Category: History

Neurasthenia, yesterday and today

Abstract:

Neurasthenia was described and explained in very mechanistic terms, at the end of the 19th century, by G.M. Beard to account for physical and mental exhaustion and for varied somatic troubles imputed to failure of too much solicited nervous resources. This concept was then universally adopted and gave rise to diverse interpretations, among which was the Freud’s one. Later, in Occident, came a deterioration, the diagnostic of neurasthenia giving way to those of anxious or affective disorders. In the same time, at least for ideological and cultural reasons, the concept remained lively in Russia and in Asia. During the last decade the western psychiatry has been led to accept that there are clinical situations focussed on fatigue and fatigability, even if it coined for them new terminologies (post-infectious fatigue, chronic fatigue syndrome, etc.) and while DSMs keep on ignoring neurasthenia, the ICD 10 gives it an important place.

 

Source: Pichot P. Neurasthenia, yesterday and today. Encephale. 1994 Nov;20 Spec No 3:545-9.[Article in French] http://www.ncbi.nlm.nih.gov/pubmed/7843049

 

The chronic fatigue syndrome: what do we know?

Abnormally persistent or recurrent fatigue is a feature of many disorders. Recently, particular attention has been devoted to people whose life is dominated by protracted and disabling fatigue. Such cases are now usually categorised as the chronic fatigue syndrome, the postviral fatigue syndrome, or myalgic encephalomyelitis. Two recent publications bring together current ideas on the topic.

The historical background is important. Although the chronic fatigue syndrome has been advanced as a malaise of the latter part of this century, such cases are not a new phenomenon: they were particularly common during the latter part of the last century. The New York physician George Beard applied the label “neurasthenia” to them although the term was more widely used. After becoming an exceedingly common diagnosis it waned at the time of the first world war.

This first wave in the history of chronic fatigue was followed by a second wave, which can be dated to 1934. Nevertheless, cases of chronic fatigue did not simply disappear in the intervening period. The “effort syndrome” had a considerable vogue at that time. “Fibrositis,” a term introduced by Sir William Gowers in 1894 to designate the occurrence of diffuse muscle aching and pain without detectable explanation, evolved into “fibromyalgia.” This currently popular diagnosis has many overlapping features with the chronic fatigue syndrome, as did the effort syndrome.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1677985/pdf/bmj00024-0007.pdf

 

Comment in:

Functional hypoglycaemia postulated as cause of chronic fatigue syndrome. [BMJ. 1993]

Chronic fatigue syndrome. [BMJ. 1993]

 

Source: Thomas PK. The chronic fatigue syndrome: what do we know? BMJ. 1993 Jun 12;306(6892):1557-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1677985/

 

Chronic fatigue in historical perspective

Abstract:

Chronic fatigue as a presenting complaint, in the absence of other evident organic illness, was seldom reported historically before the second half of the 19th century. Its first eruption was the so-called ‘bed cases’ or ‘sofa cases’ among middle-class females in the period from 1860 to about 1910. ‘Neurasthenia’ does not necessarily represent an early forerunner of chronic fatigue.

Many patients receiving that diagnosis did not complain of fatigue. Others with functional fatigue did not receive the diagnosis ‘neurasthenia’. Both medical-anecdotal and quantitative sources make it clear that by the time of the First World War, chronic fatigue was a common complaint in Europe and North America.

Medical concepts of chronic fatigue since the 1930s have run along four separate lines: (1) ‘postinfectious neuromyasthenia’, going back to an atypical ‘poliomyelitis’ epidemic in 1934; (2) ‘chronic Epstein-Barr virus’ infection, an illness attribution that increased in frequency after the discovery in 1968 that this virus caused mononucleosis; (3) ‘myalgic encephalomyelitis’, dating from an epidemic at the Royal Free Hospital in London in 1955; and (4) ‘fibrositis’, or ‘fibromyalgia’, used as a rheumatological description since the turn of the century. Recently, these four separate paths have tended to converge into the diagnosis of ‘chronic fatigue syndrome’.

 

Source: Shorter E. Chronic fatigue in historical perspective. Ciba Found Symp. 1993;173:6-16; discussion 16-22. http://www.ncbi.nlm.nih.gov/pubmed/8491107

 

The measurement of fatigue and chronic fatigue syndrome

Comment in: Chronic fatigue syndrome and heterogeneity. [J R Soc Med. 1992]

 

Fatigue remains as elusive a human experience as ever. At the turn of the century fatigue was almost an obsession of doctors, scientists, writers and even politicians. The scientists believed they could measure it, the doctors they could treat it, the writers describe it, and the politicians prevent it (1). Many confidently expected that fatigue could be eliminated from schools, factories, armies, and even society. That it had to be dealt with was not in doubt, since many authorities believed that if not checked, fatigue, the inevitable consequence of modern life in all its forms, would somehow destroy the nation’s health and its future. Perhaps only the writers achieved their objective (2) – certainly, the descriptions of fatigue and exhaustion in the turn of the century literature, and even in the medical journals, are far richer and detailed than the leaden descriptions which we now encounter.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1294719/pdf/jrsocmed00112-0007.pdf

 

Source: Wessely S. The measurement of fatigue and chronic fatigue syndrome. J R Soc Med. 1992 Apr;85(4):189-90. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1294719/

 

Post-viral fatigue syndrome. Epidemiology: lessons from the past

Abstract:

This chapter outlines the recorded epidemiological history of PVFS (including the early epidemics of myalgic encephalomyelitis) and the development of the concept, including the realisation that endemic cases also occur.

Cases of PVFS are still not recorded by the Surveillance Centre for Communicable Diseases, so it is very difficult to detect and monitor any outbreak in the community, since each GP may only have two or three such patients and would, therefore, not be aware of an epidemic in the community as a whole if it occurred.

Epidemiological issues raised by the early epidemics, including the delineation of the syndrome, the question of bias, the role of hysteria and the role of depression; the issue of symptom distribution, and its implications for aetiology; and a multiaxial framework for understanding the association with psychological symptoms are discussed. The value of a future multidisciplinary research programme designed to disentangle direct and predisposing causes of PVFS is emphasised.

 

Source: Jenkins R. Post-viral fatigue syndrome. Epidemiology: lessons from the past. Br Med Bull. 1991 Oct;47(4):952-65. http://www.ncbi.nlm.nih.gov/pubmed/1794093

 

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.

 

Source: Wessely S. History of postviral fatigue syndrome. Br Med Bull. 1991 Oct;47(4):919-41. http://www.ncbi.nlm.nih.gov/pubmed/1794091