1964 London NW outbreak

On outbreak in North Finchley, London occurred between 1964 and 1967 and was described by Melvin Ramsay. Ramsay examined a group of patients who had been ill for sometime (i.e., were in the chronic phase).

Symptoms
Patients were seen in a later stage of disease, and complained of persistent fatigue, memory impairment and inability to concentrate. Ramsay describes the muscle fatiguability as "striking," noting that in some cases it persisted throughout the day and in others was relieved by rest only to be exacerbated by minor activity.

Findings

 * Hypoglycemia
 * Hypothermia
 * Abnormal thirst
 * Low temperature (as low as 34.50 C)

"Three patients became unconscious; one was known to be prone to attacks of hypoglycaemia; the second had no recollection of being taken to hospital while the third did not remember travelling in a car and falling out of it on opening the door. All recovered with the administration of glucose."

Epidemiology
Ramsay also noted that no cases occurred among sedentary people. "This might afford an explanation for the absence of the disease among the patients in the Royal Free Hospital, or among the community of nuns who shared a building with a teaching college in Newcastle (1959). The attack rate among 120 student teachers was 40% whereas there was only one case among the nuns engaged in cooking or teaching in the college."