History of postviral fatigue syndrome

Abstract

In writing a history of any illness there is always a dilemma whether to attempt the story of the condition 'itself', the medical attempts to define its nature, or to glimpse it via our changing reactions. The easiest is a straightforward account of the attempts of scientists to solve a problem--the classic medical detective story. However, this is often more fiction than fact. Medicine rarely moves smoothly from ignorance to knowledge, but often in a more circular fashion. A historical approach is thus not solely a record of who did what, but also contributes to our understanding of the problems under scrutiny in this issue. Terminology is never easy in this subject, but the following conventions will be used: The terms neurasthenia and ME will be used in their actual context (as authors themselves used them), without defining either. Post-infectious fatigue syndrome (PIFS) will cover similar conditions when related to infective episodes. All will be used in a neutral fashion, to refer to changing realities as understood by doctors and historians. This chapter attempts both chronological description and social analysis. The justification for this approach is clear in the case of neurasthenia, since 'as so little was known of its pathological basis physicians' statements regarding the disease were composed more of social and cultural elements than of scientific knowledge'. Although much has changed, a contemporary account still reveals as much about cultural attitudes as the advance of science.

Editorial

“…Existing psychological theories have emphasized both physical deconditioning and emotional difficulties to explain the persistence of CFS (Wessely et al 1989 ;Surawy et al 1995). There has been a tendency thereby to redefine the subjective complaints of patients.…”

Neurobiological aspects of the chronic fatigue syndrome

“…One of the first cases reported in this country was a women with a 14-year history of neurasthenia, permanently confined to bed in a darkened room, whose illness had begun with a persistent cold [15]. By 1914 the observation that neurasthenia frequently followed an infection was widely acknowledged [8]. The principal candidate was influenza, but typhoid was frequently implicated, and claims were also made for typhoid and various alimentary bacteria [ 161.…”

“…However, systematic studies first disproved persistence of the bacteria, and then provided evidence for a high rate of psychiatric illness in those affected. Sufferers were described as combining a high degree of conviction of physical illness with a reluctance to discuss emotional issues [ 191. Once this evidence became widely disseminated, chronic brucellosis disappeared [8]. Nevertheless, the tendency to link formerly neurasthenia and latterly CFS with each new organism is unstoppableeven in the hothouse world of CFS the publicity that greeted a recent claim of a retroviral aetiology to CFS was unprecedented [20]-sadly the subsequent failure of many groups to replicate the observation has received less publicity [2 1,22,23].…”

“…It is impossible to cover all these aspects in a brief review. As well the volume cited above, detailed reviews already exist on psychological [3], microbiological [4], immunological [5], physical [6] and psychiatric treatments [7], and historical issues [8] surrounding CFS. This review is therefore concerned primarily with neurobiological issues, which have yet to be comprehensively reviewed elsewhere.…”

Neurasthenia in a longitudinal cohort study of young adults

“…A cluster analysis of the symptoms of subjects from the general community conducted by Angst & Koch (1991) yielded the same three distinct factors that have been the key features of clinical descriptions of neurasthenia, namely, physical exhaustion, mental fatigue and nervous irritability. Although the symptoms of chronic fatigue syndrome (CFS) are quite similar to those cited above for neurasthenia, the major difference between the two definitions is the requirement of myalgia for CFS (Wessely, 1991). The aetiology of CFS has often been attributed to viral infections as in the post-viral fatigue syndromes (i.e.…”