What was wrong with Tiny Tim in 'A Christmas Carol'? (2024)

Associated PressBob Cratchit carries Tiny Tim in a scene from the 2009 Disney version of "A Christmas Carol."

None of us can forget poor Tiny Tim Cratchit from Charles Dickens’ “A Christmas Carol.”

The “good as gold” boy from the classic story has inspired many to give generously.

But his story, set in London in the mid-1800s, has also given rise to much debate about what ailed him.

When the Ghost of Christmas Present first shows Ebenezer Scrooge the Cratchit family, we learn that Tiny Tim “bore a little crutch, and had his limbs supported by an iron frame.” The weak, sickly lad is often carried by his father, Bob Cratchit, and we are led to believe that he will soon die. As the story ends, we learn that Scrooge’s decision to give Cratchit, his clerk, a pay raise helps to save Tiny Tim.

With these limited facts, medical sleuths have tried to unravel the mystery surrounding what exactly was wrong with Bob Cratchit’s youngest son for years.

Here are a few of their best diagnoses:

RENAL TUBULAR ACIDOSIS

What it is: A kidney disease that makes a person's blood too acidic. Without treatment, it can cause growth retardation, kidney stones, bone disease, chronic kidney disease and possibly total kidney failure.

Reasons to support diagnosis: This diagnosis was put forth by Donald Lewis and written up in the American Journal of Diseases of Children in 1992. Lewis said Tiny Tim's short stature would be an early sign of the disease. Softening of the bones would account for the use of a crutch. And kidney failure can cause death. However, if Tiny Tim were to receive alkaline solutions — a remedy often proffered by 19th-century physicians to treat symptoms similar to his — the disease would have been manageable.

What the critics say: RTA is uncommon, and therefore an unlikely diagnosis. Other critics suggest Tiny Tim's suffering was a metaphor for societal neglect, not a clinical disease.

RICKETS

What it is: A disorder caused by lack of vitamin D, calcium or phosphate.

Reasons to support diagnosis: Symptoms of vitamin D deficiency include short stature, soft bones, muscular weakness and joint pain. The body needs sunlight to create vitamin D, and London is known for being gloomy. Rickets was widespread in places such as London during the Industrial Revolution, but could have been prevented and treated with a better diet afforded by Scrooge's pay raise.

What the critics say: A nutritional deficiency would likely have affected all the Cratchit children, not just one. Also, the disease is not usually fatal by itself. Rickets can also be caused by a disease like RTA, according to an entry on PubMed Health.

View full sizeAssociated PressEbenezer Scrooge and Tiny Tim are shown in a scene from the 2009 Disney version of "A Christmas Carol."

POTT’S DISEASE

What it is: Pott's disease is a form of tuberculosis that affects the spine. It's sometimes called tuberculosis spondylitis or spinal tuberculosis.

Reasons to support diagnosis: Charles Callahan submitted this diagnosis to the American Journal of Diseases of Children in 1991. He argued it is common for children not to exhibit classic respiratory symptoms of TB that are seen in adults. He said the disease usually strikes children under age 10, and will cause deterioration of the spine, weight loss, fatigue and pain. He argued tuberculosis could have been managed if the Cratchits could afford to send Tiny Tim to a sanitarium and buy him a back brace.

What the critics say: Tuberculosis is difficult to treat and was not usually curable in the 1800s.

TUBERCULOSIS OF THE HIP

What it is: Sometimes called coxalgia because of its primary symptom: hip pain.

Reasons to support diagnosis: Peter Jones suggested this diagnosis in the Australian Paediatric Journal in 1972. TB was also one of the most prevalent diseases in London in the 1800s, and this form of the disease would have explained Tiny Tim's limp. Although TB frequently caused death, Jones wanted to be optimistic, which he said is characteristic of Dickens. Jones also mentions the possibility of "pseudocoxalgia or Perthes," another disorder causing hip pain.

What the critics say: Tuberculosis was not usually curable in the 1800s.

POLIO

What it is: A viral disease that affects the nerves and can cause paralysis.

Reasons to support diagnosis: Polio was a worldwide epidemic between 1840 and the 1950s, and it was often associated with children. The description of Tiny Tim "supported by an iron frame" is reminiscent of the braces worn by those with polio.

What the critics say: Polio isn't reversible.

What about Scrooge?

Readers also have questioned whether a disease was behind Scrooge’s dreams.

While Ebenezer Scrooge attributes his dreams to food poisoning, a 2006 New York Times Magazine piece by Dr. Lisa Sanders said there is another possible diagnosis: Lewy body dementia. Lewy body dementia can cause vivid hallucinations, and they often occur early in the disease, she wrote.

While this type of dementia had not been diagnosed in Dickens’ time, Dickens has been known to accurately describe diseases that weren’t recognized by the medical community until years later.

SOURCES: Pennsylvania Medical Society news release, Sydney (Australia) Morning Herald, Toronto Star, New York Times Magazine, National Kidney & Urologic Diseases Information Clearinghouse, PubMed Health, Journal of Infectious Diseases.