Could Animal Research have saved Tiny Tim?

Text Box:  Bob Cratchit and Tiny Tim1870s frontispiece to A Christmas CarolBy Fred BarnardCould animal research have saved Tiny Tim?

 

In Charles Dickens’ A Christmas Carol Tiny Tim is literally crippled by poverty and predicted to die of his unnamed ailments by the Ghost of Christmas Present. 

 

I see a vacant seat in the poor chimney corner, and a crutch without an owner, carefully preserved. If these shadows remain unaltered by the future, the child will die.’ 

 

Thankfully Ebenezer Scrooge has a change of heart and his newfound generosity of saves Tiny Tim ‘who did NOT die.’But could animal research have fully cured him? 

 

Diagnosis

Text Box:  Agar Town, just east of Camden Town 1854Since its publication in 1843, many have combed A Christmas Carol to diagnosis Tiny Tim Cratchit. The Cratchits lived in Camden Town, then a Victorian slum with narrow streets, overcrowded buildings and skies blackend from the coal of a newly industrialised nation. The high concentration of coal soot in the air blocked both UVA and UVB rays, limiting the skin’s ability to synthesise vitamin D from sunlight. The diet of working class families of starch and carbohydrates often did not provide essential nutrients, contributing to malnutrition. Bob Cratchit’s meagre wage of ’15 bob’ a week could buy just four loaves of bread to feed his family of eight, likely leaving the youngest child (Tiny Tim) underfed. Bread at this time may also have been whitened with alum (hydrated potassium aluminium sulphate) which prevents the body from absorbing phosphate essential for building strong bones. Tiny Tim did not have strong bones. Dicken’s describes Tim as ‘feeble’and ‘withered,’ walking with ‘a little crutch, his limbs supported by an iron frame.’ These symptoms and environmental factors pointed Dr Russell Chesney towards a diagnosis of active tuberculosis (TB) worsened by rickets

 

Rickets

Text Box:  Three children with rickets c. 1920s Wellcome LibraryRickets is a condition that impairs bone growth in children, causing their bones to be painful, soft and weak. Children with rickets may be short for their age, have skeletal deformities and find walking difficult and tiring. Bowed legs, shown in the image below, are a classic symptom of rickets. Rickets is usually caused by a lack of vitamin D or calcium needed to build strong bones from poor diet, lack of sunlight and in rare cases genetic disorders. 

 

Though rickets is rare in the UK today, 60-80% of Victorian children in urban centres showed clinical signs of the disease. At the time disease was thought to be caused by bad air, called miasmas. To protect against miasmas urban children were kept indoors and fully covered in clothing, limiting their exposure to sunlight needed to synthesis vitamin D. Scrooge could have provided trips to the countryside, often prescribed to escape miasmas, which would expose tiny Tim to more vitamin D-producing sunshine. Scrooge could also provide a better diet with fish and dairy products rich in vitamin D, quality bread without dangerous alum and more calories to boost Tim’s immune system. 

 

Text Box:  Vitamin D SupplementsIt wasn’t until the 20thcentury that animal studies identified the role of diet and sunlight in rickets treatment and prevention. Cod liver oil was a commonly used folk remedy taken by Dickens himself long before Sir Edward Mellanby showed cod liver oil treated rickets in lab dogs in the 1910s. Working with rats in the 1920s, Dr Elmer McCollum identified vitamin D as the curative component of cod liver oil and proved that sunshine protected against rickets by carrying his lab rats outside. Then in 1923 Professor Harry Steenbock irradiated rat food with UV light, which increased the vitamin D content, and cured his lab rats of rickets. This method of UV irradiation was used to safely fortify foodstuffs such as milk, cereals and butter making rickets a thing of the past in the US and UK by the 1940s. 

 

Text Box:  Mycobacterium tuberculosis Tuberculosis

Tuberculosis (TB) is a bacterial infection caused by the bacterium Mycobacterium tuberculosis and is spread by inhaling particles from coughs and sneezes of an infected person. Active tuberculosis infection mostly impacts the lungs, causing fever, persistent cough lasting over three weeks, breathlessness, weight loss, extreme tiredness and loss of appetite. Most people exposed to TB are able to fight off the initial infection without becoming ill, but may remain a carrier of latent TB if their body does not completely eliminate the disease. Those with weakened immune systems - such as the elderly, those with poor diet and people living with HIV- are more susceptible to initial infection and reactivating latent TB. For patients living with HIV untreated TB can be fatal within weeks.

 

Text Box:  Young woman with tuberculosis Watercolour by R.Cooper (1912)Between 1700 and 1900 tuberculosis is estimated to have caused one in every seven deaths worldwideNearly 50% of children in Victorian London had signs of tuberculosis, then known as consumption because patients rapidly lost weight as they were ‘consumed’ by the disease. Dicken’s own nephew, Henry, died of consumption and is thought by many to be a model for the character of Tiny Tim. Victorian TB patients were prescribed rest, good nutrition and fresh, which we now understand would have increased their level of vitamin D, increasing disease-fighting macrophages in their immune system and helped fight off TB infection. By providing better food and possibly trips outside of London Scrooge could have increased Tiny Tim’s level of vitamin D treating both his rickets and his active TB infection. Though this would not have cured his TB, boosting his immune system could have greatly improved his symptoms and life expectancy.

 

Text Box:  Waksman and team testing streptomycinToday the NHS states that ‘TB can almost always be cured’ with 90% of cases completely treated by a 6 month course of antibiotics. Though Sir Alexander Fleming identified a mould with antibiotic properties in 1928, but it was not until 1940 that Florey and Chain demonstrated the effectiveness of penicillin to treat bacterial infection in lab mice. In 1943 Professor Selman Waksman observed that TB bacteria were destroyed in the local New Jersey soil and tested over 10,000 soil microbes to identify the antibiotic microbe streptomycin. Studies in mice, guinea-pigs and chicks showed low toxicity and cured all animals of tuberculosis, plague and pneumonia, winning Waksman a Nobel Prize for his discovery in 1952. Unfortunately the mutation of bacteria can result in antibiotic resistant strains, with an estimated 6-7% of UK cases today requiring treatment with stronger and more toxic antibiotics. Established in 2001, the international STOP TB Partnership works to provide global access to effective diagnosis, treatment and cure of TB so that ‘our children will see TB eliminated in their lifetime.’   

 

In the 175 years since the publication of A Christmas Carolour understanding of healthy living conditions and diet, pathogens and the immune response has improved greatly in a large part due to animal research. Laboratory animal studies identified essential vitamins and minerals for healthy bones and immune system, as well as antibiotic compounds capable of fighting bacterial infection. Though the generosity of Scrooge would have brought a better life for Tiny Tim, modern medicine and supplements developed by animal research could fully cure him.  

 

Sources:

 

Chesney, Russell W. Environmental Factors in Tiny Tim’s Near-Fatal IllnessArch Pediatr Adolesc Med. 2012; 166 (3): 271-275.

 

Chesney, RW and G Hedberg. Metabolic bone disease in lion cubs at the London Zoo in 1889: the original animal model of rickets.J Biomed Sci. 2010 Aug 24; 17 Suppl 1: S36.

 

Dickens, Charles (1843) A Christmas Carol.

 

DeLuca, HF. History of the discovery of vitamin D and its active metabolitesBoneKEy Reports3, Article number:479 (2014).

 

Microbiology Society (2012) Tuberculosis

 

NHS Overview: Rickets and osteomalacia

 

NHS Overview: Tuberculosis (TB)

 

Stop TB Partnership About Us.

 

Stop TB Partnership. Two diseases, one fight: The TB-HIV Co-infection

 

UAR First time for Tuberculosis.. Isolation of Streptomycin, first antibiotic for TB

 

UAR Penicillin.. Discovery and refinement

 

 

 

Images:

Bottle of Super-D oil capsules, London, England, 1940-1945. Credit: Science Museum, London. 

 

Fred Barnard. (1870s) Bob Crachitt and Tiny Timfrontispiece to A Christmas Carol

 

George Godwin. (1854) London Shadows, Paradise Row, Agar Town

 

Wellcome Images. (1920-1930) Three children with rickets. Credit: Wellcome Library, London. 

 

National Cancer Institute. Waksman,Selman (c1940s) 

 

NIH/NIAID. Mycobacterium tuberculosis BacteriaCredit NIAD

 

R.Cooper (1912)Young woman with tuberculosis. Watercolour. Wellcome Collection.