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Doctors In Conflict

Case of chronic fatigue syndrome after Crimean war and Indian mutiny

BMJ 1999; 319 doi: (Published 18 December 1999) Cite this as: BMJ 1999;319:1645
  1. Edgar Jones, senior research fellow (,
  2. Simon Wessely, professor of epidemiological and liaison psychiatry
  1. Department of Psychological Medicine, Guy's, King's, and St Thomas's School of Medicine, London SE5 8AZ
  1. Correspondence to: E Jones

    Chronic fatigue syndrome was first proposed as a diagnostic label in 1988 to classify a disorder characterised by severe fatigue and exhaustion after minimal physical and mental effort accompanied by other unexplained somatic symptoms.1 It was introduced partly as an acceptable clinical alternative to the term myalgic encephalomyelitis, which described a similar presentation and had been coined in 1956 in the aftermath of an outbreak of illness among the nursing and medical staff of the Royal Free Hospital.2 The condition was widely assumed to be a new addition to the medical scene. In the popular press, and occasionally in the professional publications, attempts have been made to explain chronic fatigue syndrome as a product of the unwelcome features of modern life, such as pollution, stress, working practices, and new infections.

    Attention has recently been drawn to the often striking similarities between chronic fatigue syndrome and myalgic encephalomyelitis and the condition formerly known as neurasthenia, a term first coined independently in 1869 by the neurologist George Beard and psychiatrist E Van Deusen.3 Like its modern variants, neurasthenia was believed to be a physical disorder, largely caused or aggravated by “the selfishness and luxury of modern life, the restlessness and the craving for excitement, the frantic speeding about in motors” and other features of industrial society.4 In this article, we suggest that conditions resembling either chronic fatigue syndrome or neurasthenia have an even older provenance, and draw attention to the cases of two British soldiers who served in the Crimean war and in India at the time of the mutiny.

    Summary points

    Chronic fatigue syndromes existed before the description of neurasthenia in 1869

    These syndromes are not limited to the civilian population but occur in the military as well

    Soldiers awarded a pension as a result of fatigue syndromes continued …

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