BEHNKE'S
STAMMERING,
CLEFT-PALATE SPEECH,
LISPING
BEHNKE'S
STAMMERING,
CLEFT-PALATE SPEECH,
LISPING
SECOND EDITION, REVISED AND ENLARGED BY
KATE EMIL-BEHNKE
LONDON
BAILLIERE, TINDALL AND COX
8, HENRIETTA STREET, COVENT GARDEN
1922
siouxrr
'
PREFACE
THE last edition of the treatise on " Stammering,
Cleft -Palate Speech, and Lisping " by my parents
being exhausted, it has seemed desirable to revise
and amplify it, adding thereto the results of my own
work in carrying on the method which has been so
successful over a period of some forty years in the
treatment of stammering, defects of speech, and the
training of the voice for speaking and singing.
I wish to express my thanks to the medical pro-
fession, to the Press, and to the public generally,
for the support and for the approbation of the
method which they have so frequently and
generously expressed.
KATE EMIL-BEHNKE.
39, EARL'S COURT SQUARE, S.W. 5.
September, 1922.
6ft t 7
CONTENTS
PAGE
PART I. BY EMIL BEHNKE - i
PART II. BY MRS. BEHNKE - 25
PART III. BY KATE EMIL-BEHNKE - .73
vn
PART I
BY EMIL-BEHNKE
A reprint of a paper on " Stammering : Its Nature
and Treatment" read before the South Wales Branch
of the British Medical Association, and before a
medical gathering at the Central London Throat,
Nose, and Ear Hospital.
PART I
STAMMERING
DEFINITION
THE terms stammering and stuttering are regarded
by some authors as interchangeable, implying the
same thing. Others insist strongly upon the neces-
sity of distinguishing the one from the other, as
implying two entirely different things.
My own definition is this :
Stammering and stuttering are impediments of
speech, consisting of spasmodic, or entirely sus-
pended, action of any part or parts of the vocal
apparatus, from the diaphragm to the lips.
Stammering is a defect in the utterance of con-
sonants, rather than in the utterance of vowels.
Stuttering is a defect in the utterance of vowels,
rather than in the utterance of consonants.
Both impediments are frequently found in thej
same person, and both are due to the same cause-
inability to vocalise. The two terms may, therefore,
be considered as interchangeable.
If a stammerer wants to say pa, he has a kind of
3
; . 4., ' '..THE -TREATMENT OF STAMMERING,
lockjaw, and cannot get the consonant p out at all.
This feat once accomplished, he generally has no
difficulty in adding the vowel to the consonant. But
he may be equally fixed in trying to utter a word
commencing with a vowel, when, in spite of widely-
opened mouth, no sound will be 'forthcoming.
If a stutterer wants to say pa, the case is exactly
reversed. He has no difficulty in articulating the
consonant p, which, on the contrary, he repeats
over and over again with astonishing rapidity ; his
difficulty consists in adding the vowel to it. But it
is by no means uncommon for a stutterer to go
through the same process of repetition when trying
to pronounce a word commencing with a vowel.
It will thus be seen that the defects of speech
called stammering and stuttering overlap, and it is
not too much to say that in many, if not in most,
instances, the one accompanies the other. The
question whether a given case is one of stammering
4 or of stuttering is therefore^in my opinion, more
theoretical than practical, and I shall consequently,
in order not unnecessarily to complicate matters,
"always use the term stammering to include both
impediments.*
* " Mr. Behnke sets aside this refinement of onomatopoeia
and asks us, we think judiciously, to employ the term
stammer for both, thus simplifying the matter at the onset,
5 as the conditions are often identical and their differences quite
/ non-essential." Journal of Laryngology, July, 1891.
CLEFT-PALATE SPEECH, AND LISPING 5
Mere indistinctness of speech, lisping, the burred
r, the misplaced h, the defective /, g, or k, the
substitution of w for r, of b for m, or of d for n, etc.,
do not come under the head of stammering in any
sense of the word. Their causes are local, they are
clear and unmistakable. The causes of stammering,
on the other hand, are not local, but must be sought
in disturbed action of the nervous centres concerned
in the production of speech. If speech is to be
perfect, there must be harmonious co-operation of
the several mechanisms of respiration, phonation,
and articulation, all of which are known to be under
the direct and immediate influence of that portion
of the brain which is known as the " bulb," or the
" medulla oblongata," where the centres of these
mechanisms are situated close together.
Spasm in these nervous arrangements may occur,
and does occur, without any gross material lesion
of the structure of the bulb, from disturbed mole-
cular action simply ; and this circumstance enables
us to understand why special training of the affected
nervous centre, with the view of inducing har-
monious action of the three mechanisms concerned
in speech, may succeed in overcoming the habit of
stammering in a large number of cases, provided
there are no local or general complications which
would render a cure by elocutionary treatment alone
~-
impossible.
6 THE TREATMENT OF STAMMERING,
WARNING
i A general notion prevails that a child will " grow
out " of stammering, and in some instances the
impediment does indeed diminish as the powers of
reflection and of self-control increase with maturer
age. But in the vast majority of cases the child will
no more grow out of stammering than it would grow
out of a physical deformity ; the impediment will,
on the contrary, increase, and become more and
more intractable.
If stammering is attended to when first it shows
itself, it may be prevented, and as prevention is
proverbially better than cure, parents ought to be
watchful of their children from infancy.
What shall we say of parents who are thought-
less and indifferent enough not only to neglect the
first traces of stammering, but who even foster and
aggravate the impediment by laughing at the little
sufferer and by mimicking him? A mother who
was in the habit of doing this once said in my
hearing to her little boy : 4< Ch-arlie, will you have
s-s-some c-c-cake?" Is it to be wondered at that
Charlie replied : " P-p-please, m-m-mother " ? And
is it surprising that his younger sister, as soon as
she was old enough to talk, also commenced to
stammer? Charlie acquired the impediment by
unconsciously imitating his father, from whom both
children probably inherited a predisposition. Baby,
CLEFT-PALATE SPEECH, AND LISPING 7
after the father's death, acquired it by unconsciously
imitating Charlie, and the mother, by her folly,
perpetuated the defect. It is a sad picture, but not,
I am afraid, a unique one.
In another case which came under my notice, a
mother who was a strict disciplinarian of the old
school, now happily fading out of existence, looked
upon the stammering of her little boy as the result
of obstinacy or carelessness, and thrashed him
accordingly. It is needless to say that he grew
morose, sullen, and resentful; his speech became
worse, and his whole character was ruined.
I am not here concerned with the way in which
children should be treated in general, but only in
reference to my special subject, and I say em-
phatically that parents should, upon the very first
indication of an impediment of speech, display the
greatest loving-kindness, and exercise the most
patient and untiring perseverance in order to counter-
act and to correct any hesitation or stumbling.
Much mischief is also frequently done by school
teachers, who, by indifference, impatience, and want
of sympathy, intensify the impediment of a stam-
mering boy, and thus unwittingly make his young
life a misery. The poor boy, although knowing his
lesson perfectly, cannot give a ready utterance to it,
and the teacher passes him over with a cruel " Oh,
I have not time to wait for you 1 Next boy 1"
THE TREATMENT OF STAMMERING,
Just a few words about the teasing, the bullying,
and the mimicking that a stammerer is frequently
subjected to by his companions. Boys will be boys,
of course, and we cannot expect from them the
thoughtfulness which comes with maturer age ; but
they are naturally generous, and a headmaster with
his heart in the right place will have little difficulty
in showing them the cowardice of making fun of an
affliction which is often worse than a curvature of
, the spine, though it may, to those without under-
standing, appear but a trifling matter. Should,
however, the appeal to their higher nature fail, then
the offenders must be sternly dealt with as would
be the bully who torments a little fellow who is
incapable of defending himself.
Causes of Stammering
In order to ascertain the causes of stammering in
any given case, we have to inquire into it (a) from
a pathological, (b) from a mental, and (c) from an
elocutionary point of view. But although I propose,
for the sake of convenience, to discuss the subject
under these heads, it must ever be borne in mind
that, so far from any of these different aspects being
clearly defined in actual cases of stammering, they
are, as a rule, inextricably mixed up with each other ;
and it is this circumstance which often makes it so
difficult to grapple with the evil.
CLEFT-PALATE SPEECH, AND LISPING 9
PATHOLOGICAL ASPECT
I heard some time ago a lecture by a gentleman
who advertises himself extensively as a curer of
stammering, in which he asserted that the more he
had to do with stammerers the more he became
convinced that there was nothing the matter with
them physically, that their difficulty was entirely
elocutionary, and that they could be completely
cured by elocutionary treatment alone. / deny this
in toto, and assert, on the contrary, that there are
very jew cases of stammering indeed in which there
is no necessity for medical aid before elocutionary
treatment can be of the slightest avail. Thus it is
absolutely necessary first to treat any affections of
the mouth or throat, or any general morbid con-
dition of the system which may be present, and
which may be exciting causes of stammering, or
may aggravate pre-existing habitual stammering.
Stammering is, indeed, sometimes entirely due to
such nervous affections as epilepsy, hysteria, or
locomotor ataxy, in which mere voice-training could
not, in the nature of things, be expected to lead to
any useful result, as in such cases the speech
difficulty is but a symptom of a graver disorder. It
is chiefly in the hope of calling the attention of
medical practitioners to this matter, and of exciting
their interest in it, that I have undertaken to write
io THE TREATMENT OF STAMMERING,
this paper, and will venture to relate to you a few
of my experiences, from which you will draw your
own conclusions.
CASE I. is that of a young girl whom I had known
for some years before her mother brought her to
me with regard to an impediment of speech. She
was very tall, very thin, easily fatigued, unable to
sit upright, constantly desirous of lying down. I
gave her a few lessons, but was dissatisfied with
the result, and advised her mother to have her
thoroughly examined by a medical practitioner. It
was then discovered that she had slight lateral spinal
curvature, for which she underwent treatment for a
considerable time. Some years have passed since
then, and not only has the spinal weakness been
overcome and her health fully established, but the
elocutionary exercises, which she has since resumed,
have rapidly produced the desired effect, so that she
has now lost her impediment completely and is able
to gratify her wish to go on the stage. In this case,
without doubt, the original cause of the stammering
was debility of her nervous system, due to spinal
affection.
CASE II. is that of the son of a medical man. The
boy's naso-pharyngeal passages were obstructed by
adenoid growths, which were diagnosed by the
specialist to whom he was taken to be the cause of
the impediment. The child was first operated upon,
CLEFT-PALATE SPEECH, AND LISPING n
and then sent to me, and, as a result of this pre-
liminary treatment, I was enabled to effect a cure,
which I am convinced I could not have done other-
wise.
The surgeon who sent the patient to me furnished
me with the following explanation of the case :
"The boy's respiration through the natural
passages was impeded, and as a result he had one,
if not all, of several conditions. First, his lungs
were not sufficiently aerated, and a vicious, in-
efficient, and jerky respiration resulted. This in
turn led either to general venous congestion, impli-
cating the brain, and so causing the boy to be
neurotic, and in addition, to use a new word,
aprosectic, which here signifies that he had not the
power to pay proper attention to his speech-educa-
tion ; or it may, as it often does, also have impaired
his hearing, not necessarily of ordinary sounds, but
of the appreciation of the refinements of speech ;
and, lastly, actual congestion of the organs of voice
and speech may have arisen which mechariically
impeded them."
CASE III. is that of a young man who was
addicted to masturbation. This had been recog-
nised by his medical adviser, but denied by the
patient. The pupil had not, however, been in my
house many days before I was convinced that his
doctor's suspicions were justified.
12 THE TREATMENT OF STAMMERING,
Of the good effects of surgical treatment for this
condition as a preliminary to speech treatment I
have at the present an example under my care.
If there is any reason to suspect that this practice
is being carried on by stammerers of either sex, the
family physician's advice should be sought as to
the best means of dealing with the matter.
Other points of irritation besides those just
mentioned are nasal polypus, deflected septum, or
any other nasal blockage, enlarged tonsils, elon-
gated uvula, decayed teeth, intestinal worms, etc.
\ Having thus insisted that it is in most instances
impossible for the treatment of stammering to
progress satisfactorily and thoroughly without
medical aid, or at least without preliminary medical
inspection and authoritative assurance as to absence
of constitutional cause, I must also express my con-
viction that the cure of stammering by medical
treatment alone, unassisted by elocutionary aid, is
equally impossible ; it cannot create new habits of
speech. These have to be carefully and patiently
formed by the teacher.
MENTAL ASPECT
3 A stammerer, when alone or in company with
intimate friends, can frequently talk as easily and
fluently as persons not afflicted ; yet the moment he
has to address a stranger his power of utterance is
CLEFT-PALATE SPEECH, AND LISPING 13
impeded, or even completely suspended. Here we
have incontestable proof that his organs of speech
are perfectly normal, and that his difficulty is not
physical but mental.
Amongst mental causes of stammering may be
mentioned timidity, shyness, distrust, fear of ridi-
cule, eagerness, impatience, excitement, envy, and
irritation. A person may even stammer in his
thoughts in consequence of flightiness and for want
of concentration ; this will of necessity be reflected
in his speech. Such cases are generally put down
to nervousness, which, however, may in some cir-
cumstances be not the cause but the result. I say
advisedly that these cases of nervousness in which
the physician has been unable to detect an objective
cause are essentially those to be treated by the
skilled and patient teacher, and that they can neither
be alleviated by tonics nor by general gymnastics.
The instructor must first of all gain the most
absolute confidence of, and influence over, his pupil,
and then lead him into habits of calmness, of
deliberation, and of self-reliance.
It is also important to divert the sufferer's mind
from his impediment, for the more he concentrates
his attention upon it, the more will his difficulty
increase. To this end it is sometimes useful to
direct the stammerer to accompany each trouble-
some syllable by some slight movement of a finger,
14 THE TREATMENT OF STAMMERING,
the hand, or the foot, etc., as enforced by the late
Canon Kingsley, thereby diverting his attention
from the effort to speak to the performance of a
muscular action, and his impediment is often
entirely, though only temporarily, removed. This
is one of the remedies forming the stock-in-trade
of so many so-called stammer-curers, who indis-
criminately apply it to all cases, and it has
consequently fallen into considerable disrepute.
Nevertheless, it has its legitimate uses, and will,
judiciously employed, sometimes be of considerable
assistance. It is, however, nothing more than a
device, to be used temporarily, until the stammerer
has by systematic training obtained control over the
muscles of respiration and articulation.
ELOCUTIONARY ASPECT
This section may be best commenced by a con-
sideration of the question whether it is possible to
form an opinion as to the chances of success or
otherwise in undertaking the treatment of any par-
ticular case. The matter having been considered in
its pathological and mental aspects, I am now only
looking at it from an elocutionary point of view, and
experience has taught me to divide my cases into
two classes viz., those in which the difficulty can
be traced to the management of the bellows, and
those in which it cannot. To illustrate : A patient
CLEFT-PALATE SPEECH, AND LISPING 15
presents himself who stammers badly . When trying
to say the alphabet, he can scarcely pronounce a
single letter, and upon endeavouring to reply to
questions put to him, his whole body is thrown into
violent contortions, so that it is positively painful
to look at him. I now place him on a couch, flat on
his back, comfortably raising his head on a pillow,
and then give him some diaphragmatic drill. As
soon as he has acquired sufficient control over the
diaphragm, I direct him once more to say the
alphabet, taking a very short inspiration before
each letter by contracting the diaphragm, and then
attacking the letter by relaxing the diaphragm. I
control these movements by holding my hand on
his abdomen, and he now, to the amazement of
friends who may have accompanied him, pro-
nounces every letter as quietly and as easily as they
could do themselves. In these circumstances I am
always confident of success; cure is certain, pro-
vided I have the patient under my absolute control,
and that sufficient time be allowed.
If, on the other hand, the impediment is as great
in the circumstances just described as it was before,
I am doubtful of success ; and I must, in such cases,
rely upon what I may call local remedies instead
of being able to devote myself to the removal of
the fundamental difficulty. The cases in which the
speech trouble can be traced fundamentally to the
16 THE TREATMENT OF STAMMERING,
management of the breath are, fortunately, in the
vast majority, and the results obtained by training
a patient to manage his voice by means of diaphrag-
matic action are sometimes almost miraculous.
The following case illustrates my point. The
Rev. H. H. suffered from spasm of the glottis to
such an extent as to make speaking almost impos-
sible, while his efforts were painful both to hear and
to see. He had been for years under medical treat-
ment, and had by advice resided for five years
abroad, without beneficial result. Upon putting
him to the test just described, I found that his
difficulty, for the time being, entirely disappeared,
and I came to the conclusion, therefore, that the
real seat of the trouble was in the diaphragm, and
that the spasms in the glottis were merely reflex
action. I treated him accordingly, and after a very
short course of treatment received from him the
following letter: " I am sure you will be pleased
to hear that last Sunday evening I preached in
Cathedral in the nave, and was heard perfectly
throughout the whole building, both in the choir
and down to the end of the nave. People have
remarked what a strong voice I have ! With God's
blessing, I owe this to your skill."
There are some authors who consider that lateral,
or purely costal, breathing may be exercised without
diaphragmatic action. Assuming this to be pos-
CLEFT-PALATE SPEECH, AND LISPING 17
sible, the effort involved would in itself render it
undesirable for stammerers ; and, moreover, infla-
tion which is commenced by lateral expansion is
exceedingly liable to degenerate into clavicular
breathing.
The question may be asked why diaphragmatic
breathing should have such beneficial influence
upon the propulsion of the voice. To this a variety
of replies may be given. The chief reason, in my
judgment, is that by clavicular breathing we set in
motion machinery which is unyielding and clumsy,
owing to the bony structure of the upper part of the
thorax, and over which it is therefore impossible to
get easy and delicate control ; while the diaphragm
exercises muscular force on that portion of the chest
walls which is surrounded only by soft and yielding
parts, and which can therefore be trained to act with
the utmost certainty and precision.
It is a very common fault with stammerers to try
to speak with empty lungs ; they let out all the air
they can dispose of, and then try to speak ; which
is, of course, a hopeless task. In such circumstances
the patient has to be taught economy of breath,
which, after having gone through the necessary
diaphragm drill, is a comparatively easy matter.
But stammerers attempt as frequently to speak with
unduly distended lungs, which is just as fatal to an
easy and smooth delivery ; and this is a fact which
i8 THE TREATMENT OF STAMMERING,
does not, I think, receive the attention it deserves.
To counteract this habit it is necessary to train the
patient to breathe more lightly and more frequently
than he has been accustomed to do.
PHONATION DRILL
This depends primarily, so far as the larynx is
concerned, upon the action of the adductors, or
closing muscles of the vocal cords. If these did not
act at all, no production of tone would be possible,
however perfect the remainder of the vocal apparatus
might be, and it is quite clear, therefore, that if they
act with uncertainty the voice will be produced with
uncertainty. If they act smartly and promptly the
voice will be produced smartly and promptly. It is
necessary, therefore, to educate these muscles in
order to jjnsure the proper attack of tone commonly
called the " shock of the glottis." This is accom-
plished by directing the stammerer to sing a number
of staccato tones, each one preceded by a short
inspiration. For each intake of breath, which is the
motor element, the abductors, or opening muscles,
separate the cords and open the glottis, and for
every tone, however short, the adductors, or closing
muscles, by causing approximation of the cords,
close the glottis; and these smartly and frequently
repeated movements have the effect, not only of
strengthening the opening and closing muscles of
CLEFT-PALATE SPEECH, AND LISPING 19
the glottis, but also of increasing the patient's
control over them.
Similar drill should be applied to the soft palate,
the influence of which upon the voice is much
greater than most people who have not paid special
attention to the subject have any conception of ; and
it should be remembered that, in the case of
adenoids, enlarged tonsils, elongated uvula, etc.,
conditions so often present in the stammerer, the
soft palate has been rendered paretic by an over-
weighting of the muscles. Not only is nasal quality
prevented by proper action of the soft palate, but
the resonance of the voice depends upon it to an
enormous extent, and it may be seen in a well-
managed throat to move like something sentient,
and to occupy a distinctly different position at every
different pitch at which a tone is produced. Control
over the soft palate also confers the invaluable power
of breathing through the nostrils while speaking
and singing, thereby preventing dryness of the
mouth and the throat, of which so many voice-users
complain.
We now come to a description of some of those
methods alluded to for the cure or alleviation of
stammering in cases where the difficulty cannot be
traced to the breathing apparatus. Much of a
stammerer's trouble arises from the fact that he
involuntarily exaggerates all the stops and checks
20 THE TREATMENT OF STAMMERING,
taking place in the vocal apparatus from the glottis
to the lips, which are involved in speech. The more
he exaggerates these stops and checks the greater
will be his difficulty to overcome their resistance,
and he must, therefore, be trained to make these
closures as shortly and lightly as possible. In this
matter we are assisted by the drill of the soft palate,
and I have also devised special exercises for the
tongue and the lips which greatly assist the
stammerer in the management of his articulation
apparatus.
It is a well-known fact that most stammerers can
sing without any difficulty. This is because in
singing there is a continuous flow of the vocal tone ;
the vowels predominate, while the consonants are
but lightly touched in passing. The opposite of
this takes place in speech. The vowels are passed
over quickly, and the consonants, which are only
checks, clicks, and explosive noises, predominate.
The moral of this is obvious. Let the stammerer
exaggerate his vowels at the expense of his con-
sonants, and a good many stumbling-blocks will
thereby be removed from his path.
It is equally easy for most stammerers to whisper,
and this teaches a great lesson with regard to the
difficulty they so often experience in the attack of
vowels in speech. In whispering the glottis is open,
in phonation it is closed. The air passes out of the
CLEFT-PALATE SPEECH, AND LISPING 21
open glottis without let or hindrance, and this act
should precede the closing of the glottis for phona-
tion, when the production of a vowel will be an easy
matter. In other words, the attack of a vowel should,
in case of difficulty, never be sharp or sudden, but
it should be preceded by a short aspirate. To put it
differently, the glide of the glottis should be substi-
tuted for the shock of the glottis.
There is yet another matter with which everyone
who has had anything to do with stammerers is
familiar namely, that after they have once started
they have usually no difficulty in any subsequent
words uttered uninterruptedly in the same breath.
The stammerer should therefore dwell on an easy
syllable, prolonging the vowel of it, and then tack
on the remainder of the phrase as though it were
one word, and without any interruption whatever.
If there be no easy syllable to start with, we must
make it easy by preceding it with a little indefinite
vowel sound.
I will bring this part of my subject to a close by
mentioning a few special remedies for a few special
difficulties. A stammerer frequently finds it im-
possible to pronounce the w. In that case, let him
substitute oo for it, saying oo-as instead of was,
oo-ater instead of water, oo-ill instead of will.
Similar difficulty often arises with the y and the u.
Here we must substitute an ee for the y, and precede
22 THE TREATMENT OF STAMMERING,
the u by an ee, thus : ee-oung instead of young,
ee-ot instead of yacht, ee-ooniverse instead of
universe. I may observe that this method is simply
dividing the initial vowel into its component parts,
and saying them separately with great distinction
and deliberation.
TIME NECESSARY FOR CURE
With regard to this matter it is impossible to lay
down a hard-and-fast rule, as so much depends upon
individual circumstances. But in most cases people
expect a cure to be effected too quickly. The treat-
ment of stammering, as I have shown, is a very
complicated process, and can consequently not be
accomplished in the short space of a few weeks.
Experience has led me to decline the treatment of
young stammerers unless they are placed under my
immediate care and control for at least three
months.
In all cases long-continued self-control and disci- J U--
pline are indispensable. The habit of many years
cannot be permanently eradicated in a few months ;
and patients who resume their old ways as soon as
the time of treatment has expired must not be
surprised if they are again quickly conquered by
their enemy.
Adults, having presumably greater self-control
than young folks, are frequently able to do without
guidance after a shorter period. They can continue
CLEFT-PALATE SPEECH, AND LISPING 23
the exercises by themselves ; but it should always
be distinctly understood that they do this entirely
on their own responsibility.
In conclusion I desire to express my dissent from
those who affirm that stammerers are usually secre-
tive, suspicious, sly, and deceptive. This has not
been my experience in a single instance. I have
found them, on the contrary, warm-hearted, affec-
tionate, honourable, and keenly sensitive to kind-
ness, and to interest manifested in the relief of their
distressful malady, and I am happy in the pos-
session of many attached friendships which have
resulted from close association with speech-sufferers.
At the same time I am not prepared to deny that
there are cases in which stammering is combined
with mental and moral obliquity.
While preparing this paper I have been once
more impressed by the difficulty of making matters
as clear in writing as by viva voce explanations. It
is, in fact, impossible to substitute written for oral
instruction on a complicated subject like stammer-
ing. No lasting results can be obtained without L~-
personal communication between the teacher and
the stammerer. It is impossible to lay down rules L
which shall suit every case. Each one presents*"
individual idiosyncrasies, and must be treated
accordingly. There is no royal road to the cure of
speech defects any more than there is a universal
panacea for other ailments.
PART II
BY MRS. BEHNKE
PART II
THE last edition of the foregoing treatise on Stam-
mering by my husband, the late Emil Behnke,
having been exhausted, I have been urgently advised
to issue my own observations, deduced from careful
study of the subject, and from experience gained
during the last sixteen years in the successful treat-
ment of a very large number of cases of stammering.
The more I see of this distressing complaint, the
more convinced I become of its curability in the
majority of cases, given a scientific method, suf-
ficient time, and the active and continued co-opera-
tion of the patient.
Stammering forms a bar to success in, or even
admission to, the Army, the Navy, the Bar, the
medical profession, the Church, scholastic and com-
mercial work, and also to social intercourse. The
misery of the sufferers is very great, and besides the
handicap to their prospects in life, the injury to
their dispositions and characters is incalculable.
The varieties of manifestation of the trouble are
legion. Some stammerers make frightful grimaces,
screwing up the mouth and eyes tightly, struggling
27
28 THE TREATMENT OF STAMMERING,
violently, getting red and purple in the face in the
effort to speak. Others thrust out the tongue to an
extraordinary length, standing with widely-opened
mouth, hands clenched, body swaying to and fro,
looking as if in a severe convulsive fit. In some
the tongue and head are drawn to one side ; in
others, the head is thrown back. Occasionally a
case is met with in which the saliva flows out of the
open mouth. Others clench the teeth with great
force, biting the tongue and inside of the cheeks,
often causing blood to trickle down the chin. Some
make a continuous, irregular, vocal sound, more
like a low growl than a human voice, without being
able to articulate a syllable ; lashing out with arms
and legs with force sufficient to knock down a strong
man. Others, again, keep absolutely still, the face
looking like a mask, unable to utter a sound.
A painful case of this silent battle was that of a
fully qualified medical man. He had bought a
good country practice, which he gradually lost
through this silent stammer which no one under-
stood, his inability to speak being put down to
eccentricity or to " bad manners." He could always
speak perfectly at the bedside of patients ; but if a
relative accompanied him from the sick-room anxious
to hear his opinion on the child's illness, the un-
fortunate man could neither utter a syllable or make
a movement, but stood gazing fixedly before him
CLEFT-PALATE SPEECH, AND LISPING 29
till, vanquished in the silent struggle, he would rush
out of the house unable to utter a single syllable.
He ultimately had to give up his practice and leave
the neighbourhood, and subsequently came to me
for help in conquering this terrible drawback, which
happily I was able to give him. I found the upper
airways were considerably impeded by a growth
which I advised him to have removed. This was
done, and he afterwards made excellent progress,
so much so that before long he was able to acquire
another practice, and is doing very well.
Small wonder that stammerers become morbidly
sensitive and refuse to mix at all in society, pre-
ferring the solitude of their own rooms to the morti-
fication of being unable to converse; even contem-
plating suicide rather than endure continuance of
life in such depressing conditions ; but under proper >
treatment there are very few absolutely incurable
cases.
CAUSES OF STAMMERING
I NOW proceed to enumerate and discuss more
fully than was possible for my husband to do in the
limits of a lecture some of the causes of stammer-
ing. Amongst them are : obstructions of the
upper airways, heredity, imitation, mental shock,
severe blows on the head, epilepsy, chorea, hysteria,
spinal weakness, worms ; and, as a contributory
cause, public-school life.
OBSTRUCTION OF THE UPPER AIRWAYS
Affections of the mouth, throat, or nose, or any
general morbid condition of the system which may
be present, and which are exciting causes of stam-
mering, or which may aggravate pre-existing
habitual stammering, should be treated before
speech treatment is commenced.
/ Inadequate breath-supply and absence of breath-
control constitute a marked feature in the majority
of cases, whether of children or adults. These
^ deficiencies are, as a rule, traceable to certain
physical conditions.
In looking over my cases recently, I found that
out of one hundred, taken consecutively in the order
30
THE TREATMENT OF STAMMERING 31
in which they came to me, seventy-nine had some
sort of obstruction in the upper respiratory passages,
such as adenoids, enlarged tonsils, chronic ton-
silitis, elongated uvula, deflected septum encroach-
ing on the nostril space, broken bone causing
obstruction not only by its position, but also by
the constant irritation it set up, leading to swelling
and suppuration, post-nasal catarrh and polypus.
In the majority of these cases treatment had
removed the obstruction before they came to me.
Those whom I found to be suffering from any of
these troubles I advised first to obtain medical aid.
With the upper airways blocked, or even partially
blocked, by such obstructions, the lungs were very
inadequately supplied with air, and the type of
breathing was " high chest " or clavicular.
In all instances the chest was badly developed,
in many cases measuring from three to six inches
less than their average. In some the general health
was more or less " below par," a natural conse-
quence of deficient supply of oxygen.
CASE OF MECHANICAL BLOCKAGE OF THE NOSE
CAUSING STAMMERING
A singular and interesting confirmation of the
theory that blockage of the upper respiratory pass-
ages is a potent cause of stammering, has been
afforded me by the diagnosis of a case now under
32 THE TREATMENT OF STAMMERING,
my care. The patient, when quite a little child,
pushed a button with a metal shank into her nostril.
No one had seen the action, and the presence of the
button was, for a long time, unsuspected. The
child cried when her nose was wiped, and was un-
able properly to blow it, or to breathe through it.
She snored, not only in sleep, but often when
awake in the daytime. She became very ill, and
was medically attended for six months without
obtaining relief. Eventually the nose was exam-
ined, and the button was discovered and extracted.
There was a good deal of inflammation and sup-
puration, which remained for a considerable time
after the button was removed, causing the little
patient to be very ill, and she began to stammer
between the age of five and six years. The stam-
mer remained, and continued during twenty-five
years.
The case answered to treatment remarkably well.
In fifteen days this lady obtained sufficient control
over her breathing and vocal muscles to be able to
prevent herself from stammering, whether in read-
ing or in talking ; and in another two or three weeks
of steady, uninterrupted work the tendency was
altogether overcome.
Here we have a case of artificially impeded nasal
passages causing stammering, in much the same
way that growths, such as adenoids and other
CLEFT-PALATE SPEECH, AND LISPING 33
abnormalities, have caused it in hundreds of in-
stances. Inquiries elicited the informaton that
there was no history of the impediment on either
side of the family, nor was there any association
with a stammerer, whether nurse, companion, or
relative ; yet conditions always observed to exist in
other cases were present in this. Neither heredity
nor imitation was the cause of the trouble, and there
appears to be no reason to suppose that the nerve
centres controlling the muscle movements in speech
were affected. The respiratory powers were, how-
ever, very deficient. When this lady commenced
work with me, her lung capacity registered only
130 cubic inches ; it should have been 209 cubic
inches. In a fortnight she easily registered 164
cubic inches a gain of 34.
The amount of chest expansion on the first day
she came to me was only one inch ; at the end of the
fortnight's work it was three and a quarter inches,
and her general appearance was healthier and
brighter.
The case, and the result of its treatment, prove
satisfactorily the correctness of the opinion that a
most powerful factor in the causation of stammering
is the existence of any sort of impediment in the
nasal or post-nasal passages, interfering with the
access of air to the lungs.
It also shows the necessity of properly directed
3
34 THE TREATMENT OF STAMMERING,
breathing exercises designed to suit each case, in
order efficiently to re-establish the right muscle-
habits, and to prevent the closing together again of
those passages from which growths or other block-
ages have been removed, otherwise the advantage
sought for by surgical measures may be nullified.
No persons should be entrusted to give these
breathing exercises who have not a thorough know-
ledge of the physiology and anatomy of the parts
concerned. They should possess the ability to
devise exercises suitable for each individual patient.
To treat all patients alike is to court failure.
In several instances of stammering in quite young
children, when the diagnosis indicated the presence
of obstruction of the upper airways, I have advised
their being taken to a surgeon for its treatment or
removal. This done in time that is, as soon as the
stammer begins to manifest itself has in some cases
effectually arrested the trouble. When the stammer
has established itself as a habit, surgical treatment,
while removing the exciting cause, cannot remove
the result ; it cannot create new speech habits. These
have to be carefully and patiently formed by the
sufferer under a thoroughly competent teacher.
HEREDITY
There seems to be reason to consider the
existence of heredity as causing a tendency to
stammer. It is, however, difficult to obtain accurate
CLEFT-PALATE SPEECH, AND LISPING 35
information in some cases, on account of disinclina-
tion on the part of parents to admit the existence of
the trouble in other members of the family ; and one
only hears accidentally that a grandfather, uncle,
aunt, cousin, or other relative used to stammer.
Some of these contracted the habit by imitation of
the stammering relative ; but there are many others
who have never had communication with or even
seen their stammering relatives. In these cases the
question of imitation is eliminated, and that of
heredity may be considered heredity, that is to say,
of the special neurotic condition noticeable in the
majority of cases.
Among the records of my work during a given
period namely, four years I find that in six cases
the father stammered ; in three, the mother ; in four,
an uncle; in one, an aunt; in three, girl-cousins; in
one, the grandmother ; in three, the grandfather.
In one of these families four children stammered
badly.
In another instance in which the grandfather
stammered, in each of the families of his two sons
and one daughter some of the children stammered,
the trouble having skipped a generation and re-
appeared in the third generation. There seems,
therefore, to be sufficient reason to consider heredity
as a factor in this distressing complaint. Doubtless
there were other hereditary stammerers among those
who came to me for cure during those four years,
36 THE TREATMENT OF STAMMERING,
but I was not able to get reliable information about
them. These cases are, as a rule, rather difficult to
treat, and they are liable to a recurrence of the
trouble if after being cured they are in constant
association with members of their family who still
stammer. There is a nervous instability in many
of them, making it difficult for them always to hold
themselves under control when speaking.
> IMITATION
This is an admitted cause of the trouble. One
boy, who was brought to me, had acquired the
habit through mocking the gardener, who stam-
mered. His imitation was so excellent that he was
constantly asked to give an exhibition of it for the
amusement of friends, with the result that, after
a time, he stammered worse than the gardener;
and it was long before the family realised that it had
become impossible for him to speak otherwise. He
made excellent progress with me, and quite lost the
defect.
Another lad was very fond of the groom, who
stammered badly ; and as he was always accom-
panied on his rides by the man, and as every
minute of his playtime was, if possible, spent in the
stables, he began to stammer. He came under my
care after being turned down in his medical exam-
ination for the Army on account of his defect.
CLEFT-PALATE SPEECH, AND LISPING 37
After being under treatment he went up again for
examination, and passed without the least stammer.
In another case a girl was in the class of a
governess who occasionally stammered. The girl
soon spoke much worse than the teacher, and it was
not without difficulty that she was cured. Many
such instances might be quoted ; but those given
suffice to prove that imitation is a cause of stammer-
ing.
MENTAL SHOCK
A girl of eleven years of age was alone with
her mother who died quite suddenly from heart
failure. The girl received such a shock that'
for some hours she could not speak nor produce
any vocal sound. By degrees she recovered her
voice, but stammered horribly, with violent con-
tortions. She was extremely shy and timid, dread-
ing to stammer if she attempted to speak, and was
becoming morbid about it. Great tact and care
were necessary in treatment. Everything was done
to improve the general health and the nervous con-
dition, while also treating the speech defect. She
ultimately spoke perfectly unless worried or anxious,
or if her health was in bad condition, when there
was a slight return of the stammer, which passed
away again with renewed health and careful practice.
38 THE TREATMENT OF STAMMERING,
CONSTITUTIONAL CAUSES
In constitutional causes such as epilepsy, hysteria,
some forms of chorea, locomotor ataxy, etc., the
speech difficulty is but a symptom of a graver dis-
order, which it would be useless to attempt to
benefit by treatment suitable for ordinary stam-
mering. Complaints affecting the lungs and respira-
tory tract, notably the sequelae of scarlet fever or
measles ; occasionally also influenza ; whooping-^
cough, from the excessive strain on the diaphragm
during severe paroxysms of coughing ; debility
and indigestion, are causes of stammering which
call for medical, as well as elocutionary, assistance.
PUBLIC-SCHOOL LIFE
Public-school life appears to be a serious
difficulty for many boys who stammer, or who
have a latent tendency to this trouble. Parents
often say to me of their son : l< He never
stammered until he went to school " ; or, " The
stammer came back in a few weeks after he went
to school.'* Head and assistant masters are not
now impatient and harsh with the stammerer, as
was formerly frequently the case ; but it is impos-
sible to keep a whole form at a standstill, time after
time, for the answer which takes minutes instead of
seconds to get out. The poor boy knows that the
CLEFT-PALATE SPEECH, AND LISPING 39
class is waiting on his account ; he is acutely sensi- -~~
tive and alive to the annoyance and to the gaze of \^
his schoolfellows. He becomes hot, flustered, and u
angry that his difficulty makes him appear to be
ignorant and unprepared with his work. The self-
control necessary to apply the rules for speaking
which he has learnt he is unable to use, and little by
little the old bad speech habit reasserts itself. In
these circumstances it is advisable to let the boy
return from time to time for short courses with the
teacher who has been successful in curing the
stammer, or to place him with a tutor who only
receives a few students at one time.
NERVOUS ORIGIN
Stammerers and their friends often attribute the
cause of the trouble to " nerves," because when the
patient feels quite at ease with friends, or when at
play, the difficulty vanishes entirely, while with'-""
strangers it is intensified. This sort of nervousness
is not the origin of the trouble, for the dread and
apprehension of stammering cannot have existed
before the patient began to stammer. The mental
attitude thus created, being once established, be- c
comes a powerful contributing cause in the increase
and continuance of the trouble in children and
adults; but when a stammerer obtains the power to
speak aright, that nervousness goes entirely.
40 THE TREATMENT OF STAMMERING,
As soon as a child begins to observe the difference
in his speech from that of other children, especially
if grimaces and contortions accompany his efforts
to speak, he becomes self-conscious, dreads being
spoken to and having to reply to a question ; and
the constant fear and apprehension act prejudicially
on his mind. Mothers who designedly take no
notice of the defect act in mistaken kindness.
Children are usually very quick of apprehension,
and soon perceive the desire to shield their faulty
speaking from observation. This makes them try
to do the same, and greatly increases their nervous-
ness before strangers. It would be wiser to treat
the stammer as an incorrect pronunciation would be
treated : kindly and quietly pointing out the correct
way, and getting the child to repeat the sentence
slowly and clearly. Although the stammer might
not be entirely removed thereby, many difficulties
may be corrected thus, and the children would be
saved from serious inconvenience afterwards.
Although nervousness in some instances is the
result and not the cause of the trouble, stammering
is undoubtedly of nervous origin in the majority of
cases.
As my husband has said (see p. 5) :
" The causes of stammering, not being local,
must be sought in disturbed action of the nerve
centres concerned in the production of speech. If
CLEFT-PAL f ATE SPEECH, AND LISPING 41
speech is to be perfect, there must be harmonious
co-operation of the several mechanisms of respira-
tion, phonation, and articulation, all of which are
under the direct and immediate influence of that
portion of the brain which is known as the ' bulb,'
or the 'medulla oblongata,' where the centres of
these mechanisms are situated close together."
The opinion has been expressed that the seat of
the disturbances of the nerve centres governing
speech is not in the medulla but in the cerebral
cortex. The following quotation from a paper by
Dr. W. S. Morrow, lecturer on physiology, M'Gill
University, goes to support my husband's view that
the medulla is the seat of the disturbance :
"There is a respiratory centre in the medulla
which is divided physiologically into an inspiratory
and an expiratory centre, so distinct from one
another that either one may be affected by stimuli
which fail to influence the other. These centres
may or may not be able to act automatically, but
they are in any case profoundly affected by nervous
impulses reaching them from the brain above, and
by various paths from below, especially by the
pneumogastric nerves. The respiratory centres send
their stimuli to the muscles of respiration by the
ordinary spinal nerves such as the phrenics and
intercostals."
This clear and scientific description enables us to
42 THE TREATMENT OF STAMMERING,
understand why control of the expiratory part of
respiration in speaking is most difficult of acquire-
ment by all stammerers, viz : because the expira-
tory centre is not, at the time, influenced by the
stimuli which have affected the inspiratory centre.
For this reason explosive speech, difficulties of
commencement, repetition of vowels and of con-
sonants may be traceable to spasmodic interruption
of the stimuli from the nerve centres to the muscles
of respiration, which, in their turn, act spasmodic-
ally, without control. This is also an explanation
of the apparent anomaly noticeable in all stam-
merers, that at times they speak perfectly and at
others are scarcely intelligible. We can also readily
understand the reason why carefully designed and
regulated breathing exercises react on the nerve
centres and help to re-establish exact and instan-
taneous co-ordination with the vocal muscles. A
similar result accrues in some cases of paralysis, in
which the medical gymnast effects restoration of
power by the use of massage and specially localised
movements. These movements, upon which the
patient is directed to concentrate, stimulate the brain
centres, which in turn stimulate the nerves of the
paralysed muscles, until by repeated stimulation
normal, healthy action is re-established.
Even in cases of admittedly nervous origin the
majority of the stammerers probably failed first in
CLEFT-PALATE SPEECH, AND LISPING 43
breathing ; the supply of air becoming less and less
adequate for the purposes of speech and of health.
The diminished supply - of -breath would cause
lessening of the physical stimulation of the respira-
tory nerve centres ; which stimulus would, in normal
breathing, be conveyed by the action of the respira-
tory muscles. This diminution in the supply of
nerve-stimulus soon induces incomplete control of
the motor power of voice, which is breath ; and
resulting from these conditions, voice use becomes
jerky and uncontrolled, and stammering is gradu-
ally established.
In an interesting and instructive article on
11 Defective Nasal Respiration,"* Dr. P. Watson
Williams argues that " normal nasal breathing
stimulates the bulbar respiratory centre"; and he
considers that "abrogation of this physiological
stimulation is one important factor resulting in
deficient respiratory exchanges and consequent
deficient metabolism." Thus the views on this
subject held by the late Emil Behnke receive con-
firmation from the writings quoted above.
Speech Training
The teaching for cure of speech defect has hitherto
been mainly based on the assumption that the fault
lies in the articulating apparatus. Even medical
* Bristol Medico- Chirurgical Journal, March, 1906.
44 THE TREATMENT OF STAMMERING,
writers who have observed that faults of breathing
are invariably found in all stammerers have failed
to recognise that these respiratory errors are the
primary cause of the defect ; and they consequently
proceed to prescribe treatment for the secondary
cause articulation. This occurs in Dr. John
Wyllie's otherwise admirable work, The Disorders
of Speech.
In his opening chapter he gives his opinion as
follows :
" It will be the chief object of this paper to make
it perfectly evident that the common defect of
stammering is in the great majority of cases due to
delayed action of the laryngeal mechanism, though
it may, apparently in a minority of cases, be caused
by delayed action of the oral mechanism."
On p. 16 Dr. Wyllie says : "The starting-point
of the defect is want of promptitude in the produc-
tion of the vocal element in the first syllable of
words, . . . the radical defect in the stammerer
being the absence or insufficient supply of the vocal
element . . . the stammerer produces the letter
voicelessly or with feeble or intermittent voice."
The above description is perfectly accurate as far
as it goes ; and it is much to be regretted that Dr.
Wyllie has not gone to the root of the matter, but
has taken the second position of stammering, the
laryngeal, as its fundamental cause. We must go
CLEFT-PALATE SPEECH, AND LISPING 45
further back in the formation of the voice to dis-
cover it, and must inquire into the cause of " the
want of promptitude shown by the vocal mechan-
ism," as Dr. Wyllie aptly expresses this
condition.
What is " the vocal element " or voice?
Voice is breath converted into tone by the vibra-
tions of the vocal ligaments or cords in the larynx ;
and it is in the inco-ordination of the breathing
muscles with those of the vibrating element, delay-
ing the production of tone, that the primary cause
of stammering lies not, as Dr. Wyllie states, in
the laryngeal mechanism.
Stammering is less an articulatory defect than
a breath and voice defect. The " silent sticks " of
laryngeal origin of which Dr. Wyllie speaks are
impossible of production while the stream of vocal-
ised air is passing through the vocal gates. The
stammerer must be taught to acquire control over
his breathing muscles in speaking as complete as he
has over the fingers of his hand, so that the con-
tinuity of the motor power of voice is assured.
If stammering were a delay of the laryngeal
mechanism, or a speech defect, Dr. Wyllie 's
" Physiological Alphabet " would be invaluable in
the cure of certain forms of the trouble. His study
of the alphabet and analysis of the pronunciation of
letters are excellent, and of great assistance where
46 THE TREATMENT OF STAMMERING,
articulatory defect exists; but in the majority of
cases of stammering, the defect being due to wrong
methods of breathing and of vocalisation, drill of
the mechanism of articulation alone has very little
practical use, and had better not be attempted.
Exercises having as their basis the incessant repeti-
tion of those syllables and words which present a
difficulty of pronunciation to the stammerer appear
very often to increase, rather than to remove, or
even to diminish, the difficulty, because they do not
attack the cause of his speech obstruction. If, as is
held by some writers on this subject, the flow of
nervous energy lies along the line of consonant
repetition, and if a man says b-b-b-b-bone, it is
clearly evident that he is perfectly capable of saying
the letter fr, having repeated it five times. It is not
drill on any initial consonant or vowel which will
avail him. He gives himself, sorely against his will,\
constant drill in saying initial letters, aggravating
his trouble. Instead, therefore, of encouraging this
superfluity of nervous energy in a wrong direction,
by insisting upon the practice of consonant repeti-
tion, it would surely be advisable to divert the over-
flow into another channel, as a first step towards
stopping it.
Dr. Wyllie frequently refers to the necessity of
attention to the production of the vocal element in
speech, or, to quote exactly, " the vocal mechanism,
CLEFT-PALATE SPEECH, AND LISPING 47
whose want of promptitude is the primary cause of
the difficulty." It is matter for surprise that so
accurate an observer should have overlooked the
first and basic element in the production of voice
breath. He speaks of two mechanisms only the
laryngeal and the oral ; whereas, in all speech three
mechanisms are employed :
i st. That of breathing.
2nd. That of tone production in the larynx.
3rd. That of the oral or word-making.
Of these three mechanisms, faults of breathing I [/
are the primary cause of stammering, the laryngeal
faults being secondary.
The following quotation from an article of mine
which appeared in Guy's Hospital Gazette puts the
matter clearly :
"The primary cause of stammering is want of
co-ordination between the breath muscles and the
vocal muscles ; the one or the other lags behind.
The harmonious working together of the mechanism
of the voice being thereby interrupted, the nerve
centres in the brain, which govern their movements,
spasmodically fail to control them. The conditions
are frequently aggravated, perhaps sometimes in-
duced, by blockage of the post-nasal passages, im-
peding free intake of air. Such cases require
medical aid before elocutionary treatment can be
commenced. Exercises designed to re-establish the
48 THE TREATMENT OF STAMMERING,
exact and instantaneous co-ordination of the muscles
are given ; their continual practice reacts on the
motor nerve centres in somewhat the same way
in which gymnastics and massage act in certain
cases of paralysis. But, as no two persons stammer
alike, it is necessary carefully to study the idiosyn-
crasies of each case and to conquer individual dif-
ferences before applying general principles. The
various forms of speech obstruction appear to be
reflex action, rarely requiring special attention, and
disappearing as control is obtained over breath and
voice."*
The opinion that laryngeal spasm is not the cause
but the effect of the antagonism in the mechanisms L
of speech, is amply proved by the experience of
many years of practical work in the cure of this
complaint ; the results having been attained mainly
by giving attention to correct respiratory move-
ments.
Spirometer Records
I have for many years kept records of the age,
stature, vital capacity, and power of chest expan-
sion before and after treatment. These records
show that the vital capacity of stammerers is, in
varying degree, always below their average; the
chest girth and chest expansion being less by some
* Mrs. Behnke : Guy's Hospital Gazette, July, 1897.
CLEFT-PALATE SPEECH, AND LISPING 49
inches than they should be for the age and height
of each person ; the breathing being markedly
" high chest," or clavicular. This invariable in-
feriority of lung capacity and of chest girth in all
cases of stammering, in patients of both sexes, of
all ages, and of different nationalities, is a strong
proof that errors of breathing are at the foundation
of the trouble.
In order that my readers may judge this im-
portant point for themselves, I give below the
records of the age, stature, lung capacity, and
chest girth of one hundred patients, taken before
and after treatment, in the order in which they
came to me ; fifty being women and girls, and fifty
men and boys.
50 THE TREATMENT OF STAMMERING,
WOMEN AND GIRLS.
Breathing Capacity.
&
^o
5
Age.
Stature.
J|j
ii
i f |
Girth bel
reatment.
t Girth af
eatment.
j
tl/)*O <L>
b/j QJ
S H
J"
**
jj H
H
~ "
6
I
i6|
Ft. In.
5 3f
Cubic In
195
Cubic In.
235
Cubic In.
40
Inches.
33
Inches.
37
Inches.
4
2
34
5 3
91
1 10
29
3
31$
|2
3
5 4
74
1344
264
30
34
4
28
5 7
60
203
143
34
37
5
16
5 4
132
146
33*
2.|
6
18
5 10
154
172
x8
33
38
5
7
40
5 94
"3
159
49
28
34
8
22
5 34
100
114
14
3i4
344
3
9
35
5 7*
80
101
21
294
32
24
10
20
5 9
66
148
82
3*1
X
ii
26
5 ii
167
183
16
34
36
2
12
30
5 8|
91
131
40
294
3i4
2
13
27
5 9
100
KJO
50
33*
34
I
H
17
5 54
117
156
39
3 1 *
36*
5
15
20
131
143
12
314
334
2
1 6
16
5 6|
108
1 60
52
2 7*
30
2|
17
134
5 3i
105
175
70
294
32
24
18
15
74
121
47
26
284
24
19
30
5 Si
107
I6 9
62
28
29
I
20
29
5 3
64
1 10
46
29
2 9 f
1
21
24
5 8
no
140
30
25
29
4
22
12
5 i
81
123
42
254
274
2
23
14
5 74
15
I 7 6
26
30
3 2 S
2
24
30
5 84
65
121
56
30
3 1 !
Ii
25
21
57
139
88
28
30
2
26
23
5 7
151
175
44
30
33
3
27
29
5 94
81
122
294
324
3
28
18
5 6
90
118
28
29
2
29
32
5 i
57
98
41
35
a*
30
22
5 7
156
43
29
24
32
33
24
25
46
5 i4
5 3
4 ii
149
II
203
123
93
II
32
32
29
27
34
32
2
3
4
34
36
5 44
180
226
46
33
351
2|
35
18
112
130
18
29
af
36
20
5 64
8l4
1504
69
34
3
37
16
5 7i
40
172
132
28|
34
51
38
21
5 64
136
170
34
324
354
3
39
19
5 44
135
180
30
30
32*
24
CLEFT-PALATE SPEECH, AND LISPING 51
WOMEN AND GIRLS continued.
Breathing Capacity.
i
S
rt J
.
Age.
tj
<
Lung Capacity
before
Treatment.
Lung Capacity
after
Treatment.
Increase in
Lung
Capacity.
Chest Girth t
Treatmen
Chest Girth
Treatmen
l
Ft. In.
Cubic In.
Cubic In.
Cubic In.
Inches.
Inches.
Inches.
40
28
5 10
130
164
34
29
30
I
41
42
43
16
24
5 84
5 5
5 7
134
So
190
160
144
1
30
324
334
34
24
a!
44
24
100
143
43
29
33
4
45
28
5 3
1 60
210
50
344
37
24
46
13
4 9
107
140
33
284
304
2
47
32
98
131
33
48
49
54
22
5 10
'45
122
160
iSo
5J
34
34
36*
X
ii
50
30
5 74
117
165
48
29
34
MEN AND BOYS.
1
Breathing Capacity.
Age.
Lung Capacity
Treatment.
Lung Capacity
after
Treatment.
Increase in
Lung
Capacity.
Chest Girth bei
Treatment.
Chest Girth af
Treatment.
1
Ft. In.
Cubic In.
Cubic In.
Cubic In.
Inches.
Inches.
Inches.
i
2
3
16
124
IS
5 5
4 ii
5 W
194
80
351
143
179
1
31
29
29
35
2|
4
17
5 9\
129
181
52
304
344
4
5
21
5 "1
205
235
30
35
38
3
6
20
5 *
1 80
225
45
33
36
3
8
Is
1 3
154
170
184
230
g
28|
264
294
3*
3
9
21
5 5
151
172
21
30
32
2
10
18
5 94
137
164
27
26*
294
3i
ii
22
5 8
121
150
29
27
294
21
52 THE TREATMENT OF STAMMERING,
MEN AND BOYS continued.
Breathing Capacity.
6
Age.
i
S
K
lei
'G -w
rt C
O- n W
c
2*
si
O"* rt
CJ *J
'6 t3
si
y
in
<3|1
rt a>
^^ 5
1 1
8
tf{H
J
a
*t
fcJ0^2 <u
Q0 V
u *""* cti
a>
1 *
c
5 o
U
U
Ft. In.
Dubic In.
Cubic In.
Cubic In.
Inches.
Inches.
Inches.
12
13
11
18
5 6
5 7
107
148
163
1 80
g
3'f
2 9 4
35
2
U
9
4 2
80
101
21
254
284
3
15
25
5 n
123
146
23
30
32
2
1 6
15
5 74
102
162
60
33i
34
17
18
21
"31
U
195
139
290
172
95
33
29
344
34
19
17
5 7
1 60
190
30
3'4
2
20
26
5 ii
230
285
55
36'
384
24
21
15
5 4
144
1 66
22
29*
2
22
18
6 o
I 5 8
208
50
34
364
24
23
15
4 8|
84
116
32
264
384
2
24
12
12
12
4 8
4 IO 4
4 54
9 6
82
58
128
1
27
274
264
30
30
274
ii
z
27
24
5 ii
4 8
211
163
29
33
4
28
15
5 J 4
141
1624
214
30
354
54
29
22
5 n4
160
204
44
39
4^4
24
30
22
5 9
210
234
24
29
34
5
31
33
5 n
150
255
105
33
37
4
32
33
48
24
6 '04
213
210
270
279
1
34
34
35
25
19
in
I8 4
194
207
230
12
38"
32
i
4
36
12
4 74
8 1
116
35
26^
274
i|
37
17
5 ii
138
207
69
32
334
14
38
21
5 84
182
2054
214
31
33
2
39
15
5 64
124
2014
774
29
24
40
26
42
5 84
6 o
200
254
2 I 3
262
5 i
29!
32*
34
42
29
6 3
294
304
10
32
34
2
43
39
5 4
179
191
12
31
34
3
44
5 94
1 60
209
49
314
34f
3i
45
22
5 64
145
155
10
29
2 4
46
20
5 9
190
220
30
294
32
2 4
47
21
6 o
206
224
18
3
33
3
48
21
6 04
126
249
123
33
35f
2|
49
19
6 i
72
1 88
116
33
35
2
50
24
6 o
136
200
64
334
354
2
CLEFT-PALATE SPEECH, AND LISPING 53
In the first table the ages of the female patients
were from 9 years to 54 years old.
Breathing capacity was from 51 cubic inches, the
lowest, to 195, the highest.
The gain in lung capacity was from 12 cubic
inches to 143 cubic inches.
The increase in chest girth was from }-inch to
5j inches.
In the second table the ages of males when com-
mencing treatment were from 9 years. to 48 years old.
Breathing capacity *was from 48 cubic inches, the
lowest, to 294, the highest.
The gain in lung capacity was from 8 cubic
inches to 163 cubic inches.
The increase in chest girth was from i inch to
5j inches. The patient who made the largest
increase of lung capacity was a medical man, who
stammered so badly that it was impossible for him
to take a practice. When he commenced studying
with me his lung capacity was only 48 cubic inches,
but in a few weeks it had increased to 211 cubic
inches. His chest girth also increased 4 inches.
Before coming to me he had practised articulation
drill for two years, with no good results to his speech .
All the measurements of breathing were taken on
the same instrument, and the chest girth with a
surgical tape measure.
The comparison of lung capacity on commence-
54 THE TREATMENT OF STAMMERING,
ment of treatment with the increase at the end of it,
shows undoubtedly that the breathing of stammerers !
is very deficient. Their difficulties of speaking dis-
appear as the breath capacity and control increase;
another proof that the primary cause of the stammer
lies in the respiratory mechanism, and not in the^
vocal or oral mechanism.
The increase in chest girth in every patient is
worthy of attention for reasons other than stammer-
ing. The improvement was not confined to the
youth of both sexes; for in males the ages of the
recorded cases were from 9 years to 48 years, and
in females from 9 years to 54 years. The results
were obtained, for the most part, in about eight
weeks, and in a few cases in a fortnight, the
improvement in physique and in general health
being marked. Army officers have frequently
observed that the use of similar exercises would be
an invaluable assistance in drilling their men.
There is no doubt of their value for all classes
and for all ages, if given by an experienced and
judicious teacher.
The correctness of the opinion that the primary
cause of the stammer lies in the respiratory
mechanism, and not in the vocal or the oraK
mechanism, is further demonstrated by the tracings
of the pneumograph. For the use of this instrument
I am indebted to one of my pupils, Dr. Worthington,
CLEFT-PALATE SPEECH, AND LISPING 55
who kindly endeavoured to find me siome means by
which I could test the amount of contraction requisite
for the large breathing-muscle the diaphragm for
the purpose of my work. The instrument showed
the extent of the movement, and also recorded
irregularities and stoppages of the respiratory
mechanism, giving a diaphragmatic picture of the
checks and stops of voice which actually take place
in a stammerer.
Action of Breathing Muscles as shown by the
X-Rays
A few years ago, being desirous of obtaining
some ocular demonstration of the actual movements
of the great breathing muscle the diaphragm and
of the intercostal muscles, my daughter and I made
observations with the X-rays : *
ist. In ordinary passive, automatic, natural
breathing.
2nd. In the larger requirements of voluntary
active breathing for tone-making, for use in speak-
ing and reciting, and in the greater effort to fill a
large hall.
3rd. In singing simple tones and phrases, in long
sustained notes, in rapid passages of different dura-
tion, and in staccato passages.
4th. In stammering.
* The Speaking Voice, Behnke, Curwen and Sons.
56 THE TREATMENT OF STAMMERING,
The main object of the investigation was to
ascertain if any fresh light or new fact could be
deduced from it which would be of assistance in
voice training; or, on the other hand, whether the
accepted scientific views on the all-important matter
of breath-taking and breath-control were contra-
dicted in any particular. The result showed their
entire correctness.
It was quite easy to see the raising and widening
of the lower part of the thorax corresponding to the
expansion of the lungs as the air gradually filled
them, more or less, according to the amount of air
inhaled. If the air was exhaled slowly, as in normal
breathing, the diaphragm gently ascended, the
thorax slowly returned to its former position, and
the lungs to their former size.
When voice use was commenced the wonderful
regulating and controlling power of the breathing
muscles, the diaphragm and lower costals, was
evident; at times, by will of the demonstrator,
giving out the air column so slowly and gently that
the muscles seemed hardly to move at all, while in
a forte passage the return action was much stronger
and the muscle tension greater.
When the demonstrator, instead of controlling the
exit of the breath by the great breathing muscles,
used the muscles of the upper chest and throat, the
voice, whether in speaking or in singing, at once
CLEFT-PALATE SPEECH, AND LISPING 57
became " breathy " with occasional false intonation,
and the tones became thinner and poorer in quality.
In the production of staccato tones a short, dis-
tinct upward jerk of the diaphragm, with a corre-
sponding abrupt movement in the lower thoracic
walls, was seen.
Passing on to the examination of stammerers
proceeding thus to the comparison of normal with
abnormal breathing we found that the X-rays fully
confirmed the accuracy of our view that stammering
is mainly due to faulty action and failure of co-
ordination of the breathing and voice muscles.
Diaphragmatic spasm and irregularities of the
respiratory mechanism were clearly seen, thus
corroborating the results of the pneumograph
described in the previous pages.
The Curability of Stammering
Is stammering curable ?
Undoubtedly it is curable under right conditions
in all but a very few cases, such as those in which
there is idiocy, lunacy, or epilepsy. ^
It must be clearly understood that the carrying
of the cure of this distressful complaint to a suc-
cessful issue lies in the hands of the stammerer
himself. The teacher's work is to show him what
to do, and to train him until he is thoroughly and
practically acquainted with the method necessary
58 THE TREATMENT OF STAMMERING,
for his special case. This training should always
be continued until there is no more difficulty in
reading or talking under any circumstances. When
this has been achieved and lessons are discontinued,
the rest of the work lies with the stammerer himself.
If he is negligent in carrying out the rules for con-L
trolling his speech which he has been taught, he
will, sooner or later, have a relapse, however per-
fectly he may have spoken before leaving his
instructor. It will be well if this fact is recognised,
not only by all persons so afflicted, but also by their
relatives and friends. The patient will then fully
understand that continued success in speaking
depends upon the continuation of the method in
which he has been trained, together with the control
he voluntarily exerts over himself.
Age is no bar to cure. I have had patients from
the age of five the youngest to the age of eighty-
one the eldest. Very young children, if bad
stammerers, have not sufficient determination or
self-control to be able to help themselves; and as
the cure requires the active, intelligent co-operation
of the patients, it is usually better to defer treatment
until they can themselves apply the rules given for
their assistance. Some children are much more
advanced than others ; these may begin quite young,
especially if they have become conscious of the
drawback their difficulty is to them, and are
CLEFT-PALATE SPEECH, AND LISPING 59
desirous of getting rid of it. Some of the quickest
cures have been effected in people of middle age,
and in some who were considerably beyond it.
Patience, perseverance, and conscientiousness in
following the directions given are essential ; for-
tunately these qualities can be commanded, or can
be acquired, by every adult.
Cleft-Palate Speech
Next in importance to stammering comes the
distressing, imperfect vocalisation and articulation
caused by the deformity called Cleft Palate.
The elocutionary treatment in these cases is the
most difficult of all work for the correction of speech
disorders. The difficulties are mainly due to the
conditions which exist in the nasal passages above
the palate, after the fissure in the hard palate has
been united; they also greatly interfere with the
resonance of the voice as well as with articulation.
One contributory cause is the high position of the
hard palate in the mouth ; it encroaches upon and
crowds the lower part of the air passages, of which
it forms the floor, where the largest portion of breath
passes ; narrowing the air-space, and reducing to a
minimum the co-vibration of the air in these
chambers with the vocalised air in the mouth. It
is probable that a considerable amount of feebleness
and want of development remains in the upper air-
60 THE TREATMENT OF STAMMERING,
ways and in the naso-pharynx after the operation
for closure of the palate, interfering greatly with
the timbre of the voice and with the articulation of
many letters and syllables, causing the snuffling,
hollow sound which is so marked a feature in cleft-
palate speech.
Great improvement is effected by breathing exer-
cises, which are specially devised to reach these
parts via the nose ; the repeated passage of large
amounts of air through these partially blocked
upper airways exerts a favourable stimulus on the
respiratory tract, and helps to establish a healthy
state of the nasal and pharyngeal passages. It is
absolutely necessary to insist on breath being taken
only through the nose. This is somewhat difficult
at first to many of these patients ; but a little perse-
verance will soon make it easy.
Another prominent feature in cleft-palate speech
is nasality of tone. It is distinct from snuffling, but
both are usually present, although sometimes the
one defective sound, sometimes the other, may pre-
dominate. The nasality is caused by an imperfect
and immobile soft palate ; and to the same cause we
may, in a measure, attribute some of the poor
quality of voice which is generally to be noticed in
these cases. The fissure usually extends from the
hard palate through the soft palate, completely
dividing it ; but sometimes it is confined to the
CLEFT-PALATE SPEECH, AND LISPING 61
latter part only, and the operation of uniting it
often causes some amount of thickening and a
resulting want of elasticity. Even when there is
no thickening, the soft palate becomes semiparetic,
through loss of the influence which nasal breathing
exerts on its mobility.
Sufferers from this trouble are as seriously handi-
capped by the disagreeable vocal and articulatory
difficulties following on cleft palate as are stam-
merers by their difficulties of speech, perhaps even
more so ; but they usually show very little nervous-
ness or disinclination to talk, and appear not to
realise the unpleasantness of their speech ; while
stammerers generally dread to talk, and remain
silent as much as possible.
From experience with the speech education of a
number of these patients, I find that the best results
are obtained with those in whom the operative treat-
ment for closing the palates is performed as early
as possible. Very much depends on the complete-
ness of the closure in both palates, not only for
success in articulation, but also in voice.
A girl who was sent to me by her doctor was not
operated on for closure of the cleft palate until she
was fifteen years old; and she was not brought to
me for treatment of the speech difficulty until she
was nineteen years old. It had been impossible
entirely to close the hard palate ; an aperture as
62 THE TREATMENT OF STAMMERING,
large as a pea had been left in the centre of the roof
of the mouth, through which the air taken into the
nose came into the mouth, thence finding its way
through the larynx and windpipe into the lungs.
This was not only a serious hindrance to aeration
of the naso-pharynx by breathing exercises, but also
to the correct pronunciation of several letters ; and
it was impossible entirely to overcome the nasality
which is one of the characteristics of these cases.
By the careful employment of various devices for
obtaining control over the articulatory processes,
much improvement was effected; but if the opera-
tion on the palate had been performed in early
childhood, it would probably have been possible to
close the cleft completely, and the speech would
have greatly benefited thereby.
In contrast to this is the case of another girl, now
in her nineteenth year, who can speak so well that
no one can detect the slightest abnormality in voice
or in articulation. The palate was beautifully united
in childhood, and she was sent to me by her doctor
when about eight years old. She took lessons
regularly for a year, afterwards coming again
occasionally if her parents thought there was a
little falling-off in her speaking.
There is great difficulty in speech education
whenever the cleft is left unclosed until the patient
CLEFT-PALATE SPEECH, AND LISPING 63
has reached thirteen or fourteen years of age; the
best results being obtainable if the closure is effected
quite early in childhood, and the elocutionary work
commenced at about eight years of age.
The surgical treatment of cleft palate has made
great advances of late years. The symmetry of the
mouth is rendered more nearly perfect than formerly
by the greater skill and experience of the operators.
This makes it possible to do much more on the
elocutionary side of the work. The teacher must,
however, carefully notice all divergences from the
normal in the internal configuration of the mouth ;
and when these divergences are such as to interfere
with clear speech careful study is required in order
to suggest adaptations of mouth positions for the
correct pronunciations of those letters and words
which are unintelligibly pronounced owing to the
malformations.
Occasionally, in closing the upper jaw, a space is
unavoidably left where a tooth should have come,
making it impossible to get the true sound of certain
letters, as s, c soft, sh, and 2. A single artificial
tooth can sometimes be inserted to fill the vacant
space, with excellent results on the pronunciation
of those letters. It happens occasionally that the
missing tooth comes through into the middle of the
hard palate, interfering greatly with almost every
64 THE TREATMENT OF STAMMERING,
word the patient says, making the tongue rough
and sore, and the speech quite unintelligible to
strangers. In some recent cases of mine this
happened ; and I had a little difficulty in persuading
the parents to allow a dentist accustomed to such
cases to extract the tooth. After its removal each
child made excellent progress in speaking clearly
and distinctly.
When there is entire absence of the soft palate,
it is advisable to have an artificial one of thin,
pliable gutta-percha, attached to a small dental
plate. This arrangement has answered very well,
with some of my patients, for nearly all letters but
hard g, the closure for that letter taking place a
little lower down in the throat than the artificial
velum can reach. When there is only a portion of
the soft palate also when it is slightly paretic, stiff,
and immovable exercises must be given to over-
come the difficulties of these conditions, care being
taken never to continue the practice to the point of
local fatigue.
If there has been hare-lip as well as cleft palate
the fissure extending along the whole of the hard
palate, severing the upper jaw and also the upper
lip the lip is sometimes a little shortened by the
operation for closing it ; or the muscles are inelastic
and stiff. In this condition the pronunciation of
labials, b, p, and m, is the most unfavourably
CLEFT-PALATE SPEECH, AND LISPING 65
affected ; w and y, as pronounced in the alphabet,
are difficult in a lesser degree.
But the greatest difficulties to overcome are the
snuffling, the nasality, the absence of nasal
resonance, and the pronunciation of the throatal
letters k, q, and c and g hard. All of these troubles
are the result of the undeveloped condition of the
upper respiratory passages, and in particular of the
naso-pharynx ; and also of an imperfect soft palate
and uvula, which latter are not sufficiently mobile
to fulfil their work of closing off the nasal passages
from the mouth, and of assisting in the articulation
of the letters mentioned above.
Nasal tone is caused by the vocalised air going
out through the nose instead of through the mouth.
I am aware that many persons hold a precisely
opposite opinion ; but the truth is so easily demon-
strated that anyone can satisfy himself on the
subject without special knowledge. For example :
" Close the nostrils completely, and sing ah,
when you will find you can produce pure vocal tone.
Or try this experiment : Take a thin mirror and
hold it flat against the upper lip with the glass
upwards. Sing a pure vocal tone, and the mirror
will remain perfectly bright. Sing, on the contrary,
with nasal quality, and the mirror will at once be
completely dimmed. This shows conclusively that
nasal sound is produced by singing through the
5
66 THE TREATMENT OF STAMMERING,
nose, and this cannot be done without lowering the
soft palate."*
In cleft-palate cases the soft palate is always more
or less inelastic and immovable. In its normal state
this little movable partition acts like a curtain. We
can drop it on the back of the tongue, thereby com-
pelling the tone to pass through the nose, and thus
giving it nasal quality. This nasal quality increases
the more the passages through which the tone has
to travel are impeded. Raise the soft palate, and
you may completely shut the nostrils and vet pro-
duce a pure vocal tone ; because with the soft palate
up, the nose is shut off from the throat, thereby
compelling the tone to pass through the mouth.
It is this absence of the action of the soft palate
in cases of cleft palate which causes the nasality.
Sometimes there is very little of the soft palate left
after the operation, and it is too short completely to
shut off the nose from the throat. In others the
edges are very thick, and occasionally the closing
seam has destroyed its power of movement; but it
is astonishing what can be done by educative
measures to restore its functions.
In the educational work for voice and speech in
cleft-palate cases, it must always be remembered
that "use brings function"; therefore no pains
* Mechanism of the Human Voice, i8th edition, p. 60,
Behnke.
CLEFT-PALATE SPEECH, AND LISPING 67
should be spared to devise exercises which shall
bring about the power of using the various muscles
employed in voice and speech in a manner as nearly
as possible approaching to that which is natural to
persons unafflicted with cleft palate and its results.
The sort and degree of movement requisite will
probably vary with each patient at least, this has
been my own experience ; but it is extremely interest-
ing to watch the growth of facility in using the
different muscles, and their adaptability for un-
accustomed use. Nature is wonderfully accommo-
dating if we know how to manage her.
Lalling
Lalling is the name given to the unintelligible,
imperfectly formed efforts at speaking of little
children. It is also used to designate the imperfect
speech of imbeciles. Sometimes these imperfections
of speech are retained long after the time when the
child should have spoken the words in its limited
vocabulary clearly. It is then the duty of its parents
to ascertain the cause of this delay in speech develop-
ment. It may be the result of malformation of the
throat, tongue, or mouth, or of word-deafness,
which latter trouble would prevent the child from
hearing the pronunciations of some words with
sufficient clearness to imitate them.
Grown-up people who are much with the child
68 THE TREATMENT OF STAMMERING,
should invariably speak with accuracy and distinct-
ness, employing simple words as far as possible ;
and they should use every endeavour to teach the
little one to speak correctly, never imitating its
" baby talk." Why should the poor child be put
to the trouble of first learning this " baby talk " and
afterwards having to learn entirely different words
for the same object? For instance, gee-gee for
horse ; moo-cow for cow ; baa-lamb for lamb ; bow-
wow for dog, and so on. Each of those "baby-
words " is a dissyllable, requiring two movements
of the voice and of the articulatory processes to
produce it ; yet, when learnt, the child finds that
the animal he has been taught to call a gee-gee is a
horse, and so on, to the confusion of his little brain.
When lalling proceeds from imbecility, the child
should be placed under the care of a medical prac-
titioner who specialises in such cases.
Lisping
Lisping is an imperfect way of pronouncing the
letter s, usually occasioned by wrong position of
the tongue ; sometimes also by defective shape of
the hard palate. In the simple and commonest form
of lisping the sound th is substituted for s, because
the tip of the tongue is put either between the upper
and lower teeth or against them. In a few cases,
the fraenum, or muscle of attachment of the tongue
CLEFT-PALATE SPEECH, AND LISPING 69
to the bottom of the mouth, is too short to permit of
raising the tip of the tongue sufficiently high to
reach the proper position against the roof of the
mouth for 5. If exercises for stretching the cartilage
and making it pliant fail in their object, it will then
be necessary to call in the aid of a surgeon to snip
the muscle so as to allow freer movement of the
tongue. When this little cut has quite healed, daily
practice in the right pronunciation of the letter will
overcome the habit. It is easy to correct this sort
of lisp in childhood; but some parents think the
child "will grow out of it," and they take no
trouble in the matter ; therefore the habit increases,
and gives much trouble in after years. The lisp
frequently commences at the time of shedding the
first teeth, when a gap is left in front of the mouth,
through which the tip of the tongue protrudes in
the endeavour to say s; it becomes almost impos-
sible not to substitute th for s, as thay for say, yeth
for yes, etc. The habit being thus formed, it is neces-
sary to watch the effect of the second teeth on the
mispronunciation. Sometimes the lisp rights itself,
but it often remains, unless definitely corrected.
The tip of the tongue should not touch the teeth
or gums in saying a pure s. The front of the
tongue becomes spoon-shaped, with the tip a little
depressed, and the edges at the sides slightly turned
up, just as in a dessert-spoon. These turned-up edges
70 THE TREATMENT OF STAMMERING,
touch the upper gum close against the teeth; the
breath is thus forced into the narrow groove between
the turned-up edges of the tongue, and the hissing
sound of s is made. It is more or less acute and
sharp, or dull and muffled, according to the extent
of approximation of the edges of the tongue against
the gums. The s sound can be made peculiarly
aggressive and unpleasant; and as it is constantly
recurrent in our language, it is worth taking trouble
to learn to say it well. A very little patience and
perseverance will enable anyone to conquer this sort
of lisp, unless it is caused by malformation of the
mouth, such as abnormal height of the palate, or
its narrowness, or to faulty position or absence of
teeth. Even with these drawbacks, it is often pos-
sible to acquire correct pronunciation of the letter.
The other form of lisping is caused by sending
the breath forcibly through the side teeth, causing
a disagreeable, bubbling sound. The tongue, in
these cases, is generally too thick and too large for
the mouth. Various exercises which I have devised
for acquiring control of the tongue and for reducing
its size are described in The Speaking Voice* and
have proved very useful ; but this sort of lisp takes
much longer to eradicate than the first one described,
and can seldom be overcome without special exer-
cises.
* Mrs. Emil-Behnke, loth edition, Curwen and Sons.
CLEFT-PALATE SPEECH, AND LISPING 71
One of our bishops refused ordination to a can-
didate on account of this aggressive, bubbling lisp.
The Principal of the young man's college asked
me to see what I could do to remove the trouble.
Fortunately the lisper was most intelligent and
persevering in carrying out instructions, and in
three weeks could pronounce every s perfectly. He
has since been ordained, and has had no recurrence
of the difficulty.
There are many minor forms of speech disorders,
such as the substitution of w for r, or forming the r
with the root of the tongue instead of with the tip ;
the substitution of v for th, as farver for father, wiv
for with; dropping the final g as lazy and bad a
habit as dropping the h and so on. But the worst
of all is the horrible mispronunciation of the vowels
heard amongst the populace of our large towns, as
disagreeable to hear as cleft-palate speech. These
being faults of careless pronunciation rather than
defects of speech, do not require detailed explana-
tion, and, moreover, are fully dealt with in The
Speaking Voice,
PART III
BY KATE EMIL-BEHNKE
PART III
FROM a lifetime of intimate association with the
treatment of stammering emerges the unmistakable
fact that, be the contributory factors in stammering
what they may, its root cause, in all except such as
is acquired by imitation, is to be found in some
nervous derangement. This may be a matter of
inherited neuropathic tendency; or of definite ner-
vous instability; or it may have been caused by
some shock to the nervous system. But it is im-
probable that such shock would have induced stam-
mering had not the sufferer been of a neuropathic
constitution ; and it is equally improbable that any
of the factors mentioned in the foregoing pages
bars though they are to cure, and essential as is
their removal to ensure a successful issue of speech
treatment would have contributed to stammering
without the nervous diathesis.
Thus stammering must be regarded as a nervous
disorder, and every effort must be made to reach
the psychic causes, tranquillise and stabilise the
nervous system, and treat the stammer by breathing
exercises and re-education of the muscles of speech.
No greater mistake could be made than, on the one
hand, to treat the stammerers with harshness or
75
76 THE TREATMENT OF STAMMERING,
severity, or, on the other hand, to ignore the trouble
and expect that the sufferer will grow out of it.
For one who does so there will be ninety-nine who
do not, and for whom life will be little short of
misery in consequence. Systematic treatment must
be carried out, hygienic conditions of life insisted
upon and the general health carefully watched and
any departure from the normal attended to without
delay. It is extraordinary what a variety of causes
not seeming to have the least connection with stam-
mering may act as contributory or exciting factors,
either in starting it in the first place, or tending to a
return of it if the general health be not kept up to
the mark.
In many cases that have come under my notice
stammering has commenced in childhood after an
illness, such as whooping-cough or measles, and in
some instances asthma is stated to have caused it,
The association of asthma and stammering con-
stitutes the most difficult class of case to deal with.
Much depends of course on how bad the nervous
factor is, and also upon the degree of emphysema
and spasm which exists. In many such cases, how-
ever, not only has the stammer been entirely over-
come, but the asthma has also benefited materially
through the breathing exercises and treatment of
the general nervous conditions.
In a recent case of mine, that of a girl of sixteen,
CLEFT-PALATE SPEECH, AND LISPING 77
a bad stammer commenced in childhood after acute
colitis. Diaphragmatic spasm and tremor were
very marked, with great difficulty in words begin-
ning with consonants. Speech, even when the
patient spoke without stammering, was extremely
jerky, and the stammer was accompanied by con-
siderable grimacing, the tongue frequently being
rolled out in a condition of spasm and contortion.
A curious feature of the case was that there was
little or no apparent nervous factor, the stammering
seeming to have been caused solely by the upset to
the system of unusually acute colitis. There was
also a slight lateral spinal curvature with marked
rigidity in the lower dorsal and upper lumbar
regions, and considerable lack of balance and mus-
cular co-ordination. These physical irregularities
were attended to by a medical gymnast while the
speech treatment was being carried out, and the
results were in every way most excellent.
Spinal Irregularities
I find some form of spinal curvature in 80 per
cent, of my cases, very frequently accompanied by
knock knees and flat feet; and even when there is
no lateral curvature there is more often than not a
marked lordosis with rigidity in the lower dorsal
and upper lumbar vertebrae. I am quite convinced
by long observation of such cases that this rigidity
78 THE TREATMENT OF STAMMERING,
has a bearing on nerve tension and irritation in
relation to stammering which it is impossible to
over-estimate, and my view is confirmed by the gain
in ease and freedom, with corresponding benefit to
the speech, when this is corrected. Knock knees
and flat feet, with their concomitant of faulty dis-
tribution of weight, also contribute materially to,
and in some cases are the primary cause of, the
faulty balance and general lack of co-ordination so
frequently found in stammerers ; while the flattened
ribs in scoliosis, impeding as they do expansion of
one lung, and bringing about torsion of the dia-
phragm, are amongst the causes of the characteristic
spasmodic irregular breathing of the stammerer. In
some cases I have found that a depressed sternum
has been a serious factor in the stammer.
An instance of this was the child of a medical
man, a boy of nine and a half, who stammered so
badly as to be absolutely unintelligible to all but his
own people, and whose efforts to speak were so
great as to leave him completely exhausted. The
sternum was so much depressed that a good-sized
walnut could be placed in the cavity great pressure
was caused on the heart, with consequent consider-
able degree of cyanosis. By means of carefully
graded breathing exercises the depressed sternum
was gradually corrected, and as the respiratory
power developed and spasm ceased the stammer was
CLEFT-PALATE SPEECH, AND LISPING 79
overcome. The boy, who was undersized and poorly
developed, then commenced to make normal growth.
I find it more satisfactory to have any medical
gymnastic treatment that may be required for such
cases carried out under my immediate supervision,
in close co-operation with my treatment of the speech
defect, and I have for some time had a medical
gymnast working in conjunction with me for this
purpose. Even where there is nothing in the nature
of spinal or other definite physical irregularity I
find that in most cases medical gymnastics are of
great value in combination with the speech treat-
ment. Balance and general co-ordination of move-
ments are usually faulty in stammerers ; the jerkiness
and lack of rhythm which are characteristic of their
speech being more often than not also found in all
their physical activities ; and the establishing of
correct speech habits the result of delicate complex
co-ordination of many different types of muscle
actions, which we are practically unconscious of
when they are functioning normally is materially
assisted by graded resistive movements and training
in co-ordination and balance.
Mental Shook or Fright
Stammering is more frequently the result of
shock or fright in childhood than is usually recog-
nised, and is the most difficult type to overcome.
8o THE TREATMENT OF STAMMERING,
Parents are often unaware that any shock has
occurred, the fact only coming to light after a lapse
of time ; and they are therefore completely at a loss
to understand the sudden development of a stammer.
Under these circumstances the tendency is to expect
the stammer to depart as suddenly as it came,
whereas the longer treatment is deferred the more
deeply rooted does the trouble become. Moreover,
where it has been caused by a shock of any kind
an apprehensive habit of mind in the sufferer be-
comes established, and not only does this exist in
relation to the stammering itself, but apprehension
of disaster of any kind, of bodily injury, acute
distress at sudden noise, are also frequently present,
and any mischance that may befall the stammerer
will cause bad fits of stammering.
An interesting case of stammering that developed
after an accident was that of a boy who fell out of
a window, a drop of some thirty feet, on to hard
ground. He had concussion of the brain, was for
a considerable time unconscious, and on recovering
consciousness commenced to stammer violently.
The stammer became habitual, though varying in 1
intensity, always being worse under any conditions
of nervousness.
Before the accident he was apparently quite
normal in every way, and in the opinion of his rela-
tives not of a nervous disposition. This view, how-
CLEFT-PALATE SPEECH, AND LISPING 81
ever, must be accepted with reserve, as in early
childhood a nervous diathesis is not always recog-
nised unless circumstances arise which bring the
child under expert observation.
In this case not only was the action of the muscles
of respiration and articulation spasmodic in the
extreme, but muscle action in general was spas-
modic, balance and co-ordination were very poor,
and he was quite incapable of carrying out any
smooth slow movements.
Had the psychic factor been treated when the
stammer first developed after the accident, on the
lines of the psychotherapy which has been so suc-
cessful in shell shock, the trouble would probably
have been overcome ; but the too prevalent idea was
acted upon that the boy would grow out of it,
instead of which by the time he was brought to me,
some four years later, he had grown into it: nervous
apprehension in general had assumed formidable
proportions, and incorrect, jerky muscle action had
become firmly established. One or two attempts
had been made by ordinary elocution lessons to
improve the speech as the boy grew older, when the
relatives realised that he was not " growing out of "
the stammer, attempts foredoomed to failure unless
the psychic factors were also treated and certain
adverse physical conditions attended to. The latter
I found to be not inconsiderable, consisting of a
6
82 THE TREATMENT OF STAMMERING,
deflected nasal septum, latent spinal curvature, wing
scapulas, a bad rigid lordosis, knock knees and
flat feet.
The nasal obstruction was by my advice surgic-
ally corrected, and the boy found considerable relief
in his speech therefrom, but the relatives did not
see their way to having the other matters attended
to while he was under me for his stammer, taking
the view, against my advice, that it would be time
enough for this to be corrected by the school medical
gymnast when he left me. Subsequent events fully
demonstrated the unwisdom of this decision. All
the muscular movements of ordinary daily activities
were so jerky and erratic as to render very difficult,
if not actually impossible, acquirement of the con-
trolled breathing, and co-ordinated rhythmic action
of the finer muscle work that go to produce speech.
This was proved by the fact that, whereas he was
able to speak perfectly when lying down, or when
sitting in a correct position with the weight sup-
ported in a reclining chair, he stammered violently
when attempting to talk whilst walking or standing.
His treatment with me was brought to a prema-
ture close by the sudden death of a near relative,
and he went to public school still under the handi-
cap of his stammer.
There is little doubt that, had medical gymnastic
treatment been combined with the speech training,
CLEFT-PALATE SPEECH, AND LISPING 83
as I advised, the trouble would have been com-
pletely eradicated even in the much reduced time
he was with me.
I mention this case because I do not think it is
sufficiently realised how many possible contributory
factors there may be in stammering which must be
attended to, either before or during the speech
training (according to the nature of the particular
factor) in order to ensure success.
Another case of stammering following nervous
shock was that of a girl of sixteen who had de-
veloped the trouble after fright occasioned at the
age of five and a half by a tramp snatching a locket
from her neck. She stammered badly to strangers,
and to her own people in moments of excitement.
I found here a slight nasal obstruction, so slight
that I did not anticipate it would be any factor in
the stammer, and as her parents feared the effect of
a visit to a surgeon on her extremely nervous
temperament, I decided to commence speech treat-
ment without seeking medical aid first as is my
custom in such cases. Her progress, however, did not
satisfy me and my advice was then followed and the
nasal obstruction removed, after which the stammer
yielded satisfactorily to the speech treatment.
It is certainly extraordinary how slight a patho-
logical condition may hinder success, but my ex-
perience confirms this time after time. Even an
84 THE TREATMENT OF STAMMERING,
elongated uvula may be a sufficient adverse factor,
and frequently when it has been thought unneces-
sary to have it shortened and subsequently it has
been decided during the course of treatment with
me to have it attended to, the gain in freedom of
speech and ability to respond to the exercises has
been immediate and unmistakable.
The Effect of the War
The effect of the war upon children is common
knowledge. Even here in England, where the
privations were infinitesimal compared with those
endured on the Continent, the results physically
from insufficient vitamines, fats, sugars, etc., were
obvious ; but who shall estimate the effects on the
nervous system of a child, of the anxiety and
anguish of its mother, and of actual nerve shock
from air raids ?
Who can estimate how far-reaching may be the
effect upon young children roused from sleep again
and again, often many nights in succession, and
taken downstairs to shiver with anticipation of the
deadly shattering terror that approached : to say
nothing of the hundreds who nightly slept hour
after hour in the foetid atmosphere of the Tubes ?
Who that saw this can doubt that the results ner-
vously must be incalculable and possibly inefface-
able?
CLEFT-PALATE SPEECH, AND LISPING 85
I had many cases of stammer in children directly
caused by air raid shock, and found them always
accompanied by a high degree of nervousness and
nervous apprehension.
Apart from actual causation of stammer, there is
no doubt that even outside the air raid areas the
anguish and nervous tension that the whole nation
was living under reacted on the children, and I
think we are far from having lived it down yet.
Certainly in my work in connection with the treat-
ment of speech defects, I find a much higher degree
of nervousness than formerly.
Hopes have been entertained that the psycho-
therapy which was found so successful in the treat-
ment of shell shock would be equally successful in
the treatment of stammering in general, but in
the main these hopes have not, I think, been
realised.
Where a stammer, caused by shock, can be treated
soon after it manifests itself, before wrong muscle
action has become established, this would clearly
be the right method to adopt, but where breathing
is insufficient or spasmodic, and where co-ordination
is faulty, muscle re-education and patient training
in rhythmic co-ordination will be necessary.
Naturally psychic re-education will be equally
necessary, but cure cannot be expected from this
alone where wrong muscle action has become a
86 THE TREATMENT OF STAMMERING,
habit. It is a mistake, in my opinion, to deduce
that only the psychic element requires treatment
because in so many cases a person who stammers
badly at times will speak on other occasions with-
out stammering. If the speech of a stammerer be
analysed, it will be found in most cases, even when
he is at his best, always to have in it the elements
of the defect; that is, faulty respiration, jerky
delivery, and unduly short vowels. It only requires
the spark to the magazine of nervousness or excite-
ment to convert this into a stammer.
Influence of Prevailing Habits of Speech
It is, therefore, not sufficient to be satisfied with
removing the stammer; really good speech habits
must be acquired and the stammerer's tone per-
ceptions must be awakened. He must aim not
merely to speak as well as most normal persons
but a great deal better. He must take a pride in
speaking his own language beautifully and must
not be content with the slipshod clipped mutilation
of our noble English that prevails.
The Auto-suggestion of the New Nancy School
must without doubt be materially assisted in its
application to stammering by the high standard of
speech that obtains in France. Continuity of tone
that sine qua non for the stammerer is automatic-
Ally ensured by the liaison, and further reinforced
CLEFT-PALATE SPEECH, AND LISPING 87
by nasal resonance, which is absolutely inherent in
the French language, and conspicuous by its absence
from the English language, or rather, from the
English language " as she is spoke."
The subconscious mind of the Frenchman has
registered good speech, and, moreover, speech of
the kind most calculated to assist in overcoming a
stammer. This fact should be borne in mind when
results obtained by the New Nancy School in this
respect are being considered.
Undoubtedly the careless, slovenly speech which
is heard on all sides in England makes it much
more difficult for a stammerer to conquer his defect
than it need be. All those associated with him
should do their best to speak deliberately, smoothly,
and distinctly. They can in this way render great
assistance.
It is further very wise that after the speech defect
has been overcome the stammerer should -take up
the study of singing or elocution, preferably, if
possible, under the same teacher who has treated
the stammer. In this way control is obtained of
the muscles used in the production of the voice
which will be invaluable and which will give him
the confidence born of knowledge and the sureness
arising from trained muscles which by systematic
exercise have been brought under the control of the
brain and consequently will no longer be liable to
88 THE TREATMENT OF STAMMERING,
be upset in their correct functioning by any assaults
of nervousnesss.
Confidence will still further be established as the
pupil progresses in his study of normal voice use
by discovering that he can give pleasure by per-
formance which the teacher will encourage him to
do a change in his whole attitude towards life in
association with his fellow-men the psychic bearing
of which is impossible to over-estimate.
General Health
It is essential to attend to the general health of
a stammerer. " Coddling " or fussing should be
avoided, but healthy conditions of life must be
insisted on. Plenty of exercise in the open air,
plenty of sleep, avoidance of late hours, crowded
rooms and excitement, these are all essential. A
careful diet should be carried out. Rich foods
should be avoided and meat should be taken in
moderation ; indeed, some stammerers do better on
fish in place of meat. " Sloppy " foods, rich pud-
dings and pastry should be avoided, and starch
food in general should be cut down as much as pos-
sible. Sweets particularly chocolates should not
be permitted ; condiments, pickles, sauces and the
like are better avoided altogether. Wine and spirits
should never be taken ; tea and coffee sparingly, and
not strong. Mastication should be thorough.
CLEFT-PALATE SPEECH, AND LISPING 89
Stammerers, as is so frequently the case with ner-
vous persons, are inclined to bolt their food, and
the resultant indigestion upsets breath control. A k
bad attack of indigestion has frequently caused a
relapse in a stammerer.
A diet rich in vitamines is essential, and a good
plan is to make one meal a day as far as possible of
uncooked foods such as wholemeal bread and cheese,
salad with good olive oil and lemon juice instead
of vinegar and plenty of fresh fruit. Raisins or
honey can be taken at this meal. These give the
necessary sugar in an ;easily assimilable form, and are
valuable nerve foods. For adults such a meal would
be best at midday, and it will be found that it is
much easier to work after than after a meal of
cooked foods. For children, whose chief meal is
usually the midday one, it will probably be best as
the last meal of the day. Nervous children will
sleep more quietly and be less likely to dream after
a meal of " raw M foods such as these than after one
of cooked foods.
Hurry and worry should be avoided. Stammerers
should not lie in bed in the morning till the last
minute and then dress in violent haste, go to break-
fast late and discomposed, bolt their meal, and rush
off to work. The whole day goes wrong, and many
a bout of bad stammering has its origin in an early
morning scramble. '"A stammerer should always
90 THE TREATMENT OF STAMMERING,
feel that he has ample time for everything that he
has to do. Few things are more likely to upset his
self-control than the feeling that he is keeping
others waiting, either in speech or action.
Undoubtedly an outdoor life is best, and where
this is not possible, recreation should be in the form
of outdoor amusements. Exercise should be taken
in all weathers, and not only should Saturdays and
Sundays be spent in the open air, but a daily walk
throughout the week should be insisted upon.
Young people who go into business on leaving
school, or take up work of a sedentary nature,
frequently suffer very much from the cessation of
regular outdoor games, and a great deal might be
done to counteract this by forming the habit of
.walking part of the way to and from work. When-
ever possible the walk should be through park or
recreation grounds, or along the Embankment, or
where no such open spaces are available, quiet by-
streets should be chosen rather than the crowded,
noisy main streets.
Influence of Noise upon the Nervous System
I have long been convinced that noise has a very
prejudicial effect on the nervous system, and I have
frequently noted its adverse influence on stammerers
of a nervous type. It is, therefore, of interest to
mention that this view has recently been corroborated
CLEFT-PAI/ATE SPEECH, AND LISPING 91
scientifically. It used to be thought that people
became accustomed to noise, but it has now been
demonstrated that we actually expend nervous,
energy in " refusing to hear.'* Instruments have
been devised which give approximate values for the
energy expended in not hearing noises of various
kinds, from which it is clear that dwellers in large
towns are perpetually expending nerve force in this
way unnecessarily. This naturally reacts seriously
on those who are of a nervous disposition, added
to which, in the case of stammerers, is the actual
expenditure of physical effort in trying to speak
against noise. Some idea will be formed of this
wastage of energy when it is recalled how loudly
people coming to the country from towns are
noticed to be speaking when they first arrive. It is
also noticed that they cannot at first rest. They
rush about feverishly, making excursions, seeing
sights, and so forth, and frequently only after
several days can they relax and rest.
The noise of the screeching shell and the thunder
of the big guns were as great a factor in the shatter-
ing of the morale as the fear of bodily injury.
So we see that where stammering is of nervous
origin, everything in the daily life of the individual
which has an adverse influence on the nervous con-
dition must be legislated for.
92 THE TREATMENT OF STAMMERING,
Importance of Establishing Good Conditions
of Life
It by no means follows that this necessarily means
a life of deprivation, still less that it implies a
constant "fuss," or conscious arrangement, of what
is or is not permissible. Where the patient is a
child, or in early youth, the parents or guardians
can for the most part control, or at least improve
materially, the conditions of life ; and in the case of
an adult, or one old enough to realise the drawback
of stammering, there will be every incentive to co-
operate in avoiding everything which may be preju-
dicial to cure, and reward soon comes, not only in
overcoming the stammer, but in the increase of
well-being, of capacity for enjoyment, of self-
control and competence due to a higher degree of
nervous stability.
Treatment
There is nothing to add to what has been said in
Parts I. and II. on the matter of the treatment of
stammering. It is not possible to give more than
an outline of the general principles. Their applica-
tion must necessarily vary in accordance with the
history, nature of the trouble, and nervous condition
of the individual, and it is useless to expect that
directions for cure can be given in a book or by
CLEFT-PALATE SPEECH, AND LISPING 93
correspondence. It is essentially a matter for
personal instruction, and in many cases the close
co-operation will be required of medical man,
medical gymnast, and speech specialist.
Stress has purposely been laid on the bearing of
the nervous condition, and of any adverse health
conditions, upon stammering in order to combat
the still too prevalent view that the patient will
" grow out " of the trouble, or that he could speak
properly if he were not " careless." It is incredible
to anyone who, like myself, is concerned with the
treatment of this distressing malady that either
view should be entertained, particularly where the
position and education of the parents are such as to
warrant the expectation of better judgment, as in
two cases which recently came under my notice.
The first was the son of a medical man, an
intelligent boy of 12 years of age. His father,
medical man though he was, took the view that
because at times the lad spoke without stammering,
he could, if he exercised care, do so always, and he
had only been deterred by his wife's entreaties from
attempting to " thrash it out of him." It was due
to her insistence that my opinion was sought. The
child's highly nervous condition was to me so
patent that it was difficult to believe that it could
escape lay observation, much less that of the father
who was a medical man . Despite everything I could
94 THE TREATMENT OF STAMMERING,
say, however, the boy was not placed under treat-
ment, the father adhering to his view and maintain-
ing that the boy was merely careless and could
speak properly if he chose.
The result of such an attitude is shown in the
second case.
A lad of about 17, who had just left school,
had wished to enter a civil employment (an employ-
ment of his own choice for which he had been
keenly desirous for several years). A medical
examination was necessary, and he was " turned
down " on account of his stammer. His parents
then got him into an office in the City, where they
thought his speech trouble would be no bar.
At the conclusion of his first week there he was
"sacked," his employer stating that there was no
fault whatever to be found with him in the carrying
out of his duties, but that his stammer made it
impossible to keep him. In this case the opinion
had been expressed in childhood that the boy would
"grow out" of the trouble. It probably could
have been quite easily dealt with then, whereas in
the meantime wrong speech habits had been estab-
lished, nervousness had increased, and self-con-
fidence fatally wrecked at the onset of entry into the
world by two such knock-down blows. It will
readily be understood what long and patient work
would be needed for the joint business of speech v
CLEFT-PALATE SPEECH, AND LISPING 95
re-education and establishment of nervous equi-
librium and confidence in such a case.
Age in Relation to Treatment
This brings us to the consideration of what is the
best age for treatment, the conditions necessary for
success, and the time it is likely to take.
, The first thing to be realised is that no hard and
fast rules can be laid down. Individual circum-
stances vary so widely that each case must be con-
sidered on its own merits.
Undoubtedly expert advice should be sought the
moment stammering shows itself. If dealt with at
once it may at once be eliminated. In early child-
hood, while control of the body is still being
acquired, and its habits are not yet fully auto-
matic habits which later in life give us so much
trouble to alter the matter may be fairly simple.
Particularly important is it that it shall be attended
to without delay if the stammer has been induced
by any nerve shock. A wise psychic handling
when the trouble first arises may not only prevent
the stammer from becoming established, but may
prevent the development of nerve trouble, the
ramifications of which may be incalculable.
If advice can be obtained at once the trouble may
be arrested. On the other hand, treatment in child-
hood may have to be carried over a very con-
96 THE TREATMENT OF STAMMERING,
siderable period of time, or short courses may be
needed at intervals. In some cases, when the matter
has not been attended to in the first place, it may
be wiser to defer treatment till the child is old
enough to realise the drawback of stammering, and
will, therefore, bring active will-power and co-
operation to the treatment. This is a factor of the
highest importance in overcoming the trouble, and
can only be considered negligible in earliest child-
hood. Cure may be accomplished in a compara-
tively short time in adult life by reason of the
greater degree of concentration and determination
which is brought to bear by the stammerer, but
this is no argument for omitting to treat the trouble
in childhood.
Education is obviously hindered by such a
handicap, not to mention the fact that there is a
growing tendency on the part of school authorities
to decline to take a stammerer into the school at all.
It is to be hoped in the interest of stammerers that
this tendency will become universal, for the trouble
will then of necessity be treated, as would any other
remediable illness or physical disability. And this
brings me to a very important point.
Conditions Necessary for Cure
When treatment is decided upon a stammerer's
whole time should be given up to it and to the
CLEFT-PALATE SPEECH, AND LISPING 97
establishing of the necessary health conditions.
Parents must realise that the success and happiness
of the whole future may depend on the complete
eradication of the trouble, and to talk about " sacri-
ficing education " by withdrawing a child from
school for this purpose is sheer nonsense. Educa-
tion will proceed very differently when the handicap
of the stammer is removed. The laments I hear
from adult stammerers on the hiatuses in their
education, owing to their trouble, would surprise
many who take this view.
A child must either be withdrawn from school till
the trouble is overcome, or it must be treated in the
holidays. It is easy to see that there are practical
objections to both these courses, and it may be
expedient to adopt a compromise viz., to withdraw
the child from school for a term on first commencing
treatment, and then to take holiday courses until
the trouble is completely overcome. In most cases
the school authorities must be asked to arrange for
practice to be carried on at school, and, where time
and distance permit, it may be desirable that the
pupil should visit the speech specialist once or twice
weekly during the term, an arrangement which will
help to prevent a relapse under the rather adverse
conditions for a stammerer of school life. It is also
very wise for the school authorities thus to be in
touch with the speech specialist, for relapse can in
7
98 THE TREATMENT OF STAMMERING,
this way frequently be prevented. To give an
illustration of my meaning, a public-school boy
commenced to stammer again after being rather
badly damaged in a football " scrum." In another
case the nerve shock of an injury in the carpenter's
workshop brought about a return of the trouble,
which in short holiday courses I was able com-
pletely to remove.
There are two fixed points in a boy's career when,
if stammering has not already been treated, a pro-
longed course should be undertaken ; or when, if it
has already been treated, a course should again be
taken if there be the least trace still existing viz.,
between leaving the preparatory school and going
to public school, and on leaving public school
before going to University or embarking on his
career.
Nevertheless, should adult years have been
reached without the stammerer having been treated,
no one need think it is too late. In my experience
the trouble is curable at any age, and always with
great gain in general health and happiness.
Undoubtedly it is best, not only in childhood but
also in adult life, for the stammerer's whole time to
be devoted absolutely to the lessons and practice.
No one would expect to carry on education, pro-
fession, or business while undergoing treatment for,
say, gout at Harrogate. Why should such a thing
CLEFT-PALATE SPEECH, AND LISPING 99
be expected in regard to stammering, particularly
when it has been long established ?
Daily lessons give the best results, and though
the trouble may be and is curable where these are
not possible, I find that cure is almost invariably
accomplished in a considerably smaller number of
lessons when they can be taken daily. Co-operation
at home in the practice and application of the rules
is most desirable, and will materially speed up the
cure. In the case of children it is essential, and
even in adults such assistance is of great value.
One young man who was working in London and
had little opportunity for practice in talking owing
to his being in lodgings, brought at my request a
friend with him to his lessons who devoted all his
spare time to helping him in his practice and
reminding him of the rules in talking, with
admirable and speedy results.
Stammering in Several Members of a Family
When more than one member of a family
stammers each should be treated, either separately
or together as seems the more desirable.
A child whose father or mother stammers will
find it very difficult to overcome the trouble unless
the parent's stammer is also treated, and I have had
most excellent results in several instances by taking
parent and child together.
ioo THE TREATMENT OF STAMMERING,
Conclusion
In the foregoing pages the most serious of the
disorders of speech have been considered and their
treatment indicated. As has been stated, it is not
possible to give rules for every patient, because no
two persons are alike in their defects, whether of
stammering, cleft-palate speech, or lisping. Each
case must be treated individually according to its
special requirements. In all cases patient perse-
verance is a necessity in order to remove bad
muscle habits and to form new and correct ones.
Exercises must be systematised and regularly per-
formed every day until the spasmodic, irregular
movements of the various muscles involved in
breathing and vocalisation have been entirely over-
come. No efforts can be too great to make for the
purpose of conquering the serious drawback to
success in life which stammering causes ; and
sufferers from this trouble should be much
encouraged by the knowledge that it is extremely
rare to meet with an incurable case.
No one need despair, and even if cure takes some
considerable time it is best to make the effort.
Moreover, great mental relief is experienced from
the moment treatment is commenced from the mere
fact that something is being done to alleviate such
a terrible nerve strain.
CLEFT-PALATE SPEECH, AND LISPING 101
Let no one take a pessimistic view of the possi-
bilities of cure from the difficulties enumerated in
the preceding pages, or the time that may be needed
to overcome them.
That they can be overcome in the majority of
cases is certain, and that the attempt should be
made is equally certain, for the sake of the sufferer,
for the sake of those with whom he is associated,
and last, but not least, for the sake of his or her
possible descendants.
Printed in Great Britain for Baillifre, Tindall and Cox by
Billing and Sons, Ltd., Guildford and Esher
14 DAY USE
RETURN TO DESK FROM WHICH BORROWED
This book is due on the last date stamped below, or
on the date to which renewed.
Renewed books are subject to immediate recall.
Iw
7 Q * |wO^-
. .
(Z
I
LD 21-50m-12,'61 TT .General Library
(C4796slO)476 University of Calif ornia
WOLC6)
601759
6) /
UNIVERSITY OF CALIFORNIA LIBRARY
