A history lessonBMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7414.545 (Published 04 September 2003) Cite this as: BMJ 2003;327:545
- Catriona Rundle, junior house officer
- Perth Royal Infirmary, Perth, Australia
I first met Joan after she was admitted to hospital for investigation of a persistently raised serum creatine kinase concentration. Provisional arrangements had been made for electromyography and muscle biopsy, in case she had polymyositis. Joan was grateful for the medical attention, but somewhat surprised at the urgency of admission. She had suffered from exertional muscle pain and weakness for as long as she could remember. Ever since childhood, she had experienced mobility problems: after walking only short distances, she would have to stop and rest because of the aching in her legs. These intrusive symptoms had affected many aspects of her life.
Joan's father had worked on the railways, so they had enjoyed free rail travel. …