NEW YORK - A physician who was stumped when his wife asked what ailed Tiny Tim of the classic "A Christmas Carol" has concluded that the boy probably had a kidney condition.
Dr. Donald Lewis studied Tiny Tim's symptoms as revealed in the original manuscript of the 1843 story, illustrations in later editions and movie adaptations.
The author, Charles Dickens, could not have known about the disease, distal renal tubular acidosis (type I), which makes the blood too acidic, Lewis said. The condition was not recognized until the early 20th century, he said.
The point of trying to diagnose Tiny Tim was to show medical students how to evaluate real children, Lewis said in a telephone interview.
He said his analysis was based on how a case of the disease would look if it went untreated, given the extreme poverty of Tiny Tim's family. Nowadays, the disease is treated before children end up like Tiny Tim, he said.
Lewis is an assistant professor of pediatrics and neurology at the Medical College of Hampton Roads in Norfolk, Va., and a pediatric neurologist at the U.S. Naval Hospital in Portsmouth, Va. He discusses Tiny Tim in this month's issue of the American Journal of Diseases of Children.
Here is his analysis:
-- Tiny Tim was short but apparently proportioned normally. Dickens referred to Tim's father, Bob Cratchit, as little, so Tim's stature may have been inherited.
-- Tiny Tim had only one crutch, so the disease affected one side of the body more than the other, perhaps because of bone fractures.
-- His spells of weakness, his withered hand and limpness when riding on his father's shoulders suggest a problem with the nerves that lead from the spinal cord to the muscles.
-- He was apparently supposed to die within a year, because the Ghost of Christmas Present told Ebenezer Scrooge that "none other of my race will find him here" during presumably annual visits.
-- Yet he did not die after Scrooge opened his rich purse and, no doubt, found the best doctors around. So the disease must have been treatable at the time.
Lewis consulted medical textbooks of Dickens' day and found that children with Tiny Tim's symptoms would have received alkaline solutions, which would counteract the excess acid in his blood. His improvement would have been rapid, Lewis said.