1955 Royal Free Hospital outbreak

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

Between July and November, 1955 292 members of the medical, nursing, auxiliary medical, ancillary, and administrative staff fell ill, of which 255 were admitted to the hospital.

This outbreak occurred at a prior location to the current hospital site in Hampstead NW3. The disease name Myalgic Encephalomyelitis emerged to describe the illness.

Outbreak 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.

Symptoms

 * Headache
 * Sore throat
 * Malaise
 * Lassitude
 * Vertigo
 * Pain in limbs
 * Nausea
 * Dizziness
 * Stiff neck
 * Pain in back
 * Depression
 * Abdominal pain
 * vomiting
 * Diplopia
 * Tinnitus
 * Diarrea
 * Swollen lymph nodes
 * paraesthesiae

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.

Findings
Special investigations did not reveal any specific abnormalities. Cerebrospinal fluid examined in a number of the earlier cases was normal. Haematological studies revealed abnormal lymphocytes of the type found in a number of virus diseases. The ESR was not usually raised. There were no characteristic biochemical changes. Post-mortem material was subsequently available from a patient with carcinoma of the ovary and of the patient already referred to who committed suicide. (Compston)

lactic dehydrogenase, and glutamic oxalo-acetic transaminase https://pmj-bmj-com.ezproxy.princeton.edu/content/postgradmedj/54/637/718.full.pdf

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 (Ramsay 1978) chilliness of the extremities with increased sensitivity to cold, circulatory impairment and hypothermia.

Showers of petechiae or larger ecchymotic areas on the extremities, severe sweating, constipation, bladder disturbances often so insistent as seriously to interfere with sleep, and the appearance of an area of ghastly pallor around the mouth or of the whole face (usually noticed by friends or relatives some 20-30 min before the patient complained of feeling ill) were frequent events. (Ramsay 78)

Virological and serological investigations were negative. Blood counts were done in all cases and showed the leucopenia which is consistent with virus infection. There was no anaemia. The ESR was normal or only slightly raised. Electromyography was carried out in twenty-five cases and was abnormal in twelve. The temperature was generally little raised but in one case reached 39.20 C and was maintained at a level of 38.80 C for 5 days. (R 78)

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.

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.

Prognosis
many patients the symptoms waxed and waned in intensity over a long period. In the very large majority of cases the recovery of neurological function was complete and at the time of the staff's original publication almost two years after the outbreak only four patients still presented marked physical disability. A

A follow-up study suggests 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. (Ramsay 1978)

Learn more

 * 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)