Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) has a long history with an evolution in medical understanding, diagnoses and social perceptions. In the early 19th century, the diagnosis of neuresthenia ('nerve weakness'), which had overlaps with current ME/CFS criteria, was popular. Various outbreaks of similar enigmatic disease occurred in the early 20th century, variably known as atypical poliomyelitis, Akureyri disease, or epidemic neuromyasthenia. After an outbreak in the Royal Free Hospital in London in the mid-20th century, the disease became known as benign myalgic encephalomyelitis. The benign was later dropped, and this became the first case definition of ME, published in 1956. Controversy erupted when psychiatrists in 1970, who had not spoken to any of the patients, called the outbreak a case of "mass hysteria". The first definition of chronic fatigue syndrome (CFS) was published in 1988.
Timeline
19th century Several descriptions of illness resembling ME/CFS have been reported for at least 200 years. In the 19th century, neurologist George Miller Beard popularised the concept of neurasthenia, with symptoms including fatigue, anxiety, headache, impotence, neuralgia and depression. This concept remained popular well into the 20th century, eventually coming to be seen as a behavioural rather than physical condition, with a diagnosis that excluded postviral syndromes. Neurasthenia has largely been abandoned as a medical diagnosis. The ICD-10 system of the World Health Organization categorized neurasthenia under (F48 Other neurotic disorders) which specifically excluded chronic fatigue syndrome. The current version of ICD, ICD-11, does not include neurasthenia and "deprecates" its use.
Outbreaks in the 20th century A United States Public Health Service (USPHS) official, Alexander Gilliam, described an illness that resembled poliomyelitis, after interviewing patients and reviewing records of one of several clusters which had occurred in Los Angeles, during 1934. The Los Angeles County Hospital outbreak included all or most of its nurses and doctors. Gilliam called the outbreak "atypical poliomyelitis" and described the symptoms as: rapid muscle weakness, vasomotor instability, clonic twitches and cramps, ataxia, severe pain (usually aggravated by exercise), neck and back stiffness, menstrual disturbance and dominant sensory involvement. There was a cluster of "encephalitis" cases in 1936, at a convent in Wisconsin, amongst novices and convent candidates. The following year two towns in Switzerland had outbreaks of "abortive poliomyelitis", and 73 Swiss soldiers were given the same diagnosis in 1939. Outbreaks in Iceland were called "Akureyri disease" or "simulating poliomyelitis" and were later called "Iceland disease." 800 people in Adelaide, Australia became ill during 1949–1951 with a disease "resembling poliomyelitis." Two smaller clusters in the United States during 1950 were diagnosed as "Epidemic neuromyasthenia" and "resembling Iceland disease simulating acute anterior poliomyelitis." Additional outbreaks of poliomyelitis-like "mystery diseases" occurred from the 1950s through the 1980s, in Denmark, the United States, South Africa, and Australia, among others. Several outbreaks of a polio-resembling illness occurred in Britain in the 1950s. A 1955 outbreak at the Royal Free Hospital Group was later called "Royal Free disease" or "benign myalgic encephalomyelitis". The term "benign myalgic encephalomyelitis" was selected to represent the lack of mortality, the severe muscle pain, symptoms suggesting damage to the nervous system, and to the assumed inflammation involved in the illness. Icelandic physician Björn Sigurðsson disapproved of the name, stating that the illness is rarely benign, does not always cause muscle pain, and is possibly never encephalomyelitic. After the Royal Free Hospital outbreak, a disorder with similar symptoms was found among the general population and the epidemic form came to be considered the exception. Pathology findings, both in monkeys and in rare human casualties, led to the conclusion that the disorder was caused by inflammation of the brain and the spinal cord, particularly the afferent nerve roots, perhaps with neuroimmune etiology.
Psychological framing (1960s and 1970s) In the 1960s and 1970s, chronic fatigue symptoms were often attributed to chronic brucellosis, but typically people were seen as having psychiatric disorders, in particular depression. Epidemic cases of benign myalgic encephalomyelitis were called mass hysteria by psychiatrists McEvedy and Beard in 1970, provoking criticism in letters to the editor of the British Medical Journal by outbreak researchers, attending physicians, and physicians who fell ill. The psychiatrists were faulted for not adequately investigating the patients they described, and their conclusions have been refuted. In 1978 a symposium held at the Royal Society of Medicine (RSM) concluded that "epidemic myalgic encephalomyelitis" was a distinct disease entity with a clear organic basis. Despite the criticism, the paper by McEvedy and Beard had a large impact and the view of ME as a psychosomatic disease became prevalent for almost 50 years.
… excerpt ends here. Continue reading the full article.
