Conclusion

Abstract

In a contest for the most prominent literary patient in twentieth-century medical debates, Timothy Cratchit would be a strong contender. Other Dickensian characters have been graced with modern medical diagnoses — Creakle has been shown to suffer from spasmodic dysphoria, Mrs Skewton from essential tremor, and medical wisdom has it that Jeremiah Flintwinch’s twisted neck is the consequence of cervical dystonia.1 However, it is Tiny Tim with his single crutch who has inspired modern paediatricians and forensic anthropologists to engage in medical detective work as well as in heated controversies in medical journals. Tiny Tim’s illness has variously been interpreted as distal renal tubular acidosis (a disease of the kidney), rickets (a softening of the bones caused by a lack of Vitamin D) and as a combination of cerebral palsy and diphtheria. In 1993, the American Journal of Diseases of Children briefly entertained the idea of establishing an annual prize for diagnostic essays on Tiny Tim’s disease. Medical debates were brought to a temporary halt in 1997 when building work at Saint Andrews Church, London, led to the discovery of the grave of a Timothy Cratchit, who had died in 1884 at the age of forty-five. Besides the skeletal remains archaeologists also found a frame of metal and leather which Cratchit had worn to support his legs and lower back.