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1955 Royal Free Hospital outbreak
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==Long-term follow-up== A follow-up study 65 years later found that there was one group of patients that recovered completely or nearly completely, a second group that recovered but was subject to relapses, and a third that showed little or no recovery, these patients remaining incapacitated.<ref name="Ramsay1978" /> Another follow-up study in 2021 interviewed twenty-seven former hospital staff who were present during the outbreak (including a few who developed ME), and reported on their recollection of patient symptoms and circumstances at the time. The accounts of the former staff were found to be inconsistent with the McEvedy and Beard hypothesis that the illness was [[psychosomatic illness|psychosomatic]] in nature, caused by [[mass hysteria]] or psychoneurosis. Observable signs of physical illness reported by the former staff included enlarged posterior cervical glands, ptosis (drooping of the eyelids), hemiparesis (one-sided paralysis), some patients crying due to extreme [[muscle pain]], nausea, and vomiting. Patients typically delayed seeking medical treatment for the first few days, which is also inconsistent with patients overly anxious about the possibility of contracting an illness. Some patients had blood tests which found leukopenia, or lymphocytes typical of [[virus]]es. While some patients seemed to be neurotic and lacked physical signs, a large number of patients were seriously ill with significant physical signs, leading to most hospital staff at the time believing that the cause of illness was an [[infection|infectious disease]]. Some patients remained hospitalized for over six months.<ref name="Underhill2021" /> Five patients developed long-term [[paralysis]] in a part of their body.<ref name="Underhill2021" />
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