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RESPIRATORY EFFICIENCY
THE PSYCHOLOGY OF
THE LANCET LONDON:SATURDAY, SEPTEMBER 24, 1932
THE PSYCHOLOGY OF DELINQUENCY
DELINQUENCY
687
allowed easy access and seems to have received’ full encouragement, but it is easy to read between. the lines and deduce that the authorities of rescue, and preventive homes still distrust modern methods. A stipulation that the investigation was to be in. mental testing alone was one of the factors that made one establishment unsuitable for the purposes of the work, and Dr. PAILTHORPE notes that some of her continental colleagues, whom she visited and whose methods she describes, agreed that superintendents are very unwilling for any treatment that does not act by magic or which entails time for its fulfilment. Yet the main lesson of the report is the need for treatment. The casehistories are often long records of misery arisingnot merely from material circumstances, but from inner difficulties. There are 111cases (56 prison, 55 preventive) for whom psychological treatment in one form or another is deemed necessary ; in addition, mental defectives and constitutional inferiors require segregation or supervision. Dr. PAILTHORPE estimates that of her prison cases 7 per cent. are unlikely to become recidivists, 43 per cent., if psychologically treated, may not. become recidivists, 13 per cent. will become recidivists unless treated, perhaps permanently, in hospitals or asylums, and 37 per cent. will inevitably become recidivists unless carefully
IN his attempt to control natural processes the human agent may work by the light of tradition, by rule of thumb, or, in this scientific age, by applying the results of a careful preliminary study of the processes. Such methods failing we try to find out why. In the control of our criminals and delinquents it would be rash to say that we use even rule of thumb, for the published careers of the men tried for their share in the late mutiny at Dartmoor, with the appalling lists of repeated terms of lengthy imprisonment, exclude any empirical justification of our penal system. This is, however, so traditional that any challenge to it is likely to call up every kind of oppositionanger, derision, or imperturbability. Grafted to i tradition there is a theory, based upon a belief supervised or segregated. Mental conflict, so commonly found in the cases: in intelligent selfishness as the foundation of is evidence of the presence of here behaviour, that a well-adjusted scale of punish- social reported, sentiment, or there could be no conflict.. ment suffices to ensure good conduct, that when a This sentiment could, it is held, be developed by criminal gets what we think he deserves he will treatment or intensive social cease from crime and that fear of punishment will psycho-analytical and PAILTHORPE makes the novel Dr. keep away recruits : a perfect theory with only education, that we are wasting scientific material as well That defect, however, prompts some plea one defect. as public money and human lives. cases wherepeople to apply the scientific method in finding the time for reclamation, if it wereInever present, out why criminals are what they are, and how has she shows that gone, public protection calls society can best deal with them ; to handle crime for the of legal recognition dangerous types not and delinquency, that is, just as we handle other and recalls the paranoid reactions of certifiable, urgent problems. and Kennedy (both of whom had underThis scientific aim implies the study of the Brown gone penal servitude and one a flogging before material, of the criminal himself ; apart from the the murder of police-constable Gutteridge).. light that psychopathology throws upon social Of this type she says, " Yet we treat him as a, maladjustments in general, special work has been mentally stable individual, who will react in a. done in America by HEALY and in this country normal way to correction by refraining from by HAMBLIN SMITH, whose book on the " Psycho- committing the same act again. We let him in logy of the Criminal," now recognised as a landmark and out of prison, to prey upon the public until in English criminological literature, we welcomed he kills someone, and then we hang him ! " It on its appearance.1 Dr. GRACE W. PAILTHORPE, is time that penology was brought down from the with assistance from the Medical Research Council, clouds of emotion and unreason, to take its placehas been at work for over five years investigating where cause and effect are studied, and where we psychologically the inmates of prisons and pre- shall consider what is instead of what tradition tells ventive and rescue homes, and her results are now us ought to be. available under the title Studies in the Psychology of Delinquency.2 The cases studied numbered 200, and the completeness of the individual RESPIRATORY EFFICIENCY investigations shows a thorough command of SURGEONS are now able to get from physiomodern psychological technique, including that most difficult of all, the removal of the suspicion logists guidance about the efficiency of the kidney that the investigator is busied with moral judg- before undertaking operations on the genitoments. In the prison (Holloway) the worker was urinary system and, as Dr. R. A. YOUNG has pointed out, it would be desirable to offer them the1 THE LANCET, 1922. ii., 765. same kind of help in the selection of Medical Research Council, Special Report Series No. 170. patients for H.M. Stationery Office. Pp. 113. 2s. operation on the chest. Search has long been made2
688
for some criterion of respiratory efficiency other than the number of pillows required by a dyspnoeic patient. Some rough guide may be given by observation of the rate of breathing, the shape and size of the chest, or the degree to which the accessory muscles are coming into action, and by investigation of the amount of haemoglobin in the blood and possibly of the gases dissolved in it. Apart from these it was frankly hoped that the measurement of the vital capacity might aid the surgeon, but this help has largely foundered on the difficulty of determining a normal standard, and the same fallacy has attended the use of various indexes of ventilating power. The variations in health are too wide. Finally some reliance has been placed on the time-honoured method of determining the expiratory force, reintroduced by MARTIN FLACK as a standard in the selection of candidates for the Air Force. But, as Dr. ALAN MONCRIEFF points out in a scholarly study on another page of this issue, taken alone this test is probably of little value for the special purpose of investigating respiratory efficiency before thoracic surgery is carried out. But investigators in various lands are still hopeful. An attempt to measure the efficiency of pulmonary ventilation by studying the response to carbon dioxide has been made by R. GoIFFON, R. PARENT, and J. WALTZ,1 using a spirometer of the concertina pattern to trace the respiratory movements on a revolving drum. The voluntary vital capacity and its
component parts-complementary, tidal,
and reserve air-is first determined and the subject then continues breathing into the apparatus in which the expired carbon dioxide soon accumulates in sufficient concentration to stimulate the respiration. When the limit of endurance is reached the extra ventilation then recorded is called the reflex vital capacity. In normal subjects with a voluntary vital capacity of more than 2 litres these workers distinguish three classes of respiration according as to whether the reflex vital capacity is above, equal to, or less than 2-2 litres ; the relationship between these two values they consider of fundamental importance. For example, an athlete had a voluntary vital capacity of 4-9 and a reflex vital capacity of 4-5 litres, the latter being 90 per cent. of the former. Another subject had a voluntary capacity of 4-6 and a reflex capacity of only 2-2 litres ; his " coefficient of utilisation was only 47 per cent. Whatever the value of this means of testing the ventilating power of the lungs in healthy subjects it would be asking too much of most patients to breathe into a closed space with an increasing carbon dioxide A somewhat less unpleasant method is content. that suggested byT. R. HARRisoN and his co-workers in their description of the " ventilation index," which F. C. TURLEY and he2 have recently applied to an investigation of smoking and athletics. The assumption here is that dyspncea is proportional to the quotient ventilation/vital capacity, with a correction for weight, expected and actual. 1
Presse Méd., July 16th, p. 1113. 2 Amer. Jour. Med. Sci., 1932, clxxxiii., 702.
This index is determined at rest and then after a It was found by comparison with previous figures determined on normal subjects and on patients after various degrees of exercise set series of exercises.
that " heavy " smoking (20
or more
cigarettes
a
day) for several years does not significantly diminish the respiratory efficiency in the performance of mild and moderate exercise. Judged by this index athletic individuals are not much more efficient than sedentary ones in the performance of mild exertion, but are considerably more efficient in carrying out moderately severe exercise. An investigation on quite a different line is reported by F. S. COTTON,3 who has studied the variation in the centre of gravity of the body during respiration to determine whe her there are any sex differences in respiratory movements. This method depends on the fact that in the supine position the movements of the thorax in a vertical direction do not affect the conditions of equilibrium on the special balance employed, while in the sitting position thoracic movements during inspiration produce a caudal displacement of mass, which is indicated by movement of the balance index. If the ratio of measurement expressed as so many gramme-centimetres of mass displacement in the supine posture to that in the sitting posture be calculated, any decrease in the thoracic element must increase the ratio, while a decrease in the abdominal element of respiration will decrease the ratio. After careful corrections for various factors COTTON finds that there is a significant difference between the grouped results for men and women, a decreased value being found for the latter. In other words, there is evidence that women show a definitely increased use of the thorax in respiration a further test indicated as compared with men; that clothing exerted no appreciable restraint in
diaphragmatic
movement
in
the
subjects
examined. In a recent paper A. PEIPER and 0. CAMMANN,4 dealing with asphyxial attacks in the premature infant, throw some new light on the behaviour of the respiratory centre. They deny that respiratory disturbances in the newly born are due to haemorrhages in the medulla (as suggested in a recent annotation in these columns 5), and bring forward experimental evidence to show that similar disturbances can be produced in animals when the main respiratory centre is poisoned by allowing the inspired air to consist of pure carbon dioxide or pure nitrogen. They produced a type of gasping respiration exactly similar to that observed in premature infants, and this they believe is due to a gasping "centre taking control of the respiration after the main centre is put out of action by being temporarily poisoned. This block of the respiratory centre they put forward as an explanation of the respiratory disturbances in premature infants, the excitability of the main respiratory centre being put out of action by various infections, nutritional disturbances, or temperature "
"
"
changes. 3 Austral. Jour. Exp. Biol., June 16th, p. 97. 4 Jahrb. f. Kinderh., July, 1932, cxxxvi., 165. 5 THE LANCET, August 6th, p. 298.
THE LANCET LONDON:SATURDAY, SEPTEMBER 24, 1932
THE PSYCHOLOGY OF DELINQUENCY
DELINQUENCY
687
allowed easy access and seems to have received’ full encouragement, but it is easy to read between. the lines and deduce that the authorities of rescue, and preventive homes still distrust modern methods. A stipulation that the investigation was to be in. mental testing alone was one of the factors that made one establishment unsuitable for the purposes of the work, and Dr. PAILTHORPE notes that some of her continental colleagues, whom she visited and whose methods she describes, agreed that superintendents are very unwilling for any treatment that does not act by magic or which entails time for its fulfilment. Yet the main lesson of the report is the need for treatment. The casehistories are often long records of misery arisingnot merely from material circumstances, but from inner difficulties. There are 111cases (56 prison, 55 preventive) for whom psychological treatment in one form or another is deemed necessary ; in addition, mental defectives and constitutional inferiors require segregation or supervision. Dr. PAILTHORPE estimates that of her prison cases 7 per cent. are unlikely to become recidivists, 43 per cent., if psychologically treated, may not. become recidivists, 13 per cent. will become recidivists unless treated, perhaps permanently, in hospitals or asylums, and 37 per cent. will inevitably become recidivists unless carefully
IN his attempt to control natural processes the human agent may work by the light of tradition, by rule of thumb, or, in this scientific age, by applying the results of a careful preliminary study of the processes. Such methods failing we try to find out why. In the control of our criminals and delinquents it would be rash to say that we use even rule of thumb, for the published careers of the men tried for their share in the late mutiny at Dartmoor, with the appalling lists of repeated terms of lengthy imprisonment, exclude any empirical justification of our penal system. This is, however, so traditional that any challenge to it is likely to call up every kind of oppositionanger, derision, or imperturbability. Grafted to i tradition there is a theory, based upon a belief supervised or segregated. Mental conflict, so commonly found in the cases: in intelligent selfishness as the foundation of is evidence of the presence of here behaviour, that a well-adjusted scale of punish- social reported, sentiment, or there could be no conflict.. ment suffices to ensure good conduct, that when a This sentiment could, it is held, be developed by criminal gets what we think he deserves he will treatment or intensive social cease from crime and that fear of punishment will psycho-analytical and PAILTHORPE makes the novel Dr. keep away recruits : a perfect theory with only education, that we are wasting scientific material as well That defect, however, prompts some plea one defect. as public money and human lives. cases wherepeople to apply the scientific method in finding the time for reclamation, if it wereInever present, out why criminals are what they are, and how has she shows that gone, public protection calls society can best deal with them ; to handle crime for the of legal recognition dangerous types not and delinquency, that is, just as we handle other and recalls the paranoid reactions of certifiable, urgent problems. and Kennedy (both of whom had underThis scientific aim implies the study of the Brown gone penal servitude and one a flogging before material, of the criminal himself ; apart from the the murder of police-constable Gutteridge).. light that psychopathology throws upon social Of this type she says, " Yet we treat him as a, maladjustments in general, special work has been mentally stable individual, who will react in a. done in America by HEALY and in this country normal way to correction by refraining from by HAMBLIN SMITH, whose book on the " Psycho- committing the same act again. We let him in logy of the Criminal," now recognised as a landmark and out of prison, to prey upon the public until in English criminological literature, we welcomed he kills someone, and then we hang him ! " It on its appearance.1 Dr. GRACE W. PAILTHORPE, is time that penology was brought down from the with assistance from the Medical Research Council, clouds of emotion and unreason, to take its placehas been at work for over five years investigating where cause and effect are studied, and where we psychologically the inmates of prisons and pre- shall consider what is instead of what tradition tells ventive and rescue homes, and her results are now us ought to be. available under the title Studies in the Psychology of Delinquency.2 The cases studied numbered 200, and the completeness of the individual RESPIRATORY EFFICIENCY investigations shows a thorough command of SURGEONS are now able to get from physiomodern psychological technique, including that most difficult of all, the removal of the suspicion logists guidance about the efficiency of the kidney that the investigator is busied with moral judg- before undertaking operations on the genitoments. In the prison (Holloway) the worker was urinary system and, as Dr. R. A. YOUNG has pointed out, it would be desirable to offer them the1 THE LANCET, 1922. ii., 765. same kind of help in the selection of Medical Research Council, Special Report Series No. 170. patients for H.M. Stationery Office. Pp. 113. 2s. operation on the chest. Search has long been made2
688
for some criterion of respiratory efficiency other than the number of pillows required by a dyspnoeic patient. Some rough guide may be given by observation of the rate of breathing, the shape and size of the chest, or the degree to which the accessory muscles are coming into action, and by investigation of the amount of haemoglobin in the blood and possibly of the gases dissolved in it. Apart from these it was frankly hoped that the measurement of the vital capacity might aid the surgeon, but this help has largely foundered on the difficulty of determining a normal standard, and the same fallacy has attended the use of various indexes of ventilating power. The variations in health are too wide. Finally some reliance has been placed on the time-honoured method of determining the expiratory force, reintroduced by MARTIN FLACK as a standard in the selection of candidates for the Air Force. But, as Dr. ALAN MONCRIEFF points out in a scholarly study on another page of this issue, taken alone this test is probably of little value for the special purpose of investigating respiratory efficiency before thoracic surgery is carried out. But investigators in various lands are still hopeful. An attempt to measure the efficiency of pulmonary ventilation by studying the response to carbon dioxide has been made by R. GoIFFON, R. PARENT, and J. WALTZ,1 using a spirometer of the concertina pattern to trace the respiratory movements on a revolving drum. The voluntary vital capacity and its
component parts-complementary, tidal,
and reserve air-is first determined and the subject then continues breathing into the apparatus in which the expired carbon dioxide soon accumulates in sufficient concentration to stimulate the respiration. When the limit of endurance is reached the extra ventilation then recorded is called the reflex vital capacity. In normal subjects with a voluntary vital capacity of more than 2 litres these workers distinguish three classes of respiration according as to whether the reflex vital capacity is above, equal to, or less than 2-2 litres ; the relationship between these two values they consider of fundamental importance. For example, an athlete had a voluntary vital capacity of 4-9 and a reflex vital capacity of 4-5 litres, the latter being 90 per cent. of the former. Another subject had a voluntary capacity of 4-6 and a reflex capacity of only 2-2 litres ; his " coefficient of utilisation was only 47 per cent. Whatever the value of this means of testing the ventilating power of the lungs in healthy subjects it would be asking too much of most patients to breathe into a closed space with an increasing carbon dioxide A somewhat less unpleasant method is content. that suggested byT. R. HARRisoN and his co-workers in their description of the " ventilation index," which F. C. TURLEY and he2 have recently applied to an investigation of smoking and athletics. The assumption here is that dyspncea is proportional to the quotient ventilation/vital capacity, with a correction for weight, expected and actual. 1
Presse Méd., July 16th, p. 1113. 2 Amer. Jour. Med. Sci., 1932, clxxxiii., 702.
This index is determined at rest and then after a It was found by comparison with previous figures determined on normal subjects and on patients after various degrees of exercise set series of exercises.
that " heavy " smoking (20
or more
cigarettes
a
day) for several years does not significantly diminish the respiratory efficiency in the performance of mild and moderate exercise. Judged by this index athletic individuals are not much more efficient than sedentary ones in the performance of mild exertion, but are considerably more efficient in carrying out moderately severe exercise. An investigation on quite a different line is reported by F. S. COTTON,3 who has studied the variation in the centre of gravity of the body during respiration to determine whe her there are any sex differences in respiratory movements. This method depends on the fact that in the supine position the movements of the thorax in a vertical direction do not affect the conditions of equilibrium on the special balance employed, while in the sitting position thoracic movements during inspiration produce a caudal displacement of mass, which is indicated by movement of the balance index. If the ratio of measurement expressed as so many gramme-centimetres of mass displacement in the supine posture to that in the sitting posture be calculated, any decrease in the thoracic element must increase the ratio, while a decrease in the abdominal element of respiration will decrease the ratio. After careful corrections for various factors COTTON finds that there is a significant difference between the grouped results for men and women, a decreased value being found for the latter. In other words, there is evidence that women show a definitely increased use of the thorax in respiration a further test indicated as compared with men; that clothing exerted no appreciable restraint in
diaphragmatic
movement
in
the
subjects
examined. In a recent paper A. PEIPER and 0. CAMMANN,4 dealing with asphyxial attacks in the premature infant, throw some new light on the behaviour of the respiratory centre. They deny that respiratory disturbances in the newly born are due to haemorrhages in the medulla (as suggested in a recent annotation in these columns 5), and bring forward experimental evidence to show that similar disturbances can be produced in animals when the main respiratory centre is poisoned by allowing the inspired air to consist of pure carbon dioxide or pure nitrogen. They produced a type of gasping respiration exactly similar to that observed in premature infants, and this they believe is due to a gasping "centre taking control of the respiration after the main centre is put out of action by being temporarily poisoned. This block of the respiratory centre they put forward as an explanation of the respiratory disturbances in premature infants, the excitability of the main respiratory centre being put out of action by various infections, nutritional disturbances, or temperature "
"
"
changes. 3 Austral. Jour. Exp. Biol., June 16th, p. 97. 4 Jahrb. f. Kinderh., July, 1932, cxxxvi., 165. 5 THE LANCET, August 6th, p. 298.