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I read with interest the paper by Jones and Wessely on chronic
fatigue syndrome and agree that this condition, however classified, is not
a new entity and occurs in a wide variety of cultural settings (1).
However, the description of the illness suffered by Charles Dawes, a
sergeant in the Eighth King’s Royal Irish Hussars, surely cannot be
entirely due to chronic fatigue syndrome. The symptoms of weakness,
generalised arthralgia, cough and visual disturbance could all be
explained by another systemic disorder, namely sarcoidosis. Tuberculosis
would be another possibility, especially given its extremely high
prevalence in the 19th Century.
Sarcoidosis is a multisystem disorder which usually affects young
adults with a peak incidence in the late 20’s, (Dawes was 28 when he
developed his symptoms), often presenting with ocular and pulmonary
manifestations, aswell as general malaise and arthralgia (2). In
particular, the visual difficulties and near blindness, due to iritis,
could not be attributed to chronic fatigue syndrome. The other systemic
associations of iritis (or uveitis) are well described and include
seronegative arthropathies, tuberculosis, syphilis and Behcet’s disease.
Indeed systemic disease occurs in nearly half of all patients with
anterior uveitis, and uveitis itself is found in 20-50% of sarcoid
patients (3).
Pulmonary sarcoid usually resolves spontaneously, which would fit
with the statement that no abnormality of the heart or lungs could be
found in later life. Polyarthritis due to sarcoid rarely leads to
permanent joint damage, which again is compatible with the clinical
findings of this case (3).
However, since sarcoid was not described as a multisystem disorder
until 1915, this diagnosis could not have been considered by the medical
board at the time of Dawes’ discharge from the army in 1872 (4).
Alternative diagnoses to chronic fatigue syndrome should be considered,
especially when definite organic abnormalities often found in systemic
disease, (such as uveitis), are present.
References
1 Jones E, Wessely S. Case of chronic fatigue syndrome after Crimean
war and Indian mutiny. BMJ 1999; 319: 1645-7.
2 Hosoda Y, Yamaguchi M, Hiraga Y. Global epidemiology of
sarcoidosis. Clinics in chest medicine 1997; 18 (4): 684.
IT seems Dr. Jones and Wessely are still stuck in the 18th century.
The fact is that there was no mutiny it was a WAR FOR INDEPENDENCE. Dr.
Jones and Wessely would be well advised to look for the meaning of mutiny.
British ruled India by force not by concent of Indians. Indians never
approved by any democratic means their rule in India. It is time for
people like Dr. Jones and Wessely to look at their history and apologise
for their atrocities committed on Indian population for more than 100
years and accept the events of 1857 as a start of a revolution for Indian
independence rather than a pathetic pommy argument of mutiny.
Hussar's sarcoid?
I read with interest the paper by Jones and Wessely on chronic
fatigue syndrome and agree that this condition, however classified, is not
a new entity and occurs in a wide variety of cultural settings (1).
However, the description of the illness suffered by Charles Dawes, a
sergeant in the Eighth King’s Royal Irish Hussars, surely cannot be
entirely due to chronic fatigue syndrome. The symptoms of weakness,
generalised arthralgia, cough and visual disturbance could all be
explained by another systemic disorder, namely sarcoidosis. Tuberculosis
would be another possibility, especially given its extremely high
prevalence in the 19th Century.
Sarcoidosis is a multisystem disorder which usually affects young
adults with a peak incidence in the late 20’s, (Dawes was 28 when he
developed his symptoms), often presenting with ocular and pulmonary
manifestations, aswell as general malaise and arthralgia (2). In
particular, the visual difficulties and near blindness, due to iritis,
could not be attributed to chronic fatigue syndrome. The other systemic
associations of iritis (or uveitis) are well described and include
seronegative arthropathies, tuberculosis, syphilis and Behcet’s disease.
Indeed systemic disease occurs in nearly half of all patients with
anterior uveitis, and uveitis itself is found in 20-50% of sarcoid
patients (3).
Pulmonary sarcoid usually resolves spontaneously, which would fit
with the statement that no abnormality of the heart or lungs could be
found in later life. Polyarthritis due to sarcoid rarely leads to
permanent joint damage, which again is compatible with the clinical
findings of this case (3).
However, since sarcoid was not described as a multisystem disorder
until 1915, this diagnosis could not have been considered by the medical
board at the time of Dawes’ discharge from the army in 1872 (4).
Alternative diagnoses to chronic fatigue syndrome should be considered,
especially when definite organic abnormalities often found in systemic
disease, (such as uveitis), are present.
References
1 Jones E, Wessely S. Case of chronic fatigue syndrome after Crimean
war and Indian mutiny. BMJ 1999; 319: 1645-7.
2 Hosoda Y, Yamaguchi M, Hiraga Y. Global epidemiology of
sarcoidosis. Clinics in chest medicine 1997; 18 (4): 684.
3 Lynch JP. Sharma OP, Baughman RP. Extrapulmonary sarcoidosis.
Seminars in respiratory infections 1998; 13 (3): 229-254.
4 James DG. Descriptive definition and historic aspects of
sarcoidosis. Clinics in chest medicine 1997; 18 (4): 664-8.
Competing interests: No competing interests