This is an editorial letter from the medical journal from England THE HOSPITAL. It deals with the term rheumatisms and fibrositis related to an article from ARTHUR P. LUFF published in the same year 1905.

(Personal note: DESPITE I consider that FIBROSITIS was a BAD term to describe certain rheumatic lesions, it is relevant to study how the doctors by then understood certain pathologies, such as LUMBAGO, unspecific low back pain or the influence that COLD DAMPNESS has in certain rheumatic syndromes and that, by 2019, they do not have an explanation yet).

The editor’s letter is titled:

Rheumatisms (focused on FIBROSITIS)

The author starts the article by analyzing the word rheumatisms, and he says that by then the term was confined mainly to the lesions related to the “micrococcus rheumatism” or the also called “acute rheumatism”.

He comments on a recent article by Dr. Luff, where Luff suggested new insights in an article published in Clinical Journal, October 11.

Dr. Luff had the opinion that the pathology of the rheumatic lesions was related essentially to AN INFLAMMATORY HYPERPLASIA of the white fibrous tissue that could occur in various parts of the body, and he named it “FIBROSITIS” (this term was first used by Gowers in his article titled LUMBAGO in 1904).

That meant that the ARTICULAR STRUCTURES (synovial membrane, bone and cartilage) WERE NOT primarily affected. The affected tissue involved in certain rheumatic pains would be located in the aponeurosis, tendons, ligaments, fascia, and periostium. It presented as well-defined INDURATIONS. Pain is related to the movement of the inflamed areas.

In the muscles, the only sensory structures are the MUSCLE SPINDLES that would be related to the pain (Personal note: In 1904, Gowers explained that theory).

The involvement of a local nerve by the FIBROUS INDURATION may lead to the diffusion of the pain over an extensive area (Personal note: They understood that if there was referred pain, it would be by local peripheral nerve involvement, as it happens with back mice and cluneal nerves).

Dr. A. P. Luff considered the following entities to be different forms of FIBROSITIS:

1-Muscular rheumatism: This would always be caused by FIBROSITIS, and it may affect ANY AREA of the body. The pain is at first dull, and it becomes worse by movement. IT IS RELATED TO THE ONSET OF DAMP WEATHER, when the patient becomes warm in bed or when the patient rises from bed in the morning.

2-Lumbago: It is also a typical form of FIBROSITIS. It may be an affection of the lumbar muscles but, according to Dr. Luff, the affection is localized in the neighborhood of the muscular insertions of the sacro-iliac articulations. They noticed that the patients especially complained of pain when, during the examination, there was pressure upon the sacro-iliac joint (Personal note: Especially where the back mice are located).

3-Rheumatic neuralgia: This is a FIBROSITIS OF THE NERVE SHEATHS, and it is a frequent cause of sciatica. Then the associated symptoms are pain with numbness and pins-and needles.

4-Dupuytren’s contraction: Fibrositis caused by a habitual use of the hand (it had been previously ascribed to GOUTY disturbances, but Dr. Luff could not demonstrate deposits in the thickened tissues).

About the etiology of FIBROSITIS, they related it to the following factors:

COLD, DAMP AND WET. These factors seem to be a related cause in a PREDISPOSED SUBJECT. When the ailment is established, the exacerbations of pain correspond, not necessarily, with rainy weather, but with the mere fall of the barometric pressure (Personal note: Barometric pressure seems to affect the level of DAMPNESS).

EXTREMES OF TEMPERATURE. Sudden and extreme variations in temperature will produce FIBROSITIS. Dr. Luff presented a case of a fireman (who, after working in the great heat of the Red Sea, went direct to the refrigerating chamber to cool himself. The result was an IMMFLAMATION of the FIBROUS TISSUE throughout the body, which completely prostrated him, and he recovered after a prolonged convalescence).

INJURIES: For example, GOLF is credited with certain especially localized lesions –analogues, they supposed, to “tennis-elbow”.

TOXEMIAS: Toxemias of various orders cause temporary FIBROSITIS, for instance, TONSILLITIS, INFLUENZA, and also “too free indulgence in good living”.

The treatment recommendations by Dr. Luff:

-Aspirin as analgesic

-Oral iodide of potash (as a curative agent, 10 or 12 grains) (Personal note: It can be a toxic poison).

-Combinations of iodide with NUX VOMICA or the compound GLYCEROPHOSPHATE SYRUP.

-External application by PAINT of equal parts of CHLORAL HYDRATE, MENTHOL, CAMPHOR; and gently rubbed in with the fingers.

-External application of PAINT by TINCTURE OF IODINE (followed by a hot poultice or fomentation which vaporizes the iodine).

-Also application of heat, massage, electricity, and EXERCISE.

Dr. Luff makes it clear that these various forms of rheumatism are NOT related to URIC ACID deposits (as it was thought by then), so there should not be any dietary strong RESTRICTION (Personal note: There were some doctors that ascribed all the cases of chronic rheumatism to imbalance with certain acid compounds as uric acid or lactic acid; there were even medications that were sold for balancing that as “curicones”).

Published in Jaunary 2019 by Marta Cañis Parera

Reference:

Rheumatisms. Hospital (Lond 1886). 1905 Dec 2; 39(1001): 147-148. PubMed PMID:29812609; PubMed Central PMCID: PMC5194794.