Psychosomatic Non-Articular Rheumatism

It seems now to be fairly widely agreed that emotional factors are relevant to the study of rheumatism, and particularly of non-articular rheumatism or fibro- sitis.The Horder Report (1941) stated that " Worry, anxiety, mental shock, can be often recognized as promotive of rheumatic disease ".The relationship is perhaps more often expressed as a matter of differential diagnosis between muscular pains of psychoneurotic origin and what is described as " true rheu- matism ".But quite apart from psychological considerations, there is much controversy as to what constitutes " true " non-articular rheumatism. Non-articular Rheumatism in GeneralMuch of the present controversy lies broadly between the exponents of "fibrositis " as a precise clinical and pathological entity and those, more sceptical, who recognize only a vaguer collection of conditions better described as " myalgia ".The word rheumatism has the advantage of its wide recognition by doctors and patients in the description of a certain type of pain, usually with some stiffness and tenderness, of muscle and related fibrous tissue.According to a recent definition (Annotation, Brit.med.J., 1946) the word rheumatism " by derivation implies the defluxion of a morbid humour to the part-that is to say, a local tissue change".While postulating a local tissue change, however, the word is non-committal with regard to the precise nature of this change.POSSIBLE CAUSATIVE FACTORS Some of the factors generally thought to be concerned in the production of non-articular rheumatism are as follows:(a) chill from draughts, damp, or excessive sweating; (b) trauma or strain, acute, as the " crick in the neck " or chronic, as gardeners' lumbago; fatigue from excessive or unaccustomed exercise, or from postural abnormalities such as kyphosis or flat feet; (c) infection: acute, as in influenza, sandfly fever, rubella, or many other infections; or chronic, from a focal sepsis; 36 on July 24,