Royal Free epidemic of 1955: a reconsideration

From a re-analysis of the case notes of patients with Royal Free disease it is concluded that there is little evidence of an organic disease affecting the central nervous system and that epidemic hysteria is a much more likely explanation. The data which support this hypothesis are the high attack rate in females compared with males; the intensity of the malaise compared with the slight pyrexia; the presence of subjective features similar to those seen in a previous epidemic of hysterical overbreathing; the glove-and-stocking distribution of the anaesthesia; and the normal findings in special investigations. Finally, a deliberate attempt by one of the authors to produce an electromyographic record similar to that reported in Royal Free disease was successful.