I prepared for Dr. Johnson’s annual Christmas visit by starting the fireplace video, preparing tea and watercress sandwiches, and setting out a decanter of Remy Martin. For our gift exchange, I presented the good doctor with a sterling silver duck head walking stick, and he gave me a first edition of Dickens’ “A Christmas Carol.”

Taken aback, since I knew the volume was worth thousands, I offered a humble thank you.

“Quite a man our Mr. Dickens,” he said, “and no slouch when it came to medical diagnostics.”

“I beg your pardon?” said I. My knowledge of the great author came from begrudgingly having to read him as a schoolboy before growing to love him in maturity.

“Quite so,” he replied. “While not a physician himself, he had the intuition, talent and observational skills to expertly describe the symptoms of medical conditions in his characters. And in some cases, his descriptions came years before the conditions were recognized by the medical community.”

“So, what’s wrong with Scrooge?” I asked, holding up my new treasure.

“Based on the author’s description, it seems likely old Ebenezer experienced a stroke or was afflicted by dementia or brief psychotic disorder. Some have said his complaint of indigestion on the ghostly night is evidence of poisoning with the hallucinogenic fungus ergot, once a common contaminant of rye bread.”

I thumbed through the text until I came up Scrooge’s encounter the ghost of his former partner Jacob Marley. Asked why he couldn’t trust his own senses when it came to talking apparitions, the old miser replies, “Because a little thing affects them (the senses). A slight disorder of the stomach makes them cheats. You may be an undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of an underdone potato. There’s more of gravy than of grave about you, whatever you are!”

“Some say that’s evidence of poisoning,” Dr. Johnson concluded, “while I continue to hold to the dementia or stroke explanation.

“Here’s a lonely old man, alone on Christmas Eve, who has a sudden change in mental status, entering a confused state with vivid hallucinations involving friends and relatives, which results in him waking the next day in a state of uncharacteristic euphoria, ordering a goose for the Crachits and making up with nephew Fred.

“You make the call,” the doctor challenged.

I had to admit I had no rational explanation for Scrooge’s remarkable experience, other than it made for a darn good yarn.

If Dickens was indeed describing dementia when he writes of Scrooge’s tremors, his vivid and detailed hallucinations and suggests that “the cold within him froze his old features ... and stiffened his gait,” the author was doing so a century and a half before anyone in medicine did.

“What about poor Tiny Tim?” I wondered aloud.

“Modern-day physicians speculate that the little fellow suffered from vitamin D deficiency, while others have suggested tuberculosis,” Dr. Johnson said. “Either would have explained his crippled legs, as would renal tubular acidosis, rickets, malnutrition, cerebral palsy, and a malformation of the spinal cord.”

I offered that I knew Tiny Tim lived, based on the Ghost of Christmas Future’s warning to Scrooge: “If these shadows remain unchanged, I see an empty chair where Tiny Tim once sat.”

Extra food brought to the Crachit house through Scrooge’s newfound generosity would have helped Tiny Tim, as would a trip to the sanitorium made possible by Scrooge giving Bob a nice raise.

“Dickens was a real man of science,” said Dr. Johnson, “which just so happens to the name of a recent exhibit at the Dickens museum in London.”

The museum is housed in the author’s preserved home near the King’s Cross rail station, Dr. Johnson told me. Items on display included an issue of “Household Words,” a weekly journal Dickens published in 1850.

“It was one of the popular ‘two-penny weeklies’ of the time,” the doctor added, “and covered many important issues long before they were addressed by the medical community and the public at large.”

Such topics included public health, sanitation, housing, hospitals, medical schools, health insurance, education for disabled children, compulsory vaccination, water pollution, the care of fighting men brought back from overseas conflicts, the spread of disease and how to prevent it, homeopathy, epilepsy, lead poisoning, and much more.

“A truly great man,” Dr. Johnson concluded, and I could not but agree.

Comments and suggestions are always welcome. Call Dan Mearns at 941-893-9692 or email danmearns@gmail.com.

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