1740 



HANDBOOK OF PHYSIOLOGY 



NEUROPHYSIOLOGY III 



corticoids and that animals showed a poor resistance 

 to all forms of 'stress.' The term stress was used to 

 cover any form of physical insult such as cold, burns, 

 infections, drugs, etc. It was next found that animals 

 maintained on a high sodium and high protein diet 

 and "sensitized In unilateral nephrectomy," devel- 

 oped widespread changes of the connective tissue, 

 arthritis and hypertension following long exposure to 

 such a 'stressful' agent as cold. Similar changes could 

 be produced if the synthetic adrenal hormone desoxy- 

 corticosterone was administered instead of the 'stressor' 

 agent. It was argued from this that long continued 

 'stress' result in a breakdown of the adaptive process 

 whereby a disproportion in the amounts of adrenal 

 glyco- and mineralocorticoids brings about disease. 

 The untoward changes are attributed to a preponder- 

 ance of hormones having the action of mineralocorti- 

 coids. Selye suggests that the "strains and stresses of 

 normal life" can act upon the organism like other 

 "unspecific'' stresses, and thai when unduly pro- 

 longed and severe bring about "diseases of adapta- 

 tion." From an analogy to the findings in the rat he 

 contends that arthritis, rheumatic fever, periarteritis 

 nodosa and hypertension are among the diseases that 

 may be brought about by psychological or other 

 forms of 'nonspecific stress' in man. This theory has 

 resulted in many healed claims and counterclaims 

 in regard to its validity, and has stimulated investiga- 

 tions which have yielded .1 wealth of conflicting evi- 

 dence. The results of investigation in man can be 

 summed up by saying that the findings are contra- 

 dictory to the particular scheme of hormonal derange- 

 ment which Selye claims to be at the basis of the 

 above-mentioned diseases (70). 



/',/-//, Ulca 



Of the alleged psychosomatic diseases with lesions 

 perhaps peptic ulcer provides the most convincing 

 clinical and experimental evidence of being etio- 

 logically related to emotion. From time immemorial 

 man has been cognizant ol .1 relationship between 1111- 

 ple.1s.1ni emotional states and disturbances of diges- 

 tion. Clinically, there has been found such .1 strong 



correlation between emotional disturbances and the 



onset or recurrence of peptic ulcer that great emphasis 

 is given to psychological factors in the therapeutic 



management of the disease. 



Earlv in the last century William Beaumont (7) 



ll mi id. nl. il note ol the changes of the gastric 

 nun os. 1 and secretions that were seen through the 

 g.istiic fistula of his patient Alexis St. Martin at times 



when the latter was fearful or angry. In modern times 

 Wolf and others have taken advantage of cases with 

 fistulas to make a special study of the relation of psy- 

 chological factors to the condition of the stomach. 

 Such cases admittedly may not be representative of 

 what occurs in unmanned individuals. In their famous 

 case Tam, Wolf & Wolff (71) observed that emotions 

 which were ostensibly related to anxiety, resentment 

 or hostility, were associated with increased gastric 

 vascularity, secretion and motility, whereas there was 

 a reversal of this picture when the patient seemed to 

 be fearful or sad. Other workers have made similar ob- 

 servations in regard to the stomach but have attributed 

 the changes to different emotional factors (70). At 

 this stage of our knowledge, however, it would seem 

 more important to have direct evidence that emotions 

 of various kinds mav be accompanied by profound 

 changes in gastric function than to be able to state 

 what kind of change is associated with a particular 

 emotion. 



The peripheral mechanism responsible for the 

 formation of ulcers is still not understood. Present 

 opinion is inclined to the view that a combination of 

 factors is involved, including, principally, changes of 

 vascularity and hypersecretion of acid and pepsin. 

 The central nervous system exerts a direct influence 

 on gastric function through vagal and sympathetic 

 pathways. It has recently become evident that it 

 also may have an indirect influence bv way of the 

 hypothalamic-pituitary-adrcnal axis, cortisone in- 

 creases gastric secretion, presumably as a result of 

 direct action on the gastric glands 17.2). Following 

 therapeutic vagotomy in patients with duodenal ulcer, 

 the gastric secretions are reduced to a 'normal' level. 

 This suggests 1h.1i direct vagal influences are more sig- 

 nificant in the disease than indirect humor. il factors 

 (72). 



In [932 ( lushing t 1 ; 1 published a papei that stimu- 

 lated much interest in the role of central nervous 

 mechanisms and psychic factors in the pathogenesis 

 of peptic ulcer. Reviewing .1 large bodv ol literature 

 and drawing upon his neuKistirgic.il experience, he 

 presented arguments lor inferring that ulcers are 

 neurogenic in origin and that the morbid processes 

 cm be initiated by neural centers in the legion of the 

 hypothalamus. He cited experiments -bowing that 

 gasti ii erosions could be induced I iv various manipula- 

 tions of the vagal and splanchnic nerves, and empha- 

 sized Beattie's finding (1)1 that long-continued stimu- 

 lation of the (liberal region of the hypothalamus led 

 10 -in. ill hemorrhagic changes near the lesser curvature 

 of the stomach. His clinical arguments were less con- 



