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The principal lack of agreement concerns definition of the clinical syndrome to be studied. A number of clinical syndromes have been described, all apparently referring to similar groups of patients, but differing sufficiently to preclude comparison of published studies. The various names used include epidemic neuromyasthenia1, idiopathic chronic fatigue and myalgia syndrome-, benign myalgic encephalomyelitis'', chronic infectious mononucleosis', Royal Free disease", postviral fatigue syndrome", fibrositis-fibromyalgtai-", and chronic fatigue syndrome".

An attempt to address the problem ofcase definition was made by Holmes and colleagues in 19889, who chose the name chronic fatigue syndrome (CFS) because it is descriptive and free from unproven aetiological implications. They also proposed an operational definition for the syndrome. Although a welcome advance, this definition proved to be unsatisfactory in …