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
PETERSON DC. 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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