PubMed · 5823043
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J A Macleod. 1969-10-11. Testing for phenylketonuria.. https://doi.org/10.1136/bmj.4.5675.112
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The "wonderfully fat boy" Joe described in The Pickwick Papers, by Charles Dickens, is remarkable for his glorious appetite and many attacks of sleep during the day. His medical condition was introduced as the Pickwick syndrome by Burwell et al. in 1956. For some 20 years this was an important stimulus for sleep research. Some literary and historical aspects of The Pickwick Papers are presented. The many diagnoses given to poor Joe are discussed. This diagnostic survey may still be of interest, even if the syndrome has virtually disappeared from medical literature. How does the Pickwick syndrome, as doctors today see it, fit Dickens' original description? Did Joe really suffer from the Pickwick syndrome?
The financial demise of Oxford's department of neurosurgery (OxDONS) was precipitated by the financial rules of the reformed NHS. In particular it was produced by the failure of "resources to follow patients"; the requirement that "prices have to follow costs"; and the use of private income for revenue expenditure, not capital expenditure. This process will eventually affect all hospital departments, but it affected the unit in Oxford sooner as it started as "efficient"--that is, underresourced--and has depended on income from extracontractual referrals and private work. Current NHS accounting rules act as a disincentive to private income being generated in NHS hospitals, and consultants should be aware of this.