Problems in General Medicine from the Emotional Standpoint*

I shall take it for granted that you are all familiar with the structure and functions of the vegetative nervous system, or as it is variously called, the sympathetic or the autonomic, and I shall not take time to discuss it in detail. For the purpose of to—night's presentation it is sufficient to remind you that the vegetative system is that system through which the involuntary processes of life are maintained and regulated, that it closely interacts with the endocrines and that it is completely influenced by the emotions. As you probably remember the vegetative system is made up of two sets of fibers—the sympathetic coming from the thoracic and upper lumbar segments and the parasympathetic coming from the bulbar and sacral regions. When fibers from both of these sets go to the same organ we have them acting antagonistically.

It is particularly important to keep the foregoing in mind because of its relationship to many of the conditions found in internal medicine which have developed in response to harmful stimulation through chronic unfavorable emotions such as worry, anxiety, resentment and the more intense reactions of fear and hate. I am not, in this paper, referring to the hysterias but to actual chronic organic states. I do not wish to be misunderstood on this point. In order to make this clear I shall cite a group of cases picked at random from among my histories.

The first case is that of a woman of about fifty who for over thirty years had been suffering from a particularly severe asthma. She had had the help and advice of some of the best internists both east and west, but was unable to get anything more than temporary relief at any time. About two years ago she was referred to me by her physician who said:“I do not think there could be any emotional basis for this difficulty but in the past thirty years every other field has been investigated but that one. She has nearly died during several attacks. She is so worth while that anything that