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History of Medicine |

Can Stress Cause Disease? Revisiting the Tuberculosis Research of Thomas Holmes, 1949-1961

Barron H. Lerner, MD
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From the College of Physicians and Surgeons of Columbia University, New York, New York. For the current author address, see end of text. Grant Support: Dr. Lerner is an Arnold P. Gold Foundation Assistant Professor. Requests for Reprints: Barron H. Lerner, MD, Department of Medicine, Columbia University, Black Building-101, 650 West 168th Street, New York, NY 10032.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;124(7):673-680. doi:10.7326/0003-4819-124-7-199604010-00008
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The increasing emphasis in medicine on treating the whole patient has focused attention on the association between emotions and disease.However, physicians have long studied the connection between mind and body. One particularly interesting researcher in this area was Thomas Holmes, a charismatic and iconoclastic Seattle physician who studied the association between stress and tuberculosis in the 1950s. Although lacking the sophistication of modern biostatistics, several of Holmes' studies suggested that persons who had experienced stressful situations, such as divorce, death of a spouse, or loss of a job, were more likely to develop tuberculosis and less likely to recover from it. Holmes consciously used the same scientific methods as his peers, devising a numeric scale that quantified stressful events and doing prospective studies with control groups. Yet, he also emphasized the need to understand each patient's story and to view his or her tuberculosis as the culmination of a life of emotional hardship.

Although Holmes' work was rudimentary, his basic supposition may have been correct.Recent research, benefiting from advances in both immunology and biostatistics, suggests that stress may lead to decreased immune function and thus to clinical disease. As studies of stress and disease become more statistically sophisticated, it will be important to retain Holmes' emphasis on understanding the lives of individual patients.


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Figure 1.
The relation of 17-ketosteroid excretion to emotional state and extent and character of disease in patients with pulmonary tuberculosis.

Reprinted with permission from Holmes TH. Multidiscipline studies of tuberculosis. In: Sparer PJ, ed. Personality, Stress and Tuberculosis. New York: International Universities Pr; 1956:121 (reference 68).

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Figure 2.
The number of “disturbing occurrences” in tuberculous employees in relation to time.

Reprinted with permission from Holmes TH. Multidiscipline studies of tuberculosis. In: Sparer PJ, ed. Personality, Stress and Tuberculosis. New York: International Universities Pr; 1956:99 (reference 68).

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