Aching Joints

Arthritis is one of man's and animals' oldest identifiable diseases; traces of it have been found in the bones of Neanderthal man and of dinosaurs. But doctors have no sure idea of its cause or cure. Ten years ago, when the International Congress on Rheumatic Diseases last met, the yanking of teeth and tonsils was a leading treatment recommended by the rheumatics experts. Last week, when the Congress gathered in Manhattan's Waldorf-Astoria, the 794 physicians from the U.S. and 25 foreign countries were excited about emotions and hormones.

Dog Eat Dog. Doctors now think that perhaps as many as a third of the 7,500,000 joint-sore U.S. victims of arthritis and other rheumatic diseases have trouble that is primarily "psychogenic," i.e., caused by the emotions. The pain is just as real as if the victim had a physical form of the disease; sometimes the psychogenic rheumatic has inflammations and changes in the blood that show up in laboratory tests, and sometimes not--just as victims of psychosomatic stomach trouble sometimes have ulcers that can be seen in X rays, sometimes have nothing at all to show the doctor.

The psychogenic rheumatic who has no visible changes in his joints is likely to be a psychologically distinct type of person. Psychiatrist Alfred O. Ludwig of Boston's Massachusetts General Hospital gave the rheumatologists a composite character sketch: the psychogenic rheumatic is insecure, dependent on others but denies his dependence, has trouble adjusting to changes. He finds the world a hostile, dog-eat-dog place, reacts to it violently, but suppresses his emotions; he is sensitive, resents control, drives himself too hard. Said Dr. Ludwig: such patients "do not think in terms of live & let live, but rather of devour or be devoured."

Philadelphia's Dr. Edward Weiss added that the chronic rheumatic whose trouble starts in the mind suffers from "chronic resentment," but does not realize it. The thing for doctors to do in such cases, he said, is to look for a "focal conflict" as well as for a focal infection. Otherwise, the doctor might do the patient harm by "well-meaning but mistaken" efforts to find a nonexistent physical cause; the real trouble might be an embittered marriage rather than an abscessed tooth.

Chicken or Egg? Rheumatic patients carry in themselves the cure as well as the cause of the disease, say Mayo's Drs. Philip S. Hench and Edward C. Kendall. The problem: how to wake up the dormant curative powers in the body. Drs. Hench and Kendall have succeeded in doing it dramatically but temporarily with two hormones: cortisone, originally called compound E,* and ACTH (TIME, May 2). But they were cautious in their report, warned that the hormones are still extremely scarce and that it is too early to tell how safe the long treatment will be.

Doctors are sure that there is an intimate connection between the psychiatric and medical treatments of rheumatism. The emotions are known to affect the glands that produce hormones, just as they affect the muscles; the hormones, in turn, affect the emotions. In the study of rheumatism, the doctors have not reached the point of being able to say which comes first--the rheumatic chicken or the emotional egg.

* The name compound E is no longer used because of confusion with the unrelated vitamin E.

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