Richard Caton's "case of narcolepsy": obesity hypoventilation syndrome in the 1880s?

A literary account of an obese individual manifesting excessive daytime sleepiness, Joe the Fat Boy, appeared in Charles Dickens's work The Posthumous Papers of the Pickwick Club published in 1837. Adoption of the terms "Pickwickian" and "Pickwickian syndrome" in the medical literature did not occur until much later, for example by William Osler in 1918. We present a report published in 1889 by the English physician Richard Caton in which he described an obese patient with clinical evidence of excessive daytime sleepiness, nocturnal sleep apnoeas with persistent thoraco-abdominal movements, and cyanosis indicative of oxygen desaturation. Caton's carefully observed case adds to the history of obesity hypoventilation syndrome and obstructive sleep apnoea.