Dickens expertly exploits, in the nicest possible way, the figure of Tiny Tim in order to pull at his readers' heartstrings. As a great storyteller, Dickens knows that if you wish to convey a specific message, it's best to do so by way of the emotions, rather than the intellect.
Instead of hitting the reader over the head with overtly political propaganda, Dickens chooses to adopt a more subtle approach, presenting Tiny Tim as a good-hearted young waif who wants nothing more out of life than loving care, the same as any child.
Dickens would doubtless have been aware that there were many people in society at that time who shared the widespread prejudice that the poor were to blame for their own poverty. In presenting the figure of a child as a victim of poverty, he hoped to challenge this assumption, as no one could seriously argue that a child was responsible for their own economic condition. One could reasonably argue that using Tiny Tim in this way is a form of emotional blackmail, but there's no doubting its effectiveness at getting Dickens's message across.
One could say pretty much the same about the suggestion that Scrooge will somehow be responsible for Tiny Tim's death if he doesn't change his ways. Again, there's certainly an element of emotional exploitation here. But there's enough plausibility in the suggestion to make it work. After all, Tiny Tim's father is employed by Scrooge, and if the old skinflint ponied up some extra money to his chronically underpaid and overworked dogsbody Bob Cratchit, then there's every reason to think that the young lad would soon be able to get the medical treatment he so desperately needs.
There's no doubt that Charles Dickens offers social criticism and advocates for social reform in his novels and stories like A Christmas Carol. The character of Tiny Tim personifies Dickens's social criticism in a general, population-wide sense of course, but Tim also serves as a catalyst for change for a single individual, Ebenezer Scrooge, who undergoes a transformation from a miserly, socially-indifferent curmudgeon to a generous, empathetic, and socially aware "second father" to Tiny Tim.
The danger to Tiny Tim was probably worse than we can imagine from our twenty-first-century perspective, but the danger was not worse than could be imagined by those who read A Christmas Carol at the time it was written. Dickens's readers knew what kind of fate awaited Tiny Tim and his family, and the horrors of the workhouses and the poorhouses:
Many can't go there; and many would rather die.
Can we truly appreciate the implications of that sentiment in fact, not simply in the abstract?
No doubt Scrooge could affect the course of Tiny Tim's treatment, which would vastly improve the chances that Tim would live, rather than succumb to whatever unnamed ailment afflicted him. Money made all the difference as to what kind of treatment Tim could receive and whether he would live or die. Scrooge had money, and by the end of A Christmas Carol, he was prepared to spend it on Tiny Tim's treatment:
"Spirit," said Scrooge, with an interest he had never felt before, "tell me if Tiny Tim will live."
From our perspective, Scrooge's question to the Ghost of Christmas Present seems overstated, if not overly melodramatic. Aside from walking with a crutch, Tiny Tim doesn't seem to us to be on death's doorstep, as Scrooge's question seems to imply. For Scrooge, though, and for Dickens's readers, it's not at all out of the question that Tiny Tim might die.
At the time that Dickens self-published A Christmas Carol in 1843, nearly half of the deaths in London were children under the age of 10. Half of all working-class children suffered from tuberculosis, and sixty percent had rickets—diseases which Tiny Tim might have contracted due to poor nutrition, pollution, and lack of sunlight caused by smog-like conditions in London.
Dickens didn't have to exaggerate the living conditions of the poor to draw attention to the plight of Tiny Tim and his family. Dickens simply had to point out the living conditions as they existed for a majority of London's poorer residents and let those conditions speak for themselves, just like Tiny Tim did:
"A Merry Christmas to us all, my dears. God bless us!"
Which all the family re-echoed.
"God bless us every one!" said Tiny Tim, the last of all.
While the character of Tiny Tim has often been criticized as too sweet, syrupy, and sentimental, Dickens is nevertheless being fair in his use of the possibility of the small child's death to stir our feelings. There was no social welfare safety net in Britain to speak of in this era (there were poorhouses, but they were last resort places meant to be harsh so that people wouldn't use them unless truly desperate). In reality, many children like Tiny Tim did die young due to lack of medical treatment, crowded conditions, poor food, and lack of good sanitation. Pollution from burning coal was also notorious in London at this period, making the air bad. If anything, Dickens probably understates the unhealthy conditions in which Tiny Tim lived.
Dickens does use Tiny Tim's possible death to tug at Scrooge's and the reader's heartstrings. In the eighteenth and nineteenth centuries, writers openly embraced sentiment or emotional appeal as a powerful way to influence people's behavior. They were not ashamed of it.
If it had been rare for a young child to die from not being able to afford medical treatments or from living in poor conditions, we could accuse Dickens of manipulating us. However, what he describes was only too common. He is telling it like it was. This reality just happens to be heartbreaking.
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