doses of alkaline substances would have been given to such patients, which would
neutralize the acid in the blood.
Rickets
Other
Internet sleuths have suggested that Tiny Tim suffered vitamin D deficiency, commonly
called rickets.
Rickets
was a widespread problem in cities with heavy smog that blocked sunlight, a major
source of vitamin D.
Without
vitamin D, the body can't absorb calcium and has difficulty building and maintaining
strong bones. Some signs of rickets include soft bones, muscular weakness, osteoporosis,
and joint pain.
"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," Glunk said. "At the time,
they could have unknowingly treated this condition through better foods that Scrooge
helped to buy."
Of
course, it's nearly impossible to say for sure what was ailing Tiny Tim, but that
won't keep armchair online physicians from combing for clues to other possible
diagnoses.
