My name is Byron Hyde, I'm a physician in Canada, but prior to being a physician I was the geophysical engineer looking at mines; then I became a chemist, and worked in transplantation biochemistry; then I moved to the Sick Children's Hospital in Toronto, where I was chief technician of electron microscope unit; and only then did I become a physician, and that pretty well sums up who I am.
By accident I became involved in ME. Curiously I had a very good friend and his wife were physicians she was the intake physician at McMaster University, and he was a general practitioner. They were white rafting down the Ottawa River and they came to stay with me the day after, and they asked me to come to a party at a hospital in Montreal. I didn't go, and in a way it was fortunate from my point of view, because the party was all physicians and their spouses, and few nurses, and three days later, I got a call from him saying that almost all of the 20 physicians at the hospital at this party had fallen ill with food poisoning.
They all had headaches, they had stomach problems, and then I said, "well, you're obviously going to get better, but when did this all start?" He said: "oh, it's just in the last day or two." I said: "if it was food poisoning, you'd fall ill right away, and it's taken you two or three days to get all of these symptoms?" And he said: "no, it's three or four days."
And so about a week after that, he phoned and told me that we now know what we have: we have ME. And I said what in hell is ME? I had never heard the term before. He said myalgic encephalomyelitis, it's an encephalopathy, it's a brain infection. And I said, I'm curious I've never heard about this. And I sort of forgot about it, until a week later, I had a patient who had also a physician who'd gone to do a house call of two new born twins, and a two-year-old. The woman was a heroin addict and had broken the habit, and hadn't been on heroin for least a few years, and he couldn't get an ambulance take these children to the hospital, so he drove them.
Meanwhile the mother and the three children were coughing nonstop. They hospitalized the children and mother was also hospitalized, and the diagnosis was enterovirus, Coxsackie infection. And I really didn't know anything much about Coxsackie or enteroviruses in those days. And three days after, he drove those ill children and their mother to the hospital, all who had pneumonia from this coxsackievirus, he fell ill.
We hospitalized him in the civic hospital, and the first thing we found was that he was diagnosed with a brain tumor, but it wasn't really a brain tumor, it was just the entire left brain — but particularly the posterior frontal lobe and the temporal lobe — were so dark from inflammation that we thought initially that was a brain tumor. It turned out to be a viral infection, and so we knew the incubation period was three days, and we knew that we were dealing with an enterovirus.
ME can be easily defined by two things: it is an enteroviral infection with an incubation period of three to five days, number one. If you cannot either recover an enterovirus at the onset, or by looking at the gastric mucosa in chronic individuals, they don't have an enteroviral infection. And the second diagnostic criteria of ME is to have a diagnosable inflammation of the brain. Now this is a microvascular inflammation, and you can get it either using a brain SPECT with appropriate software, or a brain PET with appropriate software.
SPECT is much, much less expensive, and there isn't radiation of any importance dealing with it. For instance, if you use the CT scan, you get an enormous amount of gamma radiation; with SPECT and PET there's almost no radiation. And what radiation exists in a PET scan is, they use particles which if you walk outside of your house, you will get a million times more radiation just from the Sun than you would from a PET scan. So radiation is not a problem in SPECT or PET.
So you need two things to define ME, and it's very simple: either recovery of an enterovirus in an acute onset, which is very hard to do, because nobody suspects it; or chronically, by looking at the stomach mucosa, and recovering the capsid protein, which is actually very easy to do if you've had a stomach biopsy, and a lot of these patients have because they have gastric problems immediately after and often chronically with this disease. And two, looking at the brain SPECTs and showing the areas injured.
Well the original definition of ME is quite surprising, because it occurred during an epidemic of polio, probably the third known epidemic of polio, and it occurred in Sweden in 1895, in the Stockholm area, and at that time, during this polio epidemic, something else occurred. And Ivar Wickman, a twenty-three-year-old physician who described it, said something curious is happening: some of these patients are not dying, they're not being paralyzed, but they have pain all over their body, and he called it a neuralgic encephalopathy — which is very close to myalgic encephalopathy, myalgic encephalomyelitis.
But the real breakthrough, historically, came in the first mass epidemic of paralytic polio: there had never been a major polio epidemic; there had never been a polio epidemic before the ones in Sweden that I just mentioned. But in 1905, 1,300 patients in Stockholm area, and 800 people in the Oslo, Norway area, in the same week, fell ill, dying or being paralyzed, with four or five different kinds of polio.
And this is how Ivar Wickman describe them: he described them as: the spinal, which paralyzed the legs usually, but could paralyze the legs and the arms; bulbar polio, which involved the lower brain stem of the brain, and because it affected the ability to breathe, almost all those patients died, usually within hours or days; then there was Landry's polio (his name was changed later on) where you got ascending paralysis, and a large number of those patients also died; but the fourth type of polio, which he called a superior polio or Medin polio (after his boss), was most interesting, because all of these forms of polio occurred at the same time.
The other two forms of polio that he also described, because he actually went around and examined these patients, was a polio which the people picked up the virus, but didn't fall ill, but then gave that poliovirus to other people. And the second one was those who had the symptoms of the first stage of polio, which was the same as the first stages of ME, and got better within a week or two. And that's when the first major epidemic of ME occurred, at the same time as a polio epidemic.