1955 Royal Free Hospital outbreak

The Royal Free Hospital outbreak was a cluster outbreak of myalgic encephalomyelitis at the Royal Free Hospital in London.

In 1955, between July and November, 292 members of the medical, nursing, auxiliary medical, ancillary, and administrative staff fell ill, of which 255 were admitted to the hospital. The disease name myalgic encephalomyelitis was coined to describe the illness.

Location
The outbreak occurred at the former site of Royal Free Hospital at 256 Grays Inn Road (WC1X) which is now the Eastman Dental Hospital. (The current hospital site is now in Hampstead NW3.)

Onset
Onset involved symptoms of an upper respiratory infection, sore throat, gastrointestinal disturbances including nausea and vomiting, or acute vertigo.

Symptoms
Symptoms included:


 * Severe headache
 * Malaise
 * Lassitude
 * Vertigo
 * Pain in limbs
 * Nausea
 * Dizziness
 * Neck stiffness, neck pain
 * Pain in back
 * Myalgia, muscle weakness, cramps, twitching
 * Depression
 * Abdominal pain
 * Vomiting
 * Diplopia (double vision)
 * Tinnitus
 * Diarrhea
 * Swollen lymph nodes
 * paraesthesia

Usually by the second or third week of the disease, there was objective evidence of involvement of the central nervous system which appeared to be characteristic of the outbreak.

Signs

 * Low-grade fever (tended to transiently occur with relapse of symptoms)
 * Swollen lymph nodes
 * Objective sensory impairment and muscle tenderness
 * Extensor plantar responses
 * Nystagmus
 * Diplopia

Findings

 * normal cerebrospinal fluid
 * electromyograms showed abnormalities of activity, but no evidence of lower motor neuron degeneration (12 of 25 abnormal. )
 * non-specific EEG abnormalities
 * neutropenia and abnormal lymphocytes, consistent with a viral infection
 * normal or slightly elevated erythrocyte sedimentation rate
 * negative virology
 * abnormally high lactic dehydrogenase and glutamic oxaloacetic transaminase

"Evidence of involvement of the sympathetic nervous system or actual hypothalamic damage was to be found in most cases. This often took the form of orthostatic tachycardia chilliness of the extremities with increased sensitivity to cold, circulatory impairment and hypothermia."

Epidemiology
Between 13 July 1955 and 24 November 1955, two hundred ninety-two (292) people, of whom the vast majority were hospital personnel, became ill. Personnel from the medical, nursing, auxiliary medical, ancillary, and administrative departments were affected. Of these two hundred fifty-five (255) were admitted to the hospital. Despite the hospital census being near capacity, only 12 patients were afflicted.

By 5 October 1955, the hospital had to close to contain the outbreak. The first to report ill were a resident doctor and a ward sister. More females became ill than males, but at the time it was believed to be because of the staff's living quarters not gender, as more females than males resided at the facility.

Similar cases had occurred in the population of North West London before this outbreak and sporadic cases continued to occur after the outbreak.

Prognosis
For many patients, symptoms waxed and waned in intensity over a long period. A very large majority had complete recovery of neurological function.

A follow-up study found that there is one group of patients that recovers completely or nearly completely, a second that recovers but is subject to relapses and a third that shows little or no recovery, these patients remaining incapacitated.

Learn more

 * 2020, Myalgic Encephalomyelitis (ME) outbreaks can be modelled as an infectious disease: a mathematical reconsideration of the Royal Free Epidemic of 1955
 * 2016, Is chronic fatigue syndrome finally being taken seriously?
 * 1987, Royal Free disease: perplexity continues
 * 1978, Epidemic myalgic encephalomyelitis (The BMJ)
 * 1978, 'Epidemic neuromyasthenia' 1955-1978 (Melvin Ramsay, The BMJ)
 * 1977, Icelandic disease (benign myalgic encephalomyelitis or Royal Free disease) (Melvin Ramsay, Elizabeth Dowsett, J V Dadswell, W H Lyle, and J G Parish, The BMJ)
 * 1970, Epidemic malaise (Dr Betty Scott, The BMJ)
 * 1970, Epidemic malaise (N. D. Compston, H. E. Dimsdale, Melvin Ramsay, and A. T. Richardson, The BMJ)
 * 1970, Epidemic malaise (Dr E D Acheson, The BMJ)
 * 1970, Epidemic malaise (Dr Paula Gosling, The BMJ)
 * 1970, Epidemic malaise (Dr G J Burke, The BMJ)
 * 1970, Epidemic malaise (Dr E J Hopkins, The BMJ)
 * 1970, Epidemic malaise (Dr J F Galpine, The BMJ)
 * 1970, Epidemic malaise (Dr D C Poskanzer, The BMJ)
 * 1970, Epidemic malaise (Dr J G Parish, The BMJ)
 * 1965, Eclipse of hysteria (Dr Betty Scott, Melvin Ramsay, The BMJ)
 * 1965, Hysteria and 'Royal Free Disease' (Melvin Ramsay, The BMJ)