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The Most Common, Complicated, and
Confusing illness in medical history
The chronic fatigue syndrome is
the most common illness in medical history and has been particularly
common in the Western World since the seventeenth century when
it was recognised as being a disorder of sedentary workers which
was rare in farm laborers and non existent in primitive tribes
people.
Nowadays it is commonly encountered
amongst patients in every medical clinic and is well known and
recognised by all doctors, but there is no generally accepted
blood test or x-ray evidence of the cause, and no officially
endorsed reliable way of diagnosing the condition, and no consistently
effective treatment, and no known cure.
The condition is so complicated
and confusing that there are more than 100 labels for it which
vary from century to century, and decade to decade, and year
to year, and from county to country, state to state, city to
city, university to university, and clinic to clinic, and from
one doctor or one type of medical specialist to another in the
same clinics, and has often been used as the subject of classroom
debates for first year medical students, and sometimes produces
heated arguments at medical conferences.
Chronic fatigue was the most common
ailment in the nineteenth century when it was called Neurasthenia
due to the belief that it was caused by a weakness of the nervous
system. That label was the most commonly used diagnosis in medical
clinics where the condition came to be regarded as an imaginary,
trivial, or psychological disorder. Some researchers thought
it was caused by tight corsets which compressed the chest, heart,
and lungs. It was therefore known as a women's ailment but it
also affected some men, especially those who wore male corsets,
which were common at the time.
During the American Civil War it
was called DaCosta's Syndrome, and was known to effect soldiers
who wore tight waist straps, and marched into battle with heavy
fully laden knapsacks at double quick pace for 16 hours at a
time in cold wet conditions.
In the early twentieth century
when time and motion studies were introduced to improve productivity
in coal mines, the condition became common amongst the miners
who were required to increase the tonnage of coal that they shoveled
each day to achieve the new and gradually increasing average
worker requirements. The illness was then called Industrial Fatigue.
However, there was no medical test that could confirm the existence
of the ailments and that created two problems. Firstly the number
of individuals developing the ailment because of the progressively
increasing workload was posing a great cost to industry, and
secondly healthy workers could start faking the condition to
avoid their occupational responsibilities, so industrialists
socially engineered the idea that it was a psychological disorder,
and in Britain the name of The Industrial Fatigue Board was changed
to The Industrial Psychology Board. Thereafter healthy workers
refrained from faking the condition to avoid being branded as
mental cases, and genuinely fatigued patients had to endure the
shame and psychological distress imposed on them by the fraudulent
defamation of their characters.
In World War 1 the condition affected
soldiers who were exposed to round the clock cannon fire in the
trenches of the Western Front, where the constant noise made
it difficult for them to sleep for months at a time. It also
affected soldiers who were exposed to the shockwaves of exploding
bombs, but were not hit by shrapnel, so it became known as Shell
shock. The undetectable nature of the condition again posed two
problems for army administrators. Firstly the number of shell
shock cases was posing a large cost to the war and making it
uneconomical, and secondly large numbers of healthy soldiers
could start faking the condition to avoid the risk of death in
the front line of battles, and then it would become impossible
to win the war. The armies therefore started discrediting the
idea that the condition was a real physical ailment and reinforced
the psychological theories by attributing it to fear, with emphasis
on the label of cowardice. Thereafter healthy soldiers would
choose to face death in battle rather than fake the fatigue and
be branded as cowards, and the genuinely fatigued patients had
to endure the shame of the devious defamation. The army chose
to conveniently overlook the fact that some soldiers were being
granted bravery awards at their bedside while they were being
treated in shell shock hospitals. The awards were given to soldiers
who demonstrated courage in battle above and beyond the call
of duty.
(During the Iraqi War the U.S.
planes were reported as carrying bombs which were specifically
designed to produce the type of shockwaves that caused shell
shock in enemy troops.
When the condition affected factory
workers who were accidentally electrocuted at work it was called
Industrial Shell shock.
In civilian life scientists observed
that most patients with chronic fatigue spoke of intolerably
distressing cardiac symptoms during physical exertion so the
ailment was called "The Effort Syndrome". However,
many of the patients had thin physiques so some researchers believed
that it was due to poor physical fitness resulting from a lack
of exercise because of a fear of exercise or sport, or laziness.
In World War 2 the condition was known to be more common amongst
lightly built sedentary workers who were sent off to war without
the proper amount of physical training, and they were expected
to keep up with the marching pace of solidly built soldiers recruited
from farm laboring communities. Their condition was called Battle
Fatigue. Prisoners of War who lost more than one third of their
body weight due to starvation developed chronic fatigue and many
of them were still troubled by abnormal fatigue thirty years
later.
Some psychiatrists continued to
believe that the absence of blood test or x-ray evidence of disease
was an indication that there was nothing physically wrong with
the patients so they diagnosed the condition as Anxiety State,
and other psychiatrists noted that most of the patients with
chronic fatigue were depressed so they called it a Depressive
Disorder, but most doctors reported that there were patients
in almost every clinic who had the condition but appeared to
be as anxiety free and as well adjusted as any of their other
patients. When the condition affected a soldier at war some psychiatrists
continued to attribute it to the fear of battle and called it
Battle or War Neurosis, and if it affected a person at work they
attributed it to laziness or psychological stress so they called
it an Occupational Neurosis, and if the person claimed workers
compensation for the ailment they believed that the motive was
subconscious greed so they called it Compensation Neurosis, and
they believed that after the workers left their employment or
received a large financial payout from an insurance company they
would make a rapid recovery. Those psychiatrists did not do proper
follow up studies, but many patients were forced to resign without
the benefit of workers compensation or other entitlements and
spent the remainder of their lives in poverty.
Furthermore by not informing workers
of the consequences of continuing to work while in a state of
fatigue they were neglecting their responsibility to provide
preventive advice, and contributing to the development of the
chronic condition, and hence were contributing to economic costs
to the patients and society.
(It has been a feature of medical
history that obscure illnesses have been prejudically attributed
to negative, rather than positive personality traits, such as
evilness, sinfulness, laziness, cowardice, or greed.)
After more than 100 years of the
condition being popularly attributed to laziness or a fear of
exercise, it became widely known to affect Olympic athletes,
Sports Champions, Football stars, Marathon runners, and World
Record holders, and the new profession of sports physicians attributed
it to excessive physical strain without adequate rest breaks,
and began calling it The Overtraining Syndrome. For example,
if poorly prepared athletes participated in too many marathons
in the one year they were likely to develop chronic fatigue.
They didn't have sufficient time between marathons to fully recover,
so when running each additional marathon they just compounded
the fatigue which permanently impaired their fitness capacity
until they could no longer compete at the elite level, and in
the worst cases could not continue with normal employment or
lead normal lives. (i.e. it was caused by overwork amongst athletes
who were enthusiastic about exercise). The sports doctors recognised
its chronic nature and the fact that it ruined the careers of
many top athletes, so they began recommending graduated and regulated
physical training programmes as important methods of preventing
and treating the problem.
Some observers have noted that
overwork can cause chronic fatigue so it could be called The
Overwork Syndrome which affected workers who worked too hard
for too long. The workers who became fatigued and took rest breaks
recovered but those who ignored the symptom of fatigue and kept
working became over-exhausted and stayed exhausted.
The condition is also common in
pregnancy and in other cases it persists or starts after childbirth
when the post-natal fatigue has been called Post-Natal Depression,
due to the belief that it is the result of the psychological
stresses of motherhood. Some women with chronic fatigue can trace
their first experience of fatigue back to a pregnancy which may
have occurred twenty years earlier, and that prior to the pregnancy
they were fit and healthy and had a lot of energy and played
a lot of sport.
Other patients report that they
can trace the condition back to a traumatic experience in their
past, such as the death of a spouse, or the break up of a relationship.
Throughout history there are many
examples of epidemics of chronic fatigue of unknown cause which
have occurred amongst localised communities such as an outbreak
in Akureyri in Iceland in 1948. The symptoms included headaches,
sore throat, muscle pain, spasms, paralysis, tiredness, and emotional
instability. This set of symptoms was called Icelandic Disease
to identify it's locality, with a medical diagnosis of Myalgic
Encephalomyelitis, and it was thought to be due to a contagious
viral infection. In some cases the fatigue persisted for weeks
or months or even years afterwards, and the duration was related
to the extent of the paralysis during the original phase. It
has been proposed that the persistence of fatigue was due to
a post-viral condition where the virus became dormant or hidden
and produced long term strain on the immune system. In 1955 there
was an outbreak of the ailment affecting 300 of the male and
female staff of the Royal Free Group of hospitals in Great Britain
where it became known as The Royal Free Disease.
After a flu epidemic in Tapanui,
New Zealand, many patients were left with persistent fatigue
which became known as The Tapanui Flu.
In World War 1 60,000 British soldiers
returned from the trenches of the Western Front where they were
exposed to the cold and wet, poor nutrition, blood, pus, rotting
corpses, bed lice, contaminated food, food poisoning, dysentery,
and wound infections, and the war was finally brought to an end
by the Spanish flu which killed millions of soldiers and civilians
and was the most severe influenza epidemic in history. After
recovering in hospital from months of dysentery and flu the fatigue
persisted and many veterans continued to suffer from fatigue
for the remainder of their lives.
There are also many cases where
patients who have had chronic fatigue for many years, can trace
the onset of their condition back to a viral infection of some
sort, such as Glandular Fever. Prior to that infection they were
fit and healthy and lead normal lives, and since the infection
their lifestyle has been restricted by the fatigue.
Other patients report that they
can trace the start of the fatigue back to a period of exposure
to farm insecticides, or factory chemicals.
Some patients report that is has
been a problem since they were born because they cannot remember
a time in their lives when they were not easily fatigued, and
others cannot recall any particular starting point or incident,
and others say that the condition seemed to start incidiously
for no identifiable reason and that it gradually got worse until
it affected their sport, and then their social life, and ultimately
their employment.
There is evidence of a disorder
of blood flow throughout the body so American medical researchers
called it Neurocirculatory Asthenia, and Russian researchers
called it Vasoregulatory Asthenia.
Apart from the fact that the actual
physical or organic cause of this ailment has not yet been found,
the other reason for the condition being confusing is that there
are probably several different disorders being diagnosed as one.
For example, some of the conditions may be sleep disorders (related
to tiredness) and some may be exercise disorders (related to
physical fatigue), and others may be a combination of sleep and
exercise disorder. There may also be several different causes
for each type which have the same ultimate affect on the body.
In the nineteenth century the condition
was commonly seen in women who wore tight waisted corsets which
compressed the chest, heart, and lungs and impaired blood circulation
from the feet to the chest and brain.
According to The Posture Theory,
poor posture compresses the chest and abdomen, and sedentary
work involves repeated or constant leaning toward a desk, and
when both of those factors are combined the heart, lungs, and
abdomen are being repeatedly compressed, and if that process
is continued for many years it can eventually and permanently
affect the the blood flow from the feet to the chest and brain,
and the regulation of physical responses to exertion, and sleep
patterns, which is characteristic of The Chronic Fatigue Syndrome.
M.B.
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