Abstract. Fibrositis—muscular or nonarticular rheumatism—is a controversial diagnosis; nevertheless it represents a real entity, whether primary or secondary. The outstanding symptoms are pain and stiffness. Objective findings are “trigger areas” and indurations. The most common sites are the soft tissues of the neck, shoulder, elbow, carpal tunnel, palms (Dupuytren's contracture) and low back, but sometimes the syndrome is generalized. Therapy for each type is outlined. The immediate treatment usually includes the administration of analgesics, immobilization of the affected area, and infiltration of the trigger points with procaine and adrenocortical steroids. Physical therapy (heat, massage and described exercises) is indispensable.

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Upon organizing a clinic for the study and treatment of joint disease in the Cook County Hospital, we were confronted by an unlimited number of patients. As treatment we had liberal hospital facilities and provision for physical medicine.A galaxy of drugs was available, some of these dignified by long use. Others had been recently introduced, were widely used, and were currently accepted with considerable enthusiasm. Some of the new chemicals, offered to us for clinical trial after preliminary laboratory evaluation, were possibly harmful and only questionably beneficial.The skeletal disease in most of our patients was chronic and rather stationary, with an unmeasured tendency to spontaneous remissions and relapses. Most of the patients had tried many drugs and procedures upon the advice of physicians, drug stores, advertisements, or acquaintances. Almost all the patients had taken acetylsalicylic acid or proprietaries containing salicylates. The application for help in our clinic could be taken as evidence of the absolute or relative ineffectiveness of their previous therapeutic adventures.To care for our patients intelligently and effectively and to utilize the tremendous clinical opportunities of separating the grain from the chaff, controls were set up for the evaluation of treatment.Factors other than therapeutic had to be considered as favorably influencing the course of the disease, thus tending to be¬ cloud evaluation of treatment. A subtle source of error in appraisal of treatment re¬ sults is the natural history of the sickness, the fluctuating influences of the harmful agent, and of the body's defense.The placebo factor in all contacts between healer and patient and the reaction of the patient to sympathetic interest required eval¬ uation in order to determine the best in¬ terests of the patient regarding continuation, increased or decreased dosage, or even ces¬ sation of a given treatment. ProcedureEvery patient entering the clinic gave a complete medical history and was thoroughly examined. While awaiting the results of the laboratory tests and during the week inter¬ vening before his next clinic visit, he was told to take a white tablet containing 5 grains (0.3 gm.) of lactose after meals and on re¬ tiring. At his next visit he was asked, "How are you?" No leading question, hopeful in¬ flection of the voice, or confident smile ac¬ companied the query. The patient's reply was entered verbatim. A patient noting some change, good or bad, was asked to particular¬ ize and demonstrate evidence of any alteration of swelling, mobility, or tenderness. Sed¬ imentation-rate determination (Westergren) and other laboratory' tests were performed at the first visit and frequently thereafter. Care was taken to give no other therapeutic advice, such as change of diet, correction of posture, application of heat, or change in working habits. The patient was also told to avoid acetylsalicylic acid and any other medica-