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February 13, 1978

Pickwickian Syndrome? The Dickens!

JAMA. 1978;239(7):645. doi:10.1001/jama.1978.03280340065028

The link between Charles Dickens and the syndrome that relates to one of his characters was first mentioned 60 years ago by William Osier, MD, who noted that "a remarkable phenomenon associated with excessive fat in young persons is an uncontrollable tendency to sleep—like the fat boy in Pickwick." The Dickensian connection, which was missed or ignored by Auchincloss et al1 who first described a typical case, was picked up by Burwell et al2 in 1956 when they labeled the syndrome Pickwickian. They ascribed the somnolence, cyanosis, polycythemia, alveolar hypoventilation, and right ventricular failure, which characterize the syndrome, to obesity with its attendant increase in the work of breathing.

As is often the case with eponymous syndromes, the monolithic structure of the Pickwickian syndrome soon began to crack. Gastaut et al3 (1965) split off a syndrome that does not conform to type. Its genesis is not in