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August 1993

Tiny Tim, Dickens, Renal Disease, and Rickets

Author Affiliations

Harvard Medical School Renal Division Beth Israel Hospital 330 Brookline Ave Boston, MA 02215

Am J Dis Child. 1993;147(8):819-820. doi:10.1001/archpedi.1993.02160320021010

Sir.—It is fitting that Lewis proposes that Charles Dickens' Tiny Tim was afflicted with renal disease,1 since a number of Dickensian characters have autobiographical attributes. Charles Dickens was reported to suffer much of his life from renal colic and may have died of kidney failure.2 The fact that he had "strokes" at a relatively young age suggests he also may have had the attendant hypertension of chronic renal failure. In addition, John Dickens, Charles' father, suffered from a form of kidney disease since his death was related to the removal of a bladder stone.2

Lewis speculates that Tiny Tim could have had distal RTA type 1, citing Dickens' descriptions of Tim's symptoms and considering the potential treatability of such an illness in 19th-century England. Other writers have suggested that poor Tim may have suffered from polio, tuberculosis of the hip, or pseudocoxalgia.3 While it is