1	Multiple Chemical Sensitivity ... or MUSES Syndrome ?
2	What is Multiple Chemical Sensitivity ? 1999 Consensus Definition (Arch Env Health 1999;54:147-9) [1] MCS is a chronic condition [2] marked by multiple symptoms in multiple organs [3] that recur reproducibly [4] in response to low levels of exposure * [5] to multiple unrelated chemicals and [6] improve or resolve when incitants are removed. Best of 7 MCS Definitions at identifying MCS cases (McKeown-Eyssen et al, Arch Env Health 2001;56:406-12)
3	How Many MCS Symptoms Have Been Reported ? List compiled by JHU Multi-Center Study of MCS Immunology CARDIOVASCULAR 9 DIGESTIVE 18 EARS // HEARING 7 EYES // VISION 12 GENITO-URINARY 10 HEAD 6 MOUTH // TASTE 14 MUSCULOSKEL. 14 NECK 3 NERVOUS SYSTEM 43 NOSE // SMELL 10 SYSTEMIC // OTHER 17 VASCULAR 5 REPRODUCTIVE 17 RESPIRATORY 6 SKIN // TOUCH 7 THROAT 5 TOTAL # SYMPTOMS = 203
4	What Objective Findings Are Reported in MCS ? Abnormal Blood & Plasma Impaired Circulation Impaired Heart Function Impaired Detox Pathways Ear & Hearing Abnormalities Endocrine Deficiencies Eye & Vision Abnormalities Gastrointestinal Impairment Immune System Activation Increased Mast Cells Mineral Deficiencies
5	Who is Funding This MCS Research ? Most MCS-related papers do not acknowledge any funding ! But 10 US federal agencies fund over $25M per year: ATSDR, CDC, DOD, DOE, DVA, EPA, NIDCD, NIEHS, NIH & NIOSH US Dept of Defense also funds MCS studies of UK veterans State governments in California, Maryland, Missouri, New Jersey, New Mexico & Washington have funded MCS studies Both patient support groups (eg. CIIN) and chemical industry front groups (eg. ESRI) have funded MCS conferences and pilot studies that reflect their respective biases.
6	Which View Predominates: Physical or Psychiatric ? Overlaps: Only 11% of First Authors and 30% of Publishers have ever supported more than one view !!!
7	On What Do All Agree? Prevalence is Very High ! 5 US studies find 28% - 37% of adults say they are “especially sensitive” to common chemical exposures 4 US studies find 15% - 17% say they’re “unusually sensitive” 6.3% in CA and 1.9% in NM say they have been diagnosed by a medical professional with MCS or “environmental illness” US, Canadian and UK studies of Gulf War veterans all find an increased prevalence of (still undiagnosed) MCS with a relative risk of 2 to 4 compared with undeployed era controls Whatever cause(s), must be very common and moreso in war.
8	But is MCS Only a Disorder of Chemical Sensitivity ? NOT JUST ODORS: LIGHT & SOUND HYPERSENSITIVITY are very strongly associated with MCS: p < 0.00001 (Miller, Tox Ind Health, 1999;15:370-85) When asked, many MCS patients also report chronic hypersensitivity to: SPICY FOODS // FLAVORS TOUCH // PRESSURE // PAIN HOT or COLD WEATHER ELECTROMAGNETIC FIELDS HEAVY METALS (NICKEL JEWELRY) MENTAL or PHYSICAL EFFORT // STRESS OF ANY KIND
9	Might MCS Be Something Else as Critics Claim ? MCS not new or unique in English or French medical literature. At least 136 similar syndromes “Discovered” before & since. Few acknowledge any relation to any others, past or current. Few propose any specific cause, etiology, biomarker or cure. Most names never widely adopted or eventually abandoned. But some are still in use and many MCS cases are still being diagnosed by one or more of them depending on the doctor. History reveals both consistency of underlying syndrome and great inconsistency of evolving medical awareness, proving doctors rarely ever discover any NEW disorders, just ones they forgot, were never taught or did not bother to look up !
10	First Described in 1733 by Dr. George Cheyne as the English Malady (EM), aka ‘The Vapours’ “To enumerate all the almost infinite Symptoms, Degrees and Kinds of Vapours is impossible, and perhaps very little to the Purpose.” “In general … the symptoms are many, various, changeable, shifting from one Place to another, and imitating the Symptoms of almost every other Distemper described.” “Those who suffer … are all of weak Nerves, have a great degree of sensibility; are quick Thinkers, feel Pleasure or Pain the most readily, and are of most lively imagination.” “Not withstanding all this, the Disease is as much a bodily Distemper as the Small-Pox or a Fever.” Worst in winter & cities. Blamed on bad air, bad diet & bad habits.
11	Some Symptoms of E.M. Cited by Dr. Cheyne “Sometimes there is an Inflation, and an actual visible Swelling, to a very considerable Bigness, in the Stomach to be seen, especially in the Sex [women]; … a Coldness or Chilliness upon the Extremities, and sometimes Flushing and Burning in the Hands and Feet, Cold Damp Sweats, Faintings, and Sickness … … Head-aches either behind or over the Eyes … Flies and Atoms dancing before the Eyes, a Noise like the dying Sounds of Bells, or a Fall of Water, in the Ears; Yawning, and Stretching, and sometimes a Drowsiness or Lethargy, at other times Watching and Restlessness, and several other Symptoms, which it is impossible to enumerate. Some have but a few of these Symptoms, and some all of them, and a great many more.” [emphasis in the original]
12	36 Focus on Allergy, Sensitivity, Neurology or Toxins 1733 The English Malady aka The Vapours 1769 Dysesthesia 1837 Neuropathy of Nervousness 1849 Nervosisme (France) 1861 Ménière's Disease 1869 Neurasthenia >1K* 1892 Hyperaesthesia 1894 Autointoxication 1921 Chronic CO Poisoning 1930 Heat, Cold and & Effort Sensitiveness
13	Allergy, Sensitivity, Neurology or Toxins continued … 1978 Chemical Hypersusceptibility 1979 Perinatal Hypoxic- Ischemic Cerebral Syn. 1982 Total Allergy Syndrome 1983 Sick Building Syndrome 1985 20th Century Syndrome 1985 Allergic Irritability Syn. 1985 Environmental Hypersensitivities 1986 Hypersensitivity Syndrome 1987 Darkroom Disease 1987 Multiple Chemical Sensitivity <1K
14	30 Focus on Variations of 1869 Neurasthenia: 1875 Spinal Neurasthenia 1881 American Nervousness 1886 Sexual Neurasthenia 1887 Gastric Neurasthenia 1889 Neurasthenia Praecox (aka Male N.) 1890 Psychosomatic Neurasthenia 1891 Female Neurasthenia 1893 Syphilitic Neurasthenia 1895 Senile Neurasthenia 1897 Traumatic Neurasthenia 1898 Encephalasthenia 1903 Disease of the Century 1906 Tropical Neurasthenia 1907 Endocrine Neurasthenia 1907 Ocular Neurasthenia 1908 Digestive Neurasthenia 1909 Battleship Neurasthenia 1968 Pseudoneurasthenic Syndrome 1976 Organic Neurasthenia 1976 Neurasthenic Musculoskeletal Pain Syndrome
15	Variations of Neurasthenia continued … 1980 Neurasthenic Neurosis 1988 Neurasthenic Fatigue Types of Unknown Origin and Date Cited by Secondary Sources and/or Listed in Stedman’s Medical Dictionary Angiopathic Neurasthenia Cardiac Neurasthenia Cardiovascular Neurasthenia Insania Neurasthenia Neurasthenia Chemicorum Neurasthenia Gravis Post-viral Neurasthenia Pulsating Neurasthenia
16	42 Focus on Psychiatry or Behavior 1765 Nervous, Hypochondriac or Hysteric 1766 Hypochondriasis, aka Hyp or Hypo 1859 Briquet’s Syndrome 1871 Hebephrenia 1895 Anxiety Neurosis >28K 1904 Phrenasthenia 1906 Psychasthenia 1912 Autism >6K 1914 Shell Shock Syndrome 1916 Battle Fatigue Syndrome 1918 War Neurosis 1930 Generalized Anxiety>1.5K
17	Psychiatry or Behavior continued … 1968 Pseudo Combat Fatigue 1968 Hyperkinetic Behavior Syn 1973 Ecologic Mental Illness 1973 Psychalgia 1974 Epidemic or Mass Hysteria 1977 Pinocchio Syndrome 1978 Mass Psychogenic Illness 1978 Psychic Possession 1980 Post Traumatic Stress Disorder >6.5K (count incl. Traumatic Neurosis) Attention Deficit Disorder 1981 Pervasive Developmental Disorder >7K
18	28 Focus on Infection, Trauma, Fatigue or Pain 1857 Remittent Fever, aka Crimea Fever 1866 Railway Spine 1871 Irritable Heart, aka DaCosta’s Syndrome 1887 Undulating Fever, aka Malta Fever aka Mediterranean Fever 1904 Fibrositis 1934 Chronic Brucellosis 1936 Morbid Industrial Fatigue 1938 Neurocirculatory Asthenia, aka Effort Syndrome 1941 Chronic Fatigue 1950 Epidemic Neuromyasthenia aka Icelandic Disease, aka Akureyri Fever 1956 Encephalomyelitis simulating Poliomyelitis, aka Royal Free Hospital 1956 Benign ME, aka Myalgic Encephalomyelitis <100 1957 Epidemic Postinfectious Neuromyasthenia 1958 Irritable Colon Syn 1959 Irritable Bowel Syn >3.5K
19	Infection, Trauma, Fatigue or Pain continued… 1960 Temporomandibular Joint Pain >3K 1970 Myofascial Pain Syndrome >4.5K 1975 Fibromyalgia >2.5K 1982 (Familial) Chronic Mononucleosis 1984 Chronic Active Epstein Barr Virus 1986 Sporadic Postinfectious Neuromyesthenia 1987 Chronic Fatigue Syndrome >2K 1988 Chronic Fatigue and Immune Dysfunction Syndrome 1990 3 types of Asthenia: Episodic, Recurrent and Chronic 1997 Chronic Pain and Fatigue Syndrome 1998 Chronic Multi-Symptom Illness 2001 Chronic Neuroendocrineimmune Dysfunction Syndrome
20	In USA, Not Even “Discovered” By Physicians: First Described in the Tales of Edgar Allan Poe 1832: 1^st Report of Symptoms in Loss of Breath 1839: Over 50 Specific Symptoms in Fall of House of Usher 1839: 1^st Report of Facial Sign in The Man Who Was Used Up 1840: 1^st Report of Cause in Philosophy of Furniture 1843: 1^st Report of Psych Misdiagnosis in The Tell Tale Heart “Now have I not told you that what you mistake for madness is but overacuteness of the senses?” 1844: 1^st Report of Successful Therapy in Premature Burial 1849: Poe dies as he predicted of “Congestion of the Brain”
21	But Only Charles Baudelaire in Paris Recognized Gas Lighting as the Cause of Poe’s Symptoms "All the documents I have read led me to the conviction that for Poe the United States was nothing more than a vast prison which he traversed with the feverish agitation of a being made to breathe a sweeter air — nothing more than a great gas lighted nightmare — and that his inner, spiritual life, as a poet or even as a drunkard, was nothing but a perpetual effort to escape the influence of this unfriendly atmosphere." Gas light made from coal contained 5 % to 50 % Carbon Monoxide CO exposure limits today= 0.0009 % outdoors, 0.005% occupational
22	“Do you know why I so patiently translated Poe? It was because he was like me.” REVERSE IMAGE TRUE IMAGE EDGAR ALLAN POE CHARLES BAUDELAIRE
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24	Many Other 19^th Century Creative Geniuses Also Apparently Poisoned by CO from Gas Lighting
25	Evidence of Van Gogh’s gas light poisoning, like Poe’s Tell Tale Face and his Purloined Letter, is “hidden in plain view”
26	Of Course, Not Just Men and Not Just Then
27	Tell Tale Face Noted in “Certain Nervous Disorders” Even Before Introduction of Gas Lighting
28	England’s Most Famous Unrecognized Case ?
29	Most Likely CO Source Prior to Gas Lighting
30	CO Role in “MCS etc” Not Yet Widely Recognized: Excluding Literature on Chronic CO Poisoning, CO is mentioned in only 11 of 90,000 other articles Fibromyalgia Syndrome 2: both claim “not CO” Chronic Fatigue Syndrome 2: 1 claims “not CO” the other says “from CO” so not true CFS ! Generalized Anxiety 1: claims “not CO” MCS / MUSES Syndrome 1: claims “from CO” Post Traumatic Stress Disorder 2: both claim “not CO” Somatization Disorder 3: all 3 claim “not CO” Even most MCS patients fail to recognize any CO connection, perhaps because CO is odorless, tasteless and invisible.
31	First Peer-Reviewed Publication Proposing Connection Between MCS, CO and Poe Donnay, A. International Journal of Toxicology 1999;18(6):383-392 “On the recognition of multiple chemical sensitivity in medical literature and government policy.”
32	Subsequent Citations
33	CO is Well Known as “The Great Imitator” and Already Well Documented to Cause or Worsen: Anemia Angina Anosmia (loss of smell) Asthma Birth Defects Blindness Deafness Depression Diabetes Hallucinations of all kinds Heart Disease Mental Retardation Parkinson’s Psychoses
34	Why So Many Syndromes? CO is Both Ubiquitous Neurotoxin & Ubiquitous Neurotransmitter CO is #1 Cause of Unintentional Toxic Deaths in USA CO is #1 Cause of Unintentional Toxic Poisonings in USA CO is #1 Air Pollutant in USA: more tons/year than all others; primarily from industry, vehicles, fires, combustion appliances CO is also produced systemically by all mammals from heme breakdown by Heme Oxygenase, the Universal Stress Enzyme. HO-1 is greatly induced by exposure to any type of stress : heat, bright light, noise, odors, drugs, alcohol and other chemicals, trauma, infection, electro magnetic fields, etc. Endogenous CO is not just bound to hemoglobin but bioactive in over 90 pathways in range of 1 to 10ppm
35	Increased endogenous production of CO from heme breakdown is documented in: Allergy Altitude Sickness Alzheimer’s Anemia Asthma Bronchiectasis Cystic Fibrosis Diabetes Heart Attack Heat Stress / Stroke Infections Methylene Chloride Poisoning Parkinson’s Pre-Menstrual Syndrome Upper Respiratory Tract Infections
36	All CO-Related Disorders Share Biomarker: Elevated Level of CO in End-Tidal Breath Normal bCO (maximum after holding breath 20 to 25 seconds) Healthy Relaxed Non-Smokers = 0-2 ppm Mildly Elevated bCO Borderline Abnormal for Non-Smokers = 3-4 ppm Moderately Elevated bCO Smokers and People with CO Disorders = 5-24 ppm Highly Elevated bCO Recently Smoked or CO Poisoned = 25-999+ppm All healthy adults have approx. noon peak and midnight trough. Higher after supplemental oxygen & if standing vs. sitting vs. supine.
37	How CO Causes MUSES Syndrome HO-CO controls sensitization and habituation to stressors of all kinds. Chronic repeated exposures to any stressor induces habituation, so that higher doses are tolerated with less or no sensory awareness. Isolated acute exposures (and de-habituation, as in ex-smokers) induce sensitization, so that lower doses are less tolerated with more sensory awareness. While exogenous stressors (heat, drugs, alcohol) may be avoided, endogenous CO produced by HO in response to ANY stressor cannot. So if/once sensitized to CO via exogenous poisoning or dehabituation, increased sensory awareness may be provoked by ANY stressor. Result is multi-sensory sensitivity to odors, lights, sounds, foods, etc aka MUSES Syndrome (aka MCS in adults or Autism in children).
38	Where to Look for Evidence of CO Poisoning Today
39	Curing MUSES Syndrome: Treatments Proposed by Cheyne, Poe and Donnay Dr. George Cheyne in The English Malady, 1733: “Seldom any lasting or solid cure is perform’d … till they have sucked in and incorporated the sweet balmy clear Air of the Country. … Diet will do infinitely more than Exercise and have more lasting Effects, but both should be joined. … Certainly the best of all is where Amusement or Entertainment of the Mind is joined with Bodily Labour and Constant Change of Air.” Edgar Allan Poe in The Premature Burial, 1844: “I took vigorous exercise. I breathed the free air of Heaven. I thought upon other subjects than Death. I discarded my medical books.” Donnay in CO Dx-Tx Protocol, 2000: O2 @ 6 L/m, 2 hr/day for 3 mo.
40	Conclusion: Distinguish MUSES from MCS ! MCS associated only with sensitivity to chemicals is rare. Most MCS cases also report multi-sensory sensitivity, aka MUSES Syndrome, consistent with descriptions of over 130 other similar syndromes published since 1733. Sentinel case in USA of Edgar Allan Poe was most likely caused by chronic CO poisoning from exposure to gas lighting. MUSES syndrome caused by chronic CO poisoning is associated with a Tell Tale Face and PaO2-PvO2<55mmHg. Oxygen uptake deficiency and MUSES symptoms may be treated successfully with daily supplemental oxygen at home.
41	Published Critiques, Rebuttals & Objections To Donnay’s Poe, CO and MUSES Theories