HISTORY OF CHRONIC FATIGUE SYNDROME (CFS) AND MYALGIC ENCEPHALOMYELITIS (M.E.)
Is Myalgic Encephalomyelitis (M.E./Chronic Fatigue Syndrome) a New Disease?
Neurasthenia.
From Neurasthenia to Chronic Fatigue Syndrome (C.F.S.)
The popular image of chronic fatigue syndrome (CFS) or myalgic encephalomyeltis (ME) over the past several decades has generally tended to view the condition as being that of a new illness - one that has arisen in the 20th century. This image has been reinforced by the media and some of the popular (and professional) literature on the condition, with headlines and titles such as "ME - The New Plague."
So is the illness that new? Despite this popular belief, it would seem that conditions similar to ME/CFS have been around for considerably longer than is generally assumed. The mixture of a broad array of neurological and muscular symptoms that can occur after an infective illness can be traced back into history. For instance, as far back as 1750, Sir Richard Manningham reported a syndrome referred to as 'febricula' (or 'little fever') that had a large number of symptoms but was hard to objectively diagnose.[1] In addition, there have been suggestions in recent well-regarded medical journals such as the Lancet and British Medical Journal, that historical figures such as Florence Nightingale,[2] and Charles Darwin[3] may have suffered from a similar illness. In the case of Florence Nightingale, her illness began after she returned from the Crimean War and spent years housebound, too fatigued to talk to more than one visitor at a time (Wessely et al. 1999; Shepherd, 1999; Macintyre, 1998).
In the mid-nineteenth century the term 'neurasthenia' was popularised by an American psychiatrist, George Beard, in 1869 for an illness that had many similarities to ME or CFS. The condition was thought to be "a disease of the nervous system...characterized by enfeeblement of the nervous force..." Young women appear to have been particularly susceptible to it and its onset was frequently 'triggered' by an infection. Other quotes describe neurasthenia as a "...condition of nervous exhaustion, characterised by undue fatigue on [the] slightest exertion, both physical and mental...the chief symptoms are headache, gastrointestinal disturbances, and subjective sensations of all kinds." Although the term was used very broadly, chronic fatigue was seen as the "primary or essential symptom" with "its cardinal characteristics being an inordinate sense of physical or mental fatigue." Thus one can see that there are many similarities with modern day ME/CFS and neurasthenia (Wessely et al., 1999).
So if it isn't a new disease, why has it only recently been increasingly recognised?
The term 'neurasthenia' began to be used to encompass a range of non-specific symptoms and consequently the usage of the term began to wane. Interestingly, In a similar manner to recent medical debate, the medical profession became deeply divided and polarised on the issue, with there being those who strongly felt it was a physical illness and others who disputed its validity. The consequence of this, as Wessley et al. (1999) argue, was that the failure of the Victorians to provide satisfactory answers to this dispute, made it inevitable in the 1980's that "both doctors and patients would experience an almost identical sequence of claim and counter claim over the legitimacy or otherwise" of ME and CFS. Consequently, the medical profession has only recently started to increasingly accept the condition. For instance, the illness in the UK was not recognised officially by the Chief Medical Officer until 1998, and only after years of controversial debate within the medical profession.
After the fall in popularity of neurasthenia, two episodes of ME/CFS in subsequent decades attracted particular attention, both involving doctors and nursing staff.
The Los Angeles Outbreak (1934)
The first of these, which occurred at the Los Angeles County General Hospital in 1934, was the first ever recorded outbreak of the condition. Initial thoughts at the time believed the illness might be linked to polio, but, as the patients' muscles, albeit weakened, did not waste, this was subsequently not deemed to be an accurate explanation of events. Around 200 members of staff contracted the condition and over 50% of them were still unable to work six months later. Their symptoms essentially composed of:
· Long-duration muscle pain, tenderness, weakness, as well as sensory symptoms
· Memory lapses, difficulty concentrating, sleep disturbance, emotional instability, and being unable to walk even small distances without suffering from fatigue (Macintyre, 1998).
The Royal Free Outbreak (1955)
This is perhaps the best-known incidence of ME/CFS on a large scale in the UK. The incident occurred over a four-and-a-half month period during the late spring of 1955. After admitting a number of people with unusual symptoms, events at the hospital then subsequently dramatically unfolded when in July of that year almost 300 members of staff were taken ill (of which 255 had to be hospitalised). As a result the hospital was forced to close until the early part of October.[8]
The most curious element was that only 12 of the 292 people ill were patients already in the hospital during the course of the epidemic. The initial symptoms developed from a 'flu-like malaise' and became more pronounced after a short period of remission, when a new set of symptoms arose. The most pronounced clinical feature of the condition was extreme muscle fatigue after very minimal exertion; and other symptoms included problems with brain function (especially short-term memory and concentration) headaches, blurred vision, and unusual skin sensations. Medical examination afterwards indicated that the central nervous system had been affected in 74% of the patients (Parish, 1978; Shepherd, 1999; Macintyre, 1998).
Other Outbreaks
Although the two incidents at in Los Angeles and the Royal Free Hospital are the most well known and publicised, there have also been over 70 smaller outbreaks around the world (Shepherd, 1999).
