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Tiny Tim and the spirit of medical Christmas
  1. Ciara O'Neill
  1. Paediatric Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
  1. Correspondence to Dr Ciara O'Neill, Children's Health Ireland at Crumlin, Crumlin, Ireland; oneilc32{at}

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Few characters in fiction evoke greater resonance with the theme of Christmas and child health than Tiny Tim in A Christmas Carol. Teasing out the possible underlying diagnoses of his condition has attracted significant clinical focus over the last century. Overemphasis on the sparse and conflicting clinical details in the novel draws attention away from the deeper social commentary on childhood poverty and inequity transmitted so effectively in this masterpiece.

Despite the modest proportion of the text dedicated to him, the pathos of his differing fates represents the essence of the Christmas spirit of renewal and redemption. Putative diagnoses suggested in the medical literature over the year include type 1 distal renal tubular acidosis,1 tuberculosis, rickets, scurvy, syphilis, cerebral palsy, spinal dysraphism, muscular dystrophy as well as recognition of environmental and sociological factors. These are often published in good-humoured sequences of reply and counterreply in paediatric medical journals. These sometimes add to the fog of diagnosis by drawing on interpretations by artists in book illustrations and the many cinematic …

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  • Provenance and peer review Not commissioned; externally peer reviewed.