An email from my dramaturg today

Why does Tiny Tim need a crutch?

Many researchers, pediatricians, and literary scholars have attempted to diagnose Tiny Tim. Here are some of their
arguments:

a) Tiny Tim had rickets, a Vitamin D deficiency.

The Case for it: Vitamin D is found in milk, which the Cratchits could not afford, and in sunlight, which would have been scarce in the poorer, smog-filled area of London where the Cratchits lived. Without Vitamin D, kids don’t build healthy bones, and their legs can bow under the weight of their own bodies—just like Tiny Tim’s leg!

The Argument against it: Rickets was not usually fatal, and the Ghost of Christmas Present insists that Tiny Tim will die if Scrooge does not help him. And if the Cratchits did have a problem getting enough Vitamin D, the other children in the family would have had rickets too.

b) Tiny Tim had TB, or Tuberculosis, a very common disease of the time.
The Case for it: Though TB was generally a respiratory disease in adults, it could appear in children under 10 as a crippling illness that also caused fatigue (Bob says that Tim is tired.) and weight loss (“Tiny” Tim). Left untreated, TB would have eventually killed Tim. But a little help from Scrooge – good nutrition, rest, and a back-brace – could have saved Tim’s life and put his disease into remission.

The Argument against it: At the end of the story, Tiny Tim is cured. TB never would have been completely cured, and
Tim never would have been well enough to run into Scrooge’s arms.

c) Tim had Renal Tubular Acidosis, a type of Kidney Disease.
The Case: Doctors would have thought Tim had TB, and they would have given him a medicine that contained excess acids. In fact, many “tonics” or medicines of the day contained acids and other harmful toxins that would have hurt Tim’s kidneys. The extra acids in Tim’s kidneys would have affected his bone production, and his short stature would have been an early sign of the disease. Then, one side of his body would have become considerably weaker than the other, causing him to walk with one crutch. And RTA is completely curable – Scrooge could have saved Tiny Tim simply by taking him to better doctors who knew what to do!

The Argument: What do you think? Which diagnosis do you think fits Tim the best?