The History



Since 1934, descriptions of a new clinical entity have appeared in the literature under a variety of headings from "abortive poliomyelitis" to "epidemic neuromyasthenia"(ENM). This illness is now known as "myalgic encephalomyelitis" (ME).

In the scientific and medical literature from 1934 to 1955, there were descriptions of the epidemic form of the disease: these reports contain many observations which not only provide clues to the pathology of the disease but also warrant further investigation by modern research techniques. These early outbreaks of ENM reveal the wide spectrum of the presentation of the illness from a mild systemic disturbance, which is similar to that of other enteroviral diseases, to a meningo-encephalomyelitis with ocular palsies and upper motor neurone signs. However, the systemic illness is distinguished in many patients by a prolonged convalescence portrayed by mental changes, particularly depression, autonomic disturbances, a profound tendency to fatigue easily and relapses of the original features of the illness. The neurological complications vary considerably in situation and severity from patient to patient and show a similar tendency to recur at the original site or in a different part of the nervous system. Several epidemics appear to have been triggered off by an outbreak of an infection with enteric organisms or poliovirus which then subsides. In some patients there was a direct involvement of muscles, which may feel swollen and tender and fatigue rapidly on sustained activities such as walking. The profound generalised and muscular fatigability is a striking feature of the disease.

None of the names commonly used for the disease in the literature is completely satisfactory. The term "myalgic encephalomyelitis" which is still used today describes inflammation to the brain or spinal cord and it is argued that there is no clear scientific evidence for this. However, some observers will contend that inflammation does occur at the acute stage of the illness.

Indeed the National Institute of Allergy and Infectious Diseases in the U.S. held a workshop in 1988 at which it was reported that "MRI scans on patients demonstrated abnormalities consistent with demyelination (loss of the myelin covering some nerve fibres resulting in their impaired function) and cerebral oedema (swelling from excessive accumulation of fluid in tissue) in 57% of patients studies". It was following this workshop that the term "chronic fatigue and immune dysfunction syndrome (CFIDS)" be recommended to replace "chronic fatigue syndrome (CFS)".

ME is now being used by some groups to stand for myalgic encephalopathy which means any disorder or disease of the brain coupled with muscle pain. But many mental conditions have a brain pathology and this leaves ME open to piracy. Because no research definition exists for myalgic encephalopathy, this in turn could create a vacuum into which the psychiatric lobbyists will fill and create their own definitions as has been done with CFS.

Until a new name emerges which has the consensus of patient groups as well as physicians, it is probably wise to stick with the original description first coined by Donald Acheson and subsequently extensively studied by Dr Melvin Ramsay.