1939 Degersheim outbreak

1939 Degersheim, Switzerland outbreak: Degersheim is a municipality in the canton of St. Gallen in Switzerland. In September 1939, eight hundred soldiers transferred to Degersheim from an area that was having a polio outbreak. During the next couple weeks, seventy-three cases of epidemic neuromyasthenia were reported.

Symptoms
Symptoms included :


 * Low-grade fever
 * Neuralgia, especially in the face, chest, and pelvic and legs
 * Autonomic dysfunction
 * Loss of concentration
 * Muscle weakness

Fifty-four (74% of total cases) developed systemic illness, twelve (16% of total cases) developed meningo-neuritic involvement, five cases developed myelitis (inflammation of the spinal cord) with muscle paresis (muscular weakness caused by nerve damage or disease). Two cases had an encephalitis (inflammation of the brain).

Prognosis
Most of the cases were short-lived. Autonomic disturbances were frequently observed during recovery. Susceptibility to fatigue and loss of concentration persisted in a few cases for more than a year.

Impact
This outbreak is the first time the encephalitis is described as 'diencephalitis,' meaning inflammation of the midbrain or intermediate brain, in explaining the autonomic disturbances of the hypothalamus.

At the time of the outbreak, Dr. Otto Gsell, a renowned Swiss internist and professor, who has the artery disease, Erdheim-Gsell syndrome, named for him, diagnosed the outbreak as "abortive poliomyelitis," but he also documented the differences in disease manifestation. Twenty years later, in 1958, after studying many outbreaks, including the Akureyri outbreak he wrote that "Encephalomyelitis myalgia epidemica eine poliomyelitisahnliche Krankheit" (epidemic myalgic encephalomyelitis is a poliomyelitis-like disease).