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1953 Maryland outbreak
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== Controversy == In 1970, this outbreak was one of fifteen mentioned in a paper by psychiatrists [[Colin McEvedy]] and [[A. W. Beard]], who wanted to rename all fifteen outbreaks as [[mass hysteria]] or myalgia nervosa.<ref name="McEvedy, 1970" /> The psychiatrists were criticized by patients and researchers, such as Dr. [[Melvin Ramsay]] who was directly involved in the 1955 [[Royal Free Hospital outbreak]]. [[Colin McEvedy|McEvedy]] admitted to Dr. [[Byron Hyde]], when invited to discuss his theory, that he did not examine any patients and undertook only the most cursory examination of medical records.<ref name="Hooper, 2007">{{Cite journal | last1 = Hooper | first1 = Malcolm | author-link1 = Malcolm Hooper | title = Myalgic encephalomyelitis: a review with emphasis on key findings in biomedical research | journal = Journal of Clinical Pathology | volume = 60 | issue = 5 | page = 466β471 | date = May 2007| doi = 10.1136/jcp.2006.042408}}</ref> In 1994, [[Nathaniel Briggs|Nathaniel C. Briggs]] and [[Paul Levine|Paul H. Levine]], from the Viral Epidemiology Branch, Epidemiology and Biostatistics Program of the [[National Institutes of Health]], wrote a review comparing twelve [[List of myalgic encephalomyelitis and chronic fatigue syndrome outbreaks|outbreaks]] referred to as [[chronic fatigue syndrome]], [[epidemic neuromyasthenia]], and [[myalgic encephalomyelitis]]. They grouped the outbreaks into four levels of increasing neurological involvement, ranked I-IV. The 1953 Maryland outbreak was rated as level III, which meant that they found "objective paresis with cutaneous sensory as well as affective and cognitive neuropsychological changes." The researchers noted that: "'unusual fatigability' was a cardinal symptom. Twelve (46%) of 26 patients reexamined 3-5 months after onset were symptomatic and 'several had to be on part-time duty with periods of daytime bed rest'" and patients experienced "frequent recrudescensces [increased severity of a disease after a remission] particularly associated with exertion."<ref name="Briggs, 1994">{{Cite journal | last1 = Briggs | first1 = Nathaniel C. | author-link1 = Nathaniel Briggs | last2 = Levine | first2 = Paul H. | author-link2 = Paul Levine| title = A Comparative Review of Systemic and Neurological Symptomatology in 12 Outbreaks Collectively Described as Chronic Fatigue Syndrome, Epidemic Neuromyasthenia, and Myalgic Encephalomyelitis| journal = Clinical Infectious Diseases | volume = 1994 | issue = Suppl 1 | page = S32-42 | date = 1994 | pmid = 8148451 | doi =10.1093/clinids/18.Supplement_1.S32}}</ref>
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