The Function of the Psycho-Biochemistry Laboratory
- Author:
Max Trumpee, Ph.D.
In charge of Psycho-biochemistry Laboratory, Psychological Clinic University of Pennsylvania There has been a rapid multiplication of specialism in all sciences since the “World War. This has enormously extended our detailed knowledge in the laboratory and in the clinic. The available data have become unwieldy. At a recent meeting of the British Society for the Advancement of Science, it was stated that we now need abstractors of abstracts and reviewers of reviews. It now becomes essential to inter-relate the data gathered in the specialties.
This furnishes a fertile field for mutual advances. This need has been recognized by the establishment of the pioneer Psychobiochemistry Laboratory in the Psychological Clinic of the University of Pennsylvania, in September, 1924. The inter-relationship of physiology and psychology is becoming more evident. The recent example of Pavlov and others who presented papers at both the meetings of the International Congress of Psychology and the International Congress of Physiology is a case in point. It is of interest to note that the point of view in physiology has shifted from the mechanical and morphologic to the dynamic and biochemical. With this change have come extensive advances in the field of physiology. While it is true that psychology cannot afford entirely to wait for progress in other experimental sciences, it should not, however, neglect the findings that become available in the fields of physiology and biochemistry. This was impressed upon the writer by the papers presented this summer at the sessions of the XHIth International Congress of Physiology. A number of the papers were as important to the psychologist as to the physiologist.
By making a biochemical approach to clinical cases as well as by research along experimental lines, Psychology can make its contributions more comprehensive. In this way the diagnosis, prognosis and treatment of Clinic cases, especially those with metabolic etiology, will be better understood. Furthermore it will serve to rule out organic disease as a predisposing or actually exciting cause of a given mental disturbance. A vast unexplored field lies in the chronic forms of poisoning both exogenous and endogenous which affect in varying degrees the mental processes. This is assuming increasing importance in the industrial field. The problem of fatigue in industry as well as in school, necessitates at least in part a biochemical approach.
It has been observed in this Clinic over a period of years that many of the problem children of school age were apathetic, phlegmatic and even lethargic, without any apparent physiologic or metabolic defects. By studies made in our Psycho-biochemistry Laboratory it had been found from analysis of the alveolar air and the hydrogen-ion concentration of the saliva that many of these cases were overloaded with carbon-dioxide.1
It is known to students of acid-base equilibrium2 of the blood that the lungs daily excrete the carbon-dioxide equivalent of twenty to forty liters of normal acid, while the kidneys excrete daily the equivalent of only one-tenth of a liter of normal acid. In view of these facts it is surprising that medical men have neglected to observe and study breathing defects until gross pathology developed. I made blood chemistry analyses, complete counts, metabolic and vital capacity tests including spirographic tracings and found the cause for this overloading of carbon-dioxide to be due to inefficient breathing. I further found that several of these individuals had developed a tolerance for carbon-dioxide, giving a spirogram of slow breathing which is similar to that obtained in early emphysema. In this regard I want to emphasize the fact that breathing efficiency cannot be estimated merely by inspection. “A doubling of the volume breathed per minute is scarcely or not at all noticeable either by the breather himself or by the casual observer unless he measure it.”3 All spirograms were obtained by the use of the Sanborn Metabolic apparatus under basal metabolic conditions and in every instance a trial test was made at first to acquaint the subject with the procedure and to insure a state of mental calm which is essential to an accurate metabolic determination and the spirographic tracings. On all subjects showing a tolerance for carbon-dioxide rebreathing tests were performed (increasing amounts of carbon-dioxide 1 Henry, E. Starr. The E-ion Concentration of Mixed Saliva as an index of Fatigue. Amer. Jour. Psych., July, 1922, p. 394. Concomitants of High Alveolar Carbon Dioxide. Psychological Clinic, March, 1928.
2 Leffman-Trumper. Compend of Chemistry, 7tli Edition, p. 233. ? Henderson and Haggard, 1925. Noxious Gases and Respiration.
were given) and the extent of their tolerance determined. This type of inefficient breathing afforded an explanation of some of the fatigue or toxic symptoms which brought these cases to the Clinic. Briefly, fatigue is due either to an excess of the end products of normal metabolism especially of carbon-dioxide, or to toxins resulting from abnormal metabolism or to chronic but mild asphyxiation. The psychological effects of fatigue, though variously produced are strikingly similar. We can, however, classify causally the fatigue by biochemical analysis, particularly by carbon-dioxide and respiratory quotient determinations, metabolic tests, blood studies and lactic acid production. To date I have six cases with more or less marked nasal obstruction showing what I have termed a definite type of resistance breathing. These cases show instability, become easily fatigued, the latter as a result of chronic asphyxiation. A few of these cases have consented to the surgical removal or correction of the obstruction. A new approach to the compensatory mechanism of the blood was studied and reported last year.4 Those subjects showing shallow breathing compensated for this inadequacy by an increase in the number and volume of the red blood cells and the amount of hemoglobin. This year I examined forty additional cases, the findings of which confirmed the above principle of compensation. In addition an extension of this principle has led me to apply it to a new interpretation of cases that have been diagnosed cryptogenic polycythemia, a rare blood disease, in which marked fatigue and symptoms of mental instability are present. My studies on one of these cases show that the breathing is very shallow, inefficient and fixedly so, with a markedly low vital capacity, compensated for by an eighty-nine per cent increase in the number of red blood cells.5 The accepted treatment is giving phenyl hydrazine in order to destroy the excess red cells. But inasmuch as the breathing is fixed in type and the blood compensation automatic, the medication has merely a transitory effect. I therefore contend that the proper therapy should be daily, extended inhalations of oxygen with minimum physical exertion, in order that the blood shall not continue to compensate by producing an oversupply of red cells and hemoglobin. Nervous excitement and mental worry have been suggested
as the exciting cause in some of these cases. The point I wish to emphasize, however, is the marked fatigue symptoms of the cases studied which illustrate once again the inter-relationsliip of Psychology and Biochemistry and demonstrate the ways in which the Clinical Psychologist may utilize the findings of the biochemical laboratory.
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