The Fish-Odor Syndrome

THE FISH-ODOR SYNDROME S. C. MITCHELL* He sent the manchila unto the rajah and kept the girl, who was reared as his own daughter. She grew to be comely andfair, but a fishy odour ever clung to her. One day, as sheferried pilgrims across thefumna, there entered her boat alone the high and pious Brahman Parashara, who was moved by the maiden's great beauty. He desired that she should become the mother of his son, and promised that ever afterwards an alluring perfume would emanatefrom her body. He then caused a cloud to fall upon the boat and it vanishedfrom sight. Introduction The words in the epigraph come from the Mahabharata, the great Indian epic of the Bharata Dynasty. This major work is an assemblage oflegendary and didactic material woven around the central theme which describes the heroic struggle for supremacy between two related families, the Kauravas and the Pandavas. The compilation is believed to be based on actual events which occurred around 1400 to 1000 b.c. and was compiled (traditionally) by Vyasa, reaching its present form about A.D. 400. This particular passage comes from the prelude to the Bharata war and describes a young woman, Satyavati, condemned to endure a solitary life as a ferrywomen, cast out from society because she stank like a rotting fish. She, thankfully, received a miracle cure from a demi-god. That acute observer ofthe human situation, William Shakespeare (15641616 ), used similar ichthyic descriptions to denigrate Caliban, a savage and deformed slave found sheltering under a gaberdine by thejester, Trinculo: "What have we here? a man or a fish? dead or alive? A fish: he smells like a fish; a very ancient and fish-like smell; a kind of, not of the newest, PoorJohn " (The TempestII.ii.26—29) . (A "Poor-John" is a salted and dried hake.) One wonders why Shakespeare waited to his latter years to include this item in one ofhis plays. Was it that by this time oflife he had actually encounted, *Pharmacology and Toxicology, Imperial College School of Medicine at St. Mary's.© 1996 by The University of Chicago. All rights reserved. 0031-5982/96/ 3903-0958$01.00. 514 S. C. Mitchell ¦ The Fish-Odor Syndrome or heard stories of, poor individuals cursed with a fish-like body odor, and knew, or had an insight into, their plight? A century later, John Arbuthnot (1667-1735), a mathematician, Fellow of the Royal Society and physician to Queen Anne, reported an intriguing observation in his treatise concerning nutrition and foods, where he writes: "The oils with which fishes abound often turn rancid, and lie heavy on the stomach, and affect the very sweat with a rancid smell, which is found to be true in some places, where the inhabitants live entirely upon fish." This astute comment contains the rudiments of the condition described within the present paper: that sweat itself contains the odor of fish, that eating fish increases the problem, and, perhaps by local community implication, that a genetic component is required within susceptible people [I]. These pointers, and others sprinkled about man's history, suggest that the phenomenon of fish-smelling individuals was not unknown and that its incidence was probably not rare. Throughout the ages, a fish-like odor appears to have been associated with social rejection and ridicule, setting an individual aside from the majority. Recent History There are over 40 cases offish-odor syndrome which have been described in the literature since 1970, arising from North America, Europe (England, Holland, Italy), Israel, and Australia [2-30]. In addition, one laboratory confirmed ten patients with this disorder over a period of about three years [29], and similar numbers have been seen in other institutes [12, 28, 30, 31] . Many other cases could and probably have remained undiagnosed owing to a combination ofunavailable assay facilities and the lack ofphysician awareness [18, 32]. The reliance upon subjective analysis (olfactory testing) alone is problematical [33, 34], as the smell to some may be of stale urine rather than fish, thereby helping to thwart diagnosis [18], and as few as 50 percent of the population may not be able to actually distinguish the pungent odor of...