Ramsay is very clear though that there is an actual disease though.
He is, but was he thinking clearly?
I will immediately reiterate that this is irrelevant to ME/CFS because it is about a quite different illness that seems to have triggered some ME/CFS cases later.
I suspect Ramsay never did a formal neurology attachment. He would have trained in the day when junior medical training was almost entirely ad hoc (1920s). Even when I did registrar training in the 1970s it was pot luck whether you did neurology. I did, and was sobered by realising how incompetent I had been before.
Neurologists would say that for patients then labelled as hysteria that there is very much actual disease. What does actual disease mean here? Hysteria is not malingering, or even hypochondria. Ramsay is talking of what is now called FND. We probably have no idea what it is, but it is actual disease.
But Ramsay seems muddled. He says 'the hysterical nature of certain features of the clinical manifestation is obvious'. What does he mean by that? And then he says 'Nevertheless it constitutes a grave injustice to diagnose hysteria in these case without recognising that the condition is organically determined.' But a neurologist is likely to assume that FND is organically determined.
What is Ramsay claiming? I think he wants to claim the symptoms are due to an infectious disease he thinks he has identified. But the signs and symptoms he describes don't fit well with known infectious disease (why he thinks they are novel.) He wants to claim that his neurological assessment, or that of his team, has picked out valid central nervous system signs. The trouble is, that the medical profession now looking back, especially if they have seen the data from McE and B, think that Ramsay's neurological assessment may have been amateur. It is very easy to elicit 'neurological signs' that do not mean what they basic books says they mean because there are a whole lot of ways they come out wrong if your technique is untrained.
Ramsay himself admits that a neurologist would be unconvinced by the patterns of signs. There are things that don't make sense. The brisk reflexes were supposed to indicate upper motor neurone involvement but there was no spasticity and the weakness that was supposed to be due to upper motor neurone change moved around day by day. Upper motor neurone lesions don't do that. The increased reflexes take time to develop (there may be flaccidity at first) and signify a process that evolves over days or weeks.
It isn't that McE and B misled people. The physician community came to realise that Ramsay's claims of focal neurological signs were probably unreliable. We have all seen signs like that. You call in an expert neurologist from Queen Square and they demonstrate that with skilled examination the signs are not there.
Ramsay should be applauded for having identified some of the features of ME/CFS later on in some cases. His reports of neurotropic viral illness at the Royal Free and another at a nearby cottage hospital are probably best consigned to the history of modern medicine growing up. They have nothing to do with ME/CFS.