Extreme Obesity Associated with Alveolar Hypoventilation — A Pickwickian Syndrome*

The purpose of this article is to consider the association of obesity, somnolence, polycythemia and excessive appetite.A careful study of one patient will be used to illustrate the discussion. REVIEW OF L ~A T U R EThe association of these characteristics has long been recognized.Medical texts of the early nineteenth century accept the association of these signs and symptoms as well established.The following quotation from Wadd (1) is an example."A country tradesman aged about thirty, of a short stature and naturally of a fresh, sanguine complexion and very fat applied to me for assistance.He complained of perpetual drowsiness and inactivity.His countenance was almost livid and such a degree of somnolency attended him that he could scarce keep awake whilst he described his situation.In other respects he was well."A classic description of the association of signs and symptoms under discussion was written by Charles Dickens (2).The author refers to "a fat and red-faced boy in a state of somnolency."This boy was subse- quently addressed as "Young Dropsy," "Young Opium-Eater" and "Young Boa-Ccinstrictor"no doubt in reference to his obesity, his somnolence and his excessive appetite, respectively.A characteristic of these patients is an extraordinary degree of somnolence in which sleep may overcome the patient while he is sitting up or even while he is engaged in conversation of other muscular activity.The somnolence of his character was described by Mr.