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Chronic Fatigue Syndrome


centurion

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I enclose a link to an interesting article in the BMJ relating to Chronic Fatigue Syndrome and two Victorian soldiers dishcharged as a result of what would be diagnosed today as being this.CFS Presumably CFS must have occured in some numbers in WW1 how was it explained (bundled in with shell shock?) and treated?

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I enclose a link to an interesting article in the BMJ relating to Chronic Fatigue Syndrome and two Victorian soldiers dishcharged as a result of what would be diagnosed today as being this.CFS Presumably CFS must have occured in some numbers in WW1 how was it explained (bundled in with shell shock?) and treated?

An interesting sideline is that one of these soldiers was serving as a recruiting sergeant in his early eighties in WW1

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I enclose a link to an interesting article in the BMJ relating to Chronic Fatigue Syndrome and two Victorian soldiers dishcharged as a result of what would be diagnosed today as being this.CFS Presumably CFS must have occured in some numbers in WW1 how was it explained (bundled in with shell shock?) and treated?

I am not sure it would have been treated, it almost certainly would not have been diagnosed as an ailment. It was still regarded with some scepticism by the medical fraternity until comparatively recently. I have a terrible feeling that anyone unfortunate enough to be suffering this condition would have had a very hard time indeed and been categorised as a persistent malingerer.

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Mental problems could receive a sympathetic response, probably depending on the normal behaviour of the soldier, and I can give and example, though not of CFS. I don't know the when and where but one of my Grandfather's stories told about when his Battery had been fighting hard for some time, moving back and forth across short distances. Sometimes they stood down in British trenches and other times they'd moved to old German ones. One morning my Grandfather was heard talking to someone but everyone else was accounted for. They found him, half awake, lying on a duck-board holding a conversation with a dead German soldier who'd begun to rot and the gas had made him rise through the mud. He said he was sent to the rear for a short break but had to take a lot of banter when he got back.

Keith

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I am not sure it would have been treated, it almost certainly would not have been diagnosed as an ailment. It was still regarded with some scepticism by the medical fraternity until comparatively recently. I have a terrible feeling that anyone unfortunate enough to be suffering this condition would have had a very hard time indeed and been categorised as a persistent malingerer.

And yet, according to the account in the BMJ the two Victorian soldiers mentioned received a sympathetic hearing and treatment even if the disease could only be called 'debility'

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Behaviour which was obviously related to stress or ' shell shock' would normally be dealt with as sympathetically as possible. That may not have amounted to much more than a cup of tea and a fag but due allowance would be made. The trouble with CFS is diagnosing it. How many M.O.s in the line would have been able to do that? It was not even described as a syndrome for a long time after. Post WW2, I'm sure.

I'll add an edit rather than reply seperately. The Victorian soldiers were not in the same war. With the horrendous conditions of the trenches, MOs were inclined to think malingerer first. How would a sufferer of CFS differ from the normal Tommy? We know that he was chronically overworked and deprived of sleep and rest. What symptoms would distinguish a man who suffered from a condition which the medical profession had not yet described and would not recognise fully for some decades to come?

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It was still regarded with some scepticism by the medical fraternity until comparatively recently.

It still is!

I have research several who served in WWI who were discharged with debility being given as the cause; so they acknowledged it at the time.

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At the end of the 19th century the condition was know as neurasthenia and normally diagnosed as exhaustion due to the stress of battle or effort syndrome. During World War One 60,000 British soldiers were diagnosed as having the syndrome, and 44,000 of these were retired because they could no longer function in combat.

From the research of Trudie Chalder lecturer in the Department of Psycological Medicine Kings College Hospital and Institute of Psychiatry, London

Regards Charles

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Interesting article, though I think that the authors overstate their case quite a bit. Even if you believe in the clinical condition of CFS, I think it is a real stretch to call these two cases CFS on such sketchy information. I would certainly not diagnose CFS based on these symptoms alone. Doc

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The phrase "debility or exhaustion of the nervous system" seems to crop up. Before WW1 there appears to have been a general category called wind contusion (from which the term windy may have come) which included 'nostalgia neurasthenia' which appears to have included what is today defined as CFS. Just as today many medics disputed its existence. In WW1 it seems to have been lumped under Shell shock (as I suspected) and called simply 'exhaustion of the nervous system' or neurasthenia. The guru on this today is a Dr Edgar Jones whose name crops up wherever I look. This paper looks useful and also covers some other conditions (including Disordered Action of the Heart) that have cropped up on this forum from time to time.

Post war syndromes

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I have research several who served in WWI who were discharged with debility being given as the cause; so they acknowledged it at the time.

A man I have researched was diagnosed with 'severe debility following dysentery' (contracted at Gallipoli). After several months' convalescence he was released back to his pre-war job, which had meanwhile been transferred from the Ministry of Labour to the new Ministry of Munitions. But he was not formally discharged and later recovered sufficiently to obtain an RNVR commission.

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I agree with Doc2. At least one of the cases mentions a condition called iritis, an inflammatory condition involving part of the eye. This is a very unusual condition and can be associated with other inflammatory problems elsewhere in the body. A systemic inflammatory disease will produce the symptoms and signs of CFS. With modern tests, an alternative diagnosis might have been uncovered.

All that being said, Simon and his team are making a general point that is still valid. The article must be seen in the context of the important work of his department within Kings College.

Robert

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Debility and debilitating are general descriptions, synonymous with run down. If you were suffering from debility, the doctor prescribed a tonic or ' pick me up'. There is no way we can equate that with CFS as diagnosed to day. This is simply a game of high redefinition.

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It's often difficult to know where in the cycle of illness the symptoms are described or precisely what was meant by "debility". The article refers to Dawes presenting with symptoms of increasing fatigue, exhaustion, tremors, weakness and pains in the legs. These symptoms are not unusual in the post plateau phases of what was identified in 1869 as "Landry's Ascending Paralysis" This was little understood then and is not wholly understood even today. It is often attributed to bacterial infections (commonly, but by no means exclusively, Campylobacter jejeuni) which would often be a complaint of soldiers living in the trenches and elsewhere. Dysentery may produce similar effects. Stress is also often cited as a factor and again this would align with some of the symptoms attributed to CFS.

In 1916 a number of French soldiers presented with similar symptoms and two were investigated in depth by three French Doctors, Messrs. Strohl, Barre & Guillain. As a result the ascending paralysis became known as Guillain-Barre Syndrome (also now known as Chronic Inflammatory Demyelinating Polyneuropathy or CIDP). Most patients recover after reaching a low plateau with what is effectively partial or substantial paralysis which proceeds from the extremities (hands, feet, top of head) towards the torso and may proceed as far as to result in an inability to breath unaided. It generally reaches a plateau and gently reverses, though not often recovering completely. Patients are likely to suffer ongoing weakness, tremors, cramps and similar related symptoms, though no two cases are alike.

The basic description of Dawes (and others) symptoms, quite possibly recorded after a period of suffering could also suggest a minor affliction of Guillain-Barre Syndrome being recorded in the recovery phase.

Treatment today means no more than around 5% of cases are fatal and cases are, in any event, unusual (about 1500 per annum in the UK). None the less I am aware of two cases of people returning from battlefield trips to the Western Front in the last 5 years, one of which, sadly, proved fatal.

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