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April 17, 1948, Vol 136, No. 16 >
ARTICLE | April 17, 1948

CARDIOVASCULAR SYSTEM AS THE EFFECTOR ORGAN IN PSYCHOSOMATIC PHENOMENA FREE

GEORGE BURCH, M.D.; THORPE RAY, M.D.
[+] Author Affiliations

Read before the Section on Internal Medicine at the Ninety-Sixth Annual Session of the American Medical Association, Atlantic City, N. J., June 11, 1947.

Aided by grants from the Life Insurance Medical Research Fund, War Department Contract No. W-49-007-MD-389 and Mrs. E.J. Caire Fund for Research in Heart Disease.


New Orleans

From the Department of Medicine, Tulane University School of Medicine, and the Charity Hospital, New Orleans.


JAMA. 1948;136(16):1011-1017. doi:10.1001/jama.1948.02890330001001
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References

Bodily functions have been known for many years to be disturbed by emotional stress. These physiologic disturbances may be manifested as symptoms referable to any organ system; e. g., the gastrointestinal tract, the genitourinary tract and the respiratory and cardiovascular systems. For unknown reasons there is a tendency for one system to predominate in its disturbances. Many isolated observations of these reactions have been described. Beaumont1 described interesting observations concerned with formation of gastric juice. Although most of Pavlov's studies were concerned with conditional reflexes, many were related to disturbed psychic states. Cannon2 conducted objective studies of gastrointestinal disturbances produced by psychic changes. Wolff and Wolf and their associates3 observed directly the effect of psychic disturbances on the vascularity of the mucosa of the stomach and changes in secretion in the stomach and duodenum associated with emotional upsets. The effect of emotional stress on respiration has been

REFERENCES

1 +
Beaumont, W.: Experiments and Observations on the Gastric Juice and the Physiology of Digestion , Plattsburgh, N. Y., F. P. Allen, 1833;
2 +
Physiology of Digestion with Experiments on Gastric Juice , ed. 2, Burlington, C. Goodrich, 1847;
3 +
Cannon, W. B.:  The Influence of Emotional States on the Functions of the Alimentary Canal , Am. J. M. Sc. 137:480, 1909;.
4 +
Wolff, H. G., and Wolf, S.:  Studies on a Subject with a Large Gastric Fistula: Changes in Function of the Stomach in Association with Varying Emotional States , Tr. A. Am. Physicians 57: 115, 1942;.
5 +
Mittlemann, B., and Wolff, H. G.:  Emotions and Gastroduodenal Function: Experimental Studies in Patients with Gastritis, Duodenitis and Peptic Ulcer , Psychosom. Med. 4:5, 1942;.
6 +
Richards, C. H.; Wolf, S., and Wolff, H. G.:  The Measurement and Recording of Gastroduodenal Blood Flow in Man by Means of a Thermal Gradientometer , J. Clin. Investigation 21: 551, 1942;.
7 +
Christie, R. V.:  Some Types of Respiration in Neuroses , Quart. J. Med. 4:427, 1935;.
8 +
White, P. D., and Hahn, R. G.:  The Symptoms of Sighing in Cardiovascular Diagnosis, with Spirographic Observations , Am. J. M. Sc. 177:179, 1929;.
9 +
Caughcy, J. L., Jr.:  Cardiovascular Neurosis-Review , Psychosom. Med. 1:311, 1939;.
10 +
Wolf, G. A., Jr., and Wolff, H. G.:  Studies on the Nature of Certain Symptoms Associated with Cardiovascular Disorders , Psychosom. Med. 8: 293, 1946;.
11 +
Finesinger, J. E.:  The Effect of Pleasant and Unpleasant Ideas on the Respiratory Pattern (Spirogram) in Psychoneurotic Patients , Am. J. Psychiat. 100: 659, 1944;.
12 +
Burch, G. E.; Cohn, A. E., and Neumann, C.:  A Study by Quantitative Methods of the Spontaneous Variations in Volume of the Finger Tip, Toe Tip and Posterio-Superior Portion of the Pinna of Resting Normal White Adults , Am. J. Physiol. 136:433, 1942;.
13 +
Weiss, S.:  The Interaction Between Emotional States and the Cardiovascular System in Health and in Disease , in Contribution to the Medical Sciences in Honor of Dr. Emanuel Libman by His Pupils, Friends and Colleagues , New York, International Press, 1932;, vol. 3, p. 1181.
14 +
Wolf and Wolff.5c
15 +
Hickam, J. B., and Cargill, W. H.:  Effect of Anxiety on the Cardiac Output , paper read at meeting of American Society for Clinical Investigation, 1947 .
16 +
Stead; E. A., Jr.; Warren, J. V.; Merrill, A. J., and Brannon, E. S.:  The Cardiac Output in Male Subjects as Measured by the Technique of Right Atrial Catheterization: Normal Values with Observations on the Effect of Anxiety and Tilting , J. Clin. Investigation 24: 326, 1945;.
17 +
Grollman, A.: The Cardiac Output of Man in Health and Disease , Springfield, Ill., Charles C Thomas, Publisher, 1932;.
18 +
Wolf and Wolff.5c Stead, Warren, Merrill and Brannon.9c
19 +
Sodeman, W. A., and Burch, G. E.:  Precipitating Causes of Congestive Heart Failure , Am. Heart J. 15:22, 1938;.
20 +
Friedman, M.:  Studies Concerning Etiology and Pathogenosis sis of Neurocirculatory Asthenia: III. Cardiovascular Manifestations of Neurocirculatory Asthenia , Am. Heart J. 30:478, 1945;.
21 +
White, P. D.; Cobb, S.; Ch[ill]pman, W. P.; Cohen, M. E., and Badal, D. W.;  Observatians on Neurocirculatory Asthenia , Tr. Am. A. Physicians 58:129, 1944;.
22 +
Barker, P. S.; Shrader, E. L., and Ronzoni, E.:  The Effects of Alkalosis and of Acidosis upon the Human Electrocardiogram , Am. Heart J. 17:169, 1939;.
23 +
Mainzer, F., and Krause, M.:  The Influence of Fear on the Electrocardiogram , Brit. Heart J. 2:221, 1940;.
24 +
Loftus, T. A.; Gold, H., and Diethelm, O.:  Cardiac Changes in the Presence of Intense Emotion , Am. J. Psychiat. 101:697, 1945;.
25 +
Master, A. M.:  Effort Syndrome or Neurocirculatory Asthenia in the Navy , U. S. Nav. M. Bull. 41:666, 1943;.
26 +
Merritt, W.:  Inversion of the T Waves of the Electrocardiogram in Two Patients with Neurocirculatory Asthenia , Ann. Int. Med. 20: 773, 1944;.
27 +
Logue, R.B.; Hanson, J. F., and Knight, W. A.:  Electrocardiographic Studies in Neurocirculatory Asthenia , Am. Heart J. 28:574, 1944;.
28 +
Grayhiel, A., and White, P. D.:  Inversion of T-Wave in Lead I or II of Electrocardiogram in Young Individuals with Neurocirculatory Asthenia, with Thyrotoxicosis in Relation to Certain Infections, and Following Paroxysmal Ventricular Tachycardia , Am. Heart J. 10: 345, 1935;.
29 +
Wendkos, M. H.:  The Influence of Autonomic Imbalance on the Human Electrocardiogram: I. Unstable T Waves in Precordial Leads from Emotionally Unstable Persons Without Organic Heart Disease , Am. Heart J. 28:549, 1944;.
30 +
Burch, G. E.:  A New Sensitive Portable Plethysmograph , Am. Heart J. 33:48, 1947;.
31 +
Burton, A. C.:  The Range and Variability of the Blood Flow in the Human Fingers and the Vasomotor Regulation of Body Temperature , Am. J. Physiol. 127:437, 1939;.
32 +
Goetz, R.:  Rate and Control of Blood Flow Through Skin of Lower Extremities , Am. Heart J. 31:146, 1946;.
33 +
Hertzman, A. B., and Dillon, J. B.:  Selective Vascular Reaction' Patterns in the Nasal Septum and Skin of the Extremities and Head , Am. J. Physiol. 127:671, 1939;.
34 +
Neumann, C.; Lhamon, W. T., and Cohn, A. E.:  A Study of Factors (Emotional) Responsible for Changes in the Pattern of Spontaneous Rhythmic Fluctuations in the Volume of the Vascular Bed of the Finger Tip , J. Clin. Investigation 23: 1, 1944;.
35 +
Neumann, C.; Cohn, A. E., and Burch, G. E.:  A Study of the Influence of the Character of an Examining Room on the Peripheral Blood Vessels of Normal, Hypertensive, and Senile Subjects , J. Clin. Investigation 21:651, 1942;.
36 +
Gottschalk, L. A.:  A Study of Conditioned Vasomotor Responses in Ten Human Subjects , Psychosom. Med. 8:16, 1946;.
37 +
Burch. G. E.; Cohn, A. E.. and Neumann, C.:  Reactivity of Intact Blood Vessels of the Fingers and Toes to Sensory Stimuli in Normal Resting Adults, in Patients with Hypertension, and in Senile Subjects . J. Clin. Investigation 21:655, 1942;.
38 +
Burch. Cohn and Neumann,7 Neumann, Lhamon and Cohn.18a

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Beaumont, W.: Experiments and Observations on the Gastric Juice and the Physiology of Digestion , Plattsburgh, N. Y., F. P. Allen, 1833;
2 +
Physiology of Digestion with Experiments on Gastric Juice , ed. 2, Burlington, C. Goodrich, 1847;
3 +
Cannon, W. B.:  The Influence of Emotional States on the Functions of the Alimentary Canal , Am. J. M. Sc. 137:480, 1909;.
4 +
Wolff, H. G., and Wolf, S.:  Studies on a Subject with a Large Gastric Fistula: Changes in Function of the Stomach in Association with Varying Emotional States , Tr. A. Am. Physicians 57: 115, 1942;.
5 +
Mittlemann, B., and Wolff, H. G.:  Emotions and Gastroduodenal Function: Experimental Studies in Patients with Gastritis, Duodenitis and Peptic Ulcer , Psychosom. Med. 4:5, 1942;.
6 +
Richards, C. H.; Wolf, S., and Wolff, H. G.:  The Measurement and Recording of Gastroduodenal Blood Flow in Man by Means of a Thermal Gradientometer , J. Clin. Investigation 21: 551, 1942;.
7 +
Christie, R. V.:  Some Types of Respiration in Neuroses , Quart. J. Med. 4:427, 1935;.
8 +
White, P. D., and Hahn, R. G.:  The Symptoms of Sighing in Cardiovascular Diagnosis, with Spirographic Observations , Am. J. M. Sc. 177:179, 1929;.
9 +
Caughcy, J. L., Jr.:  Cardiovascular Neurosis-Review , Psychosom. Med. 1:311, 1939;.
10 +
Wolf, G. A., Jr., and Wolff, H. G.:  Studies on the Nature of Certain Symptoms Associated with Cardiovascular Disorders , Psychosom. Med. 8: 293, 1946;.
11 +
Finesinger, J. E.:  The Effect of Pleasant and Unpleasant Ideas on the Respiratory Pattern (Spirogram) in Psychoneurotic Patients , Am. J. Psychiat. 100: 659, 1944;.
12 +
Burch, G. E.; Cohn, A. E., and Neumann, C.:  A Study by Quantitative Methods of the Spontaneous Variations in Volume of the Finger Tip, Toe Tip and Posterio-Superior Portion of the Pinna of Resting Normal White Adults , Am. J. Physiol. 136:433, 1942;.
13 +
Weiss, S.:  The Interaction Between Emotional States and the Cardiovascular System in Health and in Disease , in Contribution to the Medical Sciences in Honor of Dr. Emanuel Libman by His Pupils, Friends and Colleagues , New York, International Press, 1932;, vol. 3, p. 1181.
14 +
Wolf and Wolff.5c
15 +
Hickam, J. B., and Cargill, W. H.:  Effect of Anxiety on the Cardiac Output , paper read at meeting of American Society for Clinical Investigation, 1947 .
16 +
Stead; E. A., Jr.; Warren, J. V.; Merrill, A. J., and Brannon, E. S.:  The Cardiac Output in Male Subjects as Measured by the Technique of Right Atrial Catheterization: Normal Values with Observations on the Effect of Anxiety and Tilting , J. Clin. Investigation 24: 326, 1945;.
17 +
Grollman, A.: The Cardiac Output of Man in Health and Disease , Springfield, Ill., Charles C Thomas, Publisher, 1932;.
18 +
Wolf and Wolff.5c Stead, Warren, Merrill and Brannon.9c
19 +
Sodeman, W. A., and Burch, G. E.:  Precipitating Causes of Congestive Heart Failure , Am. Heart J. 15:22, 1938;.
20 +
Friedman, M.:  Studies Concerning Etiology and Pathogenosis sis of Neurocirculatory Asthenia: III. Cardiovascular Manifestations of Neurocirculatory Asthenia , Am. Heart J. 30:478, 1945;.
21 +
White, P. D.; Cobb, S.; Ch[ill]pman, W. P.; Cohen, M. E., and Badal, D. W.;  Observatians on Neurocirculatory Asthenia , Tr. Am. A. Physicians 58:129, 1944;.
22 +
Barker, P. S.; Shrader, E. L., and Ronzoni, E.:  The Effects of Alkalosis and of Acidosis upon the Human Electrocardiogram , Am. Heart J. 17:169, 1939;.
23 +
Mainzer, F., and Krause, M.:  The Influence of Fear on the Electrocardiogram , Brit. Heart J. 2:221, 1940;.
24 +
Loftus, T. A.; Gold, H., and Diethelm, O.:  Cardiac Changes in the Presence of Intense Emotion , Am. J. Psychiat. 101:697, 1945;.
25 +
Master, A. M.:  Effort Syndrome or Neurocirculatory Asthenia in the Navy , U. S. Nav. M. Bull. 41:666, 1943;.
26 +
Merritt, W.:  Inversion of the T Waves of the Electrocardiogram in Two Patients with Neurocirculatory Asthenia , Ann. Int. Med. 20: 773, 1944;.
27 +
Logue, R.B.; Hanson, J. F., and Knight, W. A.:  Electrocardiographic Studies in Neurocirculatory Asthenia , Am. Heart J. 28:574, 1944;.
28 +
Grayhiel, A., and White, P. D.:  Inversion of T-Wave in Lead I or II of Electrocardiogram in Young Individuals with Neurocirculatory Asthenia, with Thyrotoxicosis in Relation to Certain Infections, and Following Paroxysmal Ventricular Tachycardia , Am. Heart J. 10: 345, 1935;.
29 +
Wendkos, M. H.:  The Influence of Autonomic Imbalance on the Human Electrocardiogram: I. Unstable T Waves in Precordial Leads from Emotionally Unstable Persons Without Organic Heart Disease , Am. Heart J. 28:549, 1944;.
30 +
Burch, G. E.:  A New Sensitive Portable Plethysmograph , Am. Heart J. 33:48, 1947;.
31 +
Burton, A. C.:  The Range and Variability of the Blood Flow in the Human Fingers and the Vasomotor Regulation of Body Temperature , Am. J. Physiol. 127:437, 1939;.
32 +
Goetz, R.:  Rate and Control of Blood Flow Through Skin of Lower Extremities , Am. Heart J. 31:146, 1946;.
33 +
Hertzman, A. B., and Dillon, J. B.:  Selective Vascular Reaction' Patterns in the Nasal Septum and Skin of the Extremities and Head , Am. J. Physiol. 127:671, 1939;.
34 +
Neumann, C.; Lhamon, W. T., and Cohn, A. E.:  A Study of Factors (Emotional) Responsible for Changes in the Pattern of Spontaneous Rhythmic Fluctuations in the Volume of the Vascular Bed of the Finger Tip , J. Clin. Investigation 23: 1, 1944;.
35 +
Neumann, C.; Cohn, A. E., and Burch, G. E.:  A Study of the Influence of the Character of an Examining Room on the Peripheral Blood Vessels of Normal, Hypertensive, and Senile Subjects , J. Clin. Investigation 21:651, 1942;.
36 +
Gottschalk, L. A.:  A Study of Conditioned Vasomotor Responses in Ten Human Subjects , Psychosom. Med. 8:16, 1946;.
37 +
Burch. G. E.; Cohn, A. E.. and Neumann, C.:  Reactivity of Intact Blood Vessels of the Fingers and Toes to Sensory Stimuli in Normal Resting Adults, in Patients with Hypertension, and in Senile Subjects . J. Clin. Investigation 21:655, 1942;.
38 +
Burch. Cohn and Neumann,7 Neumann, Lhamon and Cohn.18a

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