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Did Tiny Tim from Charles Dickens' "A Christmas Carol" have a real, diagnosable health problem, or was he afflicted with a made-up storybook ailment?


Here're the main clues (as well as I can gather them):


* He was partially lame (could walk with a crutch)...


* His condition was degenerative -- & eventually terminal...


Most people can usually isolate some pretty good guesses based on those 2 hints, but here's the point that always stymies the doctors & nurses I know:


* His condition could be alleviated with 18th century medicine -- IF someone affluent (like Scrooge) were to pay for treatment (remember: Tim doesn't die BECAUSE Uncle Ebenezer opens his pocket book at the end of the story)...

...THAT's the wild card.


For the record: TB & polio are the 2 most common guesses I've heard, but with the confusion that late-1700's/early 1800's medicine (the time period when the story seems to have been set, rather than when it was published) couldn't do much about either.


What do you think, you med school students? (You know who you are!)




(BTW: I know the answer but just want to see what you can come up with. ;) )

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I am no med student, but my hubby is a D.C and knows a lot about this stuff. Plus, my uncle suffers an illness that has similar symptoms to Tiny Tim's mysterious illness....


Myasthenia gravis (MG) causes weakness that gets worse with exertion and improves with rest. The disease first appeared in medical reports in 1672, but didn?t earn its name, which literally means "grave muscular weakness," until the 1880s.


Physicians in 19th-century Germany, the first to begin systematic studies of the disease, noted that it produces weakness that fluctuates but generally progresses with time. Lacking crucial insights into the properties of nerve and muscle, they weren?t able to do much for their patients, many of whom lost strength rapidly and eventually died from respiratory failure. Even in the early 20th century, the mortality rate of MG was around 70 percent.


Fortunately, over the past 100 years, the origins of MG have gradually unfolded, and the outlook for people with the disease has improved dramatically... Physicians now estimate that, when MG is properly treated, the mortality rate is near zero. Most people with the disease are able to manage their symptoms and lead active lives, and a few experience remission lasting many years.


This desease causes muscular dystrophy, which explains the difficulty of Tiny Tim for walking (my uncle walks with a cane). Back in the 18th century the disease was practically unknown and the treatment could have been costly if there was any at the time, which explains the likelihood of Tiny Tim dying from it; the desease, if left untreated, would gradually degenerate his muscles including the muscles that help in the breathing process and other normal functions.


In any case, I think the fact that Tiny Tim was completely cured by the end of the story, makes this an unlikely probability. Myasthenia can be treated but not cured. In the 18th century the chances of surviving this desease would have been few if not nule.

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i've already heard this one in class, pf81, so i know the answer, but it's still pretty interesting. i would never have been able to figure it out, especially since i'm not familiar with what kind of medical treatments they had available in the 1800s.


i'd think that the only treatable kind of condition back then in which a kid presents with poor growth, weakness, and deformed bones would be vitamin d deficiency. in adults, vitamin d deficiency gives you weak bones (osteomalacia) and muscles, but in kids it can also result in bone deformities (rickets).


but a nutritional deficiency isn't really the sort of thing that would really require any sort of special medical treatment like tiny tim had. vitamin d is extremely easy to get if you leave the house once in awhile... you don't even need to eat/drink any dairy. so one would think that there is something causing tim to have rickets despite adequate nutritional intake... that's about as far as i could have gotten.


in school i heard that tiny tim probably had a kidney disease called renal tubular acidosis that basically impairs the ability of the kidneys to exchange ions from the blood properly. it causes an imbalance in your blood in which you've got too much acid and not enough potassium. basically, a kid will end up with stunted growth, vitamin d deficiency (rickets), and crappy muscles.


if tim had left it untreated, his kidneys would have let out (like zo's), and he would've died. to treat it, you have to administer some agents that neutralize the pH of the blood (i don't remember what they are), and apparently they had these agents available back in the 1800s. so to answer your question, it is renal tubular acidosis, although i wouldn't have been able to figure it out in a million years...

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