It wasn't the patient complaining, it was the nurses! The nurses and staff complained of the odor of rotten fish permeating their entire hospital floor. Some days it was overwhelming, but some days it was not there, coming only episodically, but several days a week. It was not hard to track down the source. It came from a thirty-one-year-old man institutionalized with severe mental retardation, and it came from his urine as well.

We at once suspected that this man had the “fish odor syndrome,” because years before we had encountered a twelve-year-old boy with this same foul odor. He had been virtually ostracized from school and society, because no amount of bathing, oral hygiene, or deodorant powders helped. Every breath repelled his friends. Otherwise, he was healthy, normal, and attractive.

But this patient was a tragic victim of a toxemic pregnancy and multiple abscesses in infancy. He still could not walk, talk, or raise his head when he was six years old. Institutionalized nearly all of his life, he had an IQ of 5 and a mental age below six months.

Physical examination disclosed a unique individual who had massive folds of skin on his forehead and soft skin that could be stretched out for inches. He kept hitting the sides of his head and was generally self-abusive. There was a strong fish odor present. His blood studies were normal.

But did he have the fish odor syndrome?