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The Clinical Features of Myalgic Encephalomyelitis
Melvin Ramsay, M.D., 1986

In the textbook, Ramsay began with the symptoms of the disease at its onset, then followed with the symptoms of chronic M.E. However, since most patients are unaware of the disease at onset, I have begun with the chronic symptoms. The symptoms of the onset of the disease follow - in case the reader is interested in how it begins, or in case the reader suspects there is a new cluster outbreak. There used to be cluster outbreaks; there is no reason (except for ignorance of the disease) why cluster outbreaks aren't recognized today.

[Disease in chronic state]
Once the syndrome is fully established the patient presents a multiplicity of symptoms which can most conveniently be described in three groups.

  1. Muscle phenomena

    • [Fatiguability]: Muscle fatigability, whereby, even after a minor degree of physical effort, three, four or five days, or longer, elapse before full muscle power is restored and constitutes the sheet anchor of diagnosis. Without it I would be unwilling to diagnose a patient as suffering from ME, but it is most important to stress the fact that cases of ME or mild or even moderate severity may have normal muscle power in a remission. In such cases, tests for muscle power should be repeated after exercise.
    • [Pain:] In severe cases of ME, muscle spasms and twitchings are a prominent feature and give rise to swollen bands of tissue which are acutely tender. In less severe cases, muscle tenderness may not be so readily elicited but careful palpation of the trapezii and gastrocnemii (the muscle groups most commonly involved) with the tip of the forefinger should enable the examiner to detect minute foci or exquisite tenderness….
    • [Clumsiness:] In the aftermath of the disease patients frequently fumble with relatively simple manoevres such as turning a key in a lock or taking the cork of a bottle.

  • Circulatory impairment. Most cases of ME complain of
    • Cold extremities and
    • Hypersensitivity to climactic change . . .
    • Ashen-grey facial pallor, some twenty or thirty minutes before the Patient complains of feeling ill
  • Cerebral dysfunction