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Did Scrooge save Tiny Tim with vitamin D?

A new article proposes that the crippling condition that afflicted Charles Dickens’ fictional Tiny Tim in “The Christmas Carol” was due to rickets and tuberculosis.

J.C. Cutler (Ebenezer Scrooge) and Noah Ross (Tiny Tim) in the Guthrie Theater's production of the Charles Dickens classic 'A Christmas Carol'

As I’ve noted here before, scarcely a week goes by when I don’t receive a press release touting the benefits of vitamin D supplements for this or that illness. It is definitely the nutrient du jour.

As I’ve also noted (most recently on Wednesday), we don’t really have solid evidence (large-scale randomized clinical trials) yet to prove those benefits. Those trials are in the works, but until then, claims that vitamin D supplements can prevent cancer, heart disease, multiple sclerosis or anything else are just speculation.

So I had to smile when I came across an article published this week in the Archives of Pediatrics & Adolescent Medicine.

It proposes that the crippling condition that afflicted Charles Dickens’ fictional Tiny Tim in “The Christmas Carol” was due to rickets and tuberculosis, two illnesses that could have been “cured” by guess what? Vitamin D, of course!

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Here’s the abstract for the article, which was written by Dr. Russell Chesney, a pediatrician with the University of Tennessee Health Science Center in Memphis, Tenn.:

Physicians, Dickens scholars, and historians have tried to diagnose the condition that affected Tiny Tim in “A Christmas Carol.” Leading entities include tuberculosis (TB), rickets, malnutrition, cerebral palsy, spinal dysraphism, and renal tubular acidosis. This article posits that an examination of the environment of London of 1820 to 1843 (when the novella was written) can provide important clues as to his condition. The blackened skies from burning coal, the crowding of people in tenements, the limited diet of the underclass, and the filth of London resulted in a haven for infectious diseases and rickets in children. Sixty percent of children in London had rickets, and nearly 50% had signs of TB. Tiny Tim likely had a combination of both diseases. After Ebenezer Scrooge’s transformation, Scrooge could have ensured an improved diet, sunshine exposure, and possibly cod liver oil for Tiny Tim, which could have led to a “cure.” Dickens was familiar with both rickets and TB and wrote about cod liver oil as a possible cure for rickets and scrofula. Improved vitamin D status can result in enhanced macrophage synthesis of 1,25-dihydroxyvitamin D, which increases the synthesis of the antimicrobial peptide catheliciden (LL-37). This component of the innate immune system has strong killing properties for mycobacterium tuberculosis. The combination of rickets and TB represent a crippling condition that could be reversed by improved vitamin D status.

We’ll never know, of course, whether Tiny Tim was suffering from rickets and TB. Although Dickens was aware of both conditions, he never announces a diagnosis in the novella.

But if Tiny Tim did have rickets and TB, then vitamin D would have helped. Rickets does result from a vitamin D deficiency. It’s why vitamin D was added to milk during the 1920s. The TB connection is more tenuous, but it might explain, as Chesney notes, “the success of sanitariums and the sunlit porches where patients sunbathed in the late 19th and early 20th centuries.” (Our bodies make vitamin D when we’re exposed to sunlight.)

Child labor and volcanoes

Chesney’s article offers many fascinating details about illness and medicine in 19th century Britain. He points out, for example, that one reason rickets was so prevalent among London’s children — so much so, in fact, that it was dubbed “the English disease” — was because children worked indoors from before dawn to after dusk and, thus, were not exposed to sunlight.

Chesney also points out that ash from the massive 1815 eruption of the Indonesian volcano Tambora probably blocked UV-B rays for many years, thus making it even more difficult to London’s children to get sufficient sunlight. In addition, the volcano’s debris caused crops to fail and dramatically spiked the cost of food, factors that exacerbated malnutrition worldwide among the poor — and undoubtedly contributed to the medical misery of London’s children during the 1820s,  the period of Dickens’ own childhood. (The suspended particles of ash produced one lasting benefit: the rich sunsets immortalized in oil by J.M.W. Turner.)

“A Christmas Carol was penned only 23 years after Dickens was a child laborer,” Chesney concludes. “Based on his intimate knowledge of poverty, slums, child labor, childhood death, and the medical maladies of the environment, his character lived in a milieu where a combination of rickets and TB were common. Hence, on an environmental basis, Tiny Tim had both conditions. A Christmas Day transformation of Scrooge saved him.”