1937 St. Gallen outbreak

In September, 1937, there was a small outbreak in the women's section of the cantonal hospital for St Gallen at Frohburg, St Gallen, Switzerland. This outbreak was less than three months after the 1937 Erstfeld outbreak, about 200 km or 125 miles away.

Symptoms

 * Marked fatiguability
 * Autonomic disturbances
 * Muscle paresis

The frequency of symptoms in the St Gallen outbreak were as follows: 35% had systemic symptoms, 47% had meningeal involvement, and 18% develop encephalomyelitis with paresis.

Findings

 * Minimal changes in cerebrospinal fluid.
 * Lung changes in five patients

Epidemiology
"Of the twenty-eight patients and staff at risk, seven nurses, five patients, an auxiliary and a male doctor were affected and there were three outside contacts. The age range was from 21 to 38 and six patients were over 30 years old."

Several differences appeared in this epidemic, compared to the the one at Erstfeld: 1) it spread to the community, 2) there was twice the number with central nervous symptom involvement, and 3) patients had longer recovery and more relapses.

One particularly unusual difference between this hospital outbreak and others that occurred at a later date in hospitals, is that the illness affected patients as well as staff. A possible reason, Parish theorizes, is that the hospital patients were maternity patients who were laboring when exposed to the infection and "the deleterious effect of physical exercise during exposure and convalescence" may have increased their risk of infection.

Prognosis
Prolonged convalescent period was observed with relapses.

Impact
Dr. Otto Gsell, a renowned Swiss internist and professor, who has the artery disease, Erdheim-Gsell syndrome, named for him, published several articles about the several Swiss outbreaks. He used the diagnosis of "abortive poliomyelitis," but 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).