Effects of Hypnotically Induced Acute
Emotional Stress on Carbohydrate and
Lipid Metabolism in Patients
with Diabetes Mellitus
RICHARD L. VANDENBERGH, M.D., KARL E. SUSSMAN, M.D.,
and CHARLES C. TITUS, M.D.
In a study designed to assess the effects of acute emotional stiess on the carbohydrate and lipid metabolism of patients with diabetes mellitus, stress was induced
under hypnosis by having the patient abreact the most unpleasant situation of his
life. The effects of this stress on blood glucose levels, plasma free fatty acid levels,
urinary glucose excretion and urine volume were determined by collecting blood
and urine samples at half-hourly intervals during a period of stiess and comparing
these observations with similar determinations made during a control period.
Statistically significant decreases in blood glucose levels during stiess were observed. Increases in plasma free fatty acids and urine volume were also observed,
but not at levels of statistical significance. The decrease in blood glucose levels
could not be explained by an increase in urinary glucose excretion.
VAIUOUS INVESTIGATORS have attempted
to examine the effects of the emotions on
the control of diabetes mellitus. The
From the Departments of Psychiatry and
2r,diDen;eV"colo.ity °' ^ ^ ^ ^ ^ ^ ^
This study was supported by Grants FR
00051 and AM 5101 from the u. S. Public
Health Service, by the Fluid Research Fund of
the University of Colorado Medical Center, and
by Eli Lilly and Company, Indianapolis, Ind.
The technical assistance of Diana Vichick
and Loretha Black Jones is greatly appreciated.
We also wish to acknowledge the help received
with the statistical analyses from Dr. Donald
W. Stilson.
Received for publication July 30, 1965.
majority of these patient studies and
comparable investigations in normal subjects have observed the effects of several
kinds of stress (either those naturally
o c c u r r m g m life or under artificially COntrived
circumstances) upon various asBeets of carbohydrate and lipid metabolism. For example, previous studies have
c o n c e n t r a t e d On the effect of Stress upon
, ,
.
,
e i.t h, e r b, l ,o o d , ,
glucose levels, urine glucose
1 8|
levels, or plasma free fatty acids. * '• l s
Tn t he present investigation, an attempt
was made
eva]uate ^
e f f e c t Qf h J L
.. . .
.
,
notically induced emotional stress on
carbohydrate-lipid metabolism.
382
383
VANDENBERGH ET AL.
Hypnotically induced emotional stress
provides the advantage of having the
patient under stress with a relatively
high degree of control and within a
specific period. It has been demonstrated that plasma hydrocortisone levels
are altered by hypnotically-induced emotional stress and that such induced emotions may be physiologically and psychologically equivalent to emotional reactions experienced in naturally occurring settings. 11 ' 34
Method
Diabetic patients were selected (by their
willingness to participate) from the Diabetic
Clinic of the University of Colorado Medical
Center. The 6 patients studied ranged in
age from 39 to 50 years. Four of the subjects were brittle diabetics, 3 of whom had
had a juvenile onset. Two had had mature
onset and were obese. Of the latter, 1 was
poorly controlled on oral hypoglycemic
agents. The remaining patients were receiving insulin. The type and dosage of insulin,
and the time of the injections for each
patient during the study were as shown in
Table 1.
The group consisted of 3 men and 3
women, none of whom was in any way abnormally emotionally disturbed at the time
of the study. Each patient remained in the
Clinical Research Ward of the University
of Colorado Medical Center for 2 weeks.
The first 5 days were utilized as a period of
adaptation of the patient to the hospital
environment.4 At the same time optimal
TABLE 1.
Patient
TYPE, DOSAGE, AND INJECTION
TIMES OF INSULIN
!) V.M.-JO P.M.
P.S.
J.G.
P.W.
Lente, 60U.
Orinase, 1 gm. Orinase, 1 gm.
NPH, 45U.
NPH, 8U.
Reg., JOU.
W.A. Lente, 45U.
L.B. Lente, 40LJ.
Lenle, SU.
Ultra Lente, 5U.
N.L. Lente, 40U.
Lente, 10U.
VOL. XXVIII, N O . 4 (PART I ) , 1946
dietary requirements and insulin dosages
were established (and these were then kept
constant through the remainder of the experiment). During the following 3 days a
psychiatric history was obtained and the
patient was asked to recount the most unpleasant experience of his life (that he was
able to recall).
During the remaining time of hospitalization, 4 days were set aside as test days, consisting of 2 control days and 2 days during
which the patient was placed under hypnotically induced acute emotional stress. On
the control days the patients were first
hydrated by being given 300 cc. of water
every hour from 9 A.M. until 1 P.M. From
2 P.M. until 5 P.M. the patients remained
recumbent and relaxed. A slow saline intravenous infusion was maintained during the
test period in order to obtain blood samples
at frequent intervals. During this period
blood samples were drawn every half hour
for measurement of blood glucose and plasma free fatty acid levels. The patient was
asked to urinate at the same time intervals,
and total urine volume as well as urinary
glucose excretion were determined. Each
patient reported anxiety on the first control
day due to initial exposure to the intravenous drip in his arm. This anxiety was
not present on the second control day, with
the result that a considerably higher degree
of relaxation was achieved. For this reason,
those determinations made on the second
control day were used in each case for purposes of comparison with those observations
made on the remaining test days. The blood
glucose levels were measured by the glucose
oxidase method,17 while the plasma free
fatty acids were determined
by a modification of the Dole method.2 Urine glucose
measurements were determined1S by the
method of Saloman and Johnson.
The remaining 2 test days differed from
the control days only in that during the
period from 2 P.M. to 2:30 P.M. the patient
underwent hypnosis without the inducement
of any emotional stress, while from 3 P.M.
till 4 P.M. the patient was under hypnosis
with induced emotional stress. Hypnosis
was induced by the relaxation of muscle
groups consecutively from the lower to the
upper portion of the body. The experience
of abreaction was reinforced by the hypno-
384
STRESS AND METABOLISM IN DIABETICS
tist throughout this period from 3 P.M. to
4 P.M., so that the patient remained constantly stressed.* The patient was reassured
that he would not have to report verbally
any of his experiences during this period of
hypnosis and stress unless he so wished. All
of the patient's reactions during this time
were closely observed and carefully recorded, as were his comments at the termination
of this period. Figure 1 shows the pattern
of a representative study of the blood glucose levels observed in one of the subjects
during the hypnotically induced emotional
stress.
Results
During the period of hypnotically induced stress, each patient showed varied
outward manifestations of stress, including weeping, moaning, groaning, sighing,
verbalizations such as asking to stop,
and varied movements including rapid
breathing, moving of the head, twitching,
writhing, swallowing, and fist-clenching.
An attempt was made to keep movement
and speech to a minimum by specific
instructions from the hypnotist that the
patient try not to move or to talk. This
was done in order to avoid the effects of
exercise on blood glucose and free fatty
acids.
At the termination of stress, each patient willingly reported what he had
experienced. In each case the most unpleasant situation coincided with that
reported previously during the patient's
interviews. The patient's reactions to
the experience of stress and abreaction
varied from, "It was not too bad," to
"That was really terrible." Several of the
patients expressed considerable anger
towards the experimenters for what they
had experienced.
Figure 2 shows the mean blood glucose levels during hypnotically induced
stress and those during the same time
period on the control day. Since the
subjects were for the most part brittle
*An account of one such session (Hiat of
Putient W, A.) is given in the Appendix.
2 30
3 00
3 30
TIME IN HOURS
FIG. I. Blood glucose levels in patient
(J.G.) under hypnotically induced emotional stress. Patient was diagnosed as having diabetes mellitus 6 years previously.
Open circles indicate Control Day 2; closed
circles, hypnosis day.
diabetics, it was expected that even with
the relative degree of control obtained
the blood glucose levels observed at 2
o'clock or the beginning of each test day
would not be comparable. Therefore, in
order to attain the fairest criteria for
comparison and make the data more
meaningful, the hypnosis day which most
closely approximated the second control
day in original blood glucose levels was
chosen (Table 2).
On the basis of percentage changes in
blood glucose shown in Table 2, the
blood glucose showed a significant decrease during the period of hypnotically
2 00
2 30
3 00
330
TIME IN HOURS
FIG. 2. Mean blood glucose values ±
S.E.M. for 6 subjects under hypnotically induced emotional stress. Open circles indicate Control Day 2; closed circles, hypnosis
clay.
PSYCHOSOMATIC MEDICINE
385
VANDENBERGH ET AL
tients when in insulin-induced hypoglycemic reactions, but on these occasions
the rise was not observed until levels of
hypoglycemia were reached.10 Though
Bypnosi,ithe initial mean free fatty acid figure
Control
Control
stress
(Fig. 3A) was lower on the stress day
Day S
Patient
Day 1
period
as compared to the control day, this was
P.S.
- 4
-13
-15
not at a level of statistical significance.
J.G.
-17
-36
-11
No significant change in urinary gluP.W.
-26
-25
+24
cose excretion was observed at any time,
W.A.
-37
-41
- 8
even during the period of blood glucose
L.B.
-12
-38
-15
decrease. All statistical measurements
-14
-14
N.L.
-13
were determined through a double-tailed
"Values are for the period between 3 P.M. Student's t test for matched pairs.
TABLE 2- PERCENTAGE CHANGE* IN BLOOD
GLUCOSE LEVEL WITH HYPNOTICALLY
INDUCED EMOTIONAL STRESS
mid 4 P.M. "Minus" indicates a decrease in
blood glucose levels; "plus," an increase.
Discussion
induced emotional stress (p less than
.025) as compared to that of the second
control day. Though a decrease was seen
in the blood glucose levels during the
period of hypnotic trance without induced stress, this was not statistically
significant. The direction of change in
the blood glucose levels observed on the
first control day, was the same as that
observed during hypnotically induced
stress. However, since the degree of
anxiety induced by the hypnosis was far
greater than that by the intravenous
drip, a proportionately greater lowering
of blood glucose was observed under
hypnotically induced stress (a mean decrease of 31.2% under hypnosis, as compared to a mean of 19.0% on the first
control day—not statistically significant).
Similarly, increases (also not statistically significant) were seen in plasma free
fatty acids (Fig. 3) and in the urinary
volume during the period of hypnosis
and stress when compared with the same
period on the control day. These increases were not observed during the
period of hypnosis without induced
stress.
There is insufficient evidence to explain why the level of free fatty acids
rose from 3 o'clock until 5 o'clock, particularly in the light of the coincident
fall in blood glucose. However, similar
curves have been seen with diabetic paVOL. XXVIII, NO. 4 (PART I), 1966
With the evidence at hand, it is difficult to explain the decrease in blood
glucose during hypnotically induced
emotional stress. Increased urinary excretion of glucose did not appear to account for the changes in blood glucose
observed. It is possible that the rate of
gluconeogenesis is decreased during a
period of stress. In this regard one would
have to postulate either an increase
in effective circulating insulin levels or a
diminution of corticosteroid secretion
during stress. Previous studies have
shown that hypnosis per se might cause
a decrease in the plasma 17-hydroxycorticosteroid levels.14'1C> Other studies indicate that urinary and plasma 17-hydroxycorticosteroid levels are elevated under
various conditions of stress except in
those subjects whose ego defenses were
sufficiently strong to minimize the degree of stress experienced.5'2!i 22 It
should be emphasized, however, that
these studies were performed with normal subjects rather than diabetic patients. If these factors were, however, to
hold true for diabetic patients as well as
normal subjects, then a rise in blood
glucose levels would be predicted in
each case. Particularly noteworthy, therelore, in these diabetic patients is not onlv
that the blood glucose level was altered
but that it fell rather than rose.
386
STRESS AND METABOLISM IN DIABETICS
30
20+ 100-1020304050HYPNOSIS 8 STRESS
TIME IN HOURS
300
3 30
4 00
TIME IN HOURS
The second major possibility to account for the lowering of glucose levels
during stress is an increased rate of disposal of glucose. This could occur in the
setting of increased anaerobic or aerobic
glycolysis. It is conceivable that more
glucose is being stored in the form of
glycogen in the liver, or that glucose is
combining with free fatty acids in adipose tissue to form triglycerides. Although there is no evidence directly pertaining to this point, it seems unlikely
that the organism would be storing glucose at times of increased need—that is,
during emotional stress. On the other
hand, it could be postulated that the
emotional stress might cause a generalized increase in body metabolism, or
more specifically, carbohydrate and lipid
metabolism, thereby increasing glucose
disposal. The authors are currently extending this study to include the measurement of other parameters of carbohydrate and lipid metabolism in an attempt to answer better some of the
above speculations.
It should be noted that, in performing
FIG. 3 A (left). Average changes in plasma
free fatty acids of 6 subjects under hypnotically induced emotional stress. Open
circles indicate Control Day 2; closed circles,
hypnosis day. B (above). Median percentage changes from the initial value (2 P.M.)
in plasma free fatty acids of 6 subjects under hypnotically induced emotional stress.
Open circles indicate Control Day 2; closed
circles, hypnosis day.
these studies, the duration of stress extended for at least 20-30 min. Failure to
sustain stress longer than 20 min. might
be one of the major reasons why previous investigators did not observe significant changes in blood glucose levels.20
There are four major limitations in
interpreting the data given here. First,
although not statistically significant, the
induction of the hypnotic trance of itself
lowered the blood glucose level. It is
conceivable that the following additional
lowering of blood glucose was not due to
emotional stress per se but represented a
delayed effect of the hypnotic trance.
Secondly, it is possible that the hypnotic
state alters the individual's capacity to
respond to life stresses and/or that hypnotically induced emotional stress may
not be totally equivalent to emotional
reactions experienced on nonhypnotic
levels. Third, in these studies there is
no way to measure or regulate the magnitude of stress and its effect upon the
patient. One has to assume that the
experiences recalled by the patients were
indeed quite stressful and that the
PSYCHOSOMATIC MEDICINE
387
VANDENBERGH ET AL
changes in physiological parameters observed were therefore meaningful. Finally, previous studies have indicated that
increased muscle activity can produce-a
change in blood glucose levels. In 1924,
Gordon and associates7 found the blood
sugar to be moderately diminished in 2
and markedly diminished in 4, of 11 marathon runners studied at the end of a race.
Jenkins observed a fall in mean blood
sugar from 81.5 to 66.0 mg.% in normal
subjects who had walked on a treadmill
for V,i hr., at a gradient of 1/10 and a
speed of 3K mph.10 However, the effect
of mild exercise upon blood glucose in
diabetic subjects has not been studied
in detail, but it has been clinically observed that patients who are receiving
insulin therapy are more likely to develop hypoglycemic reactions during and
following mild activity.12 In normal subjects, the glycogenolysis of the liver
satisfies the metabolic demands of the
peripheral tissues in mild exercise and
there is relatively little disturbance of
the blood sugar. In diabetics receiving
insulin, however, carbohydrate utilization may proceed so rapidly that it may
exceed glycogenolysis, and hypoglycemia
may ensue.15 Goldstein,0 and Dulin and
associates,3 in separate studies, have suggested that there exists a possible humoral factor produced by working
muscles which is responsible for the
lowering of blood glucose observed with
exercise. At first glance it would seem
that the quantity of muscle activity seen
in the previous investigations described
above is considerably greater than that
seen in this experiment during the period
of stress. Nevertheless, it must be recognized that accurate measuring or recording of the patients' muscular activity in
this experiment was not undertaken.
Movements seen during the periods of
stress, though kept momentary and to
a minimum by the hypnotist's instructions, were still in excess of those seen
during both of the control periods. Furthermore, the inhibition of movement by
VOL. XXVIII, NO. 4 (PART I], 1966
each patient in compliance with the hypnotist's instructions, may have been accomplished at the expense of isometric
contractions and thus may have involved
considerable muscle activity. It can not
be definitively stated, therefore, that part
or even all of the decrease in blood glucose levels during the period of stress
could not have been due to increased
muscle activity.
Summary
The effects of hypnotically induced
acute emotional stress on blood glucose
levels, plasma free fatty acid levels, and
urine glucose levels were measured in
6 patients with diabetes mellitus. Stress
was induced under hypnosis by having
the patient abreaet the most unpleasant
situation of his life. All of the patients'
reactions during the period of stress were
closely observed and carefully recorded,
as were their comments at the termination of this period. The laboratory determinations were made on blood and urine
samples taken at li-hr. intervals. These
were compared with similar determinations made during a control period and
during a period of hypnosis without induced stress. Each patient reported the
period of stress as being an unpleasant
experience and showed outward manifestations of stress during this period.
However, both the unpleasantness of the
experience and the outward manifestations varied in form and degree. Statistically significant decreases in blood
glucose levels were observed during the
period of hypnosis and stress. Increases
in plasma free fatty acids and urine
volume were also observed during the
same period but not at levels of statistical significance. Since the decrease
in blood glucose was not accompanied
by an increase in urinary glucose, other
possible explanations as to how the lowering of glucose levels might occur were
considered and discussed. Some possible
388
STRESS AND METABOLISM IN DIABETICS
limitations of the interpretation oi the menter then induced stress by addressing
the patient as follows.
data were discussed.
University of Colorado Medical Center I'm going to ask you to think about some4200 E. 9 Ave. thing in a minute. Before you start, I want
Denver, Colo. to give you instructions. I'll ask you to
think about something very unpleasant in
Appendix
your life—something that has happened to
you that has upset you a great deal. This
Typical Experimental Session
should be the most unpleasant situation
you can recall that you have ever been in.
W.A. was a 43-year-old white male You will not have to tell me what you have
who stated during his interviews that the thought about unless you want to so that
worst experience of his life occurred at you may feel free to go over in your mind
the age of 15, when he, with another any details you care to. Remember, this is to
boy, decided to run away from home. be the most unpleasant situation you have
Shortly after leaving, his diabetes went ever been in. I want you to think about this
completely out of control and he suffered harder than you have ever thought about
diabetic ketoacidosis. He vividly re- anything else and to recall every detail you
called awakening in the hospital, know- can. Keep thinking about this constantly—
ing that he had done something wrong, do not stop for a second—do not stop until
feeling guilty and ashamed, and, because I tell you you may. All right, go ahead.
he felt so sick, being extremely fright- Stress was then maintained by the use
ened that he was going to die.
of the following supplementary instrucIn the present investigation of the first tions, which were frequently and periodcontrol day an intravenous drip was ically repeated:
started on the patient at 2 P.M. At 3 P.M.
Keep thinking hard—you can do better
the patient asked if he could smoke a than you are now. Try not to move or to
cigarette, stating that the "intravenous talk, just concentrate as hard as you can.
made him nervous" and he felt that Go over and over the situation, detail by
"smoking a cigarette might calm my detail, again and again—you will remember
nerves." On the second control day the more about it each time. Remember how
patient showed no evidence of such you felt when it happened; you are beanxiety and slept through the afternoon ginning to feel the same way again. The
except at those times when blood and more you think about this, the more it seems
it is happening again and you are right
urine samples were being obtained. He that
there, living through it again.
confirmed these clinical impressions by
stating that he felt much more relaxed
On the first hypnosis day the patient
on the second day.
quickly showed obvious outward signs
At 2 P.M. on both hypnosis days, the of stress. His breathing became rapid
patient was hypnotized without difficulty and shallow. He developed violent ticand, until 2:30 P.M., was encouraged to like movements in his face and twitching
rest and be as relaxed and peaceful as of his arm and shoulder muscles. He
possible. At 2:30 P.M. the hypnosis was emitted loud whining and moaning
stopped and the patient allowed to relax sounds and generally gave the impresand sleep as he had on the previous con- sion of severe agitation. This continued
trol days. At 3 P.M. he was again hyp- until 4 P.M., at which time the period of
notized, being told beforehand that at hypnosis was terminated. The patient
some time in the afternoon the experi- was then reassured that nothing more of
ment might be emotionally unpleasant an unpleasant nature was going to hapfor him. He was not told when or in what pen to him and was encouraged to relax
way this was to happen. The experi- and sleep for the rest of the afternoon
PSYCHOSOMATIC MEDICINE
389
VANDENBERGH ET Al.
just as he had on the previous clay. He
was then asked if the experience had
J.
been unpleasant and he replied, "You're
darn right it was." He was then asked
if he would report what experience he
had recalled. He replied, "I thought of
the time that I ran away from home."
2.
In reply to how he had felt during the
hour, he stated, "Almost sick. It was
terrible." At 4 P.M. and at 4:30 P.M. the
3.
patient was unable to give a urine specimen, stating that he was too anxious to
be able to urinate. He asked if he could
smoke in order to help him relax and
was given permission to do so. He was
4.
unable to sleep, however, and considerably later in the evening remarked to the
nurses that he was still a bit upset by
what he had experienced in the afternoon.
5.
A very similar reaction due to the inducement of stress was seen on the second hypnosis day, with the addition of
other manifestations of stress. The pa6.
tient appeared to shiver frequently, his
teeth chattered, and on two separate
occasions, he cried out that he was cold.
7.
He coughed several times, frequently
seemed to be experiencing trouble swallowing, and made gulping movements
and noises. At 4 P.M. the patient stated
8.
that he had recalled his previous feelings
exactly as he had experienced them at
the age of 15. He said that he had felt
"sick, as if I was vomiting again" and
"cold again." That evening the patient
reported to the nurses that he was again
upset and on this occasion angry at the
9.
experimenters for having made him go
through such a horrible experience.
During the period of hypnotically induced stress, a drop in this patient's
blood glucose level was observed that 10.
was 33% greater than that demonstrated
during the same time interval on the
second control day.
11.
Department of Psychiatry
University of Colorado Medical Center
4200 E. 9 Ave. 12.
Denver, Colo.
VOL XXVIII, NO. 4 (PART I), 1966
References
UOGUONOIF, M. D., ESTES, E. H., JK.,
and TROUT, D. Acute effect of physioJogic stimuli upon plasma nonesterified
fatty acid level. Proc Soc Exp Biol Med.
100:503, 1959.
DOLE, V. P. A relation between nonesterified fatty acids in plasma and the
metabolism of glucose. ] Clin Invest
35.] 50, 1956.
DULIN, VV. E., and CLARK, J. J. Studies
concerning a possible humoral factor
produced by working muscles. Its influence on glucose utilization. Diabetes
10:289, 1961.
FISHMAN, J. R., HAMBURG, D. A.,
HANDLON, J. H., MASON, J. W., and
SACHAR, E. J. Emotional and adrenal
cortical responses to a new experience.
Arch Gen Psychiat 6:271, 1962.
FRIEDMAN, S. B., MASON, J. W.,
and
HAMBURG, D. A. Urinary 17-hydroxycorticosteroid levels in parents of children with neoplastic disease. Psychosom Med 25:364, 1963.
GOLDSTEIN, M. S. Humoral nature of
hypoglycemia in muscular exercise.
Amer ] Physiol 200:69, 1961.
GORDON, B., KOHN, L. A., LEVINE, S. A.,
MATTON, M., SCRIVEH, W. M., and
WHITING, W. B. Sugar content of the
blood in runners following a marathon
race. JAMA 85:508, 1925.
HINKLE, L. E., CONGER, G. B.,
and
WOLF, S. Studies on diabetes mellitus:
the relation of stressful life situations
to the concentration of ketone bodies
in the blood of diabetic and non-diabetic humans. J Clin Invest 29:754,
1950.
HINKLE, L. E., and WOLF, S. The
ef-
fects of stressful life situations on the
concentration of blood glucose in diabetic and non-diabetic humans. Diabetes 1:383, 1952.
JENKINS, D. J. A. Effects of nicotinic
acid on carbohydrate and fat metabolism during exercise. Lancet 1:1307,
1965.
KLINE, M. V. The nature of hypnotically induced behaviour. Psychol Rep 6:
332, 1960.
MARBLE,
A.
"Hyperinsulinism
and
Chronic Hypoglycemia." In The Treat-
390
STRESS A N D METABOLISM I N DIABETICS
meat of Diabetes Mellilus (ed. 10).
Joslin, E. P., Root, H. F., White, P.,
and Marble, A., Eds. Lea, Philadelphia,
1959.
J3. MEYEJI, A., BoLLMiiitA, L. N., and
ALEXANDER, F. Correlation between
emotions and carbohydrate metabolism
in two cases of diabetes mellitus. Psychosom Med 7:335, 1945.
14.
15.
16.
17.
IS.
SALOATAN, L. L.,
and
JOHNSON, J.
E.
Enzymatic microdetenninatjou of glucose in blood and urine. Anal Ckcin-31:
453, 1959.
19.
SUSSMAN,
K.
E.,
CKOUT,
R.
J.,
and
MARBLE, A. Failure of warning in
insulin induced hypoglycemic reactions.
Diabetes 12:38, 1963.
20.
WELLEH, C , LINDER, M., NULAND, W.,
and KLINE, M. V. The effects of hypnotically-induced emotions on continuJ. A., and MCMUBTY, M. Effect of
ous, uninterrupted blood glucose meashypnotically induced anxiety on the
urements. Psychosomatics 2:375, 1961.
plasma hydrocortisone level of normal
subjects. / Clin Endocr 19:700, 1959. 21. W O L F F , C. T., FRIEDMAN, S. B., HOFEB,
M. A., and MASON, J. W. Relationship
PETERS, J. P., and VAN SLYKE, D. D.
between psychological defenses and
Quantitative Clinical Chemistry Intermean urinary 17-hydroxycorticosteroid
pretations (Vol. I., ed, 2 ) . Williams
excretion rates. I. A predictive study
and Wilkins, Baltimore, 1946, p. 301.
of parents of fatally ill children. PsySACHAH, E. J., FISHMAN, J. R.,
and
chosom Med 26:576, 1964.
MASON, J. W. The influence of the
hypnotic trance on plasma 17-hydroxy- 22. W O L F F , C. T., HOFEB, M. A., and
MASON, J. W. Relationship between
corticosteroid concentration. Psychosom
psychological defenses and mean uriMed 26:635, 1964.
nary 17-hydroxycorticosteroid excretion
SAIFEH, A., GEBSTENFELD,
S.,
and
rates. II. Methodologic and theoretical
ZYMABIS, M. C. Rapid system of microconsiderations. Psychosom Med 26:592,
chemical analysis for the clinical labo1964.
ratory. Clin Chem 4:127, 1958.
PERSKY,
H.,
GBOSZ,
H.
J.,
NORTON,
Course in Postgraduate Gastroenterology
The annual course in Postgraduate Gastroenterology of the American
College of Gastroenterology will be given at the Bellevue Stratford in
Philadelphia, Pa., Oct. 27-29, 1966. The moderators for the course will
again be Dr. I. Snapper, Consultant, Ft. Hamilton Veterans Administration
Hospital, Brooklyn, N. Y., and Dr. John L. Madden, Clinical Professor of
Surgery, New York Medical College and Director of Surgery, St. Clare's
Hospital, New York, N. Y. The faculty for the course will be drawn from
the medical schools in and around Philadelphia. The subject matter to be
covered, from the medical as well as the surgical viewpoint, will be essentially, the diagnosis and treatment of gastrointestinal diseases and comprehensive discussions of diseases of the esophagus, stomach, pancreas,
liver and gallbladder, small intestine, and colon. A session on instrument
techniques will be held at the Albert Einstein Medical Center, Northern
Division.
For further information and enrollment, write to the American College
of Gastroenterology, 33 W. 60 St., New York, N. Y. 10023.
PSYCHOSOMATIC MEDICINE