The recent report by the US Institute of Medicine seems to have taken us back to Ramsay, stating clearly that this is a disease which is defined by the fact that exertion of any type can do harm in many systems in the body. They are definite that this is not a psychiatric disorder, and their first recommendation is that the term CFS be got rid of. They suggest the name Systemic Exertion Intolerance Disease, the word ‘intolerance’ meaning medical intolerance…like lactose intolerance, glucose intolerance….where actual harm is done if you don’t keep away from the thing that your body can’t (physically) tolerate. This completely undermines the psychiatric position- which is that you only think you have a physical illness and that exercise will make you better. The fact that influential psychiatrists are up in arms about the report shows that they can see that this report threatens their empire, even if many patients (and, of course, the media) think it doesn’t. My hope is that Ramsay’s insistence that complete rest is the first and best treatment will follow, but in our exercise-mad culture, in which all the disabled are labelled lazy slivers, this will be an uphill fight.
Ramsay sets out the defining features of ME:
1. a unique form of muscle fatiguability whereby, even after a minor degree of physical effort,three, four or five days, or longer, elapse before full muscle power is restored;
2. variability and fluctuation of both symptoms and physical findings in the course of a day; and
3. an alarming tendency to become chronic.
A Melvin Ramsay was Honorary Consultant Physician in Infectious Diseases at the Royal Free Hospital in 1955 at the time of the epidemic in that hospital and spent the rest of his life studying this illness, seeing patients and acting as advocate, right up to his death at the age of 89, while he was preparing to present a paper at a conference on the subject.
He has collated accounts of other outbreaks, 18 of the 52 which he states had been recorded up to the 1986, the date…
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