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Unlike the British and French physicians of the time the German/Scandinavian physicians assumed that there was an exudative (fluid entering areas of inflammation) proliferative process occurring within the muscles themselves rather than in the connective tissues. Froriep (1843) reported that in a cohort of 80 patients with regional pain there was palpable muscle hardness that was painful when pressure was applied to it, this he termed muscle calluses. In the late 1800s across the pond in the US, Beard, a neurologist referred to a condition that included widespread pain, fatigue and psychological disturbances. He called this condition neurasthenia/myelasthenia. These symptoms were attributed to the daily stresses. At the turn of the century a British neurologist Sir William Gowers was the first to introduce the term “fibrositis”, which was used for the next 72 years

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Noted symptoms he included in his diagnoses were spontaneous pain and asymptomatic sensitivity to mechanical compression, fatigue, sleep disturbances, and aggravation of symptoms by exposure to acute and chronic cold and muscular overstrain. For treatment, he suggested manipulation, counterirritation, and cocaine injections and noted the failure of salicylates. In 1909, Sir William Osler, at the time the best-known physician in the English-speaking world, put forward that muscular rheumatism involved “neuralgia of the sensory nerves of the muscles.” Ambiguity of physical manifestations, inconsistency of histological changes and a lack of specific diagnostic tests hindered a wide recognition of fibrositis by North American physicians.