"Will the child die?" Ebeneezer Scrooge asked of Tim Cratchit in Charles Dickens’s A Christmas Carol. Since the book was published in 1843, readers have asked a different question: "What is Tiny Tim dying of?" The character was based on the author’s own ailing nephew, Henry Burnett, Jr., but it is not clear that the fictional child had similar symptoms, let alone the same disease. It’s possible that Dickens was trying to describe an ailing child without having a specific condition in mind, but the symptoms described are consistent with particular diseases common among poor children in Victorian England.
What is known about Tiny Tim’s illness:
- It was treatable in Victorian England
- Treatment required financial resources
- It would have been fatal left untreated
- It stunted his growth
- It affected his ability to walk unaided.
On this basis, several theories have been advanced as to what Tim had. The most common is a kidney disease called renal tubular acidosis. In healthy people, acid in the body is filtered out of the blood by tubes in the kidneys and passed with urine. When this process is interrupted, renal tubular acidosis results in too much acid in the blood. This can lead to inhibited growth, kidney stones, and bone disease—all symptoms Tiny Tim exhibited in the book—and left untreated, results in chronic kidney disease and possibly total failure, which can be fatal. Treatment with citrus and sodium bicarbonate was known and available in the mid-19th century.
Another possibility is rickets, or vitamin D deficiency. Rickets is rare in the United States nowadays because of fortified milk, but, like other forms of malnutrition, was common among the Victorian poor. Symptoms include skeletal deformity, stunted growth, weakness, muscle spasms, and general sickliness. People with rickets are also particularly prone to tuberculosis, which is epidemic in times and places where sanitation is poor and also fits Tiny Tim’s symptoms.