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What Was Wrong With Tiny Tim?

Am J Dis Child. 1993;147(8):818-819. doi:10.1001/archpedi.1993.02160320020009.
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Sir.—Humbug! Lewis postulated distal RTA type 1 as the "diagnosis" for Dickens' Tiny Tim in the December issue of AJDC.1 If he intended his article as a bit of holiday humor, Time magazine seems to have missed that intention (December 28, 1992:19). If he intended the article seriously, three major intrinsic logical errors should be pointed out.

Charles Dickens was not a physician detailing a case history; he was an author telling a story. Tiny Tim's medical condition was crafted to meet the requirements of the story. It boggles the mind to think that Dickens observed the clinical course of a rare medical condition and used it in his narrative. The real observations that Dickens made were the following: (1) The children of the poor were more likely to die than the children of the rich. (2) Weak and crippled children were more likely to die than hale


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