Osler’s 1914 Definition of M.E.

The following definition of Myalgic Encephalomyelitis is taken entirely from our new textbook. You can find it in pages 140-142 in our book:

Understanding Myalgic Encephalomyelitis

 In our book, you will find Canada’s -- William Osler’s definition of M.E. which in turn comes from William Osler’s very famous 1224-page book published in 1914.

Dr. William Osler’s -The Principles and Practice of Medicine

 My discovery of Osler’s book and definition: When I was a 5-year-old child in Europe, there were hundreds of buildings destroyed by the Nazi bombing. I loved to crawl through the destroyed buildings which were full of treasures. It became a habit. Such good stuff, treasures from forgotten people that no one wanted. People continue to throw away incredible treasures.

Then, when I was a medical school student in Ottawa, I often studied in the military hospital library. One day they threw-out all their “old and no longer useful medical text-books.” As I was going through their garbage dump, I found Osler’s brilliant 1914 textbook of Medicine, along with Stitt’ textbook of Tropical Diseases, both of which I have kept to this day. Osler’s definition of M.E. (neurasthenia) comes from this government hospital garbage dump and my student garbage picking days. It is of interest, that in Osler’s book, paralytic Poliomyelitis was hardly known in North America until 1910, following the massive 1905 and 1906-7 Polio epidemics in Sweden. But in Osler’s 1914 book, Polio was less common and was given less space than was given to M.E.    In 1914 it would appear that M.E was a more important disease than Paralytic Poliomyelitis.

 Osler’s detailed discussion on M.E. where he begins by stating that Neurasthenia (M.E.) is the result of an infectious disease, is so far ahead of the CDC and NIH 1988 misreading of the M.E. as CFS, one can only wonder where the CDC minds were from the 1980s on.

William Osler (as in Hillary Johnsons brilliant book: Osler’s Web) clearly

Describes M.E. as a post infectious disease, causing major brain injury.

A Précis of Osler’s 1914 Discussion of M.E.

There were many names for M.E. in the 1800s. One which endured into the 20th century was Neurasthenia, what we call M.E. today, which many physicians downgraded as a psychological disease: Osler did not. William Osler took M.E. very seriously as do I.

 Osler describes Neurasthenia (M.E.) as an acquired disease. Ergo: Neither a primary psychiatric nor a genetic disease. He believed M.E” was due to, either an infection or a toxic exposure. Osler states clearly that Neurasthenia (M.E.) should not be confused with hysteria and has to be diagnosed from the subjective statements of the patient, rather than from the physical examination. He makes it clear neurasthenia (M.E.) can be confused with hysteria but is not hysteria. Osler further describes Neurasthenia/ M.E. as follows.

 Please note, this was Osler’s 1914 definitional description of M.E.

  1. Neurasthenia (M.E.) often arises following an infection: it is a Post infectious, acquired illness.
  2. Neurasthenia (M.E.) may include: cerebral, cardiovascular and gastric symptoms.
  3. There is a striking lack of accordance with the patient’s complaints and physical findings.
  4. Due to the fact that physicians are unable to assist, the patient falls easy prey to charlatans and quacks. The symptoms of M.E. include: (note all sources are taken from pages:

 1106  - 1116 of Osler’s 1914  book  unless otherwise noted). (Words in italics are mine.)

 The patient exhibits:

  1. Imperfect sleep,
  2. Inability to perform the normal mental work,
  3. Difficulty doing addition,
  4. Difficulty taking dictation or writing letters,
  5. Disturbance of articulation or writing abilities,
  6. Loss of fixed attention,
  7. Hyperaesthesia related to pain,
  8. Pressure points are painful, (This is one of the very few definitional points CDC got right.)
  9. Pains in the skin, eyes, joints, blood vessels,
  10. Head pains,
  11. Anxiety in almost all patients,
  12. Fear of approaching death,
  13. Increased risk of suicide due to despair,
  14. Hearing disturbances (hyperalgesia),
  15. Weariness on the least exertion,
  16. Numbness and tingling,
  17. Incoordination,
  18. Muscular weakness can be extreme,
  19. Gastralgia & gastric hyperaesthesia: (pg. 512- 513)

 Cardiovascular symptoms include, Osler following describing is largely the same as dysautonomia described first by the USA civil war physician, Dr. Da Costa in 1870s as soldier’s heart. (You will find there is also a chapter on Da Costa in our book.

  1. Tachycardia, (POTS – Major autonomic disease)
  2. Pain in the heart area,
  3. Palpitations, (770, 774)
  4. Sweats,
  5. Cold extremities,
  6. Transient hyperaemia of the skin,

Note: Osler separates neurasthenia (M.E.)  from psychiatric disease but goes on to mention the

(a) anxiety, (b) fear of death, (c) risk of suicide and (d) depression that comes with this illness.

Once again as mentioned earlier in this book, the two conditions, paralytic Poliomyelitis and

neurasthenia, appear to come on to the medical scene at approximately the same period.

Treatment:  Osler’s Treatment Suggestions are of interest and include:

  1. Treatment with drugs should be avoided as much as possible.
  2. The patient requires an understanding physician.
  3. The patient should have faith in their religion and maintain spiritual guidance.

(This obviously meant that Osler knew of nothing else which helped, except prayer?)

You will find this and more in Dr. Byron Hyde’s 2020 book:

Understanding Myalgic Encephalomyelitis

Available at NightingalePress.ca