In Reply.—The response to my seasonal offering of speculation on the illness that may have afflicted the fictional Dickens' character Tiny Tim has been most enjoyable and overwhelming. The thoughtful letters, particularly those from medical historians and Dickens' scholars, are greatly appreciated and many serve to reinforce my speculation that Tiny Tim could have suffered from reversible renal disease. In response, I would like to explain my reasons for writing the article.
The concept arose as a teaching tool. About 5 years ago, my wife and I were watching one of the film versions of A Christmas Carol. As the pitiful character of Tiny Tim limped into the scene, she asked me what was wrong with him. Without thinking, I responded that he probably had cerebral palsy or muscular dystrophy. Not satisfied with my answer, she persisted and reminded me that I was a pediatrician and ought to be