Sir.—Using retrospective diagnosis, Lewis,1 in the December 1992 issue of AJDC, hypothesizes a case of distal renal tubule acidosis (RTA) (type 1) in Charles Dickens' beloved literary character, Tiny Tim,2 and provides excellent documentation of how London's working poor lived and the types of medical treatments and measures available in the 1840s.
However, there are three critical points on Dickens and medicine that Lewis should consider beyond the case of Tiny Tim that would better substantiate the British novelist, rather than a 20th-century commentator, as an astute and accurate medical observer. The first point is to recall that Dickens was fascinated with all aspects of humanity, including the propensity to illness. A strong supporter of public health, medical, and sanitation reforms, Dickens was a frequent visitor to hospitals and helped raise large amounts of money for London's Great Ormond Street Hospital for Children, the London Foundling Hospital,
MARKEL H. On Tiny Tim, Charles Dickens, and Pediatrics. Am J Dis Child. 1993;147(8):817–818. doi:10.1001/archpedi.1993.02160320019007
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