The "chronic brucellosis" papers.

I thought it would be helpful to present in an organised form links to these papers, mentioned on another thread, which are fundamental to an understanding of the BPS approach to ME, and which should be read by those wanting an understanding of how we got to where we are. The papers usually quoted are the Brucellosis 111 of 1959 and Influenza of 1961, but these give an incomplete and partial, in its other use, understanding of the condition. Only by reading 1 and 11 can an understanding of the psychological claims of 111 be understood. The benevolent might take the view that the scarcity of reference to papers 1 and 11 is not deliberate obfuscation. The 111 and the influenza papers are quoted in the origination of the view that perpetuation of symptoms is unrelated to any continuing disease process and is due to psychosocial vulnerability of the patient.

BrucellosisI. Laboratory-Acquired Acute Infection
ROBERT W. TREVER, M.D.; LEIGHTON E. CLUFF, M.D.; RICHARD N. PEELER, M.D.; et al IVAN L. BENNETT Jr., M.D.
AMA Arch Intern Med. 1959;103(3):381-397. doi:10.1001/archinte.1959.00270030037004
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/562976
https://sci-hub.se/10.1001/archinte.1959.00270030037004

It is unusual to have an opportunity for specific clinical evaluation of patients with infectious disease prior to onset of illness, except in volunteer studies. From 1945 to 1957 sixty cases of acute brucellosis occurred among personnel of a bacteriology laboratory engaged in studies of Brucella melitensis and Brucella suis. These patients had been followed regularly by clinical examination and serological tests before infection occurred. Their known occupational exposure facilitated early diagnosis, hospitalization, and treatment. Many of the infections followed documented laboratory accidents. Most of the patients were observed frequently for one or more years after onset of the acute illness. Analysis of these cases of brucellosis brings out several interesting features of the disease and has made possible appraisal of the incubation period, diagnostic procedures, clinical manifestations, efficacy of chemotherapy, and development of chronic persistent symptoms ("chronic brucellosis").

BrucellosisII. Medical Aspects of Delayed Convalescence
LEIGHTON E. CLUFF, M.D.; ROBERT W. TREVER, M.D.; JOHN B. IMBODEN, M.D.; et al ARTHUR CANTER, Ph.D.
AMA Arch Intern Med. 1959;103(3):398-405. doi:10.1001/archinte.1959.00270030054005
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/562979
sci-hub.se/10.1001/archinte.1959.00270030054005

Four clinical types of brucellosis were described by Hughes in his classical monograph on "Mediterranean, Malta, or Undulant Fever." 1 These were characterized as malignant, undulatory, mild or intermittent, and irregular or mixed, depending largely upon the severity, duration, and course of the infection. Although brucellosis, as studied by Hughes, was probably due almost exclusively to Brucella melitensis, his classification and description of the disease became widely accepted regardless of the species of Brucella causing infection. Cases were included in Hughes' studies only if the evidence was sufficient to "prove" the diagnosis. Hughes' classification of brucellosis has been criticized in that he did not describe cases of chronic disability.2 Bassett-Smith, in 1903,3 however, described patients with "chronic brucellosis" who had persistent ill health, with fatigability and inability to carry on normal activities even in the face of a declining or negative agglutinin titer and without physical abnormalities. Acute....

BrucellosisIII. Psychologic Aspects of Delayed Convalescence
JOHN B. IMBODEN, M.D.; ARTHUR CANTER, Ph.D.; LEIGHTON E. CLUFF, M.D.; et al ROBERT W. TREVER, M.D.
AMA Arch Intern Med. 1959;103(3):406-414. doi:10.1001/archinte.1959.00270030062006
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/562982
sci-hub.se/10.1001/archinte.1959.00270030062006

Abstract

Brucellosis is usually a self-limited disease. Complications, such as suppurative or granulomatous lesions, may, however, occur. In addition, some patients remain disabled after the acute infection because of persistent symptoms in the absence of any demonstrable physical abnormalities and are commonly said to have "chronic brucellosis." The present study was done to investigate the role of psychologic factors in the pathogenesis of this delayed convalescence.

"Chronic brucellosis" is clinically similar to neurosis in that nonspecific symptoms, such as fatigue, headache, myalgia, arthralgia, "nervousness," and depression, occur in the absence of abnormal physical findings. This similarity could be attributed to factors discussed below, which may be important determinants in delayed convalescence from any illness.

1.Although similar to emotional illness, "chronic brucellosis" might be unrelated to psychologic factors and be attributed to enduring infection. The coexistence of neurosis and "chronic brucellosis" then would be no more than expected from chance alone.

….


Convalescence from Influenza A Study of the Psychological and Clinical Determinants
JOHN B. IMBODEN, M.D.; ARTHUR CANTER, Ph.D.; LEIGHTON, E. CLUFF, M.D.
Arch Intern Med. 1961;108(3):393-399. doi:10.1001/archinte.1961.03620090065008
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/566349
sci-hub.se/10.1001/archinte.1961.03620090065008

Abstract
In a recent study1 of convalescence from acute brucellosis the findings strongly supported the view that delay or failure in symptomatic recovery from that disorder is critically dependent upon the emotional state or attitude of the person. While no objective clinical or laboratory findings differentiated those persons who recovered quickly and completely from those who retained symptoms for a long period of time (chronic brucellosis), there were striking differences between these two groups in terms of psychological adjustment and life situation concurrent with the acute phase of the infection. The evidence pointed to the importance of depression particularly in retarding symptomatic recovery from the illness.

The study of convalescence of patients with brucellosis was done retrospectively in that the persons were investigated medically and psychologically some time after the acute illness had been contracted. We felt reasonably assured that certain features of the study enabled us to differentiate between...



The work was conducted by researchers from John Hopkins University Baltimore under contract to the Army Chemical Corps at Fort Detrick Frederick Maryland. The brucellosis cases (EDIT allegedly- the possibility of deliberate experimental exposure cannot be entirely ruled out-) arose from contamination within the laboratories connected with biological defence and warfare programs.

The first and second papers are valuable in showing the course of illness from acute to chronic. The third and influenza papers reveal the limitations of the work upon which the BPS approach is based.

For instance the four case studies quoted in 111 should be observed. Is it to be assumed that the remaining twenty cases showed no such history, and how did these histories compare with the non existent control?

So long as the BPS approach continues it is necessary to observe its foundations.

 

One matter has now been clarified. In this speech in 1988 which may have been of major influence referred to the survey of 480 people prior to exposure to an expected flu epidemic. He cites the 1961 paper.

The figure of 480 appears to be taken from this later paper

Asian Influenza. Infection, Disease, and Psychological Factors.


Author(s) : CLUFF, L. E. ; CANTER, A. ; IMBODEN, J. B.

Journal article : Archives of Internal Medicine 1966 Vol.117 No.2 pp.159-63 ref.12

Abstract : The influence of emotional factors upon disease is being studied in a military research unit handling pathogenic organisms, the members of which are required to report to a medical dispensary in the event of any illness. In August 1957, 480 male employees were asked to complete the Minnesota Multiphasic Personality Inventory (MMPI) and the Cornell Medical Index Health Questionnaire (CMI). Their psychological status was thus determined some months before the onset of the Asian influenza epidemic in the winter of 1957-58.
Influenzal disease was identified in 26 persons by virus isolation during the disease or by rising serum titres during the immediate convalescent period. Influenzal infection in persons with a reported illness was proved by virus isolation or at least a four-fold rise in serum antibody during convalescence. There was a significantly greater frequency of reported and proved influenzal disease in persons who had been previously identified by MMPI and CMI tests as being psychologically vulnerable. This was interpreted as being due to an increased concern of these individuals about illness.
Influenzal infection was found to be 6 times that of reported influenzal illness. There was a suggestive, but not statistically significant increase in the frequency of infection, defined serologically, in those persons who had been previously identified as psychologically vulnerable. H. Stanley Banks.
ISSN : 0003-9926

DOI : 10.1001/archinte.117.2.159

https://www.cabdirect.org/cabdirect/abstract/19662703443

I have been unable to access the full text.

The apparent loss of 120 people from the statistics makes one wonder about any conclusions. Abbey says of this paper:

Cluff et al (1966) later analysed the data from the prospective study and identified a subset of the sample as psychologically vulnerable. There was no increase in sero-conversion rates among the psychologically vulnerable group, but there was greater attendance at the medical clinic if they became infected. Two subsequent prospective studies have demonstrated not only more reporting of symptoms, but also greater evidence of illness severity, in psychologically vulnerable subjects infected with tularaemia (Canter 1972) or the common cold (Totman et al 1980).

Somatization, illness attribution and the sociocultural psychiatry of chronic fatigue syndrome.
Susan E Abbey Chronic fatigue syndrome. Wiley Chichester (CIba Foundation Symposium 173) p238-261

This was one of the presentations at the Ciba Symposium at which all the usual were present.

It can be assumed that the Canter study is again based on Fort Detrick personnel.

The Totman paper raises new questions
Journal of Psychosomatic Research
Volume 24, Issues 3–4, 1980, Pages 155-163

Predicting experimental colds in volunteers from different measures of recent life stress
Author links open overlay panelRichardTotman∗JoeKiff†Sylvia E.Reed‡J.WallaceCraig‡
https://doi.org/10.1016/0022-3999(80)90037-9Get rights and content

Abstract
Fifty-two volunteers were given experimental colds by nasal inoculation with rhinoviruses during the course of a 10-day residential stay at the Common Cold Research Unit, Salisbury. Prior to their inoculation with virus, they were assessed on five different measures of recent life stress and they also completed the E.P.I. Clear evidence of a psychosomatic component in colds was obtained. Introverts developed significantly worse symptoms and infections than Extraverts. And life events, when they involved change in the person's general level of activity, were significantly related to magnitude of infection. Infection was assessed daily by measuring the amount of virus present in nasal washings. Some implications of these findings are discussed.

So now we have Porton Down involved in the same sphere. EDIT It may be an unfortunate coincidence.

 

I wonder whether one of our scientists could explain this. It seems wrong to me. The 1961 study was supposedly accorded such merit because of the prospective study. It claimed to have data on 600 people in advance of infection. The 1966 study claims the same merits but apparently on the basis of 480. There has been some sort of selection process after the event. It cannot claim to be prospective.

 

I agree in principle with the general sentiments, but am not quite sure about this in the particulars of the case. Given the nature of the work in which they were involved there was a duty to report symptoms to the medical staff. I think the scientists would have been, if anything, more likely to be compliant. Apparently there were three fatal accidents. As well as brucellosis they were dealing with plague, anthrax, botulinum and other bio-agents. It may be that at the time there was an interest in agents causing mortality rather than morbidity, and that the reversal of the interests came later.

There is also a distinction between the professional scientists and the ancillary staff, such as those who cared for the animals. The authors make the point, which rather undermines later claims, that the ancillary workers, one of whom was illiterate, were slightly overrepresented amongst those who became ill.

I think that the point I need to explore is that Eisenberg, a colleague of the researchers, who was probably responsible for pushing the psychosocial vulnerability idea with the UK psychiatrists, appears to base his views on the 1966 paper around which there may be doubts. The reason for the loss of a fifth of the original data set may be explained in the body of the full article, but it is hard to see that it does not skew and invalidate any claims for this paper.

 

There is one aspect of Simon Wessely's work which perhaps receives insufficient credit. There is no doubting the meticulous nature of his search for and citation of precedents which enable others to follow up and comment upon his conclusions. He led me to this, which further expands on the subject, but fails to resolve the doubts.

December 30, 1961
Symptomatic Recovery from Medical Disorders
Influence of Psychological Factors
John B. Imboden, M.D.; Arthur Canter, Ph.D.; Leighton Cluff, M.D.
JAMA. 1961;178(13):1182-1184. doi:10.1001/jama.1961.73040520003003a



THE PURPOSES of this communication are to discuss some general considerations related to the proposition that psychological or emotional factors can significantly influence the course of medical disorders and to consider briefly the results of recent investigations of delayed convalescence following acute brucellosis and Asian influenza. For conceptual clarity, it is helpful to consider that there are different ways in which emotional factors can exert an influence on the course of any illness. Several of these factors are briefly described as follows:

1. Occasionally the emotional state or set of attitudes of the patient may be reflected in his inability or unwillingness to cooperate with the therapeutic regimen prescribed for him. This difficulty may be encountered, of course, in every degree of severity ranging from mildly annoying uncooperativeness to defiance of medical advice with tragic consequences. Such help-rejecting behavior may stem from a variety of psychological roots. For example....
…….

We have interpreted these results as probably indicating that clinical symptoms of depression such as fatigue, lack of energy or interest, or other vague somatic complaints—whether arising in response to somatic illness or already present—tend to be merged with the weakness or fatigability that is normally present immediately following an acute infection. This intermingling of symptoms in the convalescent period obscures the end point of the infectious illness from the views of both patient and physician. In addition, most convalescent patients are apt to attribute their persistent lack of well being to persistence of the "physical" disease, and as shown in the brucellosis study, this interpretation carries the least threat to the patient's sense of self-esteem.

https://sci-hub.se/10.1001/jama.1961.73040520003003a

I am troubled that there appears to be a lack of consistency between different written accounts, which require study. It is not immediately apparent that these studies are capable of bearing the weight of interpretation which they carry.

 

I have now located the 1966 paper referred to above . This seems to be the link that works

February 1966
Asian Influenza
Infection, Disease, and Psychological Factors
LEIGHTON E. CLUFF; ARTHUR CANTER; JOHN B. IMBODEN
Arch Intern Med. 1966;117(2):159-163. doi:10.1001/archinte.1966.03870080003001
https://sci-hub.se/10.1001/archinte.1966.03870080003001

It appears that the discrepancy between the 600 and 480 probably relates to this reported factor

Serum suitable for serological study of infection rate was obtained from 293 of the 480 persons three to six months prior to the epidemic and three to six months after the epidemic. These paired sera were assayed for rises in antibody titer using complement fixation with the A/Japan/305/57 strain of influenza virus. All titrations were done in pairs and in duplicate. Sera which were anticomplementary were not included in the 293 and were not used in the final analysis. Only fourfold or greater rises in serological titer were interpreted as indication of infection. Vaccination with available Asian influenza vaccine was not encouraged or discouraged among the employees. Careful records were kept, however, of all persons receiving vaccine during the winter of the epidemic. Most persons vaccinated received the vaccine in October or November 1957.

This seems to increase the problems. We now have three categories. 293 from whom sera was (were?) collected. 187 considered included but from whom sera was not collected. 120 who seem to have disappeared completely.

I seem to be harping on about this, but as this research seems to have been accorded fundamental significance, it is strange to see so much unexplained, and the cheerleader-in-chief being unacquainted with significant details.

 

Psychiatric Interviews.—Most of the patients indicated that they had agreed to cooperate with the study because it afforded them an opportunity to get a thorough physical "check-up" by competent physicians at no personal expense; this was, of course,particularly important to the 10 chronic symptomatic patients. Many subjects, especially those who were engaged in research,stated that they were willing to participate because this was a research project...

This comment in the Brucellosis 111 paper sheds a certain light upon the matter. We were led to believe that there was first class medical provision for staff, and that they were required to attend the clinic at first sign of symptoms. One would anticipate ongoing provision until recovery. Here we seem to be told that, presumably once the chronic infection abated, the patients were on their own to seek their own medical provision . Hands were suitably washed.

This would seem to hint at a possible motive for a psychological interpretation.

 

There is an aspect to this which puzzles me, now that we know a little more of the circumstances in which the research took place.

We are told that 60 patients developed brucellosis over a period. EDIT 16 went on to suffer from a chronic form and in 10 the condition was continuing at the end of the study. This was apparently due to emotional disturbance or psychosocial predisposition.

We now know that within the laboratories work was being done on other agents selected for their efficacy as potential weapons, amongst these were plague, anthrax, botulism, Q Fever, tularemia. We are told elsewhere that there were three fatalities as a result of infection - streets within the camp were even named after the victims. Unless the brucellosis lab was particularly lax in its standards, one might expect similar levels of infection, or at least some infection, from the other diseases under research. If the chronic illness is due to perpetuating psychological factors rather than the nature of the precipitating disease, one might expect similar incidence of perpetuating factors amonst the work force. Why are they not comparing chronic brucellosis with the other chronic conditions arising after infection with other pathogens? Why would people not attribute ongoing illness to those diseases in a similar manner?

 

I have just now made it to this thread and Holy S##t! I am not old enough to know someone to have brucellosis (undulant fever here), but I knew a couple of people who had previously had it. They were permanent invalids and nobody here thought it was psychosomatic. Brucellosis had not been completely eradicated from cattle herds and people very much feared it because they knew it could kill or permanently disable.

 

Do you think they could have been persuaded to change their mind with a suitable contract with the Army Chemical Corps?

There is a strange irony emerging. At roughly the same time as this work was being undertaken there was started (in about 1954) Project CD-22 (CD standing for Camp Detrick). This was the "Whitecoats" project for experimentation on human "volunteers"- principally Seventh Day Adventists and other conscientious objectors. One of the agents tested was Q Fever, now thought to be capable of causing an ME like illness. If the findings are written up for wider understanding, I have not found them. Here they had the power to do a prospective study and did not do so, or, if they did, we know nothing about it.

 

There is another paper from 1960 in which Imboden expresses what seemed only implied elsewhere, that the continuance of symptoms is a "conversion reaction".

In a study by one of the authors(21) of patients with a history of acute brucellosis, the development of a chronic syndrome, so called “chronic brucellosis,” was positively correlated with the concomitant presence of potentially depressing life situations. Most of the chronically symptomatic patients denied emotional problems and considered whatever depression they experienced as secondary to symptoms such as fatigue and somatic pain, which were attributed to an allegedly persistent infection with brucella. There was strongly suggestive evidence that this preoccupation with somatic symptoms had a self-esteem supporting function. Conversion reactions, then, may be used as defenses against more overt depression, which may thereby be obscured. Even when depression predominates, however, conversion reactions may still be defensively employed.

.........Phenomenologically, conversion reactions in general enable the patient to avoid or reduce affective distress by substituting fantasy-endowed and symbolically expressive somatic distress or dysfunction. In this way, an intolerable affective problem may apparently be “converted” into a face-saving physical-medical one, in which the patient shifts the responsibility for remedial action from himself to others, including the physician. The ensuing “secondary gains” (which Laughlin(26) terms “epigain”) then often become a perpetuating factor.

ZIEGLER, F. J., IMBODEN, J. B., & MEYER, E. (1960). CONTEMPORARY CONVERSION REACTIONS: A CLINICAL STUDY. American Journal of Psychiatry, 116(10), 901–910. doi:10.1176/ajp.116.10.901
https://sci-hub.se/10.1176/ajp.116.10.901

This paper is referred to by Slater in his 1965 paper, albeit to make a different point. This would appear to underpin the whole BPS approach to , although they somehow omit to mention it.

 

Reading this kind of tripe is not helping me get to sleep.

 

3 "mays" in one sentence. I may be abducted by aliens then they may give me the secret of nuclear fusion and then I may save the planet.

Equally true statements.

 

And 5 decades later, still the same. Every psychosocial research paper, even those making broad conclusions and treatment recommendations, is entirely built on may bes and could bes. Zero progress on substance, not a single reliable objective finding, and still it has taken over as a dominant medical paradigm, infecting the health care of tens of millions into a mass of confusion and malpractice.

The only way medicine truly progresses is through technology. If technology had stalled, medicine would have not budged from that point. The human element is still the weakest point, as irrational and dogmatic as it ever was. And all because medicine refuses to take into consideration patient perspective as useful information. Blergh

 

There is an interesting feature concerning the manner in which this literature made its way into the ME story. It is quite revealing.

On 19 may 1987 Leon Eisenberg delivered the Upjohn Lecture at the Department of Psychiatry, Oxford University. This was later published here

www.cambridge.org/core/services/aop-cambridge-core/content/view/S0033291700001823

He stated

Chronic brucellosis no longer has much cachet as a diagnosis, but candidates for the succession are very much in evidence. Currently, considerable attention is being devoted to 'chronic mononucleosis', also known as 'chronic active Epstein-Barr virus (EBV) infection'. The syndrome is characterized by chronic fatigue, fever, myalgia, pharyngitis, headache, depression and cognitive change (Buchwald et al. 1987; Holmes et al. 1987). Antibody titres against EB virus are somewhat higher in patients with these symptoms than they are in the general population, but exposure to EBV is so ubiquitous that there are no cut-off levels which reliably distinguish patients from controls. Whatever the cause of this symptom pattern, EBV infection is an unlikely bet. If some cases indeed prove to be due to an as yet to be discovered virus, many more, in my estimation, represent the somatization of personal distress, legitimized by a newly fashionable diagnosis.

This he referred to as spurious diseases. He cited the Brucellosis 111 and Influenza (1961) papers. It is not clear what authority need be given to the views of a child (EDIT) psychiatrist specialising in autistic disorders. It is also not clear whether he ever treated or researched the illnesses in question. This may have been his sole intervention on the subject of ME under any of its names. Anyone knowing of other examples is invited to give details.

This need not have mattered much save that it was taken up by David P Goldberg and effectively "read into the record" in his paper
Psychiatric Perspectives: an Overview TO Woods, DP Goldberg. British Medical Bulletin (1991) Vol 47, No 4, pp908-918
which set the general tone for the psychiatric lobby.

This is important because Goldberg makes an identical error to Eisenberg. He quotes a figure of 480 people being involved in the Influenza study. In fact there were 600. This must be a favourite number for such studies. The number of 480 seems to be those cherry-picked individuals included in the 1966 study. The discrepancy is not important for the numbers, but for the level of knowledge displayed on the subject, and the source of Goldberg's error. The duplication of such an error is difficult to understand.

Goldberg does not on the surface appear to have had much dealings with ME before or since, but he may have been highly influential in MUS and IAPT.

It is worth pointing out that the influenza studies were based on a follow up period of three weeks. How this is thought relevant to conditions requiring six months illness is unclear.

EDIT He does say that as an intern he saw patients with chronic brucellosis and indicates that that was thirty years ago-.so that would be around about 1957.

 

There is an intriguing aspect to the follow up period of three weeks for the influenza studies. My guess is that everyone here will have had flu and recovered within ten days....and will also have had flu and still had vague, or perhaps not so vague, symptoms after two months. That would seem to rule out childhood experience as a factor.

One wonders why they did not study the more persistent cases for longer. They had the opportunity to do so. Presumably they did not wish to largely invalidate the significance of the work by finding that all had recovered at two months.

 

I ned to correct the date when EIsenberg would have "seen" patients with chronic brucellosis. According to his entry in Wikipedia his period as an intern was served at Mount Sinai Hospital New York in 1946, 1947, forty, not thirty,years before the lecture. In the 1950's he was at John Hopkins, first as a Fellow in child psychiatry, then as Instructor in Psychiatry, then as Associate Professor and finally in 1961 Professor of Child Psychiatry.

If he had more recent experience of the condition it might have been expected that he would mention it.

It seems strange that Goldberg should have been influenced in his views on ME or PVFS by someone with no obvious higher level experience of the subject.

 

I recognise the risk in continuing harping on about these papers, when most people think them unimportant, but here goes.

There is clearly a problem with the reporting of the influenza (1961) and influenza (1966) papers. The 1961 paper reported 600 trial subjects of whom 520 were male and 60 female. 26 suffered from influenza of whom 14 recovered within 14 days and 12 did not. One of the 12 was female.

The 1966 paper states that they studied 460 males. This means they lost the 60 females and a further 60 males. They still report 26 sufferers and 12 with protracted recovery. But we know from the earlier paper that one of those was female.

The reduction of the numbers from 26 out of 600 to 26 out of 480, without any explanation, would clearly have an effect on statistical significance.

This whole body of research appears untrustworthy and unreliable.

EDIT It may be recalled that it was the figure of 480 that Eisenberg and Goldberg quoted. With all these bergs I may be making a mountain out of a molehill, but I think not.

 

The value of these papers is that they show the BPS ideas are based on sand in the same way that a close look at Freud shows the shaky foundations of psychoanalysis.

It is important to step back and see if we are just a blinkered group who reinforce each other's beliefs but things like this and the scientific flaws of later evidence show that we are on the right path.

 

You may be sad to know that I have not forgotten this issue, and have come across a rather surprising wrinkle. It seemed reasonable to look for references to these papers in the US CFS literature, to discover how they were used before the first transponder (def. someone who carries innovatory ideas across the Atlantic) brought them to Oxford.

There is an interesting quote from Strauss in the Epilogue of Osler's Web @p684. At a conference on Oct 23 1994 "he cited, in addition, 30 year old medical papers that pinned recovery speed among mononucleosis and influenza victims to "the emotional state of the patient". If we had been aware of these studies some of us might not have tried to reinvent the wheel".

It seems reasonable to suppose that he was unaware of the papers in 1979. However, he was by 8 Oct 1987, when he presented a paper which was published in March 1988

The Chronic Mononucleosis Syndrome
Stephen E. Straus
The Journal of Infectious Diseases, Volume 157, Issue 3, March 1988, Pages 405–412, https://doi.org/10.1093/infdis/157.3.405
https://sci-hub.se/10.1093/infdis/157.3.405

Imboden et al. [30]noted the psychological profiles of individuals with "chronic brucellosis" to differ from those of individuals who recovered in a timely fashion from acute brucellosis. The differences involved a higher incidence of emotional disturbance, particularly depression, among patients with persisting fatigue. Those retrospective studies could not discern whether the depression was a consequence of lingering symptoms of the disease. It was argued that they were not just reactive problems, because equivalent emotional disturbances persisted among patients who recovered from post-brucellosis fatigue.

In more compelling studies, conducted before and during the Asian influenza epidemic of 1957,it was demonstrated that the time to convalescence from influenza correlated with preexisting psychoneurotic aberrations [31]. Specifically, individuals who before influenza exhibited a "propensity to become depressed" recovered more slowly than individuals lacking this premorbid psychological trait. It was concluded that certain psychological factors render one vulnerable to postinfectious chronic fatigue. In such individuals, it was argued, somatic complaints of psychological origin become established during.....

This is written in a way which suggests that it is a new contribution to the debate on CFS and had not been raised before - but I will keep searching. What makes this interesting is the date. Eisenberg's lecture at Oxford introducing this idea was delivered on 19 May 1987, and thus predates by 5 months the Strauss reference. It seems odd for someone not known to be involved with CFS research, or to have any particular interest in the subject, to have introduced the matter in this way before the supposedly leading researcher mentioned it.

Let us not forget that Eisenberg was a colleague of Imboden, Canter and Cluff.

It rather looks as though the tail may have been wagging the dog.

It is an usual paper in other ways. It dismisses Royal Free disease in favour of McEvedy and Beard. This rather suggests that Strauss was not a good enough researcher to find the 1970, barely constrained, correspondence in the BMJ on the topic of epidemic malaise.

Strauss went on to add:

It is even more appropriate and satisfying, however, to speculate that the syndrome represents a general response to a variety of psychological or physical irritants.

Perhaps Eisenberg not only introduced Imboden et al to the UK, but reintroduced them to the US. What could go wrong with research from Fort Detrick?