1953 Maryland outbreak

1953 Maryland outbreak: In July, 1953, a sudden outbreak of a polio-like infection occurred in the student nurses at Chestnut Lodge Hospital, a private, psychiatric hospital in Rockville, Maryland, near Washington, DC.

The Montgomery County Health Department, the Maryland State Health Department, National Institute of Allergy and Infectious Diseases, and Georgetown University School of Medicine were involved in deciphering the outbreak.

Symptoms
The investigators later stated in an article for the New England Journal of Medicine: "In a typical severe case the early manifestations included localized muscular weakness, stiffness of the neck and back, headache, diarrhea and temperature elevation. Within a few days it became apparent that the epidemiologic features and the course of the illness were not compatible with poliomyelitis and that we were dealing with an entity unknown to us." The outbreak was deemed to resemble other outbreaks of poliomyelitis-like illnesses in hospitals around the same time, including the Los Angeles County Hospital in 1934. Epidemic neuromyasthenia became the final diagnosis.

The illness onset was accompanied by diarrhea and vomiting. From several of the patients, the organism Bethesda-Ballerup paracolon organism was isolated. It was believed that this organism may have triggered the disease in the same manner as an infection of poliomyelitis virus precipitated other early epidemics.

Findings
Lumbar punctures were done on 25 of the cases and all 25 were negative for cerebral spinal fluid involvement. Eight lumbar punctures were repeated and all of those were negative, also.

Epidemiology
Fifty cases were documented: 48 females and 2 males, of which 47 of the cases were in the student nurse population.

Controversy
In 1970, this outbreak was one of fifteen mentioned in a paper by psychiatrists Colin McEvedy and A. W. Beard, who wanted to rename all fifteen outbreaks as mass hysteria or myalgia nervosa. The psychiatrists were criticized by patients and researchers, such as Dr. Melvin Ramsay who was directly involved in the 1955 Royal Free Hospital outbreak. McEvedy admitted to Dr. Byron Hyde, when invited to discuss his theory, that he did not examine any patients and undertook only the most cursory examination of medical records.

In 1994, Nathaniel C. Briggs and Paul H. Levine, from the Viral Epidemiology Branch, Epidemiology and Biostatistics Program of the National Institutes of Health, wrote a review comparing twelve outbreaks referred to as chronic fatigue syndrome, epidemic neuromyasthenia, and myalgic encephalomyelitis. They grouped the outbreaks into four levels of increasing neurological involvement, ranked I-IV. The 1953 Maryland outbreak was rated as level III, which meant that they found "objective paresis with cutaneous sensory as well as affective and cognitive neuropsychological changes." The researchers noted that: "'unusual fatigability' was a cardinal symptom. Twelve (46%) of 26 patients reexamined 3-5 months after onset were symptomatic and 'several had to be on part-time duty with periods of daytime bed rest'" and patients experienced "frequent recrudescensces [increased severity of a disease after a remission] particularly associated with exertion."