In the summer of 1955 something odd happened at London鈥檚 Royal Free Hospital. It began in the middle of July, when a doctor and a ward sister fell ill on the same day and had to be admitted to their own hospital. Both had multiple symptoms, including lassitude and pain in the abdomen. By 25 July no fewer than 70 more of the staff, ranging from doctors and nurses to cooks and cleaners, had developed similar problems. Before the outbreak died away towards the end of November, 292 people had been affected, of whom 255 had to spend time as in-patients.
A mini epidemic, clearly. But of what? The hospital staff concluded that their institution had been ravaged by some mystery virus. Fifteen years later, a pair of psychiatrists offered an alternative explanation. It was not only radically different, it was also deeply unpopular.
NINA came to Britain in 1953 as an 18-year-old au pair. Keen to train as a nurse, she enrolled a year later at the Royal Free Hospital in central London. In August 1955, she joined the already lengthening toll of nurses, doctors and other staff who had fallen victim to what became known as 鈥淩oyal Free disease鈥�. The initial list of her complaints included sore throat, headache, malaise, depression, a stiff neck, dizziness, vertigo, back pain, nausea and vomiting.
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She was admitted to the hospital. Then she developed more symptoms: blurred vision, photophobia, pain under the jaw and twitching of the limbs, to name a few. Eventually she recovered. She finished her training and began working as a nurse. But her subsequent career was punctuated by episodes of ill health, some apparently physical and some psychiatric. In 1968 she took a fatal drug overdose.
Most of the Royal Free staff who acquired the illness were less severely affected than Nina. But some continued to suffer ill health for years afterwards, and a few of those who are still alive claim never to have made a full recovery. Oddly, only a dozen of the Royal Free鈥檚 patients suffered the illness.
The hospital staff investigated the outbreak using all sorts of tests. They performed blood counts; they looked for antibodies; they carried out chemical analyses; they examined bits of tissue under the microscope; they even wired up some of the victims to ECG machines. Nothing. None of the results cast any light at all on what had happened. The cause of the illness and the manner of its spread left them completely baffled.
For want of anything better, their report in the British Medical Journal in 1957 accepted a term for the illness already suggested by others: benign myalgic encephalomyelitis. Stripped of its jargon this means an inflammation of the brain accompanied by pain in the muscles.
Scour the BMJ report and you will find no claims about the cause of the problem. But you don鈥檛 have to do much reading between the lines to fathom how the authors were thinking. 鈥淭he explosive character of the outbreak suggested the possibility that the infective agent was disseminated through a common vehicle,鈥� they say. They go on to admit that 鈥渋nvestigations relating to water, milk, food, food handlers and launderers were all negative.鈥� No matter, they clearly believed they were dealing with an elusive microbe of some kind.
The victims鈥� assumption that they鈥檇 fallen prey to a virus went unchallenged until 1970. Then two psychiatrists, Colin McEvedy and Alfred Beard, reassessed the records of the patients鈥� signs and symptoms. They concluded that a more likely explanation was epidemic hysteria.
Perhaps anticipating a cool response to this conclusion McEvedy and Beard wrote: 鈥淢any people will feel that the diagnosis of hysteria is distasteful. This ought not to prevent its discussion, but perhaps makes it worthwhile to point out that the diagnosis of hysteria in epidemic form is not a slur on either the individuals or the institution involved.鈥�
Along with the paper, the BMJ published a guardedly sympathetic leader: 鈥淭he authors have performed a valuable service in drawing attention to the possible psychological origins of some outbreaks of illness that are disseminated in an explosive manner and for which a physical explanation is apt to be readily assumed.鈥�
Some of the readers thought otherwise. The first published letter, a fortnight later, was from Betty Scott, a north London GP whose practice included many of the patients affected by the outbreak. She wrote that she regarded the new explanation with 鈥渋nterest but incredulity鈥�. Her letter concluded: 鈥淚f a diagnosis of 鈥榟ysteria鈥� is even hinted, the patient experiences a profound loss of confidence in his medical advisers鈥� It is essential to treat this disease seriously.鈥�
Hysteria was and remains a recognised psychiatric condition, so it鈥檚 unclear why Scott believed its diagnosis should not be seen as serious medicine. A Dr B. Judge of Birmingham was even more forthright: 鈥淚 regard the conclusion 鈥� as nonsense. Many of the girls were known to me. Illness was alien to their nature.鈥� What kind of nature this is we are not told. It would be useful to know.
One or two wrote from personal experience, including GP Barbara Howells: 鈥淚 was a clinical student at the time of the outbreak, and looking back on myself then I rather feel that if any hysteria was around I would have succumbed. However, I remained disgustingly healthy, though my flatmate (a very level-headed girl) was a sufferer from the disease.鈥� She was, she added, 鈥渧ery sceptical about the conclusions鈥�.
It could be argued that these and other correspondents鈥� only motive was to get at the truth. Possibly. But the report on the Royal Free outbreak was hardly medicine鈥檚 first foray into the murky topic of epidemic hysteria. McEvedy himself was one of the authors of a paper published in the BMJ in 1966 that had discussed the cause of a couple of other mysterious outbreaks of headache, dizziness, nausea and the rest. The victims of this episode, however, were schoolchildren rather than nurses and doctors. Talk of epidemic hysteria in this context seems to have left the BMJ鈥檚 readership unruffled.
Along with the huffers and puffers were a couple of correspondents who took a less antagonistic view of McEvedy and Beard鈥檚 theory. One describes the letters themselves as amounting to 鈥渁 secondary wave of hysteria鈥�. Most intriguing is a letter from psychiatrist Marjorie Hare of Warlingham Park Hospital on the southern outskirts of London. She recalls that those concerned with the outbreak had originally considered hysteria the most plausible explanation. But as medical staff of various seniority succumbed, she goes on, 鈥渟uch a suggestion was silenced by unspoken agreement鈥�.
So there you have it. Hysteria may be a diagnosis fit for schoolchildren and other ordinary folk, but not for medical staff, especially those of 鈥渧arious seniority鈥�. And even if nurses might fall victim to the condition, consultants 鈥� men, especially 鈥� could not. So the unpleasantness at the Royal Free had, at all costs, to be organic not psychological.
The importance of this largely forgotten episode lies not in who was right and who was wrong about the diagnosis: that argument went on for long enough, and it鈥檚 unlikely that it will ever be resolved now. As another of the BMJ correspondents pointed out 鈥淭here may be a virus responsible for the Royal Free disease, but there is no need to wax hot in denying emotional factors as well.鈥�
What the affair does reveal is the feelings of doctors about psychiatric as against organic labels. When the action came close to home, these supposedly enlightened professionals were oddly reluctant to accept the verdict of those of their peers trained to make such distinctions. Half a century on, the stigma of an illness with a non-organic cause is supposed to have diminished. Maybe it has. But the anger generated when disorders such as Gulf War syndrome are described as products of the mind suggests otherwise.
And what of doctors themselves in the 21st century? The Royal Free is now housed in a monstrous concrete block in Hampstead, the psychoanalysis-friendly district of north London. Maybe its current staff would take more easily to a diagnosis of epidemic hysteria than their counterparts of 50 years ago. Or would they, too, search just as avidly for a mystery virus?