Dickens' "Fat Boy:" A Classic Case of What?
characters except the suitor of the previous scene, Mr. Snodgrass, Joe showed off his conspiratorial complicity with the ladies--with “smirks, and grins, and winks.” Later he poked a “sharp instrument” into Mr. Pickwick’s leg, to gain his attention. They others thought him intoxicated or “deranged.” He had reacted with alarm to his unexpected discovery of Mr. Snodgrass in the adjacent bedroom.
Thereafter a happy ending to the chapter omits further mention of Joe, who departs from the novel into medical fame.
So, what disease does Joe have? Sleep apnea? Narcolepsy? He more closely resembles the latter, but the real answer is: Joe has no known disease. His author has merely drawn him to gain the reader’s attention and amusement. Dickens has no interest in accurate portrayal of a medical condition scarcely known at the time. As in all works of fiction, characters need only convince the reader enough of their possible existence to maintain suspension of disbelief; otherwise they need conform to no principles of diagnosis. There is nothing to require that a character like Joe exists in reality.
Yet the problem here is not that Dickens failed to depict in accurate detail an actual disease. It is that doctors, taken with his artful prose, should use a fictional model for a real condition. Moreover, the error goes beyond the confusion of fiction and reality, to encompass the use of “classic cases” to define diseases of many types.
When a disease is first described, often as a report of one or a few cases, that picture by virtue of its primacy tends to become “classic,” which means that it establishes the defining features of the disorder.
In actuality, as we later gain knowledge of the broad range of manifestations possible for any systemic disease, and the wide variety of people it can affect, we also come to realize that the classic case represents a singular type, neither the paradigm nor the modal pattern. Nevertheless, a “cartoon” picture of the disease carries forward in the minds of diagnosticians, to form our stereotype image of how a person with that diagnosis should look. Like most stereotypes, this proves fallacious. Moreover, it deprives people who fail to fit the pigeonhole—for example, a skinny person with sleep apnea—to get the deserved evaluation.
Let me conclude with one more example. In epidemiological studies, men with sleep apnea outnumber women, perhaps by 2:1. However, many studies that specify
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