Sir.—Of all the haunting images that moved the hardened heart of Ebenezer Scrooge on that infamous Christmas Eve, the picture of Tiny Tim seemed to touch him most deeply. Tiny Tim, perhaps the most pathetic yet endearing character in Dickens' story, A Christmas Carol, suffered from a crippling condition. "Alas for Tiny Tim, he bore a little crutch and had his limbs supported by an iron frame." Sitting by the fire after Christmas dinner, Bob Cratchit held Tim's "... withered little hand in his, as if he loved the child, and wished to keep him by his side, and dreaded that he might be taken from him."
Dickens has little more to say about the boy's illness. Tim might have had any one of a number of congenital abnormalities of his limbs. In an age before corrective surgery and prosthesis, he was likely destined to remain a cripple for life.
CALLAHAN MCW. Tiny Tim Remembered. Am J Dis Child. 1991;145(12):1355-1356. doi:10.1001/archpedi.1991.02160120023010