There are many readily identifiable and measurable causes of long-term fatigue, including anaemia, low thyroid, adrenal burnout, chronic infection (such as brucellosis and Q Fever), sleep apnoea, narcolepsy and pineal hypofunction from microwave radiation emanating from electrical items. There is another cause, chronic fatigue syndrome (CFS), whose symptoms are severe but, paradoxically and diagnostically, without positive findings on physical examination, scanning or laboratory testing. the fact that CFS is not measurable does not rule out its presence as a disease. Albert Einstein’s maxim “not everything that counts can be counted” could well apply here.

… medical doctors and government regard CSF?as psychological, unaware of recent scientific advances…- Charles Edward Corney, Sliema

A remarkably similar condition, neurasthenia, was first described by G.M. Beard (1869) and was believed to be psychological in origin – Florence Nightingale was a sufferer. J.H. Musser (1912) was the first researcher to suggest a physical origin. since then, there have been several name changes reflecting the continuing uncertainty of the origin of the symptoms – atypical poliomyelitis in 1934, the royal free hospital outbreak in 1955, myalgic encephalitis in 1969, yuppie flu in 1980 and, finally, chronic fatigue syndrome in 1988. These outbreaks suggested an infective origin. Epstein-Barr virus was isolated from some, but not all, patients. Conversely, this virus was isolated from patients who were not suffering CFS, thus boosting the psychological origin belief. Others believed it was a physical condition causing secondary psychological depression.

A diagnostic symptom of CFS is a self-reported fatigue lasting over six months, often necessitating weeks of bed rest, producing a life-changing effect. Characteristically, exercise aggravates the fatigue and sleep is not refreshing. Sometimes, there are headaches, muscle pains and a sore throat due to preceding glandular fever. Similar symptoms may occur with Gulf War syndrome but the history of multiple vaccinations excludes CFS.

Commonly, the patient admits to fewer symptoms, such as exhaustion with poor sleeping patterns and an inability to keep working at a stressful job. However, these symptoms could reflect bipolar depression rather than CFS.

Another similar condition, fibromyalgia (FM), should be considered when the patient complains more about muscle pain and tenderness, rather than fatigue. An undue sensitivity to drugs and alcohol is often present requiring lower than expected dosing to avoid overdose effects.

Low levels of thyroid and progesterone hormones have often been observed in both CFS and FM. low progesterone may occur with certain drugs or when ovulation ceases menopausally or premenstrually – perhaps explaining the commoner incidence in women compared with men. Correction of these hormone levels sometimes ameliorates the CFS/FM, suggesting a treatable hormonal cause.

The presence of stress, by lowering the progesterone level, depresses the thyroid receptors in all the cells of the body, effectively causing hypothyroidism. both low progesterone and low thyroid function can directly cause the similar symptoms of fatigue, depression and muscle aches.

This overlap reveals the impossibility of defining the exact cause and the exact diagnosis of these symptoms. often, the diagnosis of CFS is made indirectly by the specific treatment of the other causes of long-term fatigue. Any remaining symptoms may then be regarded as those of CFS. Maybe long-term fatigue is a single, overarching disease consisting of a spectrum of conditions based on symptom predominance.

There is no specific treatment for CFS but supportive and symptomatic treatments are important.

The main aim is rest, balanced by exercising the body and the brain to within the limits dictated by the onset of exhaustion.

Gradually, this exercise is increased. Good nutritious meals are essential. Psychotherapy may help to overcome depression. Any hormone deficiencies should be corrected.

The presence of CFS has such a profound, adverse effect on home life, relationships and ability to work that the patient often fears that the condition could be terminal but this is untrue. some patients recover within 10 years while others suffer exacerbations and remissions for more than a decade.

Many medical doctors and governments regard CFS as psychological. they are unaware of recent scientific advances increasingly indicating a physical disease, whose origin will at last be revealed after 150 years of uncertainty. Better management and a cure will surely follow.