What was Tiny Tim's affliction?

[ElvisL1ves]

No, not the late, sorely-missed Herbert Khaury - I mean the crippled Cratchit kid in "Christmas Carol". Tiny Tim's disease caused him to be lame, but apparently only enough to require 1 crutch. He also had no reported difficulties with his other extremities, and the only other impliable symptom would be malnutrition. But somehow it caused his death within a matter of a few years, which one would not ordinarily expect from an orthopedic problem. Furthermore, it was treatable by London doctors in 1843 with enough funding (he did reportedly survive in the post-visits alternate universe, after all).

The only possibility I can think of is bone cancer, but I don't think that was treatable then. So what are the possible diagnoses? What did tiny Tim Cratchit have, and how would Scrooge's doctors have treated it in 1843?

[Dark Lord Davidson]

He had rickets.

I don't know what rickets is or what it does to the body, but it is the coolest sounding disease I've ever heard of, so that's what Tiny Tim must have had.

[BobT]

Rickets is caused by a deficiency of vitamin D. I would assume that if Tiny Tim had it, so would have the rest of the family, unless Tiny Tim was given different food. He should have been much weaker.

Somebody came up with a theory once about Tiny Tim's disease. I thought it was a kidney affliction.

[Gaspode]

I alwyas assumed it was poliomyelitis. I currently work with a bloke who's got one partially paralysed leg from childhood polio. He can move it now but apparently as a child it was nearly completely paralysed. The other leg is also a little weak. I don't know whether polio can kill after the initial attack though.
I suppose it's also possible Tiny Tim died of somehting totally unrealted to his paralysis. I don't recall Dickens ever specifying.

[lee]

Tiny Tim died?

[Anti Pro]

It's curious that you would ask this, I just watched the George C. Scott version of a Christmas Carol this morning and I was wondering the same thing.

I don't think it would have been polio, money wouldn't have cured that, which is what is hinted at..... rickets is a good guess, but it seems like the rest of the family would've been affected as well.

He certainly looks malnourished, perhaps, some protein deficiency, but why just his legs?? Beats me, he does manage to live happily ever after though!!

[edwino]

Rickets is vitamin D deficiency before the bones have stopped growing. It can be caused by poor diet, especially in northern countries without much sunlight. It causes bowing of the legs, stunting of growth, "rosary beading" on the ribs, and several other characteristic signs.

After the bones have fused, you don't get rickets. You get osteomalacia or bone wasting. This can cause pathologic fracture, increased risk for osteoporosis, but not stunting of the growth and bowing of the legs.

So, I think Tiny Tim had rickets.

[andygirl]

I always thought that his body was rebelling for having a mind within it that attempted to be so disgustingly and cloyingly sentimental.

"God bless us, everyone! Oh, my legs!"

I'm not really a fan of the story...

[Yeah]

Rickets is "a deficiency disease that affects the young during the period of skeletal growth, is characterized especially by soft and deformed bones, and is caused by failure to assimilate and use calcium and phosphorus normally due to inadequate sunlight or vitamin D" (from Merriam-Webster's Collegiate Dictionary at http://www.britannica.com). So you would NOT expect that if Tiny Tim suffered from rickets other family members would suffer from rickets as well (except, perhaps, for siblings close in age to Tiny Tim).

[bibliophage]

There have been a number of theories over the years, including spinal tuberculosis, vitamin-D deficient rickets, and renal tubular acidosis (RTA).

RTA leads to the symptoms of rickets due not to insufficient intake of vitamin D, but to an excessive excretion of calcium and phosphorus in the urine. It is also called vitamin D-resistant rickets, because giving vitamin D does not help. The prognosis in 1840 would have been extremely poor, with or without treatment.

references:
What the Dickens was wrong with Tiny Tim? (http://www1.umn.edu/urelate/tips/12-14-98.html)
Tiny Tim's ailment (http://quarton.evms.edu/about/evms_rr/dec/12-21_lewis.html)
Taber's Cyclopedic Medical Dictionary

[HeyHomie]

I've come to the conclusion that Tiny Tim had MacGuffinitis. That is, his disease was a Dickensian MacGuffin.


Of course, now that I've looked at bibliophage's links I think Rickets is a viable option, too. When Scrooge gave Cratchit a raise maybe they could afford to take the little tyke to a doctor, who then said "use that raise old Scrooge gave ye and buy ye some limes!" (or whatever variety of citrus they had available in Victorian London.

[Dr. Lao]

Originally posted by rastahomie
When Scrooge gave Cratchit a raise maybe they could afford to take the little tyke to a doctor, who then said "use that raise old Scrooge gave ye and buy ye some limes!" (or whatever variety of citrus they had available in Victorian London.Limes wouldn't do him much good. Vitamin D is a fat soluble vitamin found in dairy products and sea food. The body can also produce Vitamin D, but only if the skin is exposed to direct sunlight. So maybe the raise allowed Cratchit to put in a skylight in his house.

[KarlGauss]

Didn't the lad cough a lot? (Or was that just in the Alastair Sim version - I've never read the book). In any case, given the cough, weakness, and inexorable death, and coupled with what must have been prevalent in urban London circa 1840, I'd always assumed we were dealing with TB.

[AWB]

Originally posted by rastahomie
Of course, now that I've looked at bibliophage's links I think Rickets is a viable option, too. When Scrooge gave Cratchit a raise maybe they could afford to take the little tyke to a doctor, who then said "use that raise old Scrooge gave ye and buy ye some limes!" (or whatever variety of citrus they had available in Victorian London.

You're thinking of scurvy, which is caused by a lack of vitamin C.

Scurvy became prevalent when sailors began to spend months at sea without fresh vegetables, and in such cases it was usually fatal. In 1795, lime juice was issued to all British naval vessels on the recommendation of the Scottish physician James Lind, who knew that the Dutch had employed citrus fruits for several hundred years; scurvy soon began to disappear among British seamen. Unknown at the time, limes have less vitamin C than oranges and lemons. These have supplanted limes as antiscorbutic agents.

[Compass]

Figuring in the era that the book was written, judging from the medical quality and education of the time, factoring in the associated disease level within the poverty areas of London, the mentioned poverty of TT's family which would have placed them on a drastically unbalanced diet, very short on vegetable and fruit vitamins and minerals, the accepted level of sanitation, the low quality of potable water, the harsh lifestyle, acerbated by the harsh weather, and include the high probability of insufficient heating within the dwelling and you gain a theory.

Consider his lameness due to an untreatable birth defect such as the doctor or midwife dislocating his hip upon birth, or a breaking of the leg in later time or a tubercular cyst lodged within the bone, eroding the structure and his potential for having tuberculosis of the lungs as well and you have a child in ill health with a decreased immune system.

In his poverty situation, plus being exposed outside begging for coin -- which I assume he was during while his dad worked -- he would not only be highly susceptible to any number of diseases prevalent at the time, but most vulnerable to pneumonia. The TB itself could steadily increase in severity, destroying lung, organ and bone tissue in the process.

Remember, the best cure for TB then would have been keeping dry, warm and well fed with a high vegetable diet, and obtaining a good supply of natural vitamins, especially D, mainly gotten from sunlight then. He would have had to avoid exposure to even minor diseases if possible until his system recovered.

The TB alone would have caused a steady weakening of his immune system and put a strain on his physical stamina. Insufficient dietary requirements would acerbate this, and most poverty families of the time existed on diets high in cheap pork, cheap sausage, a porridge made from wheat or oats, little milk, potatoes, flour, bacon and bacon grease, salt, sugar, tea, few greens, and almost no fruit. They might have had jam in the way of summer preserves or duck packed in grease. Any fish would have, in the winter, been dried and salted.

Tiny Tim, without intervention basically increasing his standard of living in the area of diet and shelter, would probably have died of tuberculosis or pneumonia contracted locally and unable to be fought off with his weakened immune system.

There were no antibiotics, surgeons/doctors might have rinsed their hands after working on patients but probably not, sewers were often in the center of streets in the form of open trenches, and people had a habit of dumping chamber pots out of upper story windows as well as trash.

London of that period must have smelled most remarkable and even more astounding in the summer.