Tiny Tim Gets Modern Diagnosis

In one version of A Christmas Carol, the published one, Tiny Tim Cratchit doesn't die of his afflictions; rather, he lives on, thanks to the generosity of a reformed Ebenezer Scrooge.

If Tiny Tim, however, hadn't been able to live on, what would he have died of, specifically? After all, in the version of the story that is developed before Scrooge's near-miraculous conversion, Tiny Tim is on a slippery slope to an early demise. 

In the latest of real-world speculation on the causes of fictional maladies, an American doctor has a new theory for what afflicted poor little Cratchit. The doctor, from Tennessee, asserts that Tiny Tim suffered simultaneously from rickets and tuberculosis.

Rickets, a bone disorder caused mainly by vitamin D deficiency, was a common enough affliction in the 19th Century, especially in poor populations like the one obviously inhabited by the Cratchit family, which lived in a London that was full of sunlight-hampering pollution and was also close-knit but in an awful way. The disorder, which can also be caused by lack of calcium or phosphate, makes the bones soft and weak and prone to breaking. Such bones need support, and the notable means of that kind of support in 19th Century England was the kind of leg braces that Tiny Tim wore, according to Dickens. An astonishing 60 percent of children in working-class families had rickets, and boys who looked just like Tiny Tim was described would have been all too painfully common.

Tuberculosis, often called the "white plague," was deadly in the 19th Century. A young boy suffering from rickets would naturally have had an immune system that could more easily be ravaged by something like TB. (Dickens would have known firsthand how deadly TB could be: his nephew died of it.)

The modern doctor also asserts that Dickens' statement that Scrooge's money helped save Tiny Tim's life is further proof of the rickets-TB theory. The idea is that the Cratchit family's having more money would have enabled them to not only move out of the cramped, clouded conditions of working-class London that denied Tiny Tim of vital things like sunlight (a natural source of Vitamin D), but also would have afforded the family the ability to buy something like cod liver oil, a Vitamin D-rich product, and also buy more nutritious food. (Scrooge's Christmas-day turkey was just the start.)

Our latest modern doctor is not the first to suggest a diagnosis for poor old Tiny Tim, nor will he be the last. He did disagree with earlier doctors who diagnosed Tiny Tim with polio or cerebral palsy, though.

So, where does that leave us? Did Tiny Tim suffer from rickets and/or tuberculosis? Who knows? He was a fictional character, after all, no matter how many people can quote "God bless us, every one." Dickens, although he had many real-world examples to draw from, didn't leave behind any written notes stating categorically what made Tiny Tim the way he was. 

We are left to our conjecture.