Review Neurasthenia as a model of a disease thought to have disappeared. On an unpublished letter by Jean-Martin Charcot, 2024, Pérez Martínez

https://nah.sen.es/vmfiles/vol12/NAHV12N1202420_29EN.pdf

Neurasthenia as a model of a disease thought to have disappeared. On an unpublished letter by Jean-Martin Charcot

D. A. Pérez Martínez
Neurology Department. Hospital Universitario “12 de octubre,” Madrid, Spain. Neurology Department. Hospital Universitario La Luz, Madrid, Spain.

Original Neurosciences and History 2024; 12(1): 20-29

Corresponding author: Dr David A. Pérez Martínez E-mail: daperezm@salud.madrid.org

Received: 1 May 2023 / Accepted: 13 July 2023
©2024 Sociedad Española de Neurología.
Open Access CC BY-NC-ND 4.0.

ABSTRACT

Introduction.

George Miller Beard first described neurasthenia in 1869 as a clinical picture characterised by fatigue, caused by the modern lifestyle of the 19th century. However, patients often also presented sleep disorders, cognitive complaints, digestive disorders, and symptoms of sexual dysfunction. The concept was disseminated internationally from 1880 by Jean-Martin Charcot, and became one of the most frequent diagnoses at the Salpêtrière at the time. However, from the 1930s the entity practically disappeared in the history of Western medicine.

Material and methods.

This article reviews the concept of neurasthenia and its historical development. We present a previously unpublished private letter from 1888 by Prof Charcot, which includes real data on his clinical management of neurasthenia.

Results.

Charcot followed a similar diagnostic and therapeutic approach to that of Beard. Today, patients with chronic fatigue syndrome, fibromyalgia, and more recently post–COVID-19 syndrome present similar symptoms to those initially described in neurasthenia.

Discussion.

The emergence of post–COVID-19 syndrome or “long COVID” has resulted in an epidemic of patients with similar symptoms to those described by Beard in 1869. Nineteenth-century clinicians may already have described this patient profile, suggesting a shared pathophysiological basis.

KEYWORDS George Miller Beard, Jean-Martin Charcot, long COVID, neurasthenia, chronic fatigue syndrome, post– COVID-19 syndrome

 

I remember years ago somebody claiming (I never checked it closely) that Ian Hickie in Australia defined neurasthenia to make it sound like CFS. Then not surprisingly many people with CFS seemed to satisfy the definition for neurasthenia.

 

Only need to look at 1988

I've copied and pasted this from my legal research file:

Myalgic Encephalomyelitis (Hansard, 23 February 1988) (parliament.uk) (23 Feb 1988) Private Member’s Bill asking the House to acknowledge the clinical illness known as Myalgic Encehalomyelitis with with annual reports to parliament on research progress. It was presented by Jimmy Hood MP, supported by a number of MPs.


Postviral fatigue syndrome: time for a new approach | The BMJ David, Wessely & Pelosi (5 March 1988)

If you scroll down past the article for ‘debate’, you’ll also see 3 case studies of Crohn’s Disease presenting as anorexia nervosa! This is clearly not a new problem.



(13 Dec 1988) Jon Brynmor John MP for Pontypridd (one of the supporters of the proposed private members bill) earlier in the year on 23 Feb, died. He was diagnosed with ME and his GP had advised him to exercise his way out of it. He took that advice and, after leaving a session in the gym in the Houses of Parliament, died in the lobby.


5 months after his death, this article for ‘debate’ referring to the private members bill was published in the BMJ Myalgic encephalomyelitis, Princess Aurora, and the wandering womb. | The BMJ May 1989.


The letters published in Jun 1989 are an interesting response. Especially in the light of Long Covid. Myalgic encephalomyelitis. - PMC (nih.gov)


The ‘princess aurora’ BMJ article was cited, according to pubmed, in this 2020 scoping systematic review. Identifying Functional Mechanisms in Psychotherapy: A Scoping Systematic Review - PubMed (nih.gov) I don’t have access so I don’t know why it was referenced. The letters were not cited.


If you were not already aware of level of the bile that was publicly being tossed around about patients, along with newspaper headlines of benefit scroungers etc, the above will give you a good idea. They could have been written today, and is what’s so disappointing.


Skip forward 11 years and Jimmy Hood MP who presented the private members bill in 1988 supported by John Brynmor, spoke again in a debate on ME on 12 May 1999 International ME Awareness day. Worth reading his contribution. Myalgic Encephalomyelitis (Hansard, 12 May 1999) (parliament.uk)

 

Ah well if it includes "real data on his clinical management" then who could possibly not take it as fact?

You know what other condition was thought to have disappeared? Wandering womb. Let's bring all the old discredited stuff back and make medicine great again with all the modern stuff from checks note the 1800s.

 

Fact: what other illness can you think of, which requires a Private Members Bill being given permission to be laid before Parliament, to get it and the medical profession to acknowledge that the illness has been recorded by the world Health Organisation as a neurological illness since 1969? I can't think of one. Now that's landmark unique.

 

Oooof!

certainly right about it being a fantastic sum of money if 16% of the NHS budget was spent on psychosomatic illnesses in 1999. I'm assuming that means 'being given to those who are working psychosomatic depts' on the basis of the note regarding questions of how much of that was unnecessarily arising from misdiagnosis or tendency to send people there when it wasn't the correct place to have sent them

 

with the knock on effects to the DWP and lost tax revenue? Stratospheric costs.

It's clearly one of the reasons why the 2001 Woodstock Malingerer's conference happened. Just a shame they didn't spend more on biomedical research isn't it. It's one of the things the Private Members Bill was asking to be monitored by an annual report to parliament in 1988, 30 years ago! Obviously, that didn't happen.

 

interesting. so the money flowed first and then this was about them trying to explain that they weren't just a big old wastage-hole

Shame we don't have a few more people like this in the ears of the correct people reminding them that maybe the gamblers fallacy issue with the dept and staff is what is going on - they will always keep going back for more and some depts seem to get away with basically making the problem they claim they help just 'always increasing' and noone questioning whether they are 'the problem'

classic distractor to just diss your victims. and get your funders who might be already that way bigoted sadly to agree any money making things worse is fine.

 

Neurasthenia was forgotten because it lacks specificity.