Famous Patients, Famous Operations, 2005 - Part 4: The Case of the Fictitious Young Man Who Had Trouble Staying Awake

Albert B. Lowenfels, MD

Disclosures

January 05, 2006

Introduction

The patient is a fictional character whose symptoms became the definition of a well-known syndrome.

Case Presentation: This fictional patient was a young, good-natured, extremely obese, male servant with a chief complaint of daytime somnolence. Although plethoric and excessively obese, he appeared to be in good health. On one occasion, the author describes the patient as being "wonderfully fat," and again as "fatter than a carnival freak." His main obesity-related complication was excessive somnolence -- especially during the day. He fell asleep during meetings, while eating, and on one occasion, while knocking on a door. His frequent, loud snoring could be disruptive to persons in the same room.

The author wrote:

A stranger meeting the patient for the first time asked: "Does he always sleep in this way?" His master replied: "Sleep! He's always asleep. Goes on errands fast asleep, and snores as he waits at table." "How very odd," said the stranger. "Ah, odd indeed," returned his master. I'm proud of that boy - wouldn't part with him on any account -- damme, he's a natural curiosity.[1]

Past Medical History: No recorded illness or operations.

Social History: Excessive, compulsive eater. Consumed alcohol, but not known to be a smoker.

Family History: The patient's "father" was a well-known, 19th-century author who was 24 years old and in good health at the time when the patient was conceived. Father traveled extensively in Europe and in the United States. He died at age 58 following a stroke. Mother's health -- unknown.

Course: Ultimate outcome unknown, but the patient is still remembered as an early example of a person with an obesity-related sleep disorder.

What's the best diagnosis for this character?

  1. Sleep apnea

  2. Down's syndrome

  3. Prader-Willi syndrome

  4. Pickwickian syndrome

View the correct answer.

Who was the author of the novel in which the patient is described?

  1. Jules Verne

  2. Charles Dickens

  3. Walter Scott

  4. William Shakespeare

  5. Mark Twain

View the correct answer.

What is the name of the character with the unusual symptoms?

  1. Mr. Pickwick

  2. Sam Weller

  3. A servant named "Joe"

  4. None of the above

View the correct answer.

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