1955 Royal Free Hospital outbreak
In 1955, between July and November, 292 members of the medical, nursing, auxiliary medical, ancillary, and administrative staff fell ill, of which 255 were admitted to the hospital. The disease name myalgic encephalomyelitis was coined to describe the illness.
Location[edit | edit source]
Onset[edit | edit source]
Symptoms[edit | edit source]
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.
Signs[edit | edit source]
- Low-grade fever (tended to transiently occur with relapse of symptoms)
- Swollen lymph nodes
- Objective sensory impairment and muscle tenderness
- Extensor plantar responses
Findings[edit | edit source]
- normal cerebrospinal fluid
- electromyograms showed abnormalities of activity, but no evidence of lower motor neuron degeneration (12 of 25 abnormal.)
- non-specific EEG abnormalities
- neutropenia and abnormal lymphocytes, consistent with a viral infection
- normal or slightly elevated erythrocyte sedimentation rate
- negative virology
- abnormally high lactic dehydrogenase and glutamic oxaloacetic transaminase
"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 chilliness of the extremities with increased sensitivity to cold, circulatory impairment and hypothermia."
Epidemiology[edit | edit source]
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.
Prognosis[edit | edit source]
For many patients, symptoms waxed and waned in intensity over a long period. A very large majority had complete recovery of neurological function.
A follow-up study found 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.
Learn more[edit | edit source]
- 2020, Myalgic Encephalomyelitis (ME) outbreaks can be modelled as an infectious disease: a mathematical reconsideration of the Royal Free Epidemic of 1955
- 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)
See also[edit | edit source]
- Epidemic myalgic encephalomyelitis
- List of outbreaks
- Royal Free Hospital
- Melvin Ramsay
- Myalgic Encephalomyelitis
- Royal Free Disease
- Icelandic Disease
References[edit | edit source]
- The Medical Staff Of The Royal Free Hospital (October 19, 1957). "An Outbreak of Encephalomyelitis in the Royal Free Hospital Group, London, in 1955". British Medical Journal. 2: 895–904.
- Ramsay, A. Melvin (October 30, 1965). "Hysteria and "Royal Free Disease."". British Medical Journal. 2 (5469): 1062. ISSN 0007-1447. PMC 1847119.
- Ramsay, Melvin; O'Sullivan, E (May 26, 1956). "Encephalomyelitis simulating poliomyelitis". The Lancet. 270: 761–764.
- Ramsay, A. Melvin (November 1978). "'Epidemic neuromyasthenia' 1955-1978". Postgraduate Medical Journal. 54: 718–721.
- Compston, N.D. (1978). "An outbreak of encephalomyelitis in the Royal Free Hospital Group, London, in 1955" (PDF). Postgraduate Medical Journal. 54: 722–724.
- Melvin Ramsay, "Post-viral fatigue: The saga of the Royal Free Disease", 1984.
- Dawson, J. (1987). Royal Free disease: perplexity continues. British Medical Journal (Clinical Research Ed.), 294(6568), 327–328.
- Waters, F. G.; McDonald, G. J.; Banks, S.; Waters, R. A. (April 2, 2020). "Myalgic Encephalomyelitis (ME) outbreaks can be modelled as an infectious disease: a mathematical reconsideration of the Royal Free Epidemic of 1955". Fatigue: Biomedicine, Health & Behavior. 8 (2): 70–83. doi:10.1080/21641846.2020.1793058. ISSN 2164-1846.