thought to work. At the same time, different groups, primarily dermatologists and syphilologists, linked different syndromes, such as acrodermatitis chronica atrophicans and Bannwarth’s syndrome, that are now considered part of the Lyme disease complex. These Europeans were already viewing the illness that Americans would later call Lyme disease as a systemic disease.

The first U.S. case report of erythema migrans appeared in Wisconsin in the 1970s. In 1976, physicians at the naval base in Groton, Connecticut, reported the first cluster of erythema migrans cases in the Journal of the American Medical Association (Mast and Burrows, 1976). Although this report received little attention, a Danish doctor participating in dermatology grand rounds at Yale connected the cases to erythema chronicum migrans in Europe. A prospective study was mounted in 1976 that identified erythema migrans in new cases.

During this same period, Yale rheumatologists had begun investigating undiagnosed illnesses among children and adults in and around Lyme, Connecticut, focusing especially on an apparent clustering of joint and other problems in children. These clinicians suspected some kind of juvenile rheumatoid arthritis, but that illness was not known to cluster geographically. About 25 percent of the patients had a history of a rash, but that sign did not appear prominently in these early case descriptions. By 1976 the Yale researchers had postulated a new condition, which they first called “Lyme disease arthritis” (Medical News, 1976; Steere et al., 1977), now known as Lyme disease.

The Yale rheumatologists considered Lyme disease to be a new rheumatological condition because it was unlike any previously described condition, and swollen joints were one of the most prominent signs. In addition, referral patterns reinforced the rheumatological identity of the disease. Later the fact that Lyme disease represented a new synthesis of previously separate diseases provided another rationale for declaring it a new illness, reinforced by the accompanying professional rewards and media and medical interest. Some observers noted that changing ecological conditions in and around the Northeast may also be associated with the occurrence of Lyme disease.

Framing Lyme disease as new disease rather than an American variant of an existing one had consequences. Early investigations focused on viruses as the prime etiological suspect. Thereforth, many cases were not treated with antibiotics, as was common in Europe.2 Newness brought fear, uncertainty, and controversy over the proper definition, diagnosis, and treatment of Lyme disease, as did various biological and sociological factors. The

2

The committee notes that some reports from the 1980s demonstrate the effectiveness of antibiotic therapy (Steere et al., 1980b).



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