Entire issue of Post Graduate Medical Journal (11/1978) devoted to ME

Forbin

Forbin

Senior Member (Voting Rights)
I'm not sure that I've seen this linked elsewhere, but the entire November 1978 issue of the Post Graduate Medical Journal was devoted to ME and is online. It includes articles by Melvin Ramsay and J. Gordon Parish among others. I thought it might be of historical interest to some.

Here, ME is called "Epidemic Neuromyasthenia," which should not be confused with "neurasthenia."

Click on the article name in the table of contents, and then click on the PDF symbol on the subsequent abstract page to read the full article.

http://pmj.bmj.com/content/54/637

From Dr. Ramsay's article:
Muscular fatigability
Abnormal muscular fatigability is the dominant clinical feature of the disease. It has been suggested by Dr David Wilkie that this phenomenon might result from damage to mitochondria. Parish (1974) also considered that 'there is a prolonged metabolic disorder in many patients which may be affecting cellular energy systems and antibody production'.

Dr Wilkie advocated a series of biochemical investigations that might provide a useful source of information and Dr Alan Rundle of St Lawrence's Hospital, Caterham, has kindly examined blood from seven patients with unequivocal 'epidemic neuromyasthenia'. He has estimated the serum levels in units per litre of creatinine phosphokinase, lactic dehydrogenase, glutamic oxalo-acetic transaminase, glutamic pyruvate transaminase and y-glutamyl transpeptidase.

All seven patients produced pathologically high levels of lactic dehydrogenase and glutamic oxaloacetic transaminase. The full details of these studies will be reported later as they clearly indicate metabolic disturbance.
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PMJ No 637.jpg
 
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For the benefit of new members or visitors to the site, it is worth recording that Parish and Shelokov who contributed to this Journal were members of the CDC committee which established the name CFS. They resigned rather than put their names to the report. The other members of the committee were not experts on the condition.
 
Muscular fatigability
Abnormal muscular fatigability is the dominant clinical feature of the disease.
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That's the best one sentence description of what I have that I've seen! If only it, along with PEM had remained the core of the diagnosis, we might be so much further on.

Fascinating that they were looking at metabolites in the blood even then:
All seven patients produced pathologically high levels of lactic dehydrogenase and glutamic oxaloacetic transaminase
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If only...

Thanks for this @Forbin, I will read it when I have sufficient functioning brain cells.
 
Forbin said:
I'm not sure that I've seen this linked elsewhere, but the entire November 1978 issue of the Post Graduate Medical Journal was devoted to ME and is online. It includes articles by Melvin Ramsay and J. Gordon Parish among others. I thought it might be of historical interest to some.

Here, ME is called "Epidemic Neuromyasthenia," which should not be confused with "neurasthenia."

Click on the article name in the table of contents, and then click on the PDF symbol on the subsequent abstract page to read the full article.

http://pmj.bmj.com/content/54/637

From Dr. Ramsay's article:


View attachment 1576
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I wonder if current researchers are aware of this- it is approaching 2 generations ago .
Perhaps even worth sending to David Tuller for background and Dr Geraghty
 
I've just read the foreword and Introduction so far. It's the report of an international symposium held at/by? the Royal College of Medicine. (and now looks who's in charge!)

Interesting that even back then they were debating the name. They decided then to call it Epidemic Neuromyasthenia because the only alternatives at the time were Benign Myalgic Encephalomyelitis, which was rejected because only about half the patients had myalgia and it was to serious an illness to be called benign. And Royal Free Disease and Iceland Disease were too localised and didn't acknowledge earlier known outbreaks.

Edit to add. In the article about the Royal Free outbreak, the writer prefers Benign ME.
The disease was referred to as an encephalomyelitis and when the term 'benign myalgic encephalomyelitis' was subsequently introduced it was felt that the disease was best described by that title. The author has not had the opportunity of continuing to study the disorder but he certainly does not feel that the term 'epidemic neuromyasthenia' adequately describes the disorder.
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I've skimmed through most of the rest of the articles. I found this one particularly interesting.
http://pmj.bmj.com/content/54/637/771
Full pdf here:
http://pmj.bmj.com/content/postgradmedj/54/637/771.full.pdf

Here are a few highlights in my own words from the first page.

Dr Ramsay provided a couple of biochemists (I think) with blood samples from 7 patients of variable illness duration.
They found raised serum levels of pyruvate and lactate and the suggestion was made that this suggested the mitochondria and energy metabolism should be looked at.
Lymphocytes from one patient were studied for oxygen uptake and it was found to be very low. And the cells were found to be particularly susceptible to mitochondrial inhibitors.

It was suggested mitochondrial structure should be looked at with muscle biopsies, and that the mitochondrial were the obvious place to start investigation, given Ramsay's emphasis of abnormal muscle fatiguability as the key symptom.

Edited for clarity.

Edit to add. The rest of this discussion mainly focused on the name and whether they were seeing a single condition or a group of similar conditions.
 
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Trish said:
That's the best one sentence description of what I have that I've seen! If only it, along with PEM had remained the core of the diagnosis, we might be so much further on.

Fascinating that they were looking at metabolites in the blood even then:


If only...

Thanks for this @Forbin, I will read it when I have sufficient functioning brain cells.
Click to expand...

Yes, muscle fatigability - not fatigue - was Ramsay's core symptom, Behan's too.
 
The obvious question which arises after reading this is, was it purely American exceptionalism which led the CDC in 1988 to seemingly ignore the earlier serious body of work . They cannot claim to have been ignorant of it, as Parish and Shelokov were on the panel. However to read the paper

http://www.myalgic-encephalomyelitis.com/Holmes_et_al_1988_1.html

one would be surprised to learn that there had ever been anything other than Strauss' "Chronic Epstein Barr Virus Syndrome". It certainly does not appear that this CFS definition was in any way intended to replace ME, Post Viral Fatigue Syndrome or Epidemic Neuromyasthaenia.

The list of references at the end of the paper is instructive, but for all the wrong reasons.

I am sure all this has been said before.
 
It makes me a little bit sad...seems all knowledge from the past is ignored and the wheel is re-invented again and again. This leads to nowhere. I also had this feeling when reading "Osler's Web". Maybe I'm too pessimistic here?
 
Re-quoting part of Dr. Ramsay's article above...
All seven patients produced pathologically high levels of lactic dehydrogenase and glutamic oxaloacetic transaminase. The full details of these studies will be reported later as they clearly indicate metabolic disturbance.
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It looks like this 1979 paper was the result of that investigation:
Clinical and biochemical findings in ten patients with benign myalgic encephalomyelitis.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2425703/

Abstract
Ten patients in whom the clinical findings were consistent with the syndrome variously described as 'benign myalgic encephalomyelitis', 'epidemic neuromyasthenia', 'Royal Free disease' and 'Icelandic disease' were investigated for blood levels of myoglobin and various enzymes. Although there is no clinical resemblance between the two diseases, the biochemical pattern bears a close similarity to that found in Duchenne muscular dystrophy (DMD) though differing sharply in that no rise in creatinine kinase levels was found. These findings are discussed with particular reference to recent suggestions that the permeability of cell membranes may be impaired by changes in intracellular energy mechanisms.
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Odd about the enzyme pattern resemblance to DMD. I don't think I've ever heard that before.
 
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40 years and we are only just getting back to this?!

I'm enjoying the delve into the past and the desire for patients now to understand the history of the disease and the failings by the medical community that patients on this forum are showing.

@Nasim Marie Jafry posts on the nomenclature of M.E, CFS etc has spurred me on to buy Dr Ramsays book, which has just arrived. We need to know the past and understand what has happened to us as a community in order to get where we need to be.
 
Justy said:
40 years and we are only just getting back to this?!

I'm enjoying the delve into the past and the desire for patients now to understand the history of the disease and the failings by the medical community that patients on this forum are showing.

@Nasim Marie Jafry posts on the nomenclature of M.E, CFS etc has spurred me on to buy Dr Ramsays book, which has just arrived. We need to know the past and understand what has happened to us as a community in order to get where we need to be.
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Quite so. If I may remind people of Margaret Williams et al historical catalogue of articles going back to 1994, but with a couple of earlier articles, one by Ramsay and another a transcript of a Behan lecture. There is a search box at the top of the catalogue which is very useful:

www.margaretwilliams.me
 
Daisymay said:
Quite so. If I may remind people of Margaret Williams et al historical catalogue of articles going back to 1994, but with a couple of earlier articles, one by Ramsay and another a transcript of a Behan lecture. There is a search box at the top of the catalogue which is very useful:

www.margaretwilliams.me
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A place on the site or a sticky with ll these links could be a useful resource @Andy ? otherwise they just get lost in the middle of threads.
 
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