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■^//K^/i-^^^ 


1 STAMMERING 


^^ STUTTERING, 1 


^M .NATUBE AND TREATMENT. 1 


^H JAMES HUNT, PH.D., F.S.A, F.E.S.L, F.A.3.L.. 1 


^^^^1 HDD. FanlBn Suretuy of tbe Ronil Sodctr oF EJunturs of Qrnt llriuin ; Hon. 
^^^B eaud (1B87I of tbil Untyorain of (HameD ; Mambar of On IBJ^ AcBd., D«s- 

^^^r of Ihe SoB\tli tea Ami* ie 1* Kaiaro of HoHoir; of tlu Oeo- 
^^H grephiMl Socie^ of Draodon: lbs Sooteii ParUleune 

^^B E«M Dormsudt ; ind of the Upper H«h Nc 
^^H tend Hlslor; BhiIM;^ ; Ma., Mo., eU. 


^H The Rev. H. F. RIVERS, M,A., F.R.S.L. 


Hp^^DIOAn^^SBPEJ'rR EDITION. 
, « V^ ^ ^ ? '■ (^^ft ffinlargtB, onli Cnlitclg KtbiBtl. 


J*%^^^NO|^X 


^H LONDON; 


^^1 LONGMANS, QEEEN, & Co.. PATEENOSTEE BOW. 


^^^^ \An fighU reifrrfd.-] 






• • • 



,• • •• • 

• • • • 
• • ••• 

• • • • 






• • • 

• • • • 



" IfAVaUAGX 18 TO THE MIND "WHAT BXA171T 18 TO TB^ BODY. 

Aristides the Ehetorician, 



»» 




PREFACE TO THE PEESEST EUITIOX. 



A SAD and unexpected calamity has laid upon me the 
duty of editing tlie last literary and professional 
work of my brother-in-law, the late Dr. James Hunt. 
It was the author's desire that this revised, I ought, 
perhaps, to say re-written, edition of his book ou 
"Stammering and Stuttering" should be as perfect 
and comprehensive as possible. To this eud he spared 
no labour in gathering together rehable information 
relative to the treatment of speech impediments in 
Great Britain and on the continent. The digest of 
the various systems employed with this view shews 
the extent of his researches ; and the commentaries 
upon them testify to his thorough knowledge of the 
subject, and are exceedingly valuable as being the 
fruit of many years' experience, founded on the ob- 
servation of more than 1700 cases. If any reader 
should think that the author judged too hardily of 



IV PREFACE. 

mme other systems employed^ let such an one le- 
member that his great success in his own and his 
father's system gave him the right of speaking with 
authority. I owe a great debt of gratitude to the 
late Dr. Hunt for brightening the course of my life 
by the successful application of his method to my 
own case when others had CEiiled. This has led me 
U) value his judgment^ and to believe in the truth of 
his system ; whilst the general improvement of the 
jihysical and mental health of his pupils proves the 
soundness of its physiological principles. 

I have not felt warranted in making any altera- 
tions ; for the author completed all the manuscripts 
for tlie work. Had he been spared to have seen it 
through tlie press, it would have borne the evidence 
of the finishing touches of the master's hand. 

In accordance with the express wish and desire 
of the late Dr. Hunt, and a definite promise 
on my part, I have undertaken the direction of the 
institution at Ore House, and intend to carry out his 
system in its integrity. I may here be allowed to 
state that I enjoyed ample opportunities of mastering 
the principles upon which the system is foimded, 
for I resided with the late Dr. Hunt continuously for 



nearly eighteen moiitlis in the yeaiB 1859-60, and 
have made very frequent visits since that time, takiuy 
charge of his pupils in seasons of sickness, or of his 
absence from home. The many kind letters tliat I 
have received from old pupils, to whom I am per- 
aonallj known, have gi^'en me great encoiiragemeut 
to persevere in my intention, I will give extracts 
from two letters : C. K writes, " I am glad to hear 
that you have resolved, on the sad death of my 
friend Dr. Hunt, to carry on his business, and to 
teach his system of curing stammering. Aa an old 
pupil of his, I can testify to its worth ; and I am 
aware that you have had full opportunities of ac- 
quainting youi'self with it in practice as well as in 
theory." Again, C. W. T. writes to Mrs. Hunt: "I 
am glad to think that your husband's great work haa 
fallen into such competent hands as those of Mr, 
■Eivers. ... I owe much to Mr, Rivers for comfort 
at a time when I was rather downhearted." 

Among the various papers left by the late Dr. 
Hunt on Voice and Speech, there are some on " dys- 
phania dericorum," or clergjTnan's sore throat. These 
and, perhaps, some other papers 1 Lope to edit at a 
future time ; for I feel persuaded, from what I learnt 



VI PREFACE. 

from him and from personal experience, that such an 
afifection, so far aa it arises from the wrong use of 
the vocal organs (and this is the most conmion cause 
of it in clergjrmen and barristers), might be easily- 
avoided. 

H. F. EiVERS. 



Ore House, near Hastings, 
Dec&mher 30th, 1869. 



PREFACE TO THE FIFTH EDn'ION. 



The fact of another edition boing caUed for, within 
a comparatively short time, ia a sure sign that I have 
not been tmsuccesaful in supplying what I deemed 
to be a desideratum. 

It appeared to me a point of primary importance 
that the field of impeded utterance should be com- 
prehensively surveyed, so that the reader might have 
a panoramic view of all the theories and speculations 
on this subject, from the earliest period to the pre- 
sent time, as well aa the results of their application. 
In reviewing these various doctrines, I- have not 
hesitated to express ray opinion candidly, but I tniat 
not arrogantly. 

The omission of some subjects, such as the chapter 
on minor defects, etc, which I intend to treat in a 
separate work, has enabled me to introduce numerous 
and important additions. This edition, has, more- 
over, undergone further revision, and I hope also to 
have amended the general arrangement. 



Vm PKEFACE. 

For reasons stated in the text, it is not pretended 
that a mere perusal of these pages will enable afflicted 
persons to cure themselves; but they certainly will 
derive from it every information as to the nature of 
their infirmity, as well as the conviction that impedi- 
ments of speech, so long held to be incurable, are as 
amenable to treatment as other disorders of the 
human frame. 

One of the main objects of this work is, moreover, 
to impress on parents and guardians the great im- 
portance of meeting the evil in embryo, so as to pre- 
vent its future development. 

In expressing my acknowledgments for the favour- 
able reception my former contributions to this subject 
have met with from the Press, the Medical Profession, 
and Public generally, I may be allowed to add that 
it has been my anxious desire to render this little 
volume as complete as possible, in order to make it 
more worthy of the favour bestowed on its prede- 
cessors. 

James Hunt. 

Jomuary, 1863. 



DEDICATION OF THE SIXTH EDITION. 



TO MY PUPILS. 



In dedicating this work to you, I am afforded a fitting 
opportunity of addressing a few words to those among 
you who, though scattered in the world, continue to 
take an interest in my labours. 

My thanks are specially due to you for assisting 
me to remove the scepticism still existing in the 
public mind, in relation to the successful treatment 
of impediments of speech. 

I now ask for a continuance of your assistance, by 
informing the public, that the plan I adopt for the 
cure of impediments of speech simply consists in the 
rational application of the known laws of physiology 
and psychology; and not in any charm, which, I 
regret to say, seems to be the impression of many 
who apply to me for relief. 

It cannot be too frequently repeated, nor too 
widely known, that the difficulty of cure is great in 



X DEDICATION. 

proportion as the defects of articulation are numerous 
or deeply rooted; that the acquisition of perfect 
utterance is the result of labour ; and that the efforts 
of the teacher are of little efficacy unless heartily 
seconded by the perseverance of the pupil. 

I feel sure, also, that I may rely on your influence 
and advice in order to induce parents to send their 
children to me in early boyhood, as you know the 
misery that you would have escaped had this plan 
been adopted. I need scarcely add, that to hear of 
your success in your respective avocations, will ever 
afford the deepest gratification to 

Your sincere friend, 

James Hunt. 

Ore Houte, near Hastings, 
March 3rd, 1865. 



PREFACE TO THE SIXTH EDITION. 



In publishing a new edition of this work, I especially 
wish to call the attention of the reader to the neces- 
sity for an early treatment of all cases of defective 
speecL Every day's experience convinces me more 
firmly of the necessity of this course. The public 
press would be doing a great service to sufferers, by 
warning parents and guardians not to neglect defec- 
tive speech in early youth. Indeed, I am sometimes 
sanguine enough to believe that stuttering, in a 
generation or two, would no longer be one of the 
" ills that flesh is heir to," if all children thus afflicted 
were at an early age freed from their defect. I am, 
at all events, sure that the neglect of defective 
speech in childhood is a fruitful cause of its produc- 
tion in others, especially in the younger members of 
the same family. 

J. H. 

Ore House, near HcLsttngs, 
March 3rd, 1865. 



CONTENTS. 



Impediments in Speech a, Keal Affliction — An Obstacle to Fro- 
fsBBional Si]ccea9 — FerniciouB InSuencQ on the General Health 
— The Production of Speech— Migandie — ^On what Perfect 
Speech dapenda— Nonienclatnce of Impedimenta of Speech 
in VftriouB Languages — Stammering and Stuttering de- 
fined ... ... ... ... ... ... 1 



CHAPTEK II. 



HIBTOBICAL i 



FiMT PesroD. — Scriptnre Eeoorda — Hippocrates — Arifltotle — 
^^ Deraoethenes— Cioeto — Celaus — Galen — ^ASti ua — A vicenn a — 

^^L G)ny da Chanliac— Mercurialia — Bacon— Menjot — Amman — 

^^B Eflstner^ — Hahn— Hartley — Haen — Santorini— Morgogni — 

^^P Sanvages— Cullen — Mendelsaohn — Ccichton^Darwin — Wat - 

^ son— Pnwik— ThelwaU— Savary ... ... ... 13 

CHAPTEE III. 

ISiuono Pee:od.— Itacd — Rullier — Voisin— Aatri^ — Combe— 
Broster — Leigh — Bertrand— M'Cormao — Arnott— Mailer — 
Delean ^ Palmer — Hervez da Ch^goin — Wutzer — Serrea 
d'Alais — Magendie — Schultheas — Banemann — Hamiaoh — 
Otto— Bell— Poett—CuU—Berthold—Wttiren—Giood— Hoff- 
mann — Malebouche- Thomas Hunt ... ,,. 53 



xiv CONTENTS. 

CHAPTEE IV. 



HISTOBICAL AND CBITICAL BEYIEW {contVMktd^) , 

Thibd Pebiod. — Galen — AStius — Paulus ^gineta — Fabricius 
Hildanus — Dionis — Hervez de Ch^goin — Dieffenbach — Vel- 
peau — Amussat — Baudens — Froriep — Bonnet — Phillips — 
Franz — Boux — Lucas — Guersant — Dufresse-Chassaigne — 
Langenbeck — ^Wolff — Sante-Sillani — Yearsley — Braid — Lee 
— Post — Mott — Parker — Commentary — Accidents ... 125 



CHAPTER V. 

HISTOBICAL AND CBITICAIi BEYIEW {concludkeS), 

FouBTH Pebiod.— Bonnet — Marshall Hall — Wright — Colom- 
bat — Beesel — Merkel — Buhring — Lichtinger — Blame — 
Hagemann — Becquerel — Graves — Bacc. Med. Oxon. — Bishop 
— Angermann — Bomberg — Eich — Leubuscher — Bosenthal — 
Wolff — Violette — Beclard — Klenke — Schulz — Chervin— 
Marshall — Lehwess — Wyneken — Holmes Coote — Or^ Guil- 
laume ... ... ... ... ... ... 140 



CHAPTEE VI. 

STAMMEBINa : ITS CAUSES AND. YABIBTIES. 

Chief Causes of Stammering — I. Ts^chicaX Stammering : 1. Ser- 
monis tumultus— Baryloquela — II. Speech Stammervng : 1. 
Lallatio — 2. Blsesitas emolliens — 8. Bbesitas indurans — 4. 
Ghunmacismus — 5. lotacismus — 6. Ehinophonia — 7. Urani- 
scophonia — III. Minor Defects : 1 . Ehotacismus — 2. Lambda- 
oismus — 8. Sigmatismus — Neg^o — Polynesian — Eussian — 
Stammering of Foreigners ... ... ... 193 



OONTENTST 
CHiPTEK VII. 



I 



€!orTMt Di agnosia Indispenaabla — Treatment of Piychiixtl 
BUcmmering : Cluttering — Barjloqnela — Sjieech Stammering .- 
Mumbling — Hardening Soft ConaonantB— Gamnmciiin — 
lotacism — EhiniHm — Surgical Operations — Cleft Palate — Sir 
W. FerguBBOo — M. N^laton — Herr Krug — Tongue Opera- 
tioDB — Pttc^ — Division of Frfflnum — Eicision of the Tonails 
— Mr. Harrey— M. Beonati— Mr. Vinoont— Sir George Dun- 
can Gibb— Dr. Yeanlej— Minor D^ecta: Hhotaoiam— M, 
Talma— Lambdacisin—Siginatiani ... ... 212 

CHAPTEE VIII. 



Characterietic Phenomena — Causes of Stuttering — DiS*eTeat 
Degraes — Different Species — Vowel Stuttering — Conaonantttl 
Stuttering — Influence of Imitation — Influence of Age— In- 
fluenoa of Education — Influence of Temperature— InSnence 
of Time of Day — Lunar Influence — Influence of Various Dia- 
orders of tlie Body — Psychical Influence — Stuttering in Sing- 
ing — Stuttering in Vrhiapering— la Stuttering Hereditary? 
— Ee-action of Stuttering on the General Health ... 329 

CHAPTEE IX. 



^ Prqudice againat Secret Eeraedies — The Secret of the Author's 
System conBists in the Application — Ftuil voce Instruction 
neeeBsary — Eiperience^ImpOBBible to give Written Direc- 
tions for the.Cure of Stuttering — Benefit to be derived from 
Books on Stuttering — Eipecienoed Instructor indiBpenfiable 
—Dr. Klenoke — Quackery— Dr. Eosenthal— " Appliances " 
— Ehazai— Treatment — Diagnosis — Method of the Author — 



/ 



XVI CONTENTS. 

Laryngoscope — Sir Danoan Gibb — Medical Treatment — 
Gellius — Ulpian — Dr. Klencke — Prof. Langenbeok — Medi- 
cinal Remedies but rarely necessary — Dr. Palmer — Chorea 
cured by Gymnastics — Electricity of no avail — Psychical 
Treatment — Dr. Paget — Dr. Klencke — Beneficial Effect of 
the Removal of Stuttering— Firm Will indispensable— Time 
necessary for Cure — Otto — Dr. Warren — Dr. Klencke — Ee- 
lapses — Bansmann — M. Malebouche — Mr. Bishop — Con- 
cluding Remarks. ... ... ... ... 296 

CHAPTER X. 

STATISTICS OF DEFECTIVE SPEECH. 

Computation of Colombat — Otto — Chervin — Map of France — 
Number of Stutterers in the whole world — Number of Stut- 
terers in England — Map of England — Stuttering among Fe- 
males — Itard — Astrie — Rullier — Colombat — Klencke — Nor- 
den — Wyneken — Penny Cyclopaedia — Author's Experience — 
Various reasons assigned — Stuttering in different languages 
— Stuttering among Savages ... ... ... 339 



STAMMERING AND STUTTERING. 



CHAPTER I. 

INTRODUCTION. 



Impedimenta in Speeoli a BenJ Affliction, — An Obstftde t 
Profesaional Success. — Pamicioua Influence on the GeneniJ 
Haaltli. — The Prodnction of Speecb.^Magendie,— On wlint 
Perfect Speech depends. — Nomenclature of Impedimenta of 
Speech to Yarious Langaagea. — Stammering and Stuttering 
defined. 



" Oceat OS ia the number of muBclea employed in the pro- 
duction of deflnite vocal sounds, the number is much greater 
for those of articulate language ; and the rarietiea of com- 
bination which we are coEtinually fonoinif uncooBCiouHly to 
ourBelres, would not be auspected without a minute annlyaie 
of the separate actiona." — Prindfiles of Humaii Fhyaiology, by 
W. B. Carpsnteb, M.D„ P.E.S., 2nd Editiouj 1841, pp. 351-62. 

Amono the many infirmities incidental to the humftii 
oj^nism there are few so distressing to the sufferer, 
and at the same time so annoying to all who come 
in contact with him, as severe speech-impedimenta. 
The cases of defective utterance met with in general 
society are comparatively few in numher, and are 
generally of a milder character, for the simple reason 
that persons 'suffering from the severer foi-ms of iiii- 



2 INTRODUCTION. 

pediments usually shun society. It is in the do- 
mestic circle that the effects of stuttering must be 
witnessed in order to obtain anything like a correct 
idea of this affliction, for such it may be justly 
termed. 

The life of a stutterer is unquestionably one of 
great suffering and constant mortification from the 
moment he becomes conscious of his defect, and this 
is often at a very early age. It is, however, chiefly at 
the period when the stutterer enters the battle field 
of life that he becomes truly sensible of the disad- 
vantages under which he labours, and fully conscious 
that he can entertain but scanty hopes to successfully 
struggle against the formidable obstacles which be- 
set his path. The bar and the senate, the pulpit and 
the chair, seem all but closed to his ambition ; nor 
has he any better prospect of achieving honours in 
the army or navy. Finding himself thtis excluded 
from the most desirable careers, the stutterer is forced 
to strike out for himself some new path for which, 
perhaps, neither his talents nor inclination fit him. 
Apart from professional success, the victim of defec- 
tive utterance must renounce most of the pleasures 
of social intercourse ; and although he may possess 
every other requisite essential to the ensurance of 
happiness in life, this infirmity more than counter- 
balances all those advantages, and renders him an 
object of ridicule to some, and of sincere compassion 
to others who realize his unfortunate position. It is 
indeed distressing to behold a youth born to a good 
position, of refined intellect, and possessing, perhaps, 



extensive iuformation, in sliort with e^^ery requisite 
to adorn suciety, and yet, though so Idghly gii'Uid, 

1 imahle to give oral expression to his thoughts with- 

1 out inflicting pain on the Hsteuer, or suhjecting him- 

[ Belf to ridicule. 

Taking, finally, into consideration that continuous 

1 abnormal action of the respiratory, vocal, and articu- 
lating organs cannot fail in the long run to pro- 

I duce other derangements affecting the general health, 
passing, perhaps, into chronic disease, eiiougli has 
1 said to show that stuttering is a more serious 
disorder than is generally believed, and that it de- 
gervea the greatest attention of parents and of all 
who have the cliarge of children. 

The 'FrodiicUon. of Speech. — The production of 
speech is effected by the conjoint agency of tlie ner- 
vous system, the respiratory, vocal, and articidating 
organs. The muscles of the abdomen, the diaphragm, 
the thorax, the larynx, the pharynx, the tongue, and 
the face, have respectively difi'erent functions to per- 
form in the production of speech; but unless they 
act in harmony there can be no right production 
of articulate language. The function of respiration 
may be carried on independently of articulation ; but 
voice and loud speech cannot be produced without 
the action of *lie respiratory organs. 

The respiratory apparatus includes the lungs, the 

trachea, the ribs, and all the muscles connected with 

them, the diaphir^i, and the abdominal muscles. 

The production of tlie voice takes place in the larynx 

I cartilaginous case situated at the anterior port of 



4 IXTRODUCnOX. 

the neck on the top of the windpipe, with which it is 
connected by membranes and ligaments. On looking 
downwards into the interior of the larynx, there may 
})e observed on each side two folds of the mucous 
membrane. These folds, which are composed of 
highly elastic tissue, have received the name of vocal 
cords or vocal ligaments. 

The inferior membranes are the chief organs con- 
cemed in the production of voice; hence they are 
called the true vocal cords, while the superior mem- 
branes are termed the false vocal cords. The narrow 
opening between the true vocal cords is called the 
rima glottidis, or simply the glottis. 

The vocal cords are acted on by a variety of mus- 
cles which have the power of shortening, eloftgating, 
or stretching them, by which the varieties of pitch 
are produced. But though all the fundamental sounds 
are produced in the larynx, they may, by the action 
of the organs between the glottis and the external 
apertures, such as the pharynx, the soft palate, the 
tongue, the teeth, etc., be so. modified as to become 
articulate sounds — a combination of which constitutes 
speech. 

The muscles by which articulation is effected are, 
at first, only partially subject to the will. Thus, we 
have a control over the movements oflHhe lips, the 
cheeks, and the greater portion of the muscles of the 
tongue ; but over the muscles of the pharjTix, the soft 
palate, and those muscles of the tongue which carry 
its root upwards or downwards, our power is not so 
complete. 



rsTBODUonos. 5 

" We may tell the patients," obsen'es Magemlie, 

" to depress the tongue because it hides the tonsila ; 

they make many efforts, and it is more by chance 

' than by volition that the action is obtained. If they 

are desired to raise the velum, the will has scarcely 

[, any power. It ia the same with regard to the pro- 

I duction of sounds in tfie larynx and in speaking. 

The voice is produced, we articulate without exactly 

I knowing what movements are passing in the larynx 

I or in the mouth. This is one of the man-ellous results 

I of animal organisation. Tliis perfect mechaniBm, by 

1 which the most complicated acts are executed, is not 

I Subject to the will ; an admirable instinct presides, 

I the perfection of which will always remain beyond 

J human ken. It is this instinct which presides over 

I tlie innumerable movements requisite for the produc- 

f tion of voice and speech." 

These opinions of M^endie have been much can- 
vassed ; but they are in the main correct. Magendie 
L does not say, as he is represented, that the muscles of 
I the root of the tongue, the soft palate, and the pharynx 
3 7wt under our control, but only that they are not 
f completely so. They may thus be considered as in- 
I voluntary muscles in the act of deglutition ; but they 
completely under the influence of the will of a 
I perfect speaker or singer, although, like an acrobat, 
k he may not be cognisant of the state of the particulai' 
luscles called into motion, nor of the mode by which 
i effects their harmonious action. Dr. Eich justly 
L observes on this point : " to every organ of speech a 
|clifferent function is as.^igned iu the articulation of 



6 INTRODUCTION. 

individual sounds. This division of function is un- 
known to the layman, nor is it * necessary that he 
should know it, since the organism of speech as a 
whole is governed by the will, but not its individual 
parts." 

The principal nerves upon which the healthy ac- 
tion of the vocal* and articulating apparatus depends 
are : — 

1. The inferior laryngeal branch of the tenth pair 
{Pneumogastric), called, from its peculiar reflected 
course to the larynx, the recurrent nerve, supplying 
most of the muscles of the larynx. 

2. The glosso-pharyngeal, supplying the tongue and 
the pharynx. 

3. The facial nerve (portio dura), by which the 
movements of the face and the lips are regulated. 

4. The hypoglossal or lingual nerve, the principal 
branches of which are distributed to the tongue, of 
which it is the principal motor ; to which must be 
added the phrenic nerve, supplying the diaphragm, 
the spinal accessory, and in fact, most of the nerves 
connected with respiration. 

The muscles and nerves of the respective organs must 
act in harmony for the production of speech ; and a 
want of control over the emission of voluntary power 
to one of these muscles or nerves may affect a great 
number of other muscles and nerves, with which 
they are in the habit of acting conjointly. 

The process of utterance is determined by a variety 
of nervous tracts, upon which the action of the mus- 
cles of the abdomen, the thorax, the larynx, the pha- 
rynx, the tongue, and the face depends. Though each 



IKTKODUCTION. 7 

of these organs has its special functions, they must 
all act synchi'onously, or in certain aucceasions. If. 
then, their association be interrupted by an altered 
condition of any of the respective nerves or muscles, 
the emission of certain sounds and their aiticulation 



Speech, tlien, is articulated voice ; but the time 
which intervenes between the formation of the sound 
in the larynx and its articulation in the buccal 
cavity is so short that it can scarcely be appreciated ; 
hence voice and articulation appear as synchronous 
phenomena. 

The perfection of speech depends : 

1. On the healthy action of the brain, partieiilarly 
of that portion concerned in intellectual acts, and 
more especially of that portion concerned in the evo- 
lution of thoughts and the remembrance of wonls, 

2. On the healthy condition of the central oi^'an 
concerned in the co-ordination of thoughts and words 
into sentences. 

3. On the healthy action of the organs of trans- 
mission which connect the vocalising and articulating 
organs with the central organs. 

4. On the normal state and action of the oi^faus of 
vocalisation and articulation. 

Definition of terms. — The confusion wliich has 
hitherto prevailed respecting the meaning attached to 
the words Stammering and Stuttering" has been the 



• The followTBj are the ^ynonymB eipreisiTe of defective 

orticnlation and general iropedimants of speech in varioua 
langnagea : — 



8 INTRODUCTION. 

cause of much error, both in theory and practice ; for 
in no case can our treatment prove efficacious unless 
our diagnosis be correct. It is, therefore, requisite 
that the distinctive characters of each affection should 
be clearly defined at the very outset. 



Anolo - Saxon. — Stommettan ; stamer ; stomer ; stomm- 
wlisp ; wlips or wlisp (to lisp). 

Arabic. — Ayiy (a stammerer); rattat; rataj; rett; rata (a 
female stammerer) ; ta-ta-a (one who stammers, falters, or pro- 
nounces with difficulty the letter ta), 

Basque. — Motel hitzeguin (to stutter). 

Chinese. — Eow keih ; keih she (to stammer, to speak with 
hesitation). 

Cochin-Chinese. — Su c^ lam. 

Danish. — Stammen; stammer; stammeren. 

Dutch. — Stameren ; stameln. 

English. — The foUowing are the chief expressions used in 
the English language (inclusive of provincialisms) to denote 
imperfections or impediments in speech : stutter, stut, stute, 
stuter, stoot, stotter, stoter, stammer, lisp, burring, rattling, 
tardiloquence, lurry, clutter, patter, mumble, falter, hesitate, 
di'awl, jabber, gibber, splutter, sputter, hammer, muffle, throttle, 
mutter, mouth, mince, mump, taffel. 

In the north to stoter means to stumble ; to stammer means 
to stagger; stammering, doubtfol (Wright's Provincial Diet.). 
In Scotch, to stotter, to stumble (Jamieson's Diet.) ; taffel, to 
stammer (Webster's Diet.). To stut, stute, stoot, mean to stut- 
ter; stuter, a stutterer. 

The early English form of the word stuttering seems to 
have been stut. Subjoined are a few illustrations from old 
authors : — 

" Her tongue was verye quycke, . 
But she spake somewhat thycke. 
Her felow did stammer and stut. 
Bat she was a foul slut." 

John Seblton, Elynour Rummynge, 1598. 



INTRODUCTIOH. 9 

Slaw.m.ering, which may be constitutional, organic, 

ir habitual, is characterised : 1. By the inability 

or difficulty to properly and distinctly enunciate 

/some or many speech sounds, either when they occiir 

' at the b^inning or in the middle of a word,, for 



Jae. — "Ib ha not wondroua like your deceaaed kinHman, Ai- 

Andrea, — " Eioeedingly, the strangest, nearly like. 
In Toice, in gesture, face, in — 

Rand.—" Nay, ho haa Albano's imperfection too. 
And stuHes when he ia reheroeotly mou'd." 

John MiBSTON, Witat ^0" will. Act i, 1607. 

Stuttering is thus liere connected nith mental emotion. 

LoBD Bacdh also saya (^ylva Sylvarum, Cent, iv. 1627), 
"biVBra we see do tUi." 

EBTHOHiAN.—Totp keel (stammering or stuttering), 

Fben;:h. — B^gue,h^ayer, b£gaiement(froiD the Latin big&re, 
to repeat), bulbutiement, baryphonie, mogilalisme, bredouille- 
ment, bleaite, jotacisme, lambdaciame, lallalion, seaaeyemeut, 
graeaeyemeut, baibouillement, parler gras, parler bits. 

Gaelic. — Oogach (lisping, stammering), gaige (Uijping, stam- 
mering), mandoch (liaping). 

GGHUAH.^SbaniDieln, Btummern, stottern, atoetern, ana- 
tosaen, atackeln (stag'getQ), gaxen, lallon, dalilen or dallen, 
BohnaiTen, rafcschen, lorbsen, lurbaen, lorken, liapolo, polteni, 
spree h-polt em, mummein, mumpeln. 

In the Misao-Qothic, the earliest Qerman dialect prececvcd, 
afamms means a stammerer. Ulpbilas haa also stajiiniitjia for 
niinnin (dumb). We find, therefore, similar terma for speech 
affections in all the Qecmanic and Scandinavian dialects (see 
Swadiab, Danish, Dutch, Anglo-Saxon, Engliijli,) 

In the Gothic we find stautixn, to but, to puab, to strike 
l^uinst. From this cornea tho German siosaen and (low-Gor- 
rnuJi) itoeUn.. Hence ansiossfln (allidere) to strike with the 
tongue against the teeth or other parts of the buccal carity, 
ns in German both stammering and stuttering. Also atoltcni. 



10 INTRODUCTION. 

which sounds the sufferer usually substitutes others 
less difficult for him to ]^ronounce : 2. By a drawling 
or hesitating delivery in some cases, and in others by 
a rapid, careless, hSilf articulate enunciation. 

Stutteringy on the other hand, is a vicious utterance, 
manifested in many cases by frequent repetitions, or by 

and (low-G&riuan) atoetern. In machinery the wheels are said 
" to stotter " when they do n >t move rhythmicaUy . 

Greek and Latin. — YeAAio-/Li^f, ^ewSrriSj rpav\iafjihsy rpav- 
A^Jrijs, lfrx*'0<l>a>i'ia, iax^^^'^^^y fiarrapta/xhs, i(rd<p€ia 7\c6ttijs, fioyiKa- 
/ios, Banfiaivtiv, Hrvwos, &yKv\6yKwairoi, These are the chief words 
used by Greek writers. The foUowing are the Latin : — bal- 
buties, balbus, blsesus, blsBsitas, blsBsa vox, hesitantia linguae, 
hsBsitantia vocis, lingua hsesitare, titubare, titubanter loqui, 
hsBsitantibus verbis dicere, bambalio. 

It is not surprising that translators and commentators have 
been much perplexed as to the proper meaning of the above 
terms. According to the etymology of the word, iaxvoipavia 
{iaxf'os, weak ; tpofvri, voice), is merely a defect of the voice, and 
not of articulation, in contradistinction to Ka^ivpoipapia, full 
clear voice. Tet Aristotle expressly says that l<rxvo<l>wyla consists 
in the inability of properly conjoining syUables and letters, i.e. 
stuttering. The more correct term for stuttering would be hrx"*- 
(ftwvia {iax*^> ^ arrest ; tpwptiy voice), which has in fact been used 
by Herodotus, Menjot, Sauvages, and Schulthess, though the 
other term was far more common. But stuttering neither has 
nor can have a well defined corresponding Greek or Latin term 
as it has been till very recently confounded with stammering. 
Mogilalia ischnophonia was proposed by Frank ; Merkel pro- 
posed paralalia aylldbaris, in contradistinction to paralalia 
liter alia or verbalia, meaning stammering. 

Alcibiades is by Plutarch called rpav\6T'nSy translated a lisper, 
but there is no evidence that Alcibiades actuaUy lisped : he had 
a defect in the enunciation of the letter r. TpavKia/ihs seems, 
therefore, to mean what is now understood by rhotacism, 
and ^tWia fxbs, lis;jing. ** VcAAoj," says Hesychius (factum a aono, 



IKTRODUCTIOlf. 



11 



a continuance of tbe initial or other somid or syllalile ; 
in others by a convulsive stoppage before the same ; 
and is frequently attended by useless, and more or 
leas violent, contractions of the various muscles of the 
respiratory, vocal, or articulating apjiaratus, or even 



BJi onomatopoeia) "ia a, peraon who caniiot properly pronoiince 
( — a lieper." ThoBomanB frequently called a lisper blmui; bla- 
sitas would therefore properly mean liapinp. Tbe word balbas 
Beeme among tbem to hare been chiefly ased to designate one 
who Dould not pronounce the letter r. Tlien again tLere are 
tbe Krwoi. derived either ttora Tvrii*, I form, or model, and the 
priv B, or form Tirrm, I itrike ; such peraoua cauaot Use tbe 
tongue with Bufficient expedition ; and ciyiiiryABirtrDi or i-yKvXi- 
7^ uirro-ai— tongue 'tied, are thoae whose tongue is abnormally 
restricted by the frEUum, or acoidentallj from indurated cioa- 
tricea, tbe result of uluera. 

Hebbrw, — Eobad peh (slow of speech), loag (to stniumei), 
eleg (a stutterer), balbel (to apeak tonfusedly I. 

HiNDoeTANi. — To lisp.^ — tutlana, luknat-k, zaban-giriftagi, 
Ac.; to atammer,^ — haklSofi, iBrbaraua, Ea,ban-la|^a ; to stut- 
ter, — larkhaiSnS., atakna; a stutterer, — larbaraba. 

HCNQABiAN. — Selyp [Btammering, atutteriug.) 

Ibibh. — Qaige (Btammering and stuttering). 

Itahan.— Balbettare, tartagliare. balbutire (to stomnier 
and atutter}, scilinguare (to liap). 

Maxat. — Qagap (to stutter). 

OcKANic. — ^Ha-a-ta-u-ta.u, pa-a-pa-a.pa-u, bo-e, pala-le-no- 

PESsiAU.^Aikanl (a tarn i 

PoBTDonESE, — Gaguojar 
ciciosos(toliap). 

8pan:sh.— Tartaraudi'ari cecear, ia Spanish, is the aubatitu. 
tion of the s aound for the Ik, in the letter c. Tbe Andalucian 
haa the cteeo, the Caatilion tbe correct sound. 

SwBOiSH -. Stamma. 

Wklsh. — Atiiil-iaith (attfll, checking, an impediment in 



12 INTRODUCTION. 

of muscles not directly concerned in the production 
or formation of speech, such as those of the face, 
neck, arms, legs ; and, in extreme cases, the whole 
body may be violently distorted. 



speech) ; bloesg-blaw-esg (lisping, thick-speaking) ; attaldy- 
wedyd (to speak with hesitation). 

I may here observe that the author who, to my knowledge, 
first distinguished the above terms was Adelung, in 1786. 
He says, " Stammering and stuttering are frequently used an 
synonymous terms ; but strictly speaking, the latter term 
means the repetition of one and the same syllable." This, 
though not strictly correct, is a near approach to the truth, 
and is the same distinction as has been used by subsequent 
author tin a very recent date. 



CHAPTER II. 

HISTORICAL AND CRITICAL REVIEW OF THE THEORIES 
AND MODES OF TREATMENT OF STAMMERING AND 
STUTTERING, FROM THE EARLIEST HISTORICAL PERIOD. 



FIRST PERIOD; — FROM THE EARLIEST HISTORICAL PERIOD TO 
THE BARLT PART OF THE NINETEENTH CENTURY. 



" The examination of the steps by which our ancestors ac- 
quired our intellectual estate, may make us acquainted with 
our expectations as well as our possessions ; — may not only re- 
mind us of what we hAve, but may teach us how to improve and 
increase our store." — Dr. Whewell, History of the Inductive 
Sciences, vol. i, p. 4. 



Scripture Eecords. — Hippocrates. — Aristotle. — Demosthenes. — 
Cicero. — Celsus. — Galen. — Aetius. — Avicenna. — Guy de Chau- 
liac. — ^Mercurialis. — Bacon. — Menjot. — Amman. — Kiistner. — 
Hahn. — Hartley.— Haen. — Santorini. — Morgagni — Sauvagcs 
— CuUen.— Mendelssohn. — Crichton. — Darwin. — Watson. — 
Frank. — Thelwall. — Savary. 

The history of the literature of defective speech may 
be conveniently divided into four periods : first, from 
the earliest historical period to the early part of the 
nineteenth century; second, from the early part of 
the nineteenth century to the period of surgical 
operations; third, the period of surgical operations, 



14 THEORIES AND MODES OF TREATMENT 

chiefly confined to the year 1841 ; and, fourth, from 
the surgical period to the present day. 

The earliest record of defective speech is to be 
found in the Scriptures. It is not a little curious 
that the first case to be met with is in the person of 
one chosen to perform so high and important a part 
as that which Moses was called upon to enact. When 
commanded to go before Pharaoh, he says,* " O my 
Lord, I am not eloquent, neither heretofore, nor since 
Thou hast spoken to Thy servant, but I am slow of 
speech, and of a slow tongue." f The defect here 
alluded to has been supposed to have been merely 
a want of eloquence, but the next verse contradicts 
this supposition, and a more serious defect is indi- 
rectly mentioned. Moses was answered : " Who hath 
made man's mouth? or who mak^th the dumb, or 
deaf, or the seeing, or the blind ? have not I the 
Lord ? Now therefore go, and I will be with thy 
mouth, and teach thee what thou shalt say. ... Is 
not Aaron the Levite thy brother ? I know that he 
can speak well, and thou shalt speak unto him, and 
put words in his mouth; and I will be with thy 
mouth, and with his mouth, and will teach you what 
ye shall do, and he shall be thy spokesman unto the 
people : and he shall be, even he shall be to thee in- 

* Exodus iv, 10-16. Moses, according to some, became a 
stutterer by fright, viz., at the sight of the burning bush. 

t Exodus iv, 10-16. Kehad peh kehad loshun anochi, Greek, 
Iffxvo^oivos KaifipaHvyKwaffos fyw tifxt, Latin, Impeditiotis et tardi- 
oris lingucB sum. 



OF STAMMEBINa AKD aTUmtRDfG. 



15 



stead of a mouth, am! tliou alialt be to hiui instead 
of God," 

A national peculiarity of enunciation we find as- 
I cribed to tlie Ephraimites*: — "And the Gileadites took 
1 the passages of the Jordan before the Ephraimitea : 
and it was so, that when those Epliraimites which 
were eacaped said, Let me go over ; tliat the men of 
Gilead said unto him. Art thou an Ephraimitc ? If 
he said, Nay ; then said they unto him , Say now, 
Shibboleth : and he said Sibboleth : for he could nut 
frame to pronounce it right. Tlien they took him, 
and slew him at the pasaages of the Jordan." 

Defective speech is also alluded to by Isaiah : " For 
■with stammering lips and another tongue will he speak 
to this people."-!- "And the tongue of stammerers shall 
be ready to speak plainly." J Again, " Thou shalt 
not see a fierce people, a people of deeper speech 
than thou canst perceive ; of a stammering tongne 
that thou canat not understand. "§ 

We find also in St. Mark : " And they bring unto 
him one that was deaf, and had an impediment in 
his speech, and they beseecli him to put his hand 
upon him. And he took him aside from the midti- 
tude, and put his fingers into his ears, and he spit, 
and touched bis tongue ; and looking up to heaven, 
be sighed and said unto him, Epbphata, that is. Be 
opened. And straightway his ears were opened, and 



16 THEORIES AND MODES OF TREATMENT 

the string of his tongue was loosed, and he spake 
plain."* 

The following extracts from the works of the 
ancients contain some of the principal passages re- 
ferring to disorders of the function of articulate 
speech. I have considered it advisable, for the sake 
of comparison, to give in notes the original terms 
used by the respective authors, which may enable 
the reader to form some opinion as to the meaning 
they apparently attached to their definitions of the 
varieties of defective utterance. 

Hippocrates •}• says, "Indistinctness of speech J 
arises either from some disease or from the ears ; 
also when something is spoken before pronouncing 
what precedes it ; or when we meditate upon some- 
thing before pronouncing what had already been me- 
ditated upon. We meet with this mostly without any 
visible disease in such as cultivate arts. Age, if the 
afflicted is still young, has sometimes a very great 
(healing) power." 

" Stammerers§ are much subject to long-continued 
diarrhoea." 

" Persons who stutter || are freed from their impedi- 



• Chap, vii, 32-35. 

t Prsecept., 6; Aphor. 6, 32; Epidem. 2, 5; Epid. 2, 6; De 
Judicat. 6. 

Hippocrates, the most eminent of the Greek physicians, and 
deservedly styled the father of medicine, was bom B.C. 460. He 
died at Larissa, in Thessaly, at the advanced age of 99. 

J *A<ra<plri y\doTrrii» § TpavAol. || *l(rxvo<pwvivT\v. 



OF sriJaisiiiKa and btdtteeing. 



17 



[.'ment by varices; the impedimcDt remains if ikj 
[» varices appear." 

"Tall, lialiiheadeii shimmerara and atutterers* are 
kgood." 

"A utanmierer, bald, and a stutterer, tliick-haired, 
II suffer much from atrabilious diseases. All who hesi- 
I tate in their speech, and are not mastei's of their lipa, 
l-flre diseased. When they recover they muBt niices- 
r'aaiily acquire some (internal) suppuratuig ulcers." 
" Stammerers "I" who have a large head and small 
es are passionate." 
" >Stammerer8j who have a voluble tonijue§ are full 
of black Viile." 

" He who baa a little head wQl neither stammer || 
nor become bald, unless he have blue eyes." 

" In gouty persons there are observed timiours under 
the tongue containing calculi, which interfere witli 
articulation." 

AristotleU says: " The tougue is either broad or 
narrow, or of a medium shape, which latter is the Ijeat 
for distinctness ; or it is free, or tied, as in those that 
lisp and stammer.** 



" Tpai'J.oi, lirxyi'l"""". + T)»uXu!. 

1 T,!ai,\ol, 5 Taxh'^-^""'"- II T^a«\«. 

IT Hist. An., lib, i, cap. li. De Fart. An., lib. ii, cap. ivii. 
Problem. Sect, li, 30, 35, 36, 38. 

Aristotle, the great founder of the peripatetio aeot of pbilo- 
Bopbers, was bora at Stagfra, in Thrace, b.o. 384. He became 
a pupil of Plato, and subaequentl; tutor of Alei<uiiler the Orcat. 
Being accused of atheism by the Athenians, he retired to Chalcis, 
where bo died in the 63rd year of hia age, b c. 321, 

•• Ton l^>A\HI II«l Toil 7ptuKtlI. 



TSEORIKS AND MODES OF TBEATHENT 

"An equable and broad tongue is also conveniait 
for the formation of letters, and the purpose of 
speech, for beii^ such and free, it is eminently 
capable of being dilated and contracted in a variety 
of forms. This ia evident in all persons in whom 
the tongue is not sufficiently free, for they lisp and 
stammer."* 

" Staimnering,-t" therefore, ia the inability of aririeu- 
lating a certain letter ; but lispingj ia the omission of 
some letter or syllable ; and atutteringg ia the in- 
ability of joining one syllable with another, All 
these arise from debility, for the tongue ia not obe- 
dient to the will 

"Intoxicated persons and old men are similarly 
affected, but in a less degree. 

"Why are those who stutter || melancholy ? Is it 
because that to follow the imagioation rapidly ia to be 
melancbdly ? Such, however, ia the case with those 
that stutter, for in them the impidse to speak pre- 
cedes the power, in consequence of the mind rapidly 
following that which is presented to it. This is also 
the case with thosethat stammer, for in these the 
tongue ia too slow to keep paee with the imagina- 
tion." 

The reader will see that in translating the above 
passages I have supposed la^oifitavia to mean stutter- 
ing ; rpavKoTTii, stammering ; and i/reWdTTj?, lisping. 
This appears to me to be the most suitable to the 



». T;>a.^,^«, 






Oy STAMKBBDTG iSD BTUTTEEIKa 



19 



I 



ImeRning of the respective authors ; hut at the same 
Btiine I do not assert that they were absolutely used in 
* this sense. 

Plutarch* refers to the defect of speech which af- 
^feeted the prince of orators in the following terma : — 
' Demostlienes, In his ttrst address to the people, 
t was laughed at and interrupted by then- clamour ; 
Ifor the violence of his manner threw him into a con- 
f'fusioa of periods and a distortion of his arguments. 
He had, besides, a weak voice, indistinct speech, and 
Bhoit breath ;J which caused such a distraction in his 
discourse, that it was difficult for the audience to 
understand him. At last, on his quitting the aaaemhly, 
, Eunomos the Triasian, a man now extremely old, found 
I him wandering in a dejected condition in the Piraeus, 
and took on him to set him right, ' You,' said he, ' have 
a manner of speaking much like Pericles, and yet you 
lose yoiu^elf out of mere timidity and Cowardice, 
You neither bear up against the tumult of a^popular 
audience, nor prepare your body by exercise for the 
labour of the rostrum.' " 

Another time, we are told, when his speeches had 
been ill-received, he went home with his heatl covered, 
and in the greatest distress. Satyrus, the actor, who 
was an acquaintance, followed him. Demosthenes 
lamented that though he was the most painstaking of 



■ Til. Farall. Demosth. {i. 

Latin — Lftbcmivit vero etiftm 
Bpiritns angnatia. 



ia exilitate, lingaa ineipUiiata, 



20 



THEOKIEB ANB MODES OP TEEiTMENT 



all the orators, yet could he find no favour witli the 
people. " You speak truly," repUed Satyrus, " but I 
will goon provide a remedy, if you will recite to me 
some speech in Euripides or Sophocles." When De- 
mosthenes had finished, Satyrus repeated the same 
speech, with such propriety of action, and so much in 
character, that it seemed quite a different passage, 
Demosthenes now imderstood, how much grace and 
dignity of action add to the best oration, and he 
thought it of amall matter to compose and premedi- 
tate, if the pTonuDcifltion and propriety of gesture 
were not attended to. On this he built himself a 
subterranean study. Thither he repaired every day 
to form his action and exercise lua voice; and he 
woidd stay there for two or three months together, 
shaving one side of his head, that the shame of ap- 
pearing in that condition might keep him in. Deme- 
tiiits, the Phalerian, gives an account of the remedies 
he applied to his personal defects, and he says he had 
it from Demosthenes in hia old age. The indistinct- 
ness and stammering" he corrected by practising to 
speak with pebbles in hia mouth, and he strengthened 
Ilia voice by nmning or ■walking up hill, and by pro- 
nouncing some pass^e of an oration or poem during 
the difficulty of breathing which that caused. He 
had, moreover, a looking-glass in his room before 
which he declaimed, to adjust his motions. 

CiCEBO-f speaks of defective speech in the following 
terms : — 



+ Cic, de Orat, lib. i. 61 {106-43 b.c). 



OF BTAHMSUKO AM) STDTrBXING. 



21 



" Let him imitate him to whom unquestionably the 

highest exceUenca in oratory is conceded, Demos- 

thenea the Athenian, who is said to have been so 

studious and laborious, that he first of all overcame 

the impediments of nature by diligence and labour ; 

and although he was such a etammerer that he was 

unable to articulate the very first letter of the art 

which he studied* [rhetoric], yet he accomplished 3o 

much by meditation, tliat no one ia believed to have 

spoken more distinctly ; and although his breath 

was short, he effected ao mudi by holding it in in 

speaking, that one sequence of words (aa shown in 

Ha writings) contained two risings and two fallings 

I of the voice ; and he also (as is recorded), after putting 

■■stones in hia mouth, enunciated in the loudest voice 

I many verses in one breath ; not standing in one ijlace, 

Ibut walking and mounting a steep ascent." 

In another place Cicero says : " Is there any doubt 
I that many, though born with natural defects, are 
1 nevertheless cur^d, either by the self-corrective power 
of nature, or by the skill of the physician ? Or who 

thave been boru ao tongue-tied, that they could not 
speak until their tongues were liberated by the appli- 
cation of the scalpel ? 
"Many have also, by meditation or exercise, re- 
Jhoved natural defects. Phalereus thus records that 
pemosthenes could not pronounce r, but by practice 
learned to articulate it correctly."-f- 

■ Quum its. balbuB esaot ut eJDB ip5iuB artis cai Htndene 
primam literum non posaet dicere, perfecit meditandi, at nemo 
I plftniuB eo loqantns pntai^tar. 
t Sb iKvinafione, lib. ii, xItI. 



SI 

.hi 

k 
I' 



22 THEOHIES AND MODES OF TREATMEnn' 

After all, it can scarcely be said that Demoathenea 
was a stutterer in the strict sense of the term, Hia 
cliief defect, as described by most authors, consisted, 
apart troni weakness of voice, in his faulty enuncia- 
tion of the letter t. 

Celbus" says: "When the tongue is paralysed, 
either from a ™e of the oi^an, or in consequence of 
another disease, and when the patient cannot ai-ticu- 
late, gargles should be administered, of a decoction of 
thyme, hyssop, or pennyroyal ; he should drink water, 
and the head, the neck, the mouth, and tlie part below 
the chin should be well rubbed. The tongue should be 
rubbed with lazerwort, and be should chew pungent 
substances, such as mustard, garlick, onions, and 
make every effort to articulate. He must exercise 
himself to retain his breath, wash the head with cold 
water, eat horae-radish, and then vomit." Celsus tdso 
describes the operation of dividing the fKenum in 
tongue-tied subjects. 

GALEN-f- refers stanunering to an intempenes hu- 
mida. Intoxicated persons stammer because their 
brain is too mucli moistened, and the moisture ex- 

* De Resohxlinns JAnjua. AureliuB Comelins CelauB, a Bornan 
phjBioiaa of the time of Tibarius (u.c. 43— j.d. 37) : author of 
treatises on agriculture, rhetoriu, and military affairB, and of 
eiglit books on medicine. AU except the lust work are lost; 
but that haa long been conaidBred oa the beat and moeb 
Hysteinatio teit-book of mediuine left us by the ancients, 

+ De locis affectii, 6. Claudius Galenua, born at Pergamus in 
1 D. 131. Having practised about four years in his native oity, 
he went to Borne, from vhence he was driven by the jealouay 
of hia rivala, who attributed his eueceaa to magic. He returned 



OF aTAlCHEBma and STUTTESmG. 2S 

ftionda to the matrumeats that move their tongue, and 
■to the tongue itself. Again, he says that stuttering, 
for ischfiophonia, is owing to the debility of the musclea 
f fcom the diminution of heat 

AeTius' says : " Some are born tongue-tied, others 
■Tjecome so from some aS'ection, Thoae are bom so 
Pvhen the membranes under the tongue are too hard 
and naturally defective. It may also proceed from an. 
ulcer, which leaves a bard cicatrice under the tongue, 
Those who are naturally tongue-tied {aneyglossi ex 
I natwa) commence speaking late ; but when they do 
I commence, they speak without obstacle, and pretty 
' fluently. They are, nevertheless, impeded in the jiro- 
duction of words the pronunciation of which is diffi- 
cult: such, for instance, in which the letters r, I, or 
It frecLuently occur. Such may be cured for a cer- 
L tainty by surgery," 

He then gives directions how the operation is to 
Ite performed, but cautions the operator against divid- 
L i ng with the membrane the subjacent veins, 

.^^iNETA-f says : " Ancygiossis is sometimes a 
I congenital disease when dense and shortened mem- 



toPergamns, but was recalled bj the Emperor Marcus Aureliuj, 
and entrusted with the care of his son Commodus, while the 
emperor went to war with the Oermans. He is BUppoaed \a 
bare died at Borne in bis 70th year. 

• Aetii Qrad contraeUB ex reteriinu medicina TelrabibloB, etc., 
Builes, 1542, cap. xixai. Autiu^ a pbjsician of Mesopotamia 
(abont 600 a.d.), is said to hare been tbe firat Christian phy- 
tioian whose worlca ha»e oome down to ua. 

t •ETiratt^f isTfiiKqi B'B>.la i-wji. Be Be Medica libri Beptem. 
Hffi ArKvhDT AwiTffou raeoKi. Baail. 155G. Pautua £giiieta, a 



24 



THEORTES AND MODES OF TREATMENT 



hranes restrain the tongne. Sometimea it is acquired 
trom thick cicatrices, after some tilceration, raider the 
tongne. Those who are bom with this affection are 
known hy beginning to apeak late, and tlieir fi-senmn 
appears thicker than it ought to he. In those who 
have acquired it, the cicatrice is seen. 

"The patient being seated, and tlie tongne raised 
against the palate, the fraenum is transyeiaely di-' 

\*iJed Care shoidd he taken to avoid the aectioa 

of the deeper parts, so as to obviate hemorrhage, fre- 
quently difficnlt to arrest." 

In the next two chapters, he treats of the excision 
of the tonsils and the nvnln. 

A\acENNA.— Hitsain Abu-AIi Ben Ahdallah, Ebn- 
Sina, Sheikh-el-Eeys, the prince of philosophers and 
physicians,* of whom it was not nnjnstly said that 
neither did philosophy teach him good monJs, nor 
medicine to preserve his health, has left na in hia 
El-Kamin jU tebb (Canon Med.ictna:) some chapters in 
which he treats of affections of the voice and speech. 
Tlie Cmuin was printed in the original at Eome, in 
1593, by Arab compositors. There exists no good 
Latin translation. The subjoined extracts are taken 
from one of the latest editions of Avicenna's works.-f 



e of the island of .f^na. He 
le cathu'tic qualitiei 



medical autlior, a 

to huTS been the firat ti 

rhubarb. 

• Avicenna was bom in 9fi0, and died 1037. 

t ATiceanifi Principis, et FhOoaophi Bapientisaimi Libi'i in re 
m^icK omnoa qui hactenna od noa pervenera. etc., n Joanne 
Paulo Mongio et JoanoQ Coatteo recognito. Venetiia, 156^ 



or flTXKMEBTNa kSV gTU'ITBHINO. 



25 



De voce. Ten short chapters are devoteil to defects 

I of the voice and tbeir cure. I shall only notice what 

hfl says on the cure of " short voice " {de voce breai et 

'■ cjiis), or rather sliortness of breath. " Short- 

1 of the voice (he aays) is caused by shortneaa of 

breath, and it can ha gradually cured by retaining 

I the breath, and by exercises such as running up and 

I down hill."* 

Bemeiology of voice, speech., and, sHonce.'f " A strong 
voice and well-ordered speech are good signs; the 
contrary is a bad sign. 

"Great and prolonged tacitiunity signifies either a 
k softening of the muscles of the tongue and of the 
i epiglottis, or a spasm of the sauie, or may be the de- 
struction of the inif^nationj which is the principle of 
Speech. When a taciturn person begins to talk very 
much, it signifies the approach of mental aberration 
and the perversion of reason."! 

Avicenna also devotes no less than sixteen chapters 
to the anatomy and diseases of the tongue and their 
cure.§ TheactionofthetongHe,he3ays,i8tlireefold. It 
possesses motion (for speech), tact, and taste. Some- 
times motion is destroyed or weakened by some dis- 
' ease. At other times taste and tact are desti'nyed, and 
again, only one of these senses may suffer, leaving the 



■ tii. Teriiva, Ven. 10. Traclaiiis 8«™»(I«i, p. 628. 
t Signa Bampta ex voce ot loqnela et eilentio. 
j Tom. 2, lib. iv, Fen. 2, Tract. 1, cap. 52, p. 90. 
, § Da ^grituiUnibut LingiuE, x, cap. 2 ; Lib. tertius. Feu. f 
' Tract. 2, p. 580. 



26 



THEORIES AND MODES OF TREATMENT 



other in its integrity, Thus speech may be affected 
without loss of taste or tact, and vice versa. The mol- 
lification of the tongue, as he calls it, has for ita cause 
sometimes hiunidity, or the seat of the affection may 
he in the hrain. It renders speech difficult, or alters 
it so that it causes stuttering (lata, an impediment in 
which these sounda, or similar ones, are frequently 
heard). It therefore sometimes happens that a hot 
disease will cui-e the affection by removing the hu- 
midity from the tongue and its nerves. It ia also for 
this reason that a stuttering boy, when he grows up, 
speaks more freely, because the humidity is dimi- 
nished. 

In another place he says :* 

" Speech impediments may arise from some lesion 
of the brain, or of the nerves which proceed to, and 
move the tongue. Sometimes the lesion is in the 
muscles of the tongue, or there may be spasm, or 
tetanus, or hardening or softening of the tongue, oi a 
shortening of the ligament, or nodosities, or a hard 
imposthume. 

" Sometimes speech is impeded by some defect in 
the muscles of tlie epiglottis, ■which are softened or 
relaxed. Somdi-mes the voice fails at the cnitset ; but 
when the individval takes an inspiration at the he- 
giiming of his speech, his speech becomes more free. 
Suck a -man must, therefore, prepare kimeelf before 
peaking hy taking a deep inspiration and i 



' De Alehalel in £ocution<, cap. 10, p. 858 j Lib, toliiu. 
Tract. 11, Pen. 6. 



Of OTAMMEMNO AKD BTUTTEHING. 



27 



I Jm chest. When a man ihua accustoms himself his 
\ speech mil be free''* 

I have italicised this advice, as it shows that the 
remedy propounded aa a modern diacoveiy, and gene- 
rally thought to he 80, is very old indeed. 

Commentary. — Although the enthnsiaam for the 
Arahiau physician has long passed away, the pre- 
ceding extracts show that there is in his works a 
I mine of knowledge, hidden, no doubt, under an accu- 
I molation of errors. Thus we find that Avicenna,ju9t 
s is done by some writers at present, places the cause 
f stuttering either in the brain, ot in the motor 
I nerves of the tongue. He also obaervea that stutter- 
' ing may arise from spasms in the organs of speeclt 
Speectdessness may, he saya, be owing to psychical 



* The pbarma.cop<eia of the Aj^bs was mucli riclior than that 
of the Greeks. It may, perhupa. interest the medicjil ruoder to 
read some praacriptiona for apeech impedimenta oa given by 
Avicenna,, and which were adopted by aub3e<iuent praetitiOQera. 

With referenee to mollification of the tongue, be aajs ;— 

" Et quando mollificatio ait vebemena at prohibet locutionem, 
tnno Bumatur aliquid eupborbii, et oondiai, et asaiduetur £ci- 
catio lingual et radieia qus cum ipsia. Et oportet, ut pocatai 
iste medioinie et earum aiinilea auper oollum etiam. 

" Dcacriptio pilularum, quie tenentur in ore Biib lingua con- 
ferantes mollificationi : turebinthinra droch. ii, asBafcetido', 
droch. i, £aat ex eia pitulm slcnt cicer, et t«neaatur sub 
lingua. 

" Et BX BIB, quBB Bipertft sunt in hoc capitulo, eat gargorianms 
ex aale ammoniaco et pipere, et Bf napi, et pjrethro, et nitro, et 
zingibers, et staphiaagrio, et origano, et aale naphtico, terantur 
et cribellentur, et fiat cam sis gorgmismua in aqua callda die- 
bus contiuuis." 



28 THEORIES AND MODES OF TJIEATMEST 

causes, or to the destruction of the imagination, 
which he terms the principle of speech. 

Our UE CUAULUC* eayai "Stuttering may be 
caused by eonvulsiona, ulcers, and other afl'ectiona of 
the tongiie. It mostly arises from some paralysis, or 
from too large a quantity of liumoni's soaking the 
nerves, muscles, and even the substance of the 



- He also observea that fever may cure stuttering 
when it is caused by an abundance of humours. This 
is also the case with convulsions. Stuttering which 
has persisted for a long time is never readily cured. 

• Guidode Cauliaco, Chirurgia, Venetiig, 1498. Guy de Chau- 
liac wrotB hia work at ATignon, in 1330, nnder Pope Urban V. 
He was, it appears, a diBdple of the celebrated school of Mont- 
pellier, dutplain and phyaician to the pope, and one of the last 
adherenta to the Arabian at^ool. 

Guy de Chauliac was bom in Cbaalioc, a village of Gevan- 
dan, on the frontiers of Auvergne. After puTsain^ his medical 
atudiee at Montpellier, and eubaequently at Bologna, he prac- 
tised at Lyons, and then at Avignon, where he BneeesBiveiy 
beoame the physician of Popes Clement YI, Innocent YI, and 
Urban V. In 1363 he composed hia Inveniarium, aive collee- 
toriwn parlia tkirurgicaUa medicinie. The first edition of hia 
work was pahliahed in 149H at Yeoice. Haller mentions 
another edition of 149H, published at Bergamo. This cele- 
brated sotgeoD was held in such esteem, that the aurgeona, 
pla^ring upon his name, called him their guide. Fallopius oom- 
pares bim toHippocrateaj Calvo calla him the first legislator of 
Bui^ery. Haller aays that Chauliac has thrown much light upon 
sorgery. He haa read aU that had been written down to his 
period; ho carefully eipounds the opinions of his predeceasori, 
so that his work constitutes an exsellent historical sketch of 
ancient sui^ery. Neither the date of his birth nor of his 
death is known. 



OF BTJLJMfiEKa AKD STDTTEHING. 



29 



-Still, it is greatly improTed in cliildreii wlien tliey 
arrive at adult age. 

With regard to the treatmeut, he aaya, "although, 
generally speaking, tiie treatment of stuttering is the 
same as that fop paralysis, we must. Apart fruui diet 
andpurgativ'es, have tliree purposes. The first couaists 
in a diversion of the humoura ; the aecoud in desiocat^ 
ing the brain ; the third in consuming the humidities 

. collected in the hrain." 

. The first is effected by pungent hUsters, frictioua, 
and cupping Iwhind the neck. 

Tlie second I>y desiccating emhrooations on the 
head, made with mustard, pepper, ginger, laurel 
grains, aniseed, and other drags, which, hy fortifying 
the brain, possess the virtue of sucking up tlie hu- 
mour. Cauteries are very proper, even if applied to 
the vertex or to the cervical vertebrse. 

The tiiird intention is effected by gai^ariams, and 

- by washing and rubbing the tongue with a variety of 
medicaments which he proposes, of which we are to 
commence with the weakest, and ascend gradually to 
the strongest. 

Mebcorialis • was the first author who may be 
said to have written acientifically on defective utter- 
ance. According to the notions prevalent in Ills 

■ time, he considers a moist and cold inUmperifs as the 
chief cause of balhilies, comprehending both stam- 

* De puerortim morbii. Ed. J. QroHOMii, Prancofucti, 1584. 
HieronjmuB Mercurialis, bom at Porli, 1530, and Hubsequently 
pmfeBBor at Padii», Bologna, and Pisa, was tbe greatest phj- 
~ ~ a of bis time, and eiiually diatuigiiiBbed aa a philoeopber 



80 THSOBIBB A5D MODES OF TSKA.TMXKT 

mering and atuttering. He, therefore, forbids wash- 
ing tlie heads of stammering and stuttering children, 
as that increases tlie moisture. In order to desiccate 
the head, he ad^-ises cauteries and blisters on the 
neck and behind the ears, which should be kept open 
for a considerable time. To diy the tongue, he re- 
commenda that it should be frequently rubbed with 
salt, honey, and especially with sage, wliich had 
proved singularly effective in curing the infirmity. 
The diet should be salt, spicy, and heating ; no fish, 
no pastry, is to be allowed. Our author is, however, 
aomewliat puzzled by finding that Hippocrates attri- 
butes stammering and stutteriug also to the dryness 
of the tongue. To reconcile this opinion with his 
own, MercuriaJia is obliged to assume two species of 
balbuties — a natural and an accidental. The natural 
is produced by humidity ; the unnatural or accidental 
by dryness ; and it is of tliis species that Hippocrates 
has spoken. Now, when balbuties proceeds from dry- 
ness, aa after fevers or inflammation of the brain, we 
Bhould direct our attention to the moistening of the 
tongue and the top of the spinal cord. Grargles with 
woman's milk are advisable ; the tongue must be fre- 
quently moistened with a decoction of marsh-inailow, 
to which sweet oil of almonds may be added, or some 
nymphica leaves, by which the eft'eet will be increased. 
Tlie spinal cord, especially the cervical region, should 

and antiquary. The Emperor Maiiiniliun II, vliDm lie cured 
of a fever, created him a count, aud the PadusJiH erected a 
moDument to his memorj, 



1 BTDTTERING. 



31 



te acted on "by convenient linamenta, apt to soften 
I these parts. Impedimenta in speech, he says, are also 
[ produced by emotions, deep cogitations, prolonged 
I ■watchfulness, sexual excesses, habitual intoxication, 

which, by injuring the brain and the nerves, produce 

But, although a physician, Mercurialis does not 
j- Beem to have entirely relied on drugs and diet, 
r for he expressly says that the body and the voice 
F must be exercised as much as possible, and if there 
• be anytliing which may benefit stammerers and 
stutterers, it is continuoua loud and distinct speak- 
ing. He supports this opinion by the example of 
Demosthenes.* 

Lord Bacos thus writes -.f " Divers we see do stut. 
The cause may be, in most, the refrigeration of the 
I tongue, whereby it is less apt to move. And, there- 
fore, we Bee that naturals [idiots] do generally stut. 
and we see that in those that stut, if they drink wine 
\ moderately, they stut less, because it heateth ; and so 
' we see, that they stut more in the first offer to speak 
' than in eoutinuance ; because the tongue is by motion 



• Eieroendum est corpus quantam fieri potest, prEoaertim 
vero eierceDdu. est vox; et ei quid eet, quod poeait prodease 
"balbis et hiesitantibuB est continua locubio slta, et cla.rii. De- 
rooatbeiiGS BuperaTit balbutiem sola rocis eieruitatione et ood- 
tentione, nam dedit decern millia dtachmorum Neoptolemo 
hiatiioni, qui illuia doouit versna pliirea uno apiritu profsrre, 
aoilicet ut iojectia in as colculis oscendens et currena veraas 
continao pioferret. 

■f Sylva Sylvamm, or Natural Hulory. Firat published 1637. 



32 THEOSEES iXD UODEB OF TSKiTMSST 

Bomewliat heated. In some, also, it may be, though 
rarfJy, the dryness of the tongue, which likewise 
maketh it less apt to move as well as cold ; for it is 
an eifact that cometh to some wise and great men ; 
as it did unto Mosea, who was liiiguw prwpeditce, and 
many stutterers we find are very choleric men; choler 
inducing dryness in the tongue." 

Menjot,* after enumerating certain national peeu- 
liaritiea of enunciation, says ; " Some also stammer 
(JrififfuHiunl-Y), that is, they utter obstructed and 
obscure words, aud some have a Ixiorish and rude 
pronunciation," Following Aristotle, he reduces 
stammering fhalbalies) to three kinds, viz., iraulateta, 
pselloleta, and ischnopltoRm, 

Traulotism is that vice, when the tongue cannot 
articulate certain consonants and changes them into 
others ; for instance, i is softened into d, g into s. 

Psellism is mutilated speech (loquvMo detrwncata), 
when a letter or a syllable is omitted. 

Ischnophonia (to which, however, he prefers iscko- 
phonia) is when a man in the middle of his speech, 
by some impediment, cannot properly connect the 
syllables, but repeats the syllables ; so that, for Csesar 
he says, Ca^-Gwsar. 



* Diaae/taiio Fathologica de Miititale el Salbviie, Antonio Men- 
joto Scriptore. Febriutn Malignarum Misioriit, etc., PariBiia, 
1674. Antoine Menjot was bom of Protestant parents at Paria, 
lfi36. Be tooh liia degree at MontpcUier^ and became phy- 
sician of the king. Menjot had a very large practice to the 
time of his death, which took place in 1896. 

t FHjpitio, to twitter, chirp, like birda. 



or STAMMEKISG AND 3TUTTEKIXC. 33 

He continues : " The causes of balbuties are 
lumeroua. First, the muscles of the tongue are not 
I so much affected as in mutism ; but suffer rather 
from tremor, so that speech lias lost its iutegi'ity. 
Secondly, the tongue may be too short, so as not sufH- 
cieutlj to reach the anterior teeth, or it may be too 
thick, or too inflexible ; for the tongue must also be 
broad ; hence, birds which imitate the human voice, 
have broad tongues. It may also have lost its pliancy 
I from fever. It may be too dry or too moist, or too 
cold or too hot. Whdst there are also some who 
[ stick fast, ao to speak, so are there others whose 
I speech is like a torrent. There is a third sjiecie.? 
I which arises from tumours, rarely phlegmonous, but 
I frequently [edematous, under the tongue, wliich is 
I called ramda. Then come, fourth, the affections of 
i the frcenum, which may be too short or too con- 
[ Btrietcd. Fifth, the lips may be too thick or muti- 
I lated, too bard or too soft. Then the teeth may be 
badly disposed. Finally, balbuties maybe accidentally 
I produced from impetuous cogitation, as in delirium, 
' just as a servant cannot obey at once the various com- 
mands of liis master, neither can the tongue, however 
agile and free, obey the swift behests of the mind." 

Commeiiiar?/. — AU that is necessary to slate is that 
thia dissertation on Balbuties, although it contains 
nothing striking, is the most complete treatise on 
this subject of the seventeenth century. 

JoHANN Conrad Ammas,* of Amsterdam, to wbo.se 



THEORIES AND MOLES OF TREATMENT 

works* most subsequent writers are much indebted 
witb regard to a correct theory of tbe formation of 
voice and articulate sounds, did not confine hia prac- 
tice solely to the education of deaf-mutes, but ex- 
tended it to tbe remedjdng all kinds of defective 
utterance. Vicious articulation, he conceived, was in 
some cases owing to organic defects in some portion 
of the vocal and articulating apparatus, or to debilily. 
The tongue, for instance, is sometimes so lai^ that it 
fills nearly the whole buccal cavity, and materially 
interferes with tbe enunciation of many sounds. " I 
had," be says, " a Danish gentleman under my care, 
who, on account of the size of his tongue, articulated 
badly, and could by no effort of his own pronounce 
ka, but always said ta. Whilst placing my two fingers 
firmly on this organ, I desired him to enunciate hi. 
I well perceived that be tried to say ta, but as he 
could not approach the tongue to the teeth he was 
forced to enunciate ha to the admiration of the by- 
standers." Tbe tongue may also be deficient in mo- 
bility, owing to its being fixed by the fraanum, or the 
latter may be absent, in which case, the tongue lies 
at tbe bottom of the cavity. The uvula may be too 
voluminous, too smaU, or altogether wanting. The 
palate, the lips, the teeth, may also be in fault. 

Amman distinguishes two species of defective 
speech. Tiie first he calls Hollentotism., which con- 
sists in modifying the soimds in such a manner that 



I 



OF STAMJrERING AND STCTTEBIXO. 3a 

ley 'become uninteiligilile. He quotes the case nf n 
yoimg lady of Haarlem, who could scarcely pronouDce 
Koy letter but (, and whose utterance was of course 
a ridiculous farrago of an interminable repetition of 
that sound. Amman cured this young lady within a 
Bpace of three months, so that not a vestige of her 
defect remained, and her elocution became perfect. 

Tlie second kind Amman terms HcesilanCia, con- 
sisting in a laborious repetition of the explosive 
sounds. Dmnng the efforts to produce them, the 
patient is frequently much agitated, the countenance 
livid, and the featiu'es distorted. This kind 
of defective utterance, he further observes, is not tlie 
result of organic defects, but originates in the con- 
traction of a viciooa habit, wliich in time becomes 
inveterate. 

Commentary. — Haller very justly calls the Disscr- 
iatw de Loquela a golden book ; for the author developsi 
in it both the mechanism of language in general and 
the process he employed in teaching deaf-mutes to 
§peak, and to relieve impediments of speech. 

KiJSTNER* saya, " Speech is depraved from tiimoura 
of the tongue, ranula, inflanunation, or any other 
wounds. Tliis happens also in stammering, hesitation, 
or titubation of the tongue, which vices are owing to 
its being too long or too short. Tlie frffinum may bo 
too constricted, too lax, or too rigid. The cause may 
also be in the nerves of the tongue. Tlie motion of 



* Dittettaiio Inou^ralta de Lingua Sa-na et ^gra. AlidorSi, 



36 



THEORIES AND MODES OF TREATMBST 



the tongue ia also depraved in convulsioiis from terror 
or any otlier such cause." 

He further mentions amongst the symptoms of a 
diseased tongue, paraJysia of that oigan ariaing from 
the interrupted flow of animal spirits into the muscles 
of the tongiie. " Thia takes place," he continues, " in 
various diseases, as in apoplexy, syncope, concussion, 
■violent emotions, or it may occur jier se. To cure 
thia evO, we must inquire into the caiise of the inter- 
niption of the flow of animal spirits, and try to restore 
their free influx, which must he effected in various 
modes, according to the difference of causes. The 
paralysis of the tongue must be treated by internal 
remedies found useful ia general paralysis, such as 
aromatics, nervina, fixed and volatile salts, sudorifics, 
and purgatives, and sometimes emetics. Externally, 
stimulants should be frequently applied to the tt)ngue, 
especially distilled oQ of amber, sage, cinnamon, and 
other aromatics. 

" If the action of the tongue is impeded on account 
of the contraction of the fnenuluni, it should be 
divided by the suigeon. This is, however, far from 
necessary in all infants, as so many formerly believed. 
It is only requisite in such cases when the tongue is 
so fettered that the infant cannot protrude it, and can 
neither properly suckle, nor swallow, nor distinctly 
enunciate when the time for speaking arrives. This, 
however, scarcely occurs in one of a thousand cases. . . 

" When speech is depraved, and there ia hesitation, 
stammering, or tituhatiun from some vicious conform- 
ation of the nerves, there is seai'cely a remedy for it. 



OP BTAMMEKING AKD STDTTEBISG. 37 

But if it is owing to laxity and humidity exaiecauts 
and roborants are of mucli use. If from dryness or 
rigidity, huinectants and frequent emollient rinsing of 
the mouth are indicated." 

Hahn* attributes stuttering, stammering, and mu- 
tism to a singular conformation of the hyoid bone. 

HARTLEYf saya: "Stuttering appears generally to 
arise from fear, impatience, and some violent passion, 
which prevent the cliild from articulating correctly 
by the confusion which they cause in the vibrations 
which descend to the muscular system ; so being in 
default, the child makes continuous efforts, until he 
succeeds in articulatiog properly. 

" When stuttering ia once established in some 
words, it extends more and more, and especially to 
all the first words of plirases, because then the organs 

pass from inactivity into action Stuttering is also 

caused by a passion, a natural weakness, etc., whicli 
prevents us from finding the proper word at the 
instant. Like other modes of prontmciation, stutter- 
ing ia sometimes produced by imitation....... 

"A palsy of the oi^ans of speech may be occa- 
sioned in tlie same manner bs any other palsy ; and 
yet the muscles of the lips, cheeks, tongue, and 
fauces may still continue to perform the action of 
mastication and deglutition sufficiently well, because 
these actions are simpler than that of speech, and are 



• Commert, Litt. ann. 1736. J. QottfriKd Hahn, bora ICOt j 
f died 1753. 

+ Observation an Man. Looduu, 17*9. 



38 THEOETES AND MODES OP TBEATMENT 

also excited by aensatioiiB wliich have no oiiginal 
influence over them." 

Haen* assigns tlie cause of stuttering to pulmonary 
voraicEe. 

MoKGAGNI and SANTORiNi.f — Morgagni has a few 
reraM-ks on impediments of speech, at the end of his 
fourteenth letter on diseases of the ears and do.'m ;i 
and as he refers to Santorini's opinion touching the 
cause of stuttering, they may well be ranged side by 
side. 

In the 21st observation, saya Morgagni, of Bonet's 
Sepvlchretv/m-t sec. 21, Santorini is made to teach as fol- 
lows i§ "That in the middle region of the palate, i.e., 
at the fourth bone of the superior jaw, there was in all 
subjects he had seen tUL then who could not pro- 
nounce the letter r, two holes not open, and which are 
not easily perceived in such as are not alHicted with 

• EaHo meiendi, eic, Vienna, 17G0. Anthony de Kaon, or 
Van Hoen, a celebrntod physician, bom at the Hague, ITOi, 
where he atudied nnder Boerhaave. He died in 1776. 

+ J. B. Morgagni (b. 1682j d. l77l). De Sedibwa el coum 
mvrboTMin, etc. Lugduni Batav. 1761. Lib. 1, Epist. Anat, 
Medica zrv. De uurium, et nariunt affeciibxa, aliquid aiditur da 
Balb-alit. i. D. Santorini (b. 1636; d. 173G}. Opvacula medica, 
Bto. VenetiiB, X703, 

J "Namqne observatione ssiinduoitur Sanctorina noBter, hmc 
docena : eeee in media polati Togione, id est in quarto oaae 
Buperiorifl maiillte, in iUia omnibus quoa ad id terapns vidiaBet 
qui littecam t eiprimece non possent, duo foramina quse nullo 
Diodo aperta et obvia inveninntar in iis qui illo offecto tenentur: 
Ergo causam immediatam qns posita ponit, fore illoa duos 
nieatna apei-toa." 

§ Otserraftoiies Analow/itiE, Venetiia, 1734. 



■ 
■ 



OF BTAHUEKmO AXD STUTTEKmO. 

this defect; and conse<nieiitly he places the proxi- 
mate caxise of the defect as depending on the width 
of these apertures."* 

Santorini has been incorrectly cit«d as having 
placed the cause of defective speech in the ahsenee 
of the incisive canal ; for it is in this same passage 
that he says : 

"There are seen in the middle of the region of the 
palate two canals, which cause stammering, as therein 
are seen two holes near the teeth, by which the pituity 
trickles into the month, moistening the tongue in its 
anterior part, and rendering elocution thick, whence 
arise only half-artictdated words." 

li continues : " It is, therefore, evident that 
from the too large opening of this canal 
placed behind the incision, not that vice called by 
the Greeks Tpav\6T7]<i (stammering ?), but that which 
they called i/feXXo'-n?? (lisping ?)." The defect here 
indicated by Morgagni aa i^eXXonj? would no doubt 
correspond to the defect caused by the above aper- 
ture, viz., lisping in the strict sense of the expression, 
or an indistinct, hissing sound accompanjing every 
syllable, and not (as the term is now used) simply a 
defect in the pronunciation of the sibdants. 

Morgagni further says : " As for myself, I cannot 
say that I have seen these holes in the palate in all 
the heads I have examined, although I cannot bring 
myself to believe that in all that number, there 
should not have been a single stammerer. But al- 



• Bonet'a Sepulcftro 



40 



THE0BIE8 AND MODES OB TREkTMEST 



though T have reaaon to suspect that Santorini has 
ascribed to all stammerers what he may have seen in 
some, and although he himself admits that those who 
have naturally a superabundance of pituity in the 
mouth are not necessarily affected with either kind of 
stammering, I nevertheless tliink that from the great 
merit of this author we ought not to pass judgment 
till numbers of such cases have been carefully exa- 
mined by skilful anatoraista." He continues : " I 
coujecture, however, by a not unfounded reasoning, 
that stammering cannot be attributed to a double 
velum (as mentioned by Deliua*). In fact, I have 
seen several instances of tiiis kind unconnected with 
any vice of speech. But it can easily be beheved that 
great injuries of the hyoid bone may sometimes pro- 
duce stammering ; and I can well conceive that the 
learned Hahn-f believed that a bad conformation of 
this bone gave rise to stammering, stuttering, or 
mutism. The direction of the muscles moving the 
tongue cannot be changed without the movement of 

the latter part. As for myself, I beheve that from 

whatever cause stammering may arise in children, 
the stuttering in adults is derived from the same 
source. We ought to observe the defect in children, 
because, in point of fact, they all stammer, in order to 
better discover it in adults, so that we may diminish 
or cure it altogether," 



1730. J, GoLtlried Hahn ( 



OF BTAHUIKIHa .iSO STUTTHBINO. 

SAUVAr.ES* places stuttering among dyce 
iaaea the chief symptoin of which conaiatB in debility, 
diminution or suppression of the moveoients of the 
oi^iana submitted to the will. Sauvages divides 
Psellism into eleven species, of which the firat, 
Psdliwius iadmophoiiia, treats of stuttering. He 
aaaigna the cause to the difficulty of moving the 
velum, the uvula, and the root of the tongue. Hence 
he asserts that the chief difficulties to the stutterer 
are the guttural sounds, g and k. For the treat- 
ment, he advises attention to the instructions of an 
experienced master. Tlie rest of the defects men- 
tioned are ; Fsdlisnitis rhotaeismus, rhotacism ; Psellia- 
m-iis traiUotes, indistinctness ; Fsellismus balbv,(ics, 
difficulty of enunciating the labials ; Fsdl-mi-m mo- 
gUalia, another species of labial miapronnnciation ; 
Psellisnius mstallieus, peculiar to gilders and painters ; 
Fsellismus iolacism.'us, iotacism; Fsellismus nasitas, 
ihinism ; Fsellismus lagoslomaium, defect caused by 
hare-lip ; and, finally, Psdlism/us d ranula, or defective 
speech caused by tumours. 

CcLLEN.f and many subsequent authors, have 
adopted the opinion of Sauvages as to the cause of 
stuttering being debihty. 

Mendelssohn, grandfather of the celebrated com- 
poser, in a commentary on the well-known case of 
aphasia of Spalding, discusses at some length the 

* Sotologie Mtthodiq-ae, by F. Boisaier da Sanmges, Ljoa, 
1772. 

t Svnop, Noi. Slid. William GaUen, bora at Lanark in 1713 ; 
died 1790. 



42 THBOBlSa AND MODES OF TFEATMMNT 

phenomena of speech impedimeDta. Under the head 
of atnittering, he saya :* 

" It might he supposed that the defect is in the 
organs, and that there miiat he something wroi^ in 
the strueture of the organs of speech which may ex- 
plain the infinnity. But many observations show 
that the defect is more psychological than mechanical 
or organic. I shall indicate a few of the observationa 
which I had ample opportunity of making: 

" 1, When labouring under strong emotions, we are 
all more or less subject to this infirmity, 

" 2. We are more exposed to it when speaking in 
a foreign tongue with which we are not familiar. 

" 3. We are more liable to it in the presence of a 
stranger who may notice the infirmity. 

"4. We are least exposed to it when we are alone, 
speak slowly and loudly, and least of all in singing, 

" 5, When the stutterer wishes to continue speak- 
ing, he repeats certain syllables, in order to begin 
again. He then very rapidly passes over the difficult 
syllable, and freq^uently without any hesitation ; but 
sometimes he fails, aud the operation must be re- 
peated. 

" All this would be inexplicable if a defect in the 
structure of the organs were the cause of stuttering." 

According to his hypothesis, stuttering is nothing 
hut a kind of coUision between two heterogeneous 



• Frychological Obterralions on the Caie of Spalding, by Ifoaei 
MeiidelBBahD(b. 1729j d. 1T8G). Magazin eur Er/alirangiaeelm- 
Uhre, V, 1, part 3, p. *6. Berlin, 1783. 



OF STAMMERING AND BTUTTERING. 



43 



, whiclL act on the speech organs with nearly 
f equal force at the same tune. He continues : 

" Something like stuttering may occur in other or- 
L gana of the hody suhject to voluntary motion. Hence 
J we can explain the staggering of intoxicated and 
I feverish persona, as well as the tremhling of the 
I old and debOitated. In the former, the ideas suc- 
ceed each other too rapidly, and the limbs cannot 
follow them with equal celerity. Their ideas cross 
each other, come into coUision, and obstruct each 
I other..... 

" In old and weakly persons the ideaa proceed more 
1 naturally, but the organs are too rigid or too weak to 
ep pace with the ideas. 

" Loud reading or singing present, besides, the ad- 
I vantages tliat the mind is sensually occupied by the 
[ ear, so that it can less wander to foreign ideas, 

" The intrusion of foreign ideas may alao he obvi- 
' ated by opposite means, namely, by great rapidity 
on part of the stutterer in the enunciation, by which 
the speech organs are enabled to overcome the diffi- 
cult syllable : in the same way as when io physical 
movements we wish to surmount an obstacle, we take 
I a run at it before leaping over it. 

" One of the best remedies against the evil consists, 

according to my experience, in loud and slow reading. 

It wiU be better to cover the following lines, so that 

the eye may only rest on the syllable which ia to be 

I pronounced. By doing so, the intervention of foreign 

I ideas connected with enunciation of the following 

I letters 13 obviated, and a colliaion of ideas, which in 



TU£OBIE& AND UODBS OF TBUtloafT 

most caaes is the cause of Btuttering, ia thus avoided. 
By repeating such exercises in the presence of other 
peraons, the power of the mind in controlling the 
articulation, and the succession of ideas connected 
therewitli, is generally strengthened." 

Commentary. — Mendelssohn's article on speech im- 
pediments ia one of the moat suggestive treatises of 
the period in which it was written. "When he says 
that he had ample opportunities of ohaerving this 
defect, he probably means in liis own person, for one 
of his hiographers says that he spoke " with a lisping 
tongue." But what ia remarkable is, that, to my know- 
ledge, no author on stuttering alludes to Mendelssohn's 
article on this subject. 

Crichton* observes: "A very singular phenome- 
non concerning this impediment of speech is that the 
hesitation is generally confined to the pronunciation 
of a few letters, and tliia ia the cause why its effects 
are always heard and seen ; for if it concerned whole 
words, a total stop would he put to speecL The per- 
son begins a concentrated chain of actions, or, to apeak 

more plainly, he begins to pronounce the words 

He arrives at one of the lettera alluded to, and imme- 
diately a doubt arises in liis mind how it ia to be pro- 
nounced He then begins to pronounce it in a 

different way, and the doubt again arises He 

cannot stop, for he ia in the middle of a word, the 
pronunciation of which he has been accustomed to 
conclude, and he therefore continuea to struggle with 



■ An Ingulry info the Kalnre and Origin of -Venial Derail^ 
b7 Alexander Criobtoti. London, 179^. 



OP STAMMERISG AND STlTrTEBING, 45 

till at last, owing to some accidental causes, wliicli 
it is not easy to discover, he accomplishes its proper 
attemnce." 

Daewin* maVea the following remarks on the 
theory of impedimenta in speech : 

" If a train of action is dissevered, much effort of 
volition or aenaation will prevent it being restored. 
This ia common in impediments of speech, when the 
association of the motions of the mnacles of enuncia- 
tion with the idea of the word to be spoken is dis- 
ordered : the great voluntary eiforts which distort the 
countenance prevent the rejoining of the broken aaso- 
eiatione. So, in endeavouring to recaJ to our memory 
8ome particular word of a sentence, if we exert our- 
selves too strongly about it^ we are less likely to 
regain it" 

Again : " Impediment of speech is owing to the as- 
sociation of the motions of the organs of speech being 
interrupted or dissevered by ill-employed sensations 
or sensitive motions, as by awe, baahfulness, arabi- 
Hon of shining, or fear of not succeeding, and the 
persons use voluntary efforts in vain to regain the 
Icioken associations. 

The broken association is geneially between the 
first consonant and the succeeding vowel, as in en- 
deavouring to pronoimce the word parable, the p is 
Voluntarily repeated again and again; but the re- 
mainder of the word does not follow, because the 



* 2otmoniia : or the Lout <if Organic LiffJ^}J 'Eruama Darwin, 
I.D.. London, 1800. 



46 THEOKIES AND MODES OF TREATMENT 

association between it and the next vowel is disse- 
vered," 

He recommends, in order to ciire this defect, that 
the stutterer should repeat the word wliich he finds 
difficult to him eight or ten times witliout the initial 
letter, in a strong voice, or with the aspirate hefore it ; 
as in the word parable, he should repeat several times 
araile or harable, and at length, to speak it very 
softly, with the initial letter p, parable. This shotild 
be repeated for weeks or months in every word wliich 
he hesitates in pronouncing. He further says : " To 
this should be added much commerce with mankind, 
in order to acquire a carelessness about the opinions 
of others," 

Watson published two volumes on the deaf and 
dumb,* in which he treats of stuttering, and makes 
the following very sensible observations on the cause 
and cure of this affection. 

" These hesitations proceed from a sudden interrup- 
tion or break in the connection of those sympathetic 
or Ijijked (to use a plain word) muscidar motions, 
that perform articulation in our ordinary discotu'se. 
This disseveration is not occasioned by any defect in 
the organs concerned in the formation of the sound, 
for then it would operate uniformly; but by the 
influence which external objects or cireumstancea 
have on the mind. Pear, shame, or any other strong 
internal feeling, will, for the moment, produce falter- 



or STAioiERma and btuttebing. 



47 



ing and hesitation in speech, even in those who do 
not habitually atammer. Agreeably to this, we find 
that persons of great nervous initability and lively 
consciousness are most liable to stammering. This 
sort of impediment is, in fact, a bad habit, founded 
upon tins constitutional susceptibility, 

"It may be observed that musical instruments 
afford an apt illustration of the mechanism of speech. 
Instrumental music is harmony of sounds produced 
by forces purely mechanical; and speech is modu- 
lating of sounds produced by similar forces, but more 
perfect, by as much as nature exceeds art. 

"The organs of speech are moved by muaclea, which 
from tlie laws of the animal economy are the instru- 
ments of the wiU. But the frequent repetition of 
these motions so links or associates them, that they 
seem to proceed by sympathy or habit ; and we are 
conscious of an act of the wUl only at their com- 
mencement. Hence, anjd^hing that suddenly dis- 
severs them throws the whole into disorder, invo- 
luntary or convulsive muscular motions take place, 
and instead of the habit of regular and voluntary 
motions, succeeding each other in a train, if these 
interruptions are frequent, a habit of hesitation and 
stammering is introduced. This may account for 

I the origin and progress of the first sort of impedl- 

' ments in speech." 

After dilating on the importance of bringing per- 

I sons thus afflicted to reason on the subject, he says : 
" Impress strongly on their understandings, and 

I induce them continually to keep in view, that though 
we cannot explain hi/tn mind acta on animal fibre, yet 



48 



THEORIES AND MODES Of TREATMENT 



experience proves that there exists in our frame, some- 
where, ft power, whitih we cttll will, whereby our mus- 
cular strength is put in motion or made quiescent ; 
that by this power we first learnt to do these things, 
which repetition has converted into habit ; though we 
are now no longer conscious of an act of will in per- 
forming them after we have willed to set about them. 
This may he exemplified by the acta of walking, run- 
ning, speaking, writing, fingering a musical instru- 
ment, etc., and a little consideration will serve to 
make it understood." 

He recommends the exercise of the vocal and arti- 
culating organs, and conversation ; and continues : 
" These directions, it will be perceived, are founded 
upon the principles of association of ideas, than 
which a more powerful principle in the formation of 
human habits cannot be conceived. It la a trite ob- 
servation that we are the 'creatures of habit,' No- 
thing can be more true, and we become so by the 
influence of this principle. To overcome a bad habit 
is, therefore, no easy task ; but the first step towards 
it is to break the chain of associations by which it 
was breught about, by introducing a contrary ten- 
dency. What can effect this but a rational system 
of action, carried on with watchfulness and perse- 
verance ?" 

In conclusion, he says it may be laid down as an 
incontrovertible position that, by these means, per- 
sona possessing an ordinary mental capacity, with an 
adequate aliare of industry and strength, may cfj-- 
tainbj overcome the vicious habit. 



49 

Frakk* dividea defective 3]:ieecb into two inaiu spe- 
I'Cies — difsphoni<e,OT defects of the voice ; &nd di/slaiia^, 
tdefects of articulation. The fonner is subdivided into 
P jxmipAonia!, disagreeable tones of the voice ; anda^jAo/m, 
a of the same. The latter (dysialiw) is subdivided 
I into alalia, loss of speech or mutism ; and mogilalia, 
I- jjilficulty or imj-wssibihty to pronounce correctly cer- 
r tain letters or syllables. This last, again, is divided into 
I mogilalia isch^urphonia, or stuttering ; mogilalia irau- 
\ H^mus, or rhotacism ; and tnogi/alia psellismus, which 
1 softtmiug hard consonants, etc. These 
I two last constitute stammering. To these he adds 
eeveral other defects of speech, such, for instance, as 
when / andy are badly pronounced, or when strange 
words are intennixed. Tims, one of his pupils inter- 
mixed tlse words hedera, /t^era, in the middle or at 
the end of every sentence. 

Among the causes of mogilalia isrhnophonia, or stut- 
tering, Frank enumerates (following Mercurialis) bad 
iducation, depraved habit, cerebral affections, sexual 
es, etc. Stuttering, he says, is characterised by 
; repetition of the first syllable or word of a aeu- 
Ftence ; and he agrees with Sauvagea in saying that it 
P chiefly takes place at the gutturals. In respect to 
[■■the prognosis, he observes tliat stuttering seems to 
■illiininish, and frequently ceases with advancing age ; 
T'but when inveterate, it is an incurable evil For tlie 
^treatment, he says : " It is above all necessary that a 



■ Praieot Mediea Cmiiierso Pracejiia, ohap. II. De m 
)tloq'aelm Joseph Frank. Lipsis;, 1611-18. 



TFIEOIIIES A?JD MODES OF TREATMEST. 

teaclier practised in the art of teaching deaf mutes 
should take pains by repeated attempts, either "by kind- 
ness ur by blows, to teach the stutterer to overcome 
the difficulty of pronouncing certain guttural letters 
or syllables." 

Thelwall • ob8er\-es : " The treatment of impedi- 
ments embraces many impoi-tant considerations, he- 
aides those that have immediate refereDce to what is 
usually comprehended under the term ' elocution." 
It requires a profound knowledge of human nature, 
only to be acquired by long and acute observance of 
mankind, assisted by habits of philosophical analysis 
and researches into tlie source and varieties of mental 
action and development. Many of the leading prin- 
ciples are universal in their efficaj^y; hut almost every 
individual case requires a different mode of applica- 
tion." 

Under the head of serious impediments, he men- 
tions stuttering as " a spasmodic interruption of one 
or more of the organs of speech during the effort of 
enunciation, accompanied always with some degree 
of hurry or embarrassment of mind ; and frequently 
with considerable agitation of the whole nervous 
system." Tliis is more an intellectual than an or- 
ganic disorder, and the original causes are terror 
and imitation. This he divides into (what he calls) 
— " Slam7}iering~~JnB.j)tituAe or indocility of the lips. 
Stvllerinff—laeiititniic or occasional indocility of the 

• Illvstrations of English Ehiflhmm, by John Thelwall. Lon- 



TUELWALL — SAVAKY. 



51 



I tongue ; generally with forcible protrusion against 
h. Throttling — Obstmetion in the guttural 
Constipation, or suppression of the voice 
Eiamodic agitation, apparently affecting the 

■ lironchial tubes, or the muscles in the neighbour- 
Fliood of those organs, and impeding the passage of 
I the air from the lungs to the larynx, during some 
[ ill-directed effort for enunciation. Similar pheno- 
] mena are produced by injudicious inhalation or by 
\ tenacity of breath, making a vacuum in the mouth." 
ilThe general causes are, he says, " Hiitried viola- 

■ tion of the proportions of musical cadence and of 
m&ie physical principle of pulsation and remission." 

) proved by the fact that there is seldom any 

mpediment in song and comparative facility of vei-ae, 

md that persons frequently continue to have impedi- 

■itnents in their conversation when tl^y have entirely 

I surmounted them in reading and reciting. 

In another place he observes that he considers all 
ases of impediments, with few exceptions, eompU- 
■tated with moral and intellectual causes, and that 
fcthey do not obviously arise out of palpable imper- 
fections or deficiencies of the organs. 

Alluding to the case of a gentleman who hail 

. constriction of the tongue, he says, that might 

prevented him from forming the sounds tk, 

etc. ; but this conformation could never have 

saled his lips, aa it were, hermetically, when he 

^liauld have pronounced an open vowel or guttural,' 

paor to have constricted the glottis, till he was in 

langer of suffocation. And all these phenomena are 



52 THEORIES AND MODES OF TREATMENT. 

observed when there is no maKormation whatever in 
any part of the organs of speech. 

Commentary. — ^As regards the great remedy with 
which Mr. Thelwall cured stuttering, it was simply 
"rhythm"; and, as he himself says, "the rhythm 
of Milton is the favourite object of my system." 
Long, therefore, before Colombat, was rhythm em- 
ployed as the chief remedy for defective utterance. 

Savary* speaks of this defect as foUows : " Stutter- 
ing, or linguce hcedtantia, is a difl&culty of speech, or 
rather a vice of pronunciation, which consists in 
several times repeating the same syllable. This vice 
may depend on a particular conformation of the 
tongue, or on any other cause which impedes its 
movements ; but it probably also depends on the 
character of the individual who speaks in a hurried 
manner, or is intimidated. What is certain is, that 
one sees stutterers read several phrases in succes- 
sion, or even several pages, without hesitation, and 
wlio generally do not stutter in singing." 

* JHct. des Sciences M4d., tome iii, p. 69, Paris, 1812. Art. 
lidgaiement. 



CHAPTER III. 

toSTORICAL AND CRITICAL REVIEW OF THE THEORIES 
AND MODES OF TREATMENT OP STAMMERING AND 
STUTTERING, FROM THE EARLIEST HISTORICAL PERIOD. 



— RuUier. — Voiaiit. — Astcie . — Combe, — Broster — Leigh — 
Bsrtrand. — M'Cormac — Amott — MdUer. — Beleau, — PaJmer. 
— Hervez de Cbdgoin. — Wutzer. — Sarrea d'Alaia. — Magendie. 
— Schnltheaa. — BanBmann — Hamisuh. — Otto. — BelL — Poett. 
— CulL— Berthold. — "Warren. — Good. — Hoffmann.— Male, 
bouche. — Hunt. 



"A JUST atory of learning, containing the antiquities and 
originBla of knowi.edqbb and their aecta; their inTentiona, theii' 
divecae administratioiiB and QmiiBgiiigs ; their flouriahinga, 
their oppositionB, decaya, depceaaionH, obliviona, reinoveB ; witb 
the cauaea and occaaiona of them, and all other eventa oon- 
ceming them, I may truly affirm to be wanting. 

"The use and end of which work I do not ao much design 
for carioaity, or satisfaction of those that axe the losers ui 
learning ; but chiefly for a more serious and grave purpoae, 
which ia this, in few worda, that it will make learned men more 
— Bacon, Advancement of Leariiing, book ii. 

Itasd* says : " In order to tletermine the cause of 
nittering, it ia sufficient to dweR for a moment on 
i principal plienoraena which accompany it. We 
may remark that what distinguishes tliis lesion of the 



54 



THEORIES AND M0DJ3 OP THEATSIEST. 



vocal functioDs from others ia, that it is subject to 
vary in inteiisity, which forma the principal character 
of nervous debility." 

Further, he observes : " In those cases of stuttering 
which supervene accidentally in consequence of apo- 
plexy or a dynamic fever, in the precursor of some 
cerebral afl'ection, all the movements of the tongue are 
visibly weakened. The completely asthenic character 
which accidental stuttering presents, and which evi- 
dently belongs to the domain of paralysis, render the 
nature of congenital stuttering evident, and we can- 
not doubt that its proximate causes must be the 
(same, with some modifications, weakness of the muscles, 
for congenital stuttering; sympiomatic weakness for 
stuttering allied with any material lesion. 

" It is impossible to mistake in the phenomena of 
stuttering a spasmodic affection, and in this spas- 
modic affection, the result of the debility of the mus- 
cular powers of the tongue and of the larynx. 

" But this debility cannot be detected in the move- 
ments and tension of these muscles. Experience has 
proved this to me. It ia only in the delicate, imper- 
ceptible movements that these organs are deficient in 
force." 

With regard to the treatment he says : " I have no 
doubt the affection is curable. The remedies must 
necessardy be adapted to the degree and duration of 
the disorder. It is not sufficient to make the pupil 
acquainted with the mechanism of articulation, aud 
to repeat frequently the individual sounds, but tliey 
must be studied in all i>03sible combinations. Some 



I 



syllables are more easily pronounced, wlien preceded 
by one whicli places the tongue in a position fa- 
vourable for their production ; whilst the enunciation 
of them will be more difficult if they foUow a syllable 
not affording this advantage, A good deal also de- 
pends on the vowel with which the consonant is 
combined ; thus stutterers find less difficulty in ar- 
ticulating CO than ca. 

" When stuttering increases and extends to a great 
number of individual sounds and syllables, it will be 
necessary by mechanical meaua to atrer^then the 
organs of articulation, and to lessen their spasmodic 
tendency. We must treat tlie miisclea of the vocal 
and articulating organs like those of locomotion ; and 
as dancing and fencing will render the latter more 
firm and flexible, so must the tongue and the hps be 
subjected to analogous exercises. I avail myself foi' 
this purpose of a small apparatus, which I place 
under the tongue* The instrument ia scarcely in- 
.troduced, when we hear a confused, indistinct voice, 
tut no stuttering. The most difficult syllables are 
articulated with some trouble, but they are not re- , 
peated. "We must, however, not deprive the tongue 
of thia mechanical support at too early a period, 
otherwise the defect will reappear. The apparatus 
should be used for a very considerable time, and 
when, at meals and during the night, it is removed, 
the patieut must strictly abstain from speaking. I 

• Tlie instrument conaistB of a. gold or ivorj fork placed in 
the liOQoave centre of a short stalk, and applied by ila eonvei 
Barrfl,oe to the cavity of the utveolftraroh of the lower jiiw. 



oB THEORIES AND MODES 07 TREATMEST. 

cannot exactly say how long it should be worn, having 
only effected two cures by its agency. The first case 
was that of a young man, set. twenty, who used the 
instrument for about eighteen moutha. The perse- 
verance of the patient to subject himself to such an 
inconvenience for so long a period was powerfully 
supported by the hope of meeting, after the removal 
of his infirmity, witii a more favourable reception 
from a young lady to whom he was greatly attached. 
The cure was complete ; but I have not been in- 
formed whether he met, in another quarter, with the 
success he so amply merited. The second case was 
that of a boy, aged eleven, who wore the apparatus 
very reluctantly, and removed it whenever he could 
do so unobserved. I saw him much improved after 
he had used it for eight months, and I have reason to 
believe, though I lost sight of him, that he ultimately 
recovered." 

Cormnentary. — In comparing the phenomena of stut- 
tering with those impedimenta of speech caused by 
cerebral affections, apoplexy, etc., it seems to me that 
Itard has misunderstood the nature of these very dis- 
similar affections, as the phenomena manifested by 
them respectively are so different that we can scarcely 
imagine how so eminent a practitioner as Itard could 
have confounded them. Admitting them to be of a 
similar nature, we might suppose their treatment to 
be somewhat analogous ; and then we cannot under- 
stand Itard treating a person afBicted with defective 
speech caused by cerebral lesion or apoplexy, simply 
liy the aid of a mechanical obstacle placed under the 



HCLUEE. 67 

tongue. The supposition that stuttering is owing to 
lieliility cannot be wondered at, having, aa we have 
Been, heen advanced by the ancients, and adopted by 
Sauvagea and others; but what surprises us chiefly 
is, that Itard should opine that those defects which 
come under " the domain of paralysis " render " the 
natiire of congenital stiittering evident." Starting 
from such premises, it is not surprising that, even by 
his own account, he only succeeded by means of his 
instrument in effecting two cures, after a lapse of 
eighteen months in the first, and eight months in the 
second case, and did not even know whether the 
cures were permanent. 

In the days when the real nature of stuttering was 
very little understood, it was not surprising that 
resort should be had to such unnatural appliances 
as a fork of silver in the mouth. Dr. Itard was one 
of the most distinguished French physicians of liis 
time ; and the sanction which his name gave to the 
use of such mechanical agents has exerted its influ- 
ence down to the present day. 

Edllier* ranged himaeli' among those authors who 
place the immediate cause of stuttering in the brain. 
He remarks that the cerebral irradiation which fol- 
lows thought, and puts the vocal and articulating 
organs in action, gushes forth so impetuously and 
rapidly, that it outruns the degree of mobility poa- 
aessed hj the muscles concerned, which are thus, as it 



58 



THEORIES AND MODES OF TREATUENT. 



were, left behind. Hence the latter are tliruwn into 
that convulsive and Bpaamodic state which charac- 
terises stuttering. 

To substantiate this defective relation between the 
exuberance of thought, the celerity of cerebral irra- 
diation, and the corresponding organic motions, he 
observes, that the great majority of stutterers are 
distinguished by the vivacity of their understand- 
ing and the petulance of their character ; when acl- 
vaucing age chps the wings of the imagination, and 
ripens the judgment, stuttering diminishes, as the 
action of the organs is now in equilihrium with cere- 
bral irradiation. 

On the treatment of stuttering, Rullier ia content 
to sum up those that have occasionally succeeded. 
The principle that has been applied, lie tells us, in 
the mechanical means proposed, is that they oppose 
a sort of moderator or obstacle to the tumultuous 
movements of the oi^ns of speech. These remedies 
are either physical or material, or intellectual. The 
former — the pebbles of Demosthenes and the fork of 
Itard — act du^etly on the disunlered movements of 
the speech organs. The latter act indirectly, by 
means of the attention, the will, the memory, and 
imitation, such as the study of a foreign language, 
speaking in an assumed tone, and declamation in 
familiar intercourse. 

Commenlary. — Eullier's theory connecting stutter- 
ing with an exuberant imagination is certainly not 
new, having, as the reader may find, abeady been 
advanced by Aristotle. The coimection between 



voiaiN. 59 

thouglit and speecli is no doubt an interesting subject 
of iii<iiiiry. In plain, diatinut speech, good speakers 
do not utter more than three syllables in a second, 
but in rapid delivery, as many as eight or nine 
syllables may be uttered within tliat time. Yet it 
seems certain that a long train of thought may run 
through the mind during the time it takes to articu- 
late a single word. The anxious endeavours to ex- 
press these thoughts may certainly interfere with 
articulation in two ways. If there be no command 
of words, it will produce hesitation, just as its oppo- 
site a want of matter ; but I doubt much whether it 
can ever be tlie cause of stuttering, though it may 
give rise to rapid enunciation or cluttering. The 
assigned reason that stuttering diminishes with ad- 
vancing age, solely in conse<iuence of the wings of 
the imagination being clipped, appears to me very 
imaginary. 

I am far from depreciating the intellectual develop- 
ment of stutterers ; but that the great majority of 
them are distinguialied by the vivacity of their intel- 
lect is too sweeping an assertion. Neither can I 
assent to his implied deduction, that stuttering is 
generally the result of "mental vivacity," That 
stutterers are frei^uently distinguished by the " petu- 
lance of their character " may readily be admitted ; 
but this petulance is evidently the effect, certainly 
not the cause, of the infirmity. 

VoisiN* also attributes stuttering to the irregular 

!9, >e) diferenta degr^i, etc.hj Dr.Falix 



60 THEOREEB AND MODES OV TREATMENT 

and imperfect action of the brain on the muscular 
system of the organs of pronunciation. " On observ- 
ing," he adds, " not merely atutterera, but individuals, 
distinguished by their brilliant elocution and the fa- 
cility of their dehvery, we shall see tliat the latter 
Bometimea present all the symptoms of stuttering 
when they labour under some emotions which dis- 
turb their intellect, and their stuttering will be more 
marked in proportion to the strength and suddenness 
of these emotions. This evidently proves that the 
action of the organs of speech is entirely subordinate 
to the condition of the brain, and that the stutter- 
ing is the direct conseq^uence of its incomplete re- 
action." 

Dr. Voisin being himself afflicted with stuttering, 
left no method untried, from the pebbles of Demos- 
thenes to the methods of Mra, Leigh and Malebouche, 
for the purpose of removing it. Chance first led him 
to the discovery of the method he recommends.* He 
was reading a paper before a society, and wishing to 
do so with energy, he happened to look into a mirror 
which was opposite him, and perceived that he rested 
the border of his right hand upon his chin, in a manner 
so as to depress the inferior maxilla and to hold the 
mouth half open. The idea immediately suggested 
itself that this instinctive and mechanical movement 
might contribute to his reading more promptly and 
easily. In fact, upon ceasing the pressure, the difficulty 
of expression was quickly reproduced ; but upon re- 



• Bulletin, de VAcad. Roy. de .Wi., 1837. 



voieiN. 61 

placing liis band tlie freedom of the aitioulatiou iiu- 
liately returned. Endeavouring to give an ac- 
r count of this, he observes : first, that the mouth was 
i kept half open, the distance between the teeth being 
I a line and a half. Second, that the tongue, aban- 
[ cloned to itself, in the state of repose, placed itself 
I against the inferior dental border, whilst during pro- 
I nunciation it is projected forwards and upwards, but 
I is withdrawn almost immediately behind tlie alveolar 
I arch. Third, that a medium pressure is necessary 
I npon the chin; this should he sufSiciently strong to 
resist the muscles wliicli move the inferior maxilla, 
without impeding its movement of elevation, so 
I strong as to prevent perfect approximation. To pro- 
I duce this pressure, and at the same time make it 
t excusable, it is necessary to use some artifice, so 
j that the manccuvre may not appear forced, but on 
I the contrary, almost natural This pressure should 
made with the external border of the right or 
I left hand indiscriminately, the thumb applied to the 
I chin, and the lingers free. He has, he says, observed 
I the same in other individuals afflicted with impedi- 



Commentary. — ^There are few cases in which any 
f benefit will be derived irom the artifice recommended ; 
9 at best merely a palliative, not reaching the 
cause of the evil : nor was Dr. Voisin cured by if. 
I The pressure upon the chin during emmciation may, 
in some instances, give temporary relief, like many 
I other tricks, but it can do no real good to any stut- 
I terer, much less cure him. 



62 TBEOBIES A5D MODES OF TREA'DIEST. 

AsTBiK* follows Ms predecessors by placing the 
cause of atattering in the hrain. He says: "The 
hrain, hy its complex texture and by the sapreinacy 
of its functions, is in some respects the dictator of 
the republic of organs. None of these organs is so 
much ander its command as the oigans of voice and 
speech. In fact, the vocal phenomena are in constant 
relation with the different degrees of cerebral excite- 
ment, and always correspond in their precision to the 
energy of the feelings and the clearness of ideas. 

" There is an intimate connection between intelli- 
gence and speech. 

" In congenital idiotcy speech is not developed. A 
well-oi^nifled man, who has long enjoyed tlie faculty 
of thought, loses his speech the moment he becomes 
an idiot. We daily find that when the ideas are 
numerous and well co-ordinated, elocution is free, 
easy, and agreeable. On the contrary, when the 
intelligence is slow, and the ideas are confused and 
have not a luddus ordo, we become accidentally 
stutterers, fatiguing our audience by the midtipUclty 
of repetitions and difficulties of articulation 

" What I baA'e said of the marked influence of 
mental aflections on tlie phenomena of stuttering 
leads US to believe that the latter arise fram.the same 
source, and must be attributed to some modification 
in the action of the brain." 

In answer to the question, " But in what consists 
tliis modification ?" he adopts the theory of Eullier, 



63 

I but he says the correctness of that conjecture must be 
I received with reserve. 

With reference to treatment, he recommends reci- 
f tation, tlie study of the theory of articulate sounds in 
all possible combinations, and reading Itefore lar^e as- 
semblies in order to overcome that timidity so natural 
to stutterers. 

He adds, " By reading much the stutterer liecomes 
I familiarised with all the intricacies of our language'; 
I he learus the synonymy of terms which may enable 
iliim to avoid such as are difficult to him. Like the 
I j«destrian who avoids tlie big stones in the roail, the 
I stutterer, witli a well cultivated mind, will form cor- 
Irect ideas and acquire facility of expression." 

Astri^, finally, approves the method of Pemoa- 
lienes, and, abtive all, the fork of Itard. "Honour 
land gratitude," he says, "are due to M. Itard for the 
Isignal services wliicli he has rendered to stutterers," 
Commentary. — There is little to comment on in ]"lr. 
Astri^a essay, as he pves nothing original either in 
theory or treatment, unless the reading before large as- 
semblies and the study of articulation may Ihj so called. 
k With regard to the former, there are very few stut- 
I terers who would attempt it, and fewer still who 
■"would not increase their infirmity by so doing. The 
■ latter advice is, perhaps, more rational ; but is little 
I better than useless to stutterers, who, as frer[uently 
I happens, have no peculiarly difficult words, but hesi- 
) tate indiscriminately at any initial sound. Tlii.'s ad- 
e would be more applicable to the slighter degrees 
of stammering. 



C4 THEORIES AXD MODES OF TEEATilEXT 

CoMBE,* or a reviewer of Dr. Voisin's theoiy, makes 
the following remarks : " If physical malformation 
were reallv the ^reneral cause of stutterinsr, the effect 
wonld necessarily be permanent, and would affect the 
same sounds everv time thev occurred ; but the re- 
verse of this Is the truth, for it is well known that on 
occasions of excitement the stutterer often displays a 
fluency and facility of utterance the very opposite of 
his habitual state. But passion or excitement can 
never remove a physical cause, make a large tongue 
small, set crooked teeth straight, or tighten the liga- 
ments of the tongue, and then let these imperfections 
return as soon as the storm is over." He agrees with 
Dr. Voisin, " that the real cause is irregularity in the 
neiTOUS action of the parts which combine to produce 
speech," 

Again : "From this xiew, it will appear that the 
cure of stuttering is to be looked for in remo^'ing the 
exciting causes, and in bringing tlie vocal muscles 
into liarmonious action by determined and patient exer- 
cise. The opposite emotions, so generally perceived 
in stuttering, may, especially in early life, be got rid 
of by a judicious moral treatment ; by directing the 
attention of the child to the existence of these emo- 
tions as causes ; by inspiring him with friendly con- 
fidence ; by exciting him resolutely to shun any at- 
tempt at pronunciation when he feels himself unable 
to master it." 



♦ Phrenological Journal, vol. iv, p. 464. 1827. This article 
proceeded probably from the pen of Dr. Andrew Combe. 



In concluaioD, he says : "It is scarcely necessary to 
\ add that debility, in which this, in common witli 
many other forms of nervous disease, often originates 
in tlie young, must be obviated by a due supply of 
nouriBhing food, country air, regular exercise, and 
last, though not least, by cheerful society, kindness, 
I and encouragement" 

Commentan/.— The preceding obaervationa, written 
more than forty years ago, deserve quoting, from their 
flhewing that the writer entertained sound views, both 
on the etiology and the treatment of stuttering. 

Ebosteb.* — About tliia period a Mr. Broster, of 
Cheater, was said to have discovered a very successful 
method for the cure of impediments of speech. Ac- 
cording to Ilia own account, he had discovered it above 
twenty years previous to that time, but had only from 
the year 1823 professed it pubUcly. " If hie methods 
{he tells us) were publicly reported to the world, they 
would serve but little purpose to any one, witboiit a 
I regiJar course of experimental practice. A physician 
I might communicate his Materia Medica, but his skill 
I and experience could not be conveyed therewith, but 
must be vested in himself alone." The cures reported 
I to have been effected are aolhetimes (not without 
reason) incredible. Such are those cases when the 
pupil writes to the effect that he " had an interview 
with Mr. Broster, and in the course of half an hour 
was cured of a veiy bad impediment in speecli." 



■ The RUe tmd Progress 0/ the I 
Brostei, 1827. 



-. Sysl, 



, by John 



66 TIKOKIES A»D MODES OF TREATMENT. 

Among the cures effected is mentioned that of 
the celebrated Dugald Stewart, who had nearly lost 
his speech through a paralytic affection, and who 
was enabled by Mr. Broster to read aloud to him- 
sell' and in company. I have taken some pains to 
obtain particulars eonceming the theory and practice 
of Mr. Broster. It is certain that after leaving Edin- 
burgh in 1825, he established himself in London, 
where, in 1827, he pubUshed a pamphlet consisting 
entirely of testimonials (unsigned) from pupils, and 
a reprint of four articles from Blackioood and other 
magazines. In the preface of this pamphlet, Mr. 
Broster peremptorily declines to say anything about 
his system. We are, therefore, reduced to form an 
opinion from the scanty materials furnished by one 
of his pupils, who signs himself "E. D., of Cam- 
bridge," and who gives vent to his gratitude in the 
following lines ; 

" Due to him who loosed my voioe, and broaght 
The light of words to ra; darkened thought ; 
Not more grateful could Cain hare been X trow, 
Had the light of heaven been erased from hia brow 1 " 

As regards the system, he says : " It is no miracle. 
It ia generally effective, but it is not always per- 
fective. It is powerful, but not almighty ; a partial 
remedy certainly ; a total one possibly ; a nearly per- 
fect one probably. In a word, it is only a potent 
remedy, not an infallible one. This is my opinion, 
founded on my experience. It may either exceed 
that of the public, or fall short of that of the in- 
ventor, both of which are about equally distant from 



BROBTBR. 67 

my wish to flatter or follow It is not always per- 
fective, nor omnipotent, nor infallible, for I, I repeat, 

I am yet uncured, who have tried it. Explicitneas is 

' the life of information :— Of twelve cases which fell 
under my own observation whilst at Mr. Broater's 
house (including myself), it raay be said that three 
are nearly as elociuent now aa their friends, and three 
are nearly as toi^e-tied as their enemies could wish 
' them. The remaining six (of which I am one) are 
all partially or considerably relieved, both species of 

I relief being in different degrees In some cases it 

is difficult, and in others disagreeable, to put this 
system in force, which makes the fallibihty of the 

system- Supposing it were the secret of the sys- 

' tern that the pupil ahoxdd stand with his arm ex- 
tended at right angles to hia body whilst speaking, 
and that this, whilst acted, was infallible — would the 

system be infallible ? Certainly not Now, there 

is something, I do not say of what kind, in Mr. 

Broater's system, which in certain cases is required 

for its success, and which in these cases is not always 

practicable to the pupil, though when he can practice 

I it, it is remedial. Thus much it is incumbent on me 

I to asaert : great as is my admiration of the system, I 

cannot allow it to be infallible, and I think, hnmo, 

I it to' be my duty so to declare to the public.'* Such 

\ are the words of an old pupil. 

Commentaty.—ln. the year 1843 a small work was 
I published anonymously by " A Physician," who pro- 
I fessed to decipher Mr. Broster's method as consisting 
I purely and solely of rhythm. This writer says : " If 



68 



THEORIES AXD MODES OF TREATMENT. 



any reader has ever perused the glowing annual 
accounts of the wonders eifected by the Broaterian 
system, it will he understood in a moment, when 
the word " rhythm " ia mentioned, that this is the en- 
chanter's wand, the trae solution of the Brosterian 

enigma The only means poaseeaod by Mr, Eroater 

was the apphcation of rhythm." 

This was, however, a hit in the dark. Broster's 
method did not consist in the application of rhythm, 
but was, in reality, the same trick as is usually attri- 
buted to Mrs. Leigh, and described as the "American 
method." A German writer, Dr, Julius, haa tiad the 
merit of pointing this out many years ago, although 
it is not generally known by writers on this sub- 
ject. 

In the Magazine of Foreign Medical Literatv/re, voL 
XV, edited by Drs. Geraon and Julius, oeouxs the fol- 
lowing passage : " It may be known to our readers 
that Mr. Broster, formerly of Edinburgh and Liver- 
pool, has now a school for stuttei-ing in London. His 
method of treatment, which his pupils must promise 
not to conamunicate (which method Broster is said to 
have learned from a poor man in Edinburgh), consista 
probaVdj_in_8ome trick in ti*e mode of speaking. It 
is either successful in a few days, or not at alL This 
method was transplanted from Liverpool to New 
York." 

As regards the cure of the "veneraUe philosopher" 
mentioned in Blackv^ood's MagasiTte, who it seems from 
Mr. Broster'a pamphlet was no other tliau Bugald 



BROSTER. — LEIGH. 



60 



Stewart, I find in the biographical memoir of Dugald 
I Stewart by John Veitch* that in January, 1822, the 
profeaaor was strack with paralysis. Tlie attack con- 
, aiderably affected his power of utterance, and deprived 
him of the use of hia right hand. In fact, it was what 
now is called a ease of aphasia concomitant with 
tight hemiplegia. But it seems that in 1824, Mr. 
Stewart's health was already considerably improved, 
for in a letter written by Mrs. Stewart to her hus- 
band's friend, M. Prevost of Geneva, she says : " He 
suffers no pain ; his spirits are uniformly cheerfid, and 
his mind as aciite as ever. He walks between two 
and three hours every day ; and, in fact, except a 
difficulty of speech and a tremor in his hand when 
he attempts writing, no symptoms of paralytic affec- 
tion remain." 

Mr. Stewart died in Edinburgh in June, 1828, 
after a fresh stroke of paralysis. It is, therefore, 
quite clear that when Mr. Broster treated the vener- 
able philosopher in 1825, nearly all the symptoms 
of paralysis liad already disappeared, and Diigald 
Stewart had comparatively recovered. 

Leigh. — Tlie "American Method." — As the so-called 
American method coustitutes an epoch in the history 
of Paelliam, and so many contradictory reports are 
current touching its inventor, it is, perhaps, time (t<j 
use a popular expression) "to put the saddle on 
the right horse." I transcribe, thei'efore, the version 



• The Collected ti'oris o/ Dvgald Sleieart, vol. i 



70 



THEOKIBB AKD MODES 0¥ TREATMENT. 



of Dr. Edward Warren, of Boston,* which haa every 
appearance of a truthful account of the rise and pro- 
gress of Mrs. Leigh's syatem : — 

" The inventor of Mrs. Leigh's system. Dr. Chris- 
topher C. Yates, of Kew York, a medical gentleman 
of high talents and very strong natural powers, had a 
daughter afflicted with stanunering. After attentive 
obsei-vation and a long study of her case, he succeeded 
in hitting upon a method which effected a cure. This 
method he imparted to the young lady's instmctress, 
Mrs, Leigh, an EngUshwoman, in order that it might 
be pursued during school-hours. 

" The inventor soon determined to extend its bene- 
fits to others. Finding Mrs. Leigh enter into the 
scheme with zeal and ability, he placed her at the 
head of the institution ; and, fearful of the reproach 
of empiricism, he chose that it should pass under her 
name 

" Two great mistakes were imdoubtedly committed. 
The first was in attempting to make permanent cures 
in BO short a time. The second was in attempting to 
qualify so many teachers. Most of them, probably, 
beUeved that the possession of the secret was all that 
was req^uisite. They were not aware that years of 
observation and experience, a knowledge of elocution, 
a knowledge of the human mind and of human nature, 
were requisite to make them successful teachers 



• Eemarki on Stammering, i 
Journal (^Medical Science. B 



"The gentleman who invented Mrs. Leigh's system 
■was qualified for the purpose as few men can be. Not 
destitute of sufficient learning, he has yet Uttle re- 
liance ou hooks, and depends upon observation prin- 
cipally for his sources of knowledge 

" The effect of imparting their method to so many 

teachers was soon apparent Multitudes of other 

persons soon set up to cure impediments of speech. 
It is not surprising, therefore, that the system soon 
fell into disrepute. 

" The inventor, at first, gave directions merely for 
the position of the tongue, but afterwards he made 
great improvements in his treatment. The suppres- 
sion of the voice he believed to be caused by a spas- 
modic closure of the glottis, the same cause to which 
Dr. Amott ascribes stammering." 

Such is the version of D. Warren. There are, how- 
ever, other versions of this "discovery" current on 
this side of the Atlantic, of which the following is 
the most generally received : 

Mrs. Leigh had been kindly received in the family 
of Dr. Yatea (Otto writes Jades), whose daughter 
was a stutterer. Mrs. Leigh thought tliis a good 
opportunity to show her gratitude. She accordingly 
endeavoured to cure her pupd, and procured as 
many works as possible on this subject ; but not 
deriving from them the desired information, she de- 
termined to use her own judgment, and after some 
trials succeeded in her object. Observing that in 
stuttering the tongue was fixed to the floor of the 
mouth, she cured her pupil by making her raise the 



72 THEORIES ASD MODES OF TREATMEST. 

tip of the tongue, and keep the latter in a horizontal 

position. 

M. Malebouche, a Frenchman, bought the secret 
I'or a round sum of Mrs. Leigh, and introduced it, in 
1827, into the Netherlands and Germany. Both the 
Netheriand and Prussian Govermnenta considered the 
subject of sufficient importance to grant to those who 
were in possession of the secret considerable privi- 
leges, and to appoint them professors at public estab- 
lishments. 

Herr Bansmann contrived to obtain possession of 
the secret, and was appointed by the Prussian Minister 
for Ecclesiastical Affairs to give a course of iustruetion 
on the system in the training colleges. Bansmann, 
again, gives another version of the discovery. He 
says that Mrs. Leigh's husband was a stutterer, and 
that ahe set to work " with that practical acumen 
peculiar to her sex " to examine the cause of the afflic- 
tioD, and which after nine (others say ninereen) yeais' 
observ'ation she accomplished. The same is asserted 
by Dr. Zitterland, in a pamphlet pubhshed at Aix- 
la-Chapelle in 1828. Both writers were personally 
acquainted with M. Malebouche. In the Netherlands, 
the King appointed a commission to inquire into the 
affair. The consequence was, a number of stutterers 
were confided to the care of M, Malebouche, who are 
said to have been cured. For this, his Majesty be- 
stowed a pecuniary reward on the holder of the secret, 
and appointed a special instructor to cure poor stut- 
terers gratia, on the sole condition that they would 
swear never to divulge the secret. 

The next perao" '"'"i obtained possession of the 



LEIGH. 13 

secret waa a M. Charlier, a mercliant, who agreed to 
give half his profits to M, Malehouche. M. CharUer, 
who was of a generous disposition, applied his share 
of the profits to charitable pui^waes, to pay the ex- 
penses of the poor travellers who caiue to Aix-Ia- 
Chapelle to drink the waters. Dr. Zitterland was 
appointed to examine all stutterers who presented 
themselves before and after the treatment. In his 
report, he says : " This method may justly he num- 
bered among the moat important and useful dis- 
coveries of this century. M. Malebouche assured me 
that the principles upon which it is founded threw a 
new light on physiology, and even on metaphysics, the 
correctness of which is confirmed by the auccesa of 
this method ! We may certainly expect that when 
further developed, it will cause great revolutions in 
medicine and psychology." 

Com.meiUary.—AX the present period, it seems diffi- 
cult to understand how this method attained such a 
I wide reputation, and even enlisted the support of 
physiologists of great repute. The only explanation 
that can be given is that little or no attention had 
down to that period been paid to impediments of 
speech by scientific men, and consequently any 
remedy for the relief of an apparently intractable 
infirmity was gladly welcomed. A simple investiga- 
tion of the phenomena of stuttering sliows that the 
chief point insisted upon by Mrs. Leigh — namely, 
that in stuttering the tongue is fixed against the 
inferior inciaora — is not true. 
It affords abundant evidence, if any were needed. 



74 



THEOKIES AND MODES OF TREATMENT, 



of the laige omouiit of ignorance prevalent half a cen- 
tury ^0, not only respecting the true nature of 
defective speech, but also respecting the physiology 
of the organs of speech, Angermann accuses the 
French authors on stuttering of being the cause of 
the attention which has been dii-ected to the advo- 
cates of this method. We cannot, however, allow 
that the French authors are wholly to blame in this 
matter. Both French and German authors maybe 
fairly charged with giving a prominence to this 
method it never deserved. Had it not been for the 
discussion it called forth, it might have been passed 
over ill entire silence. 

Behtrasd.*— When, in the year 1828, Magendie 
read to the academy the report on Mrs. Leigh's 
method, as introduced by Malebouche, ProfesBor 
Bertrand made the following observations : — " Our 
investigations as regards the treatment of nervous 
affections have long since convinced me of the possi- 
bility of curing stuttering. Stuttering is a spasmodic 
nervous affection, which, like all diseases of the same 
kind, is eminently susceptible of being advantageously 
combated by a suitable moral treatment. We are not 
acquainted with the kind of vocal gymnastics which 
Mrs. Leigh employs ; but we are convinced that these 
gymnastics have, by themselves, no specific efficacy, 
and that any method which tends to occupy the at- 
tention of the stutterer whilst speaking may for the 
time being cure him of hia infirmity. It is well 



• ATchiv.G^n. da M^d., 1838. 



75 

known, that those whoae pronunciation is most de- 
fective can sing without any difficulty, Why ? Be- 
cause the attention required to follow the measure, 
and the emotion which attends singing, produce the 
I distraction which we have mentioned. We thus liave 
I a choice of a number of processes more or less inge- 
Oblige the stutterer to modify, wliilst speak- 
ing, his respiration in such or such a manner ; to 
confine himself exclusively to this or that pecuharity 
of enunciation ; to precede each phrase with this or 
that syllable ; force him, if you like, to speak with 
pebbles in liis mouth, as Demosthenes did, or con- 
^ fine him to certain regular motions of the fingers or 
i you will cure all those gifted with sufficient 
force of will to execute these motions in speaking. 
These ideas are probably very different from those 
which enter into the method of Mrs, Leigh, and those 
who sell her secret. With regard to the latter, it 
must he admitted, that it is even good that they 
spread the idea of possessing a special eflicacious 
method. We are too much convinced of this truth, 
which we do not hesitate to express, that from the 
moment the method shall cease to be a secret, the 
number of cures will gradually diminish; and we 
shall, as regards stuttering, have again to observe 
that, like all other secret remedies the success of 
I which has I>een proclaimed by ao many skiKul ob- 
I servers, it will cease to be efBcacious after having 
been made pubhc, simply because it has lost the 
F mystery which at first surrounded it, and 
I which made its due impression on the patients." 



76 



THEORIES ASD 



acpDES 



OF TREATMENT. 



—These observations of Profeaaor Ber- 
tmnd are a somewhat ex parte statement respecting 
the great influence which is exert-ed on stutterers by 
a witlidrawal of the attention. No doubt, most stut- 
terers can sinj^, and many can also act any other cha- 
racter, and imitate the voice of any other person. For a 
time, at least, they can nearly do all this : but this 
voluntary imitation of some one else cannot go on for 
any length of time, and even if it could, experience 
has shown that after a. little time persona begin to 
show tlieir defect even in the assumed tone. As to 
the tricks of motions of the fingers, it is well known 
that they afibrd only very temporary relief, and tend 
eventually more to aggravate than remove any nervous 
defect of speech. Professor Bertrand's observations 
respecting the advantages of aecresy would he most 
sound, if we only had to act on the imagination. But 
stuttering ia more or less a functional disorder. It is 
true that it is often excited in the brain : but after a 
time it simply becomes a habit. We must bear in 
view also that Professor Bertrand's observations were 
made more than forty years ago, and we will hope 
that the day for giving credence to these exploded 
nostrums is gone for ever. Physiology is now a 
popular study, and it is only by disseminating the 
truths we are taught by it that we can successfully 
eradicate any misuse of the organs of speech. No 
cure, indeed, can be permanent or satisfactory which 
has not been eflected by natural laws based on 
sober reason : all influence on the imagination is 
temporary. 



77 

M'CoRMAC.* Leiug in New York in 1826, was given 
to nnderstand that a, Mrs. Leigli, of that city, was very 
■successful in the removal of impedimenta of speech. 
He ia reported to have said that what a woman had 
done, he might possibly do likewise. 

Dr. M'Cormac now employed much of Ms time 
a pondering on this subject, untU. he arrived at 
the acme of his desires : for it suddenly occurred tf) 
him tliat the proximate and sole cause of stuttering 
was an attempt to speak when the lungs are in a 
state of collapse, or nearly so. 

" In this," says M'Cormac, " consists the discoverj' 

I hitherto made by none. The patient endeavours to 

apeak when the lungs aie empty, and cannot. We 

can utter a voice without speech or words, hut not the 

latter without the former." 

In the preface of his treatise, he uses the fol- 
lowii^ somewhat pompous terms; "That tlie fol- 
lowing work will communicate, without the possi- 
bility of a failure, to the reader, whether medical or 
.otherwise, tlie means of curing habitual stoppage of 
speech, may appear at first sight a little paradoxical, 
when we consider that thousands of years have 
elapsed without any individual liaving e\'er been 
' able to discover and communicate to the world any 
means by which the distressing affliction could be 
alleviated. Hut any scepticism tliat may exist on the 
I subject will quickly vanish when the stutterer, once 



i Treatise oit the CoMie and Cure of Hesitation qf Speech, t 
I 5l«nHn#rin^. B; Henrj H'Cormsa, SLD, Xioudan : 182S. 



78 THEORIES AND M0BE8 OP TREATMENT. 

in poaseasion of the means, shall essay them on him- 
self, and find that, ■without trouble or difficulty, he 
may learn to speak with the same facility as other 
men. The peasant and the artisan will equally re- 
ceive the benefit of tliis communication ; and that 
which for many ceuturies wealth could not purchase 
will now be placed within the compass of even the 
most abject poverty," He further says, that "we 
may rationally expect that in the course of a year or 
two, both in Europe and America, confirmed stutter- 
ing will only be a disease to be spoken of as a thing 
of the past, or only to he witnessed in persona afflicted 
with insanity," After giving an account of the various 
methods that had been used, from the pebbles of De- 
mosthenes to his time, he proceeds to expound, with 
"uneiTing certainty," the discovery "hitherto made 
hy none." 

"I have," he says, "the satisfaction of assuring 
the reader, that habitual stuttering, however severe its 
form may be, will invariably yield to his efforts in a 
greater or less space of time, if he employs with con- 
stancy the means which I shall dictate. It would, 
no doubt, be very desirable that some mode of cure 
could be devised, while the patient remained passive 
the while;" but "the quickness of the cure must 
depend solely upon the earaestnesa of his own exer- 
tions 

" The main thing to be attended to, and which, in 
fact, is the groundwork of the whole system of cure, 
is to expire the breath strongly each time when 
attempting to speak, the lujigs being previously filled 
to the utmost ; or, in other words, to reverse the habit 



79 

i stuttering, which ia that of trying to speak without 
[piring any air." 

Commentary.— Dissenting from Dr. M'Cormac's as- 
tnption that stutterers always try to speak with empty 
i, I bold that the remedy which he proposes, viz., 
fill the lungs to their utmost extent, and to expel 
words with force, ia entirely inapplicable. In 
Mt instances, the practice recommended ia mote 
ikely to aggravate the impediment than to remedy 
The regulation of the breath ia no doubt of the 
Sitmost importance in all cases ; but it certainly 
Biuat not be effected in the way indicated by Dr. 
■ M'Cormac; and as the late Mr. Hunt remarked in 
1 1846, " his ayatem haa long aince been proved to be 
l&llacioi 

The error into -which tbia author Las fallen must 
be partly attributed to the false premise from which 
he started, namely, that voice is indispensable to 
articulation. "We can," he obaervea, " utter a voice 

I without worda, but not the latter without the former." 
Kie stutterer siiould, therefore, cause his vocal cords 
io vibrate, and that he can only effect by forcible 
ifctpiration. Now, it ia well known that in whisper- 
ing we articulate perfectly, without producing any 
Toice. A person whoae vocal cords are obliterated 
&om disease may still ha able to whisper out his 
thoughts; the voice is gone, but the articulation 
remaina. 

Finally, we have seen that the essential point, " a 
deep initial respiration" before attempting to speak, 
had already been insisted upon by Avicenna, atid, no 
jdouht, long before liim. I am only surprised that 



80 TBEOBIES AKD MODES OF TREATMENT. 

this has not heen fooDd out by some uf the many 
authors oa stuttering. 

Arsott* Bays; "The most common cause of stut- 
tering, however, is not, as has been universally be- 
lieved, where the individual has a difficulty in respect 
to some particular letter <«* articulation, by the dis- 
obedience to tlie will or power of association of the 
parts of the mouth which should form it ; but where 
the spasmodic interruption occurs altogether behind 
or beyond the mouth, viz., in the glottis, so as to affect 
all the articulations." 

Starting irom the principle that the closure of the 
glottis is the cluef cause of stuttering, it follows that 
a stutterer is inatantly cured, O, by having his atten- 
tion directed to it, he can keep it open. In order to 
effect this. Dr. Amott advises to begin pronouncing 
or droning any simple sound, as the e of the English 
word herry; whereby the glottis is opened, and the 
pronunciation of the following sounds is rendered 
easy. The words should be joineil t«^ther, as if 
each phrase formed but one long word, nearly as 
they are joined in singiiag: if tliis be done, the voice 
never stops, the glottis never closes, and there is, of 
course, no stutter. With regard to the strangeness 
of such a mode of enunciation. Dr. Amott observes : 
" There are many persona not accoimted peculiar in 
their speech, who, in seeking words to express them- 
selves, often rest long between them, on the simple 
sound of e mentioned above, saying, for instance. 



* EUmmtt of Ph^jtiin, etc. ByQ. Neil Arnott, M.D. 1323-9. 



OF STAMMERING .VXD STUTTERIXG. 



81 



! I e tliink e you may/— the 

sound never ceasing until the end of the plirase, how- 
ever long the person may require to pronounce it." 
Dr. Amott continues : " Were it possible to divide 
the nerves of the muscles which close the glottis, 
without at the same time destroying the faculty of 
producing voice, such an operation would be the most 
immediate and certain cure of stuttering ; and tlic 
loss of tlie faculty of closing the glottis would be of 
no moment" 

MiiLLER* agreed with Dr. Amott in considering 

I the immediate cause of stuttering to be a spasmodic 
f the glottisj and that the cure must, there- 

i fore, be effected by conquering this morbid tendency 
to closure by voluntarily keeping it open. For tliis 
purpose, Dr. Amott advises that the patient should 
connect all bis words by an intonation of the voice, 
continued between the different words, as is done by 
persons who speak with hesitation. " This plan," 

' observes Miiller, " may afford some benefit, but can- 
not do everything, since the main impediment occurs 

I in the middle of words." He, therefore, advised, iu 
addition to Dr. Arnott's plan, the following procedure : 

I " The patient should practise himself in reading sen- 
tences in wliich all letters, which cannot be pro- 

I nounced with a vocal sound, namely, the explosives, 

1 should be omitted, and only those consonants in- 

I eluded which are susceptible of an accompanying 



• Elements of Physiology. 
hV. Baly, M.D. 1B57. 



B Mailer. Tranalat 



S2 



i USD HODB8 at TtEATMSST 



intonatioii, and that tlie sound should be much pro- 
longed. By this method, a mode of ennnciation 
would be attaineil, in which the glottis is never 
cloeed, owing to the artjcniation being combined with 
rocaliaation. When the stammerer has long practised 
himself in this manner, he may proceed to the ex- 
plosive sounds. In such a plan of treatment, the 
patient himself would perceive the principle, while 
the ordinary method — that of ^ladame Leigh — is 
mere groping in the dark, neither teacher nor papO 
knowing the principles of the method pursued." 

CommeniaTT/. — The so-called spasmodic closure of 
the glottis, considered by Drs. Amott and Miiller and 
their followers as the chief cause of stuttering, ie, 
I am convinced, not a c^use, but an effect, produced 
by the misemployment of the respiratory and vocal 
organs — in short, by the application of inadequate 
means to surmount the difficulty. If the contraction 
of the glottis were spasmodic, in the proper sense of 
the term, the patient would scarcely have the power, 
wliich he undoubtedly possesses, even in the severest 
form, to an'est it instantly by silence. 

Again, stuttering does not, as freiiuently asserted, 
occur only at the explosive sounds, hence, the omis- 
sion of these letters in the exercises, as recommended 
by Miiller, will not always stop the paroxysm. 

Tliose who make use of the trick of an intervening 
« sound for the purpose of keeping the glottis open, 
must be reminded that, in order to derive any benefit 
from this artifice, the next sound must closely follow, 
otherwise the glnttia will again contract. That such 



M&LLER. — ^DELEATt. 83 

a mode of drawling enunciation attracts, compara- 
tively, little notice, ia a proposition to which I cannot 
subscribe. In some casea it is, perhaps, more dis- 
agreeable to the listener than the original defect. In 
justice to Dr. Amott, it may be observed, that he 
expressly states, that though the simple sound e. of the 
word bcrri/, is a means of keeping the glottis open, 
there are many cases in which other means are more 
suitable, aa the intelligent preceptor soon discovers. 

A medical writer* makes the followijig sensible 
observation on this method: — "My experience in- 
duces me to believe, that if it is looked upon as a 
panacea, and consequently insisted upon in all cases, 
and amongst them in many nervous ca'^es, where 
success does not ijnmediately result from the system, 
it may only cause the substitution of one sort of 
stammering for another, and that perhaps of a worse 
land than the original stammer." 

DELEAti+ divides defective speech into three species, 
the two first being stammering, the third stuttering. 
1. Tbe first is owing to vicious habits contracted in in- 
fitncy, and ia caUed grassei/evieitt, latnMacisme, sessci/e- 
■ment, hott&ntotisme. This is only a vice of pronuncia- 
tion consisting in the bad articulation, or in the sub- 
stitution of one sound for another. 2. The second is 
caused by an organic lesion, and constitutes that 
continuous stanunering observed in apoplectics, para- 
lytica, idiots, and in persons having a notable lesion 

* On BtammeTii\^. B7 ~Baua. Med. Oion. Londoci : ISiiO. 
tJcud, dej Sciences, 1838.~Jlf<!moirfl s«r le b4ga\einent. Ream 
md., t, i, p. tts. Paris : 1829. 



84 



THE0BI2S ASD UODES OF THEATMEST. 



in some of the organs of speech. 3. Of the third, — 
stuttering, he distinguishes three kinds : first, l>4gaie- 
vtent lingual ou loquace. The persons thus afflicted 
repeat the sounds with extreme voluhilit)'. Tlie 
tongue only is at fault in this kind. Secoud, M- 
gaiement labial ou difforme. Tlie stutterers in this 
case seem unable to open the mouth. They utter 
smothered, bellowing sounds ; they contract the faci^ 
muscles with violence ; open and shut their eyes, 
and contort all the features. Lastly, Mgaiemenl dou- 
lourenx cm muet, characterised by the difficulty or 
impossibdity of producing any sound, despite great 
efforts manifested in the chest and diaphragm. The 
aperture of the glottis is so constricted that respira^ 
tion is for a time suspended. 

Tlie cause of these three kinds of stuttering Deleau 
considered aa " an infirm wiU, an incomplete cerebral 
action ; or, it may be, an insufficient innervation for 
the proper government of the organs of speech." 

He begins the exposition of hia method by de- 
jiloring the feet, that we no more perceive the move- 
ments going on iu the mouth while talking, than we 
do the movements of the stomach during the process 
of digestion. He, therefore, teaches the stutterer the 
positions of the organs in emitting and modifying the 
sounds, and endeavours to make him, as far aa pos- 
sible, forget that the ear has been hitherto his sole 
guide in speech. The letters of the alphabet must 
no longer represent the sounds, but must lie made to 
denote the position of the organs. This answered, he 
tells us, very well in reading, but in conversation, being 



85 



I to think, tlie niJnd ceased its action upon 
the organs of speech. To remedy this, Deleau pro- 
ceeds as follows : — The letters of the alphahet have 
becijme so familiar, that no sooner are they seen than 
the attention is directed to hearing. " Could we not," 
says he, " in the same way represent the movements 
- of the organs hy other arbitrary signs ? Nothhig 
more easy. By studying them the attention would 
he drawn to this system, as the signs of the alphabet 
fix that faculty to the organ of hearing." 

Oomtiienta-n/. — Ore observes on tliis method that it 
is " an ingenious idea, but difficult of application. It 
necessitates a power of the will which few stutterers 
possess, and before which their efforts will fail" To 
which I may add that the method in no respects 
corresponds to what Deleau considers as the cause of 
stuttering. How the method proposed is calculated 
to strengthen the nervous influx to the organs is 
difficult to imagine. Moreover, he says, that the plan 
succeeds whilst the pupil is reading, hut fails mostly 
in conversation. "What " arbitrary signs" can be de- 
vised for the pupil to read or observe during conver- 
sation ? On this point Deleau ia not very explicit. 

Deleau's classification deserves considerable com- 
mendation considering the period at which it was put 
forward. The cause which he assigns for his three 
Species of stuttering evinces a deep study of the 
nature of this affection. The theory is faulty in so 
far as it is too dogmatic and too general If Deleau 
had merely said that the cause of stuttering in the 
greater number of cases was an " insuflicient ii 



86 



THEOHIES AND MODES OF TREATMENT. 



tiou for the proper government of the organs of 
siwech," he would have liad the merit of being one of 
the first who had aacertained and described the true 
nature of most apeciea of stuttering. A& it is, our 
author's place in our hiatorietd survey is one of con- 
siderable eminence, although his labours in this de- 
partment have been scarcely recognised by many 
authors who have written on this subject. 

Palmer* says : " There are some morbid affections, 
which, although for the most part of physical origin, 
are yet signally kept up and aggravated by the opera- 
tion of moral causes. Among these, impeded elocution 
holds a conspicuous rank. This affection, from the 
popular ignorance of its real source, the singular and 
^Ttrying character of its attendant phenomena, the 
restraint and misery which it inflicts, and, more than 
all, from the notorious failure of every remedy hitherto 
employed for its permanent removal, possesses a strong 
claim on the attention of the enlightened philanthro- 
pist, and is eminently calculated to excite the curi- 
osity and call forth the talent of the moral and 
medical pliilosopher." 

" Difficult or imperfect utterance admits of division 
into two distinct kinds, according to the peculiar 
source of the disease. These are the organic and 
the functional 

" The infirmity, when arising from defective con- 
struction of the cerebral mass, or consequent on its 
fixed disease, is incurable. 

s o/ Mtdieine, by Shirley Palmer, M.D. 



PALMEP. 87 

" Fuiiciionnl defect of elocution is, as its distiucLive 
title imports, wlioliy indepeuJeiit of inall'orination, nr 
any morbid cliange in the structure of the organs of 
speech. It results simply from derangement of their 
fimctione. It constitutes Ity far the most common 
form of defective utterance 

"The eaxUing causes of impeded utterance are 
various. Most commonly, it may be traced to some 
powerful shock inflicted on the nervous system by 
severe disease, or a violent moral impression ; some- 
times to the well-known influence of the imitative pro- 
pensity. Some original peculiarity in the constitution 
of the mind is, however, probably requisite to pre- 
dispose an individual to the operation of these causes. 

" The irregular action of the muscular apparatus of 
the chest, larynx, and mouth, which constitutes the 
proadmate cause of impeded utterance, once eatab- 
lished, will acquire confirmation from habit, and, 
like many other diseases, become independent on the 
cause from which it originally sprung. Several va- 
rieties of impediment may be distinguiBhed In prac- 
tice ; but a particular discrimination of them would 
be superfluous, since they are referable to no diversity 
of origin ; and the same principle of moral discipline 
is, with slight modifications in the empirical method 
Of treatment correctly applicable to the whole. 

" Impeded utterance in its nature and phenomena 
exhibits a closer affinity with chorea than with any 
other morbid affection. 

" It is very curious, and, according to the writer's 
experience, an invariable fact, that in defective articu- 



88 THEORIES AMD MODES OF TREATMEST. 

lation from a merely functional cause, tlie most iuve- 
terate stammerer, when alone, or believing himself 
alone, can articulate without the slightest embarrass- 
meat or unnatural effort, and without particular at- 
tention to the process of verbal delivery. He can even 
speak or read aloud with the most perfect facility 
before a congregation of persons, however numerous, 
provided they are speaking at the same time ; and he 
consequently feels tliat the attention of the assembly 
is not directed upon himself. But the moment the 
solitude of the stammerer is, in the one instance, 
broken in upon ; or, in the other, the company among 
whom he is declaiming becomes silent, the brain loses 
its salutary control over the organs of voice and 
speech, and hia progress is airestsd." 

CcmvmeniaTy. — Dr. Palmer, it appears, laboured, 
like most other authors on stuttering, imder a severe 
impediment of speech, which he vaiidy tried to con- 
quer. His observations on this infirmity are, how- 
ever, on the whole, so judicious, that it is greatly to 
he regretted that he did not fulfil his promise of 
writing " a philosophical inquiry into the cause of the 
phenomena and treatment of impeded speech." Very 
likely he found the task more difficult than he ex- 
pected, I may have to recur to some observations 
of this author when considering the treatment of 
stuttering. 

Hbrvez de Gh^goin* says ; " Stutterers, hitherto 

convinced of their incurabdity, have resigned them- 

* Bxiihenhti sur Ui CoMta ef Is "UxoMemeni du Bl^oMxnerA. 



hervez db csioais. 98 

selves to their fate, some with indifference, resulting 
from their character or profession : others, on the 
contrary, felt moch grieved, owing to the olistacles 
they met with, the consequences of which they had 
nor foreseen. They might have consoled themselves^ 
had it been confined to jokes, which were too old and 
too frequently repeated to be oflensive ; they might 
liave laughed with those who laughed at them ; for 
this singular infirmity does not even excite in those 
who witness it that feeling of compassion which other 
disorders usually arouse. How could it be other- 
wise ! How coidd a rational treatment be devised 
for an affection of which the cause was not known 1 
Some placed the cause in the chest ; others in the 
tongue ; some in the larynx ; others in the brain. 
Uncertain as to the cause, traditional remedies were 
resorted to. We were told of Demosthenes and his 
pebbles, but by some fatality pebbles don't cure 
stuttering now-a-days. We were then recommended 
to articulate slowly ; but the reason why was not 
known." M. Ch^goin then resolved to investigate the 
matter. For tliis purpose he placed himself before a 
mirror, and came to the conclusion that in pronoun- 
cing each syllable separately he did not stutter, but 
that it was in the transition from one mechanism 
into another that the impediment takes place. The 
cause of stuttering, he contends, is in the tongue ; — 
" In the disproportionate distance between the length 
of the tongue and the points of contact in the 
buccal parietes. The latter may have the most 
varied conformation without producing stuttering. 



90 THE0BIE8 AND MODES OF THEATMENT. 

prorided the tongue can easily reach them at the 
points of contact oecesaary for the formation of ayl- 
lahles. The tongue, on the contiiiry, contains the 
cause of Btuttering if it wants hut a line in dimen- 
sions in order to reach, without effort, the points of 
contact ; or if it contains some inherent impediment 
to the change of its form and position." The reason, 
he contends, why no difference is perceptihle be- 
tween the tongue of stutterers and non-stutterera is 
that it ia not ubsolute, but only relative. Aa an illus- 
tration of this view, he continues : " Let us suppose 
two wheels, the action of which depends on the reci- 
procal contact of their teeth, hut that one of the 
wheels contains one tooth less than the other wheel, 
be it one-tenth or one-twentieth of a line, or less, in 
short, just Bufiicient to prevent the contact. Here it 
ia not the eye which perceives the want of contact, 
but it becomes known by the defect of their action. 
The comparison will be more striking by applying it 
to a musical instrument, the sounds of which depend 
on the contact of the smaU points fixed upon a 
cylinder, and determining the opening of the sonorous 
tubea,— a bird-organ, for instance. If there be only 
one-hundredth of a line wanting, the sound required 
will not be produced, and it ia the absence of the 
note, and not the eye which informs us of it. In the 
same way we perceive by the badly pronounced syl- 
lables the cause of the had pronunciation, more easily 
than by inspection." M. Chegoin also contends that 
it is not sufficient that the tongue should be long 
enough, but that it must not be too long in order to 



HXRVEZ DS OHXOOIH. 



91 



4void Btiittermg. " It seems Iiere," he says, " as in 
I .other functions, nature has not confined our ot^ns 
I iwithin strict limits. On the contrary, in order that 
L their action should be more complete, and le,ss ob- 
l«tnicted by alight causes, nature has enlarged their 
Bcapacity. For this reason we find that the epiglottis 
f is lai^ger than is necessary for covering tlie entrance 
of the larynx ; the stomach can be dilated more than 
18 necessary for the support of life. All the respira- 
tory forces are not put in action at every respiration ; 
every muscle does not in its ordinary action display 
I all the contraction it is capable of. In the same way, 
1 -I believe, that the tongue, in order to possess all 
I proper conditions, must possess dimensions larger 
I than are strictly necessary. Hence, wlien it descends 
I beneath that point the difficulty commences, and 
I Btuttering is the result . . ." 

If, then, he found that the cause has its seat in the 

frsenum, he divides it ; and if he thouglit the tongue 

to be too short, he doubles the dental arches by 

[ inserting a silver arch, by which they are brought 

I neaxer the tongue. 

L . C&m/mentary. — That cases of congenital malforma- 
\ tion of the tongue or of its fnenum do now and then 
occur is undeniable. But it cannot be sufficiently 
repeated that such abnormal conditions give rise to 
stammering only in the first instance, and may even- 
tually degenerate into stuttering. "What chiefly con- 
k cems us here is that M. Ch^goin looks upon tlie ab- 
\ normal condition of the frEenum as the main cause of 
t stuttering, and consequently holds that the division 



92 



THEORIEB AND MODES OF TBEATMENT. 



of the ligaments ia the chief remedy. But when we 
inquire how far he auceeeded in curing stuttering by 
this method, the reply ia far from being aatisfactory. 
M. Ch^goin gives ua only three cases. The first he 
ackuowledgea to have been a complete failure ; for the 
stutterer apoke wofte after the operation. The next 
case waa a child, aged two, who had only stuttered 
once, and the operation waa followed by speech exer- 
cises, and the pupil waa cured. The third was a chUd 
who had not yet learned to apeak, but commenced 
speaking a fortnight after the operation. These re- 
sults apeak for themaelves, and need no comment to 
point out theii value. One merit is certainly due to 
our author : he strongly recommends the old maxim, 
"Pi-evention ia better than cure." In adults, he has 
not much faith in the treatment hy operation. In all 
cases he strongly insiata that the " ulterior exercises " 
must be perseveringly attended to, and it is to the 
neglect of these that he attributes the failure of pre- 
vious sections of the freenum, 

WUTZEK* attiihntea stuttering to the abnormal po- 
sition of the tip of the tongue, which is applied to 
the fossa beneath the inferior incisions. This he tried 
to remedy by a meclianical appliance, called a glosao- 
■nioejdion,^ having for its object to prevent the tongue 
from entering this cavity. This instrument, conaiat- 
ing of a thin plate of gold or platinum, ia made to 
coireapond with the cavity of the lower jaw on a 






Btutbaring, b; ProfesBOr 
t Tongue -lever. 



WUTZEK. — BSBRES D ALAIS. 



93 



[ level with the incisors, and is fixed to the side of a 
I tooth like artificial setting. 

ERHES d'Alais * considers stuttering a nervous 

RffectioD, presenting two weU-maiked aspects. The 

f first resembles chorea of the muscles which modify 

I the sounds ; in the second, there ohtains a tetanic 

rigidity of the muscles of phonation and respiration. 

' In the firstj the will loses the power of influencing 

' the rapid motions of the lips and tongue; in the 

second, the respiration is ohstmcted. To cure a 

alight stutter, it is sufficient to pronounce hriskly 

every syllable ; for courage, you must pronounce 

rapidly cott-ra-ye. Wlien tliia stuttering is severe, 

this simple kind of gymnastics is insufticient ; the 

amis must join in the movements. The stutterer 

must te shaken by tie arms at every syllable, or lie 

may do it himself, and he will be surprised at the 

fecility which these motions will give him. 

Commentary. — Unfortunately, from the author's ex- 
perience, the remedy proposed has frequently the op- 
posite effect. It succeeds in some cases at first, but 
when the novelty is gone, the stuttering is generally 
worse. In hi-s firet treatise on the subject, M. Serres 
asserts that lie had by tlie means advised effected a 
cure on liimself ; but in a subsequent treatise, read 
before the Academy in 1838, he greatly detracts from 
the importance of the method— or, more correctly, 
trick — ^by candidly admitting that the cure is not by 
such means complete, and that even in his own ease. 



94 



THEORIES AND HODXB OV TBRATUENT. 



his stuttering returned when the attention was with- 
drawn from the method. 

In short, he had his doubts about the radical cure 
of stuttering. This seems to have aroused the ire of 
Colombat, who offered to cure M. Serres of his remain- 
ing difficidty of speech. M. Serres is said to }mve re- 
plied, " And I offer to prove by an extemporaneous 
diacourse on any given subject that I speak better 
than you" — a challenge which M. Colonibat declined, 
as he had no desire to enter the lists with an adver- 
sary who pretends to be a modem Demosthenes.* 

MAGENDiEl"attributes stuttering to a want of instinct 
— a sort of organic intelligence, as will be seen from the 
following passages ; " Most of the muscles subservient 
to both speech and d^lutition act without our being 
perfectly acquainted with the part played by each of 
them. We produce voice, we articulate, without ex- 
actly knowing what movements pass in the laiynx or 
in the mouth ; we attain our object — that is alL" 

The admirable mechanism by which the most com- 
plex acts are effected is, according to Magendie, de- 
pendent on an organic intelligence as marvellous as 
intelligence itself It is this oi^anic intelligence which 
presides over the innumerable movements necessary 
for the production of voice and Hi>cech : it is, there- 
fore, this instinct which stutterers are in want of, 

" That stuttering may be cured," he says, " there is 



■ Letter bj M. Colombat fc 
faiae, April 13, 1S37. 

fJaura. GAi. ds HM. IS 
Praiique. 18;iU. 



the Editor of the Lancetta Fran- 



— IKrf. de MM. tt dfl ChWurg. 



MAGESDIE. — 8CHULTHES3. 



9S 



1 DO doubt, and it ia not necessary to go so far bauk aa 
r Demosthenes and bis pebbles. We know tbat tbere 
i are stutterers who, by means of a strong will and 
I driven by necessity, have treed themselves from their 

I infirmity. Such only as are by nature endowed 

I with the requisite moral force have succeeded in con- 
t quering their infirmity. In all eases, the method of 
f acting on the movements of the organs of speech were 
re successful than a real therapeutic mode of 
ciu'e." 

CommetUary. — I cannot agree with a recent French 
writer. Dr. Ore, in bis strong condemnation of the 
expreasiou, " organic intelligence " {intdligtnce or- 
I ffanique). Magendie expressly says that he means 
imtiTUit, and there is no doubt tliat this term is, 
though in conMnoii use, equally undefinable. By 
this " oi^nic intelligence," Magendie understood 
many complex acts which seem mechanical, and are, 
as we now geuerally express it, automatically per- 
formed. " We should never foi^'et," be observes, 
" tbat most movements of the tongue are instinctive, 
and do not directly depend on the wilL" 

ScHULTHEBS • considered the spasmodic closure of 
the glottis as the prosuuate cause of stuttering. He 
adds : " Tlie direct communication of the nerves of 
the larynx with those of the organs of speech, espe- 
cially with the tongue and those of the respiratory 
organs, explains (as the association of their functions 



96 



TEEORIEB AND UODES DF TRXATHEXT. 



during speaking) how the spasm of the musclea of the 
vocal ligamenta in stuttering may extend to the other 
organs. Hence we can also explain why stuttering, 
the heesitalio vocis, or even perfect aphonia, may not 
only originate from an irregular or imperfect reaction 
of the brain upon the musclea of the vocal organs, 
but may take place wlien the reaction of the brain is 
perfectly normal ; when, namely, there ia reaction 
from the sympathetic nerve or from the abdominal 
nervoiis plexuses. Hence, also, the emotions which, 
according to the ancients, have their seat in the heart, 
stomach, liver, etc., may exert so great an influence on 
stuttering. 

" The glottis stands to the other organs of speech, 
especially to the tongue and the lips, in a similar re- 
lation as the iris to the eyelids and the muscles of the 
eye. There is also a certain analogy between stutter- 
ing and the photophobia, or winking of the eyelids, aa 
seen in hysterical persons ; whilst the various kinds 
of etarameiing may be paralleliaed with squinting, 
and other defects of motion of the eye and eyelids." 

"A rational treatment of any disease must be 
founded upon the knowledge of its nature and its 
causes. Until these are known, every treatment, 
however successful, ia mere empiricism. But when 
the rational physician has ascertained the nature of 
the disease and its causes, he is enabled, according to 
the rules of science and art, to form a plan of treat- 
ment with every probability of success. Wlien ex- 
perience in a sufficient number of cases has justified 
the expectations, tlie physician may be said to be in 



BCHCLTHES3. 

posaessinn of a inetliod of cure of the disease. The 
experienced practitioner knows liow to adapt the 
treatment to individual cases, and to modily it ac- 
cordingly." 

Scliulthe^ distinguishes idiopathic, symptomatic, 
and sympathetic stuttering. The first depends upon 
want of harmony between innervatioii and the action 
of the vocal and articulating organs. Stuttering, the 
result of imitation, ia idiopatliic. 

Stuttering is sympathetic, if the disorder of the 
larynx is consensual, owing to an afl'ection of the 
Lrain, or of the abdominal viscera. 

Symptomatic stuttering generally disappears with 
I the affection of which it is the symptoni. 

In symptomatic stuttering, we must combat the 

affection of which it is a symptom. Wlien stuttering 

I is sympathetic, the treatment must be directed to the 

I primary evil which produced it, and which has chiefly 

its seat in the abdomen and the brain, But though 

stuttering may originally be a secondary symptom, it 

may, by long continuance, become idiopathic ; we 

I must then, after having removed the original cause, 

I direct our attention to the spasmodic affection of the 

I laijnx, which may still remain. 

Though agreeing with Dr, Arnott as to the spas- 
1 modic state of the glottis, he doubts whether the 
I enunciation of a simple vowel sound will much re- 
l lieve the stutterer. Dr. Schulthess concludes his 
t work by expressing a wish that some person would 
I take the trouble of embodying, in a single volume, all 
llhe methods which have occjisiontilly succeeded, so 



98 THEOBIEH ASD MODES OF TBXAIMEST. 

that the practitioner Toay have Ms choice of remsdies 
in ease of failure. 

Commentary. — Dr. Schulthess's work is, in many 
respects, a very meritorious performance. He does 
not, however, appear to have enjoyed much oppor- 
tunity for practice. Hence his views are theoretical, 
and his fault consists in having treated the subject 
chie0y from a medical point of view. Though folly 
admitting the paramount importance of a psychical 
treatment, which, as lie observes, has been success- 
fully employed when medical treatment only aggra- 
vated the disorder, he still considered stuttering, in 
most eases, a disease, or symptomatic of a corjrareal 
afiection — an opinion which is daily losing ground, 
and which I cannot at all agree in. This opinion, no 
doubt, partly restdted from the confusion of this evil 
with stammering resulting from various spinal, ali- 
dominal, and cerebral affections ; but though these 
affections may co-exist with stuttering, they by no 
means can he said to constitute the afiection. Again, 
these diseases may be the exciting causes of stutter- 
ing, but they are not necessarily so, for it is well 
known that every one tlius afflicted does not conse- 
quently stutter ; and Schulthesa himself admits that 
there must be a certain predisposition on the part of 
the individual in order fur these diseases to result in 
stuttering, 

Bansmann,* whilst giving a course of instniction 



eriide titid Stainmclnde ii* 



by order of the Prussian Government, on the Ameri- 
can method, puhlished a short pamplilet on this snlv 
ject. He says : " I soon became convinced by expe- 
rience that this method contained only a part of n 
perfect mode of treatment, inasmuch as all patients 
do not stutter, because they in speaking press the tip 
of the tongue against the lower teeth," He accord- 
in^y tried to perfect it. " To obtain our object," he 
continues, " it ia solely necessary to show the stut- 
terer the way to form the first letter." He divides 
the letters into breath, tongue, and lip letters. Of thi; 
iirst (the vowels, etc.), be says : " Those who stutter 
at the breath letters usually compress the trachea 
and the lungs in such a manner that the breath which 
afterwards, by means of the glottis, forms the sound, 
does not reach the latter, but remains in the chest. 
Here the method of Mrs. Leigh, to raise the tongue, 
affords no aid whatever." The second kind, tlie Un- 
guals, are to be remedied by the raising of the tongue ; 
but in the last, the labial stuttering, the method is 
likewise useless. Herr Bansmann, in onler to remedy 
the defects of the method, teaches the stutterer the 
way to expire and the way to form the labials. TJiis 
ia the extent of his plan ; but, he says, " The whole 
method of cure will rarely lead to a happy result 
unless the teacher combines experience with i?ide~ 
fatigable perseveratiee." 

Commentary. — The supposition that the only thing 
necessary for the cure ia to teach the stutterer the 
way to form the first letter, is without foundation. 
The initial sound is certainly in most ca.ses a gresit 



100 



THEOEISa AND MODES OF TEKATKENT. 



obstacle to the stutterer, though it is an error to sup- 
pose that it is invariably ao. Another error is to 
suppoBe that the trachea and. lungs are so compressed 
that the air cannot reach tlie glottis. In aueh cases, 
the interruption takes place in the glottis itaelf 
through the violent action of the speech -organs, and it 
is this that gave rise to the theory that the spasmodic 
closure of the glottis was the cause of stuttering. 

Haknisch ,• in a prefatory article to Otto's work on 
this subject, says : " Stuttering ia_ a stoppage of the 
sound, which is caused by pressing forcibly the larynx 
upwards, closing the glottis, and placing the posterior 
part of the tongue against the velum. This stoppage 
of the sound may have arisen from a certain tremor 
of the tody, ttu'OUgh fright or other causes : it then 
may become habituaJ, and is communicatfid to all the 
oigans of speech. As stuttering ia solely a stoppage 
of the sound, it may, if not too severe, be removed if 

the patient wills it earnestly The stutterer can 

properly only stutter at the initial consonant, he- 
cause the sounding of the vowel removes the diffi- 
culty. Hence stuttering is chiefly observed at the 
beginning of tlie word, but it may also occur at the 
beginning of middle syllables. The latter is, how- 
ever, rarer, because when the first syllable is formed, 
the following one is easdy conjoined with it. It is 
also found that some stutter at words commencing 
with a vowel. TJiia arises from tlie stutterer thinking 



HARXISCH. — OTTO. 



101 



of the following soimd before he has performed the 
first" He diatinguisliea tliree external species of 
stHtterera, 1. The stutterer is at g and k advised 
to raise the tongue in front. 

2. At d and t, to touch very slightly with the 
tongue the crown of the superior incisors. 

3. At 6 and p (v, f) the stutterer ia to be cautioned 
against strongly pressing the lips against each other 
or against the teeth. 

Gom-nientary.—'X\x theory that stuttering is meraly 
a stoppage of the sound ia t;ontradict«d by every-day 
eifperience. At the explosives, h and p, etc, the 
sound is naturally not produced till the letter is 
ready to be articidated ; but the difficulty of forming 
these letters does not lie solely in the stoppage of 
the sound. This is proved by the fact that in form- 
ing the continuous consouanta (??, m, n, etc.), the sotuid 
is not only produced, but continued ; still the stut- 
terer does not proceed with the word or syllable. 
The method recommended for the treatment is merely 
a modification of the American trick. The precepts 
as to the formation of the letters are no doubt ad- 
visahle, but they apply more to stammering — that 
ia, defective articulation — than to stuttering, for which 
they are intended. 

Orro,* after considering the phenomena of stutter- 
ing, comes t<5 the conclusion — 1. That no souml is 
defectively articulated ; 2. That the defect in speak- 
ing does not affect the sounds themselves, but only 



102 



THEORIES AND MODES OF TKEATMENT. 



their connection with each other ; 3. That the re- 
tarded ot interrupted union of the sounds is not 
founded on the difliculty of articulating them, but on 
their mutual position ; 4. That the inability of pro- 
ducing a sound is only momentary ; 5. That tliere 
exist no OP^mjiic defects in the organa of speech, as all 
sounds of the worda can be separately articulated. 
" We must, therefore," he continues, " not seek for 
the cause of stuttering in these organs. On assum- 
ing that stuttering arises when the vowel of a syllable 
or a word is impeded— that is to say, when it is not 
sounded, when it does not conjoin with the succeed- 
ing consonant — then our attention ia necessarily di- 
rected to the voice, and consequently to the vocal 

organ It is, however, possible that the nerves 

supplying the muscles of the larynx may be mor- 
bidly affected, by which the normal function of the 
muscles is disturbed, and the voice ia thereby im- 
peded." He then observes that as the nerves which 
govern the vocal oi^ns are in immediate connection 
with the brain, it is clear that the mental influence 
must be normal for the proper functions of the 
muscles. But when this is disturbed, the function 
of the muscles will be disordered. 

" Every action," he continues, " represents force ; 
therefore where there is action there must be force. 
But the acting force may be weakened by special 
circumstances, and be neiitralised or overcome by an 
antagonising force." Thus, as the vocal organs and 
the acting force represent antagonisms and differ- 
ences, the normal function of the vocal apparatus 



OTTO. BELL. lOS 

depends partly on tlie coudition of its parts, niul 
partly OQ the condition of tlie oi^ans goveminf; 
tliem. Tbe remote causes of stuttering, he there- 
fore assumes, are partly psychical, partly djiianii- 
cal, and partly mat«riaL Tbe psychical depend on 
the action of the soul ; the dynamical are such 
as cause debility of the acting force, as mental 
labour, sexual excesses, etc. ; and the material are 
such as affect the condition of the vocal oi^gau 
itself. 

Commentary. — I do not purpose now to follow Hen- 
Otto into the psychological aspects of the question 
which he has here presented, further than to say that, 
with some modiii cations, I agree with him. Otto's 
work well illustrates the advantage derived by a 
study of mental phenomena in relation to speech 
defects. His work, although containing very many 
physiological blunders, is one of the best systematic 
works of this period. Our author ridicules the idea 
of any one ever expecting him to lay down instruc- 
tions for the cure of all cases of stuttering, and in 
this he has shown himself to be somewhat in advance 
ef his contemporaries. 

Bell* attributes to the pharynx a much greater 
ahare in articulation than is generally allowed. He 
considers that this smaller cavity is substituted for 
tbe larger cavity of the chest, to the great relief of 
the speaker, and the incalculable saving of muscular 
exertion. 



• On the Organs of the Human Voice, by Sir Cbarlea Bell. 
PhUoioiphical TransactioTis. lB'i2. 



104 



THEORIES AND M0DE3 OP TREATMENT. 



Both the musical notes in singing and the vowels 
in speech are affected by the form and dimensiuna of 
the pharynx, and it is during the distension of the 
bag of the pharynx that the breath ascends and 
produces the sound which proceeds and gives the 
character to the explosive letters ; and the pharynx, 
after being distended, contracts, and forces open the 
hpa. 

He further observes that, with each motion of the 
tongue or lips, there is a correspondence in the action 
of the velum and pharynx, so tliat the compression 
of the thorax, the adjustment of the larynx and 
glottis, the motions of the tongue and lips, and the 
actions of the pharynx and palate, must all coincide 
before a word is uttered. 

Applying this to impedimenta of speech, Sit 
Charles remarks that, " in a person who stutters, the 
imperfection is obviously in the power of intonation, 
and not in the defect of a single part. The stutterer 
can sing without hesitation or spasm, because in sing- 
ing, the adjustment of the glottis and the propulsion 
of the breath by the elevated chest, are accomplished 
and continue uninterruptedly, neither does he expe- 
rience any distress in pronouncing the vowels and 
liquid consonants. For the same reason, and if he 
study to commence his speech with a vowel sound, he 
can generally add to the vibration already begun, the 
proper action of tlje pharynx. Anotlier necessary com- 
bination distresses the stutterer, namely, the action of 
the expiratory muscles, and those of the throat. He 
expels the breatli so much in his attempts at utter- 



BELL. — POEIT. 



105 



ance, tliat, to produce the sound at all, the rils must 

I be forcibly compressed." 

Commttnta'n/.—lt will be perceived that our dis- 

I tdnguished physiologist considers stuttering not as a 
ease, but chiefly as the result of disordered respir- 
ation. He, therefore, lays down no specific plan, 
but recommends the common means wliich, by regu- 
lating the respiratory acts, may tend to overcome the 
difficulty of the stutterer in combining tlie action of 
the organs of speech. 

POBTT* says : " Those affections of incorrect utter- 

, ance most frequently met T.vitli, which are commonly 
called stammering or stuttering, originate in an over- 
action or spasmodic action of certain muscles belong- 
ing to the organs of speech, without the organs of 
Bound or voice displaying the slightest irregiUarity." 
Mr. Poett also admits a laryngeal impediment caused 
in the same manner, by a spasmodic action of the 
muscles of the liuynx. Again : " A spasmodic action 
of any muscle is the result of a certain degree of ex- 
citement pertaining to the ner\-e of volition supplying 
that particidar muscle." Further on he says : " It 
must be allowed that a derangement in the functions 
of that order of the nervous system which relates to 
voice and speech is the actual cause of those diseases, 
and that the stammer, stutter, or impediment is the 
mere effect of such derailed action. Unless the 
debilitated or excited muscles be restored to their 



• A Practical Treatift On Stammvritig, by loaepb Poett. Lon- 



106 



THKWTES ASD MODES OF TBEATSIEXT. 



currect and natural actions, a satis&ctor)- and penna- 
neot cure cannot possibly be especbed," 

Commmiary. — I qoote these views not so much 
from their theoretical or practical value, as &om a 
desire of giving as complete an account as possible of 
the literature on the subject of speech impediineuts. 

ClTLI,* says: " I have no opinion of any means for 
the self-removal of the impediment I think them 
all nugatory to effect a cure without vivA voce in- 
structioas from one who has studied the voice, and 
has had experience in various obstacles which impede 
its formation ; the dividing it into elements of speech, 
and the articiUation of those elements into combina- 
tions — into discourse The grand object in the cure 

of an impediment of speech is the knowledge of the 
means of vocal enunciative training ; when this is 
possessed, the end is in our grasp — ^it only requires 

industry. It is not sufficient for a cure that power 

existe to introduce at will the new term of exact 
knowledge, and thus to speak without hesitation by 
a mental effort — to produce a new sequence by an 
especial mandate of the will. The effort must have 
been repeated sufficiently, so often, that the new term 
rise in its place in preference to the old one, by the 
first solicitation of the terms of the sequence, without 
requiring a special volition, or even an effort. If a 
cessation or relaxation of industry take place ere this 
is ftcconipliahed, the previous efforts will be found to 



• StammaHn} and it* Cnrt, in a Letter addresBed to Geo, 
IHrlibeok, by Kiohard Cull. London: 1S35. 






CTLL. 107 

nugatory. There must be a constant ^\-atchMiie83 
until tlie new sequence is apter than the old. One 
achievement is of no nltimat« use unless it be fol- 
lowed up by another, but eacli in succession becomes 
greater importance. At the same time, each in 
iccession requires less effort than the last, according 
the laws of suggestion." 
Again he aaya : " 1 do not attempt to transcribe 
any of the exercises employed, aa they would require 
a volume of explanation to make them intelligible. 
I have in some cases explained and illustrated vivii 
voce for patients, in order for their practice, when they 
have resided at a distance in the country, but liave 
ivariably found they have gone astray, although in 

cases they were pereons of understanding." 

Comtrunta.nj. — Mr. Cull belongs to the class of 

tffriters on this defect who have derived their know- 

from practical experience. The extracts 1 have 

[iven from the book are no doubt sound and j udicious. 

author is a pupil and a follower of Thelwall, who 

LS the great English master of rhythm. I liave 

one word to say against rhytlmi, but I do as- 

that a purely rhytluuical treatment of stuttering 

loea not really touch its real nature or seat. That 

lany stutterers may be enabled to read distinctly by 

intinued application of rhythm, under an experi- 

iced master, I do not doubt ; but it does not effect 

of stuttering even in reading. The true cause 

stuttering lies deeper, and is far more various than 

ise -who practise rhythm as a remedy can possibly 



108 THEOEIEg ASD MODES OF TREATMENT. 

Berthold " says : " One of the moat frequent and 
disagreeable defects of speeoli is stuttering, the causes 
of which were beUeved to be either an oigauic defect, 
a want of pliability in the larynx, the tongue, etc., 
defective respiration, or an abnormal psychical con- 
dition. But as speech depends on motion, and stut- 
tering is impeded or unregulated motion, it must have 
for its cause an abnormal condition of the muscular 
or nervous action of the organs of speech, 

" In speaking, there ia alternately a separation and 
approximation of the lower jaw, a rising and depres- 
sion of the larynSj an opening and closing, advancing 
and retracting, of the lips, a rising, advancing, and 
retracting of the tongue. Now, stuttering arises from 
this — that the motion of the speech muscles are not 
r^ulated." 

Commentary. — All this is most undoubtedly true, 
and it ia not a little singular that while this distin- 
guished physiologist was teaching in Germany, his 
principles were being practically worked out in this 
country, as will be seen at the end of the present 
chapter. 

Warres-|- commences his essay as follows: "A 
physician who has had an opportunity of observing a 
chronic disease in his own person, may naturally be 
supposed better qualified to wi'ite upon that disease 
than any one whose attention has only been called to 
the matter he treats upon in the common routine of 

• Berthold'a Phyaioloyie. Ooettingen : 1837. 
t Bemarki on Stammering, by Dr. Edward Wftrren, American 
Jounal of Med. Science. Vol. xii, p. 75. Boflton : 1837. 



lOO 

jiractice. This consideration hns led me to suppose 

■ that I miglit perform a useful seirice in committing 
f to paper some remarks, the result of mj experience, 
r upon the subject of PselUsmus." 

Stammering, he says, is a complicated affection. 

■It originates in weakness of the nervous system- — ^in 

tregular action of the ner\'es. Afterwanis, a fear of 

[i stammering causes a person to stammer; the organs 

[ of speech soon acquire a depraved Iiabit ; the nerves 

'also are habituated to irregular action, as in chorea, 

and the habit may become difficult to eradicate, even 

'if the mental cause ia removed. We have, therefore, 

mental and physical causes united, in every degree of 

complication. 

" I may allude," he continues, " to another thing 
also, which givea a singular appearance to the con- 
versation of the stammerer, e\'en when he appears to 
speak with ease. This is, that without being perfectly 
■aware of it himself, he is constantly considering I*e- 
fore he speaks whether the words he means to 
' employ are easy to articulate ; and he is constantly 
[■ in search of easy words. Hence he makes use of odd 

■ and ov^r^ expressions, which are chosen in haste, and 
lifor no other reason than that they are easy of utter- 
lance. In this way he may very readUy obtain the 

laracter of an idiot or an imbecile." 
With regard to temperament, Dr. Wan-en observes, 
ihat having had ample opportunity of observing num- 
s of persons thus affected, he believes an athletic, 
Iftnguine, or a phlegmatic stammerer to be very rare. 
^e affection occurs in persons of extreme suscepti- 



THEOSIEfi AND MODES OF TBEATMBNT. 

bility, whose coustitutiona would readily make them 
subjects of hysteria or chorea. Tliia nen'ous suscep- 
tibility may be caused by siekneas in childhood. This 
is the remote cause. 

In r^ard to imitation as a cause, he believes it to 
be comparatively rare. From the known tendency of 
chorea and hysteria to be extended by imitation, we 
might imagine this t« be a more frequent cause than 
it actually is. 

He contends that there are two different species of 
stammering. The first is that in which the organs of 
articulation, the hps, and tongue, are concerned. In 
the second, the oi'gana are not in fault, but tlie voice 
is wanting. The effort to speak is made, the hpa and 
tongue move, but the voice will not come. The two 
kinds are frequently united. Indeed, when the voice 
ia not at the command of the patient, the violent 
efforts he makes to speak will produce convulsive mo- 
tions of the features and distortion of the coujitenance. 

Even ill less violent cases, the wliole nervous 
system is in intense agitation; every nerve in his 
body, to the ends of lus fingers and toes, seem to him 
to vibrate like the strings of a harp, producing a sen- 
sation like that caused by the filing of a saw, and he 
feels a sense of suffocation at his chest. 

" Stammerers," he continues, " are said in general 
to have narrow chests, and that their lungs have not 
free play. My experience, as far as it goes, conlu-ms 
this. A naiTow chest, also, is said to be one of the 
characteristics of the nervous temperament, I have 
seen some athletic stammerers — at least, one or two — 
but the most 1 have seen lielong to the nen^ous clni^s." 



WAEBES. — GOOD. 

Commeniary. — From Dr. Wareni's intrcHlitction, we 
must infer that he laboured himself under some im- 
pediment of speech. He thmks that imitation as a 

cause of stuttering is very rare ; whilst there can be 
no doubt that numerous cases of stuttering have been 
distinctly traeed to this propensity. The moat glar- 
ing defect which pervades the whole essay, and which 
gives rise to errors both as regards theory and prac- 
tice, is the constant use of tlie term " stammering " 
for all kinds of speech impediments. Taken, how- 
ever, as a whole, this treatise is unquestionably the 
beat on the subject of the period in which it was 
written. 

Good • has devoted a small space to this subject, 
and has, with slight modification, followed Sauvages 
in his division of Psdlismiis blmsitas, or stammering, 
into seven varieties : — 1. Psellismus bl^sitas ringeim, 
or vicious pronunciation of ?• ; 2. ZaHaTts, vicious pro- 
nunciation of /, or lambdacism ; 3. Smolliens, softeii- 
ening hard letters ; 4. BnlbiUiens, repetition of the 
labials ; 5. MogUaiia, omission of labials, or exchang- 
ing them for other letters ; 6. DeniUoqvtns, vicious 
employment of dentals; and 7. Gutturalis, vicious 
prommciation of gutturals. 

"Where these defects are the result of organic mal- 
formation, he says, they will mostly be foimd without 
R remedy, though they may be palliated by a laborious 
discipline. Where they are the result of debility or 



■ study qf Medidna, by John Mason Qo^d. M.D,; tJilfid by 
i. Cooper. London : 1840. Vol. I. 



THEORIES AKD MODES OE TBEATMENT. 

^■icioua Labit, he recommends the exercise of the 
difficult letters. 

Psellism-us bamialia, or stuttering, he says, may be 
regarded as a sort of clonic spasm or St. Vitus's 
dance, confined to the vocal organs, and offers tis the 
two following varieties — keesitans, hesitation ; and 
tiluhims, stuttering. In the hesit-ating variety, there 
is an involuntary and tremulous retardation in arti- 
culating certain syllables. The organs are generally 
too mobile and unsteady, and the will has lost its 
power over them, if it ever possessed any. In the 
second variety, we have a higher degree of stuttering 
than the first, accompanied with more impetuosity of 
effort. It consists in an involuntary and tremulous 
redupbcation of some syllables, alternating with a 
tremulous hurry of those that follow. He continues : 
" The convulsive action of the muscles of the glottis, 
and which are communicated to the other organs of 
speech, whether productive of the present or pre- 
ceding variety, may often be overcome by a firm and 
judicious discipline, insomuch that some of the most 
distinguished orators of both ancient and modem 
times are well known to have been subject to this 
affection in their youth." In ordinary conversation, 
and when a stutterer has time to choose out words, 
tlie infirmity manifests itself most ; while in singing, 
the whole mind is led away by the tune, and a strong 
desire to keep time and harmony. " One of the worst 
stutterers I ever knew," he adds, " was one of the 
best readers of Milton's Paradise Lost He was a 
scholdr of considerable attainments, and bad taken 



GOOD — ^HOFFMANN. 



113 



I 



great pains with himself for his natural defect, but 
without success This affords ua one means, there- 
fore, of remedying the evil before us : tlie stammerer 
[stutterer] should learn by heart, and repeat slowly, 
whatever most arrests his attention. But, at the 
same time, the will must leam to obtain a control 
over the muscles of articulation ; and for this pur- 
pose, single words should be uttered for hours at a 
time, deliberately, and when alone ; and perhaps, too, 
as was the custom of Demosthenes, a practice of 
haranguing by the sea-shore, or on the brinJ; of some 
awful waterfall, where the fearful noise and the mag- 
nificence of the scenery have a tendency to break in 
npon the habit, and render the conq^uest easier, may 
be found advantageous," 

Commentary.~lt is hardly necessary to comment 
on Dr. Good's remarks on stuttering, as they show, 
with regard to treatment, scarcely any advance from 
tlie period of Demosthenes. 

Hoffmann • says : " The chief cause of stuttering 
is a spasmodic affection of the glottis, caused by the 
Wrong use of the organs of speech. The seat of the 
evil is in the vocal ligaments of the larynx. Whilst 
the organs of the mouth labour to produce an articu- 
late sound, the muscles of the voc^ ligaments sud- 
denly deny the necessary co-operation, the vocal 
ligaments cannot give the tone, and although the 
whole mechanism of the articulation is put into 



• Theoretitck-Pralitiache Anteeisung zwr Radical- lleilang Stot- 
f lentder, by A. Hoffmann. Berlin, 1840. 



114 



THEORIES AND MODES OP TREATMENT. 



mntion, the air is wanting which is to he articu- 
lated. In curing the evil, the main object should 
lie the prevention of the dosure of the glottis, and 
the attention should be directed to the production of 
the tone." He adds : " The pupil must acquire the 
necessaiy calmness of mind." 

Commentary. — It is unnecessary to offer many re- 
marks on Hoffmann's theory, which holds true in 
some cases. His adrice, to prevent the closure of the 
t,'lottis, by paying attention to the tone, and exhort- 
ing the pupil to acquire the necessary calmness of 
mind, are, no doubt, very excellent precepts, but I fancy 
that HoHiuann, if he were a nervous stutterer, would 
find that he would he obliged to say with the philo- 
sopher, " I could easier teach twenty what were right 
to be done, than he one of the twenty to follow my 
own teaching." Hoffmann, however, only wTote on 
the subject wlien it was causing some controversy, 
without having anything new to communicate. 

Malebouche,* who introduced Mrs. Leigh's method 
into France, distinguishes four species of stuttering. 
The first is caused by the faulty action of the tongue 
irom behind forwards (tpavant), as required in tlie 
letters s, c, x, z, Tlie second, the moat serious and 
most frequent, is that resulting Irom the imperfection 
in the movements of the tongue from in front back- 
vrards {(Tarri^re), as required in the letters b, c, d,f, 
g, h, i, k,p, q, r, t,v. The third species of stuttering 



iULEBOCCHK. 



115 



is caused by the faulty uiuvemfuts of the touj^iu 
from below upwanla (de kavt), as in /, m, n, r. The 
fourth is caused by the combination of the above 
difficulties. M. Malebouche contfinds that there are 
no such things as labial letters, nor, indeed, any other 
kind but Unguals. The tongue forms the principal 
part in their production; the movemeuta of the lips 
are only secondary, and entirely subordinate to the 
movement of the tongue. Tliis study of the pheno- 
mena of articulation ia sufficient to remedy not only 
stuttering, but other vices of enunciation, such as cluU 
tering, lisping, rhotacism, which are easily remedied. 
The only dilierence between the treatment of the 
latter and that of stuttering, is that the minor de- 
fects simply require the tongue to be tmined In 
move difierently, while in stuttering the tongue must 
undergo a complete re-education. 

On the treatment, he says that the method of Mrs. 
Leigh was not applicable to all species of stuttering, 
and that the cures effected by it were not lasting. He 
had, therefore, attempted to remedy its shortcomings, 
and to discover a more perfect method of cure. His 
starting-point is directly to oppose the curative reme- 
dies to the vicious action of the oigans of speech : as 
he does not think that respiration iias miich to do 
with the production of stuttering, he deems it unne- 
cessary to occupy himself with tliia fundamental 
element of speech, which, be assumes, becomes 
regulated in its actions in proportion as stuttering 
diminishes. The lips form a special object ol' M, 
Maleboucbe's treatment, With regaid to tJie tongue, 



116 



THEORIES AND MODEB OP TREATMENT. 



M, Malebouche recommends that not merely the tip. 
but the whole organ, should be raised and appliud to 
the palate, retractmg it as much as possible. In this 
manner, the stutterer begins to perceive the motions 
necessajy for pronunciation ; he must be made, while 
the tongue ia thus glued to the palate, to pronounce 
all kinds of syllables and words, which he succeeds 
in effecting after a longer or a shorter time, according 
to the inteUigence of the pupil, or the degree of 
flexibility of his organs. The pronunciation, no 
doubt, is much altered — it is thick, clammy ; but 
experience has proved that this defect disappears in 
proportion as the pupil becomes master of his move- 
ments. The teacher should not yield to the desire of 
the stutterer to be soon relieved from this mode of 
enunciation ; it must be continued for a considerable 
time, until the pupil can, with the tongue placed in 
the indicated position, enunciate distinctly. It is 
important, nay, indispensable, that during the time 
of treatment, the subject should, excepting during the 
hours devoted to the exercises, keep perfect silence. 
The invariable, infallible rule is this — to articulate aa 
distinctly as possible, with the least possible detach- 
ment of the tongue from the palate. The more the 
pupil succeeds in articulating clearly, while the 
tongue is retracted, the more perfect is the cure. 

Commentary. — M. Malebouche deserves consider- 
able commendation for the great zeal with which he 
studied the phenomena exhibited in cases of stut- 
tering. His conclusions, however, owing to false 
premises, were erroneous. Not ouly is his tlieory 



MALKBOUCIIE. 



117 



untenable as to the nature and causes of stuttering, 
but he seems to liave entirely mistaken the action of 
the organs of articulatioQ during speech. For in- 
stance, his assertion that the tongue plays the prin- 
cipal part in the articulation of the lahiala will not 
stand the teat of observation. The tongue has no- 
thing whatever to do with the labial letters, apart 
from their connection with the succeeding vowel. 
To be convinced of this, it is sufficient to pronomiee 
auccesaively the syllables 6a and bu (pew). In the 
first case, the tongue retains its natural position, the 
mouth being widely opened ; but in the second, the 
tongiie is advanced towards the teeth and then sud- 
denly retracted. This movement of the tongue is thus 
not connected with the labial articulation, but simply 
with that of the foUowiug voweL His classification of 
stuttering sufficiently indicates the errors into which 
his theory led him. His labours have an interest, as 
showing how large a mtmber of wrong roads are taken 
by authors as to the causes of any disorder before any 
satisfactory and lasting theory can be arrived at. It 
is right to add that the method of Mrs. Leigh led M. 
Malebouche into most of hia errors ; and although he 
detected many of its faults, he did not succeed in 
entirely freeing himself from the errors he had fallen 
into during the early part of his career, So defective 
a theory could not, of course, stand the test of time 
and observation, and I am not surprised at hearing 
Dr. Becquerel ask, " Has M. Malebouche effected any 
real curea ? I know not. All that I know is, that 
several stutterers who consulted me had been unauc- 



lis 



TitEonrES and modes of teeatment. 



cessfully treated by M, Malebonche. Be this as it 
may, this method ought, in my opinion, to he rejected 
for the following reasons : 1. It ia difficult of appli- 
cation. 2, It requirea great force of will always to 
employ it. 3. It is difficult to contract the hahit. 
4, The mode of speaMng is as disagreeable as stut- 
tering itself." 

Hunt. — The late Thomas Himt was bom in 1802. 
During his residence at the University of Cambridge, 
the painful impediment of speech of a fellow student 
forcibly attracted his attention to this infirmity. After 
carefully watching all the phases of this evil, he felt 
satisfied that he had discovered the main cause of the 
disorder, and effective means for its removal. He not 
only entirely relieved hia college friend from his 
impediment, but successfully treated many similar 
cases. Mr. Hunt then left college with the determi- 
nation of devoting hia entire attention to the allevia- 
tion of defective speech. 

An extended provincial tour, undertaken to en- 
large his experience, more and more confirmed his 
conviction as to the real nature of this evil and the 
most appropriate means for its removal. 

One of the earliest proofs of hia provincial succeaa 
is vouched for by the late Sir John Forbes, in a com- 
munication dated April 1828, which runs as follows ; 

"Mr. Hunt was kind enough to give a lesson in 
my preaence to Thomas Miles (a patient in the Clii- 
chester Infirmary), a poor man who has been affected 
with stammering, in a very high degree, from hia 
infancy. And from the unreserved exposition of hia 



m^xT. 119 

principles on that occasion, as well as from the 
remarkable improvement (amountinf^ almost to a 
complete ciire) prodiicud by tliis single lesson, I am 
of opinion that Mr, Hunt's method will be ancceasfiil 
in nearly every ease of stammering not depending on 
any oi;gaDic defect, provided the requisite degree of 
attention is paid by tbe pupil." 

At first he experienced, to tbe fidl, all the diffi- 
culties which usually attend tlie establishment of a 
new theory. The greatest surgeon of the day, the 
late Mr. Kobert Liaton, stepped before the public, and 
not only raised hia voice against any further mutilH- 
tions, but evinced his admiration of tbe simplicity and 
efficacy of Mr. Hunt's system in the following terms : 

"I have, with much pltiaaure, "ftitnessed Mr. Hunt's 
process for the removal of stammering. It ia foundtnl 
OH correct physiological principles, ia simple, effica- 
cious, and unattended by pain or inconvenience. 
Several young persona have, in my presence, been 
brought to him for tlie first time ; some of them 
could not utter a sentence, however short, without 
hesitation and frightful contortion of the features. 
In less than lialf an hour, by following Mr. Hunt's 
instructions, they have been able to speak and to 
read continuously, long passages without difficulty. 
Some of these individuals had previously been sub- 
jected to painful and unwarrantable incisions, and 
had been left with their palates horribly mutilated, 
hesitating in their speech and stuttering as before." 

Tliis opinion was given in 1842. Those only who 
know bow acrupidously chary that eminent surgeon 



120 



THEORTES AND MODES OF TREATMENT. 



was of giving the aanction of his name to aught, 
either professional or general, of which he could not 
conscientiously approve, can estimate tlie paramount 
importance of such aid. 

Ardently pursuing his task, Mr. Hunt, at the close 
of his London sojourn, in 1851, left for Dorsetshire, 
when, in the midst of health, he was suddenly re- 
moved from liis sphere of usefulness. 

The Illiistraied London News of August 23, 1851, 
after noticing the loss sustained by the death of one 
" so long and so justly held in high esteem for his 
skill in the cure of stammering," observes : " During 
some twenty-five years of Mr. Hunt's practice, a 
great number have been benefited by his care, and 
very many have to be grateful to him for resening 
them, not only from the mortification and distress of 
a painful disorder (for such it is), but for rendering 
them eligible to undertake higher stations in trade, 
the army and navy, all the liberal professions, and 
even in the legislature. His system was simply to 
teach the sufferers, by the plainest common-sense 
direct-ion, the means of restoring nature to its func- 
tions, winch were perverted and counteracted by evil 
habits, or the curious infection of involuntary imita- 
tion. Mr. Hunt held, and truly held, that not one 
case in fifty was the consequence of deficient or 
mal-organisation ; and he sternly and perseveringly 
eschewed the knife. In many cases, the effect of a 
single lesson was so remarkable as to appear like 
magic, converting the convulsive stutterer from dis- 
tressing unintelligibility into freedom of voice, dis- 



121 



r tinctness of utterance, and correctness of prouimcia- 

tion. The pupil and the witnesses of sucli an hour's 

change were alike astonished by the obvious process, 

■which only required a degree of moderate attention 

^ft to confirm for ever." 

^ft I must here correct a singular mistake made by 

^Blseveral continental writers on impediments of speech. 

^BiTii one of the early volumes of tlie Medieo-Chirwrgi- 

^Bea2 Review, its editor, the Ute Dr, James Joimson, 

^f stated as a fact, that a youth who had undei^one an 

1 operation for stuttering without having derived the 

least benefit from it, had subsequently been cured of 

hia infirmity in the course of a few days by Mr, 

Hunt. 

In 1830, Dr. Schulthess, in commenting upon the 

I American method, writes : " It seems that Mra. 
Leigh's method was known in Ei^land ; for the 
journals of that country state that several cases of 
■stuttering have been cured by ' Dr. Hari ' (Hunt)." 
In 1833, Dr. Eullier alludes to the above case, and 
writ«8 : " A son of Dr. Jolmson, of London, has been 
cured ofhis infirmity by 'Dr. Hert' (Hunt)." "Hari 
and Hert " underwent further transformations by sub- 
sequent writers. All, however, agree in one point, 
,. namely, that the above cures were effected by the aid 
tof Mrs. Leigh's method. Now, it is chiefly to re- 
fpudiate emphatically this last and perfectly gra- 
Ltuitoua assumption that I notice the sad havoc made 
(ith the name of my late father. 
Apart from contributions to the periodicals of the 
', and some miscellaneous papers on impediments of 



122 



THEORIES ASD MODES OF TREATMENT. 



Speech, Mr. Hunt did not publish a syateniatic work 
on this subject. Had his life been spared, he would, 
no doubt, have done so. This much, however, I have 
reason to know, that, like all who have had much ex- 
perience in the treatment o£ speech impedimenta, he 
had a very poor opinion of the effluacy of WTitteu 
rules for the cure of this infirmity. His system was 
entirely practical, and adapted to each individual 



Commentary. — It would acareely become me to ap- 
preciate in appropriate terms the labours of one so 
nearly related to me. I shall be happily released from 
this task by being allowed to quote the words of an 
eminent author (Professor Charles Kingsley), who 
expresses himself to the following efl'ect :* " The elder 
Hunt's ' System,' as he called it, is a very pretty 
instance of sound inductive method hit on by simple 
patience and common sense. He first tried to find 
out how people stammered ; and for this purpose had 
to find out how people spoke plain — to compare the 
normal with the abnormal use of the organs. But 
this iavolved finding out what the organs used were, 
a matter little understood thirty years ago by scien- 
tific men, stiU less by Hunt, who had only a Cam- 
bridge education and mother wit to help him. How- 
ever, he found out; and therewith found out, by 
patient comparing of health with unhealth, a feet 
which seems to have escaped all before him — that 
the abu.se neither of the tongue nor any other single 

{t'rater'i Hagatine), Loogniwis 



HUNT. 123 

I ia the cause of stammering — that the whole 
I malady ia so complicated that it is very difficult k) 
J what oigana are abiised at any given mo- 
r ibent — quite impossible to discover what organ first 
I .went wrong, and set the rest wrong. For nature, in 
[ the perpetual struggle to return to a goal to which 
she knows not the path, is ever trying to correct one 
morhid action by another; and to expel vice by vice; 
ever trying fresh experiments of mis-sjreaking, and 
failing, alas ! in all ; so that the stammer may take 
very different forma from year to year ; and the boy 
who began to stammer with the lip may go on to 
\ Btammer with the tongue, then with the jaw, and 
J last, and worst of all, with the breath ; and in after 
' life, try to rid himself of one abuse by trying in alter- 
nation aR the other three. To these foiir abuses — of 
the lips, of the tongue, of the jaw, and of the breath 
—old Mr. Hunt reduced his puzzling mass of morbid 
L phenomena ; and I for one believe his division to be 
I Bound and exhaustive. He saw, too, soon, that stut- 
teriug was no organic disease, but simply the loss of a 
habit (always unconscious) of articulation ; and hia 
j notion of his work was naturally, and without doi^e 
I or trick, to teach the patient to speak consciously, aa 
I other men spoke unconsciously." 

Again, he says : " There is no secret in Mr. Hunt's 

' System,' except in as far as all natural processes are 

1 a secret to those who do not care to find them out. 

Any one who will examine for himself how he speaks 

' plainly, and how his stammering ne^hbom- does not, 

may cure him, as Mr, Hunt did, and ' conciuer Nature 



124 THEORIES AND MODES OF TREATMENT. 

by obeying her/ but he will not do it. He must give 
a lifetime to the work, as he must to any work which 
he wishes to do weU. And he had better far leave 
the work to the few who have made it their ergon and 
differential energy throughout life." 



HISTORICAL AND CRITICAL REVIEW OF THE THEORIES 
AND MODES OF TREATMENT OF STAMMERINO AXD 
BTDTTEEING, FROM THE EARLIEST HISTOKICAL PEUIOD. 



I 



Qalen. — ABtina. — Paulna JIgineta. — Fabricina HildanuB, — 
Dlonis. — Herrez de Cb^goin. — Dieffenbach. — Velpaan — 
AmtiBeat.— BaudeoB. — Froriep,— Bonnet. — Phillips.— Frona. 
— Roui. — Lncas. — Gueraant. — Dufreaae-ChaaaaigTie. — Lnu- 
genbeck.— Wolff. — Sante-Sillani. — Yearsley. — Braid. — Lee 
—Post , — Mott. — Porker, — Coni meatarj. — Acoidenta . 



pnblished in man; caaea tbe 
raomiDg after tbe operation, wben the enthusiasm of the ox>era- 
tor and tbe victim lias not had time to cool down, would be 
deceptive. The fact ia, that by ceaaitti; to operate, tlie authors 
of theae sooceaaea have tacitly acknowledged their fiiat iUuflioo, 
if they have not proclaimed it aloud like Fbillips and Qaer' 
aant." — Dft. A., Oaii.i,i.i]aE — Diciionnaire Eneyclop^diqae det 
Bcimcet Medicalea, p. 724. Paris, 1863. 

We have seen that operations for defective utterance 
are not bo new as ia generally believed. Galen speaks 
of the thickening, induration, and shortening of the 
tongue, as intiueneing articulation, and recommends 
cauterisation. Aetiua and Paulua .^gineta not only 
■wrote on ancyglossia, but performed the operation of 



THEORIES AND MODES OF TREATMENT. 



126 

{lidding the ligament of the tongue. The latter even 
excised the tonsils and the uvula ; but not^ as we 
find, for defective articulation, hut only in cases where 
deglutition was impeded. 

In 1608,rahriciua Hildauus operated upon his little 
hrother, who, at the age of four years, could not pro- 
nounce a word, on accoimt, as was said, of the short- 
ness and thickness of the frienum, so that the tongue 
could not reach the teeth and the palate. Dioiiis, in 
1672, proposed to make two or three small incisions 
in the tongue of children who seem not to articidate 
easily. These operations appear, however, to have 
been confined chiefly to the division of the frasnum, 
an operation as old as suigery, which has even been 
pertbrmed by mothers and nurses. 

A more recent operation of this kind has been re- 
commended in cases of stuttering by Hervez de 
Ch^goin, which has been already noticed. 

It was reser\-ed for modem suigery to extend the 
operations to the muscular apparatus of the tongue, 
and DiefTenbach is generally considered as the chief 
authority for the practice. 

DiEFFENBACH* says, " The idea of curing stuttering 
by means of an operation, first presented itself to 
my mind on being requested, by a patient cured of 
strabismus, to operate upon him for defective utter- 
ance. My attention being directed to the subject, 
1 remarked, indeed, that many persons affected by 
strabismus, had at the same lime an impediment in 



DtEFPENBACH. 



127 



their speech. As I was of opinion that the derange- 
ment in the niechaniam of articulation was caused 
by a spasmodic condition of the air passageu, wluch 
extended to the lingual and facial musclea, I con- 
ceived that, by interrupting the innervation in the 
muacular organs which participate in this abnormal 
condition, I might succeed in modifying or completely 
curing it."* 

Starting from these premises, he tried three methods, 
each having for its object the total division of the 
lingual muscles : 1. Horizontal section of the root of 
the tongue ; 2. Subcutaneous transverse section of 
the root of the tongue, with preservation of the 
mucous membrane ; and, 3. Horizontal section of the 
root of the tongue, with excision of a triangidar piece 
in all its width and thickness. 

The first operation he tried in four cases. One 
was a perfect failure. The other three arc reported 
to have been successful, but it is not stated how they 
progressed after the wound was healed up. 

The second he used in one persou only. Dief- 
fenbach had not so much faith in tliis operation as on 
the other two ; but it seems that eight days after the 
operation the mouth was healed, and the patient no 
longer stuttered. 

Tlie third was Dieffeubach'a favourite o[>t;ration, 

• Though there maj be oases in which squinting is concomi- 
tftnt with pBelliHm, they are eicp-ptional, and hove little or no 
relation to eauh other, whilat by intemipting the innervation, 
the reapectiVB parts are not merely nioililioJ, but paraljaed in 
theit fiiuotion. 



128 THEOBIES Aim MODES OF TBEATKEST. 

and required a special surgical apparatua. He declares 
that he then operated upon nineteen cases with satis- 
factory results. Of these nineteen cases he cites four, 
of which we find one was a complete failure. This 
case, the failure of which was attributed to its not 
being true stuttering, was the only one in which 
Dieftenbach found strabianius concomitant with stut- 
tering, 

Dieffenbach himself admits that the operation is a 
very serious oue. Apart from the danger of hemor- 
rhage, the tongue may be lost by gangrene or exces- 
sive suppuration, or it may be torn by an unskilful 



Obe remarks on these operations as follows : " Now 
either the hypoglossal and lingual nerves were divided 
or they were not. If divided, how can we explain 
the fact, that the patients cotdd apeak immediately 
after the operation, so as to show that stuttering had 
disappeared ? Vivisections and clinical facts have 
proved that the section or lesion of the hypoglossi 
induce paralysis of the tongue. If the nerves were 
not divided, then the starting point of the operator is 
false." 

Velpeau claims priority for his method. He aaserta 
that as early as 1837 he conceived the idea that in 
stutterers there was an unusual depth of the palate, 
and to remedy this, he proposed to enable the tongue 
to be more easily raised by one of the four following 
operations, according to the nature of the case : — 

1. The section of the hypo-gloasi when the direct 
elevation of the tongue is impeded. 



AHUSSAT.- — BACDEN8. — FHOHIEP, 



129 



2. The section of the atylo-glossi, when the fault 
f was in the pharynx. 

3. Excision of a triangular piece from the tip of 
I jihe tongue, when the dental letters are affectei 

4. Division of the genio-glossi at their insertion in 
' , tlie apophyses, when there is difficulty in raising tlie 
I tongue to the palate. 

AMUSBA.T also claims the honour of having first 

I applied Buigical operations to the cure of defective 

' utterance* He writes that he conceived his idea of 

dividing the genio-glossi as an extension of tile 

operation for squiuting, and that he conununicated 

the idea to M. Plulippa, when no one at Paris 

knew that it was thus treated in Germany, Male- 

bonche, on the other hand, says that Mrs. Leigh had 

t ;^vi8ed it, and that it was acted upon years before, in 

] America. 

BAtTDENS-t* announced that he operated " in ten 
\ .aeconds by a new process," He added to the section 
I ■trf the genio-glossi that of the genio-hyoid muscles. 
' In fact this process was analogous to that of Vel- 
I 4)ean. 

FBOHffiP.f again, conceived tliat the local cause of 

' , stuttering was the retraction of the lingual muscles 

ae side only, which may be detected by the form 

of the tongue and the neck. He therefore confined 

himaelf to dividing the genio-glossus on one side. 

.and attributed to this mode his own success, whilst 

• In hiB Letter to the French Academy, Feb.. 1811. 
J" + Lancette Frani;aise, Mareh 6, 1SJ4I, 
t Froriep'B Ifoh.™, 1841. 



130 



THE0ME8 AHS MODES OF TREATMENT, 



the division of both these muscles by Boimet and 

others led to no certain reaults. 

Bonnet (de Lyon) advises the section of the genio- 
glossi beneath the chin, thus avoiding the danger of 
hsemorrhage. This operation, however, is confined to 
cases in which the tongue has a tendency downward 
and forward, and even then only in young persons 
under thirty years of age ; because, he tells us, he 
failed in ten such cases. It must be abstained from 
in respiratory stuttering. He estimates his number 
of cures at about two-thirds of the cases. But he 
only cites ten cases of cure out of seventy operations ; 
and despite such a formidable number, he candidly 
admits that he cannot solve the question of the right 
of sui^cal intervention, because from this mixture of 
successes, half-successes, and failures, it is impossible 
to draw correct conclusions. 

Whether, or not, Dieifenbach first introduced the 
practice, certain it is that the example of so high an 
authority gave rise to a host of operators, each of 
whom, by cutting different ways, aspired to the honour 
of beiug the inventor of some new method. Each of 
the methods cited had its proselytes. Phillips and 
Franz followed Dieffenbach's, or the German method. 
Phillips subsequently abandoned the method of Dief- 
fenbach, and adopted that of Velpeau, wlilch was 
also followed by Roux ; Lucas and Guersant followed 
the process of Amussat ; Dufresse-Chassaigne that 
of Baudens ; Petrequin, Richet and Robert that 
of Bonnet. Jobert (de Lamballe) also joined the 
surgical crusade agaijist stuttering. Langenbeck in 



VARIOUS OMHATIOSB. 



131 



Goettingen divided the styloglossi and byo-gloBsi, 
and Wolff the nemis hypo-gloasus. Sante-Sillani, an 
Italiaji aurgeon, puhUslied the case of one P88<iu^e 
Creapoli, aged 57, who suffered from strabism, with a 
concomitant deviation of the month, and great difln- 
ctilty of articulation. This individual Sante-SUlani 
cured, not only of the vice of pronunciation and the 
abnormal position of the mouth, but also of tlie stra- 
bism, by simply dividing the genio-gloaai. The English 
surgeons chiefly confined themselves to the excision 
of the tonsils and the uvula. Yeaisley and Braid 
seem to have discovered this procedure nearly at the 
same time. Braid is said to have cured a great num- 
ber, but nevertheless admits some failures : he also 
added the division of the frfeiium, Yearsley is said 
to have been still more successful. He had noticed 
in many that enlarged and tumefied tonsils gave rise 
at once to both stuttering and deafness, so that the 
excision of the tonsils cured both by the same stroke. 
He asserts that he has successfully operated on 
twenty-six subjects, Edwin Lee also made use of 
the knife in the cure of stuttering. But tlie greatest 
zeal was exhibited in Fmnce, where not less than 
two hundred persons were operated upon within one 
year. The rage* for opei'ations spread to America, 

* " He must be r young surgeon who lias not witnessed an 
operating mania; he mast be a ;oung pliysician wlio has not 
felt the pressure £rom without of a new and fashionable drug. 
Soma thousand operations have been performed on man and 
woman, the greater number, seemingly, without a reiifion or 
ase ; the prufesaiou ia entitled aurel; to be made ocq^uainted 



133 



THS0RIS8 AND MODES OF TBEATHENT. 



where Dr. A. Post performed the first operation. May, 
1841, by div"iiling the genio-hyo^losai near their 
origin. Drs. ilott and Parker, of the New York 
University, divided the genio-hyo-glossi either with 
the knife or sciasois, cutting closely to the symphysis 
of the lower jaw. In many instances tlie pntienta 
seemed immediately to he much benefited, and spoke 
with fluency. A few hours, however, dispelled the 
delusion, and they found themselves as bad as ever. 
Dr. Detmold passed needles through the tongue, and 
the same improvement followed, but as in the rest 
the impediment returned. 

The utility of theae operations has been deduced 
from their succe.^ful application to squinting, wry- 
neck, and clubfoot.* The premises were wrong, and 
the conclusion false. In these affections the evil is 
pamanent and always associated with a contraction 
or shortening of the respective muscles. Stuttering 
is, on the contrary, frequently temporary; were it 
the result of an organic defect it would he equally 
permanent. Dieffenbach found no oiganic defect in 
sixteen cases iipon which he operated, nor were there 
any found in forty cases treated by Blume. Since, 
also, the seat of stuttering ia but rarely situated in 
the tongue, it follows that in such eases all operations 



with the resulta,— reaults which, I fear, when bnonTi, will be 
found to be, though remote, not lesa melancholy." — Har7eyi 
On Exoinon qf the Tonsils. 

• " This conceit," soya Merkel, " is not better than to malce 
a bad piano-pU;eT a good artiat by dividing aome ainewa of his 
fingers." 



mUTT Of THESE OPERATIONS. 133 

on that innocent organ are useless. No doubt, the 
patient frequently ceases stuttering, either from the 
shock upon the system, or from his strong faith in the 
efficacy of the operation; hut after the wotmd is 
healed up, he relapses into his old hahit* 

Nor is it true, as asserted by some surgeons, that 
stuttering irequently results from an abnormal con- 
dition of the tonsils and the u^Tila, and that the 
exciflion of these organs would relieve the impedi- 
ment. Tumefaction of the tonsils exists in most 
cases, without producing stuttering, while few stut- 
terers have enlarged tonsils ; nor, if they have, is it 
the cause of the infirmity. We may, however, admit 
that hypertrophied tonsils, or an abnormal condition 
of the tongue, the palate, and the u^nila, may, and 
frequently does, give rise to defective articulation of 
certain sounds, that is to say, to stammering; but 
rarely is it the eauae of stuttmwj. There is then 
something in a name, i.e., in an exact definition of 
these affections ; for from the confusion of the teiius 
arose the confusion in their treatment. 



" Elenke quotes Beveral easeB in whicli stuttering caaaed in 
wounds of tUe speech organs, but returned when they healed 
up. Speaking of operationa, he says, " But when the wound 
heals up, the articulation of the consonants again predominates, 
and he stutters as before. The operators, however, say that 
they produce an alteration in the muscular and nervous Sbre^. 
I have had stutterers who have shown ma the scars, but no 
alteration had talcen place, nor have I seen a single caae cured 
by divTBioa of the tongue muscles. If such an alteration really 
occurs, it would only be an auxiliary means, paving the way f<jc 






1?4 



THEORIES AKD MODES OT TREATSIEST. 



Besides organic defects, the cause of stuttering has 
also been attributed to the defective action of the 
muscles of the organs of speech, that is, either to 
debility or to spasmodic action. Debility cannot be 
always the cause, otherwise wounds, issues, and above 
all, age, which, according to most authors tend to 
diminish stuttering, and which undoubtedly weaken 
the muscles, would increase the infirmity, rather than 
diminish it. Debility may cause a bad enunciation 
of individual soonds, but certainly not stuttering. 
Nor can the local spasm of the glottis, though a 
frequent concomitant of stuttering, be considered as 
the cause of the affection. All reasoning on this 
subject has been in a circle, and it might as well 
have been said a man stutteis because he stutters. 

The tongue operations indicated above were obvi- 
ously intended to act on the movements of the tongue 
only. Those stutterers who in any way misemployed 
the breath, the voice, the jaw, the hps, were invari- 
ably left in the same state after as before the opera- 
tion. But do not lingual stutterers furnish the ma- 
jority of cases ? By no means. It must, on the con- 
trary, be looked upon as exceptional to see a purely 
lingual stutterer. Even if such an one have recourse 
to an operation, he is far from being warranted in ex- 
pecting any permanent amelioration. It will cer- 
tainly stop any spasmodic action for a time, but on 
cicatrisation, the faulty action returns. On the other 
hand, it may be fairly asked. Could no advantageous 
use be made of this interval- — this temporary respite ) 
Could not the stutterer, while recovering from the 



ACCIDENTS. 135 

effects of the operation, be prevented from recom- 
mencing his bad habit, and be made to use hia tongue 
in the same manner after, as before cicatrisation ? 
Most certainly he couM — that is, on the supposition 
of hia beii^ purely a lingual stutterer. Under care- 
ful guidance and directaon, this inter\'al would be 
very valuable, but the same result may be arrived at 
by infinitely more simple and less dangerous means. 

Accidents. — The rage for operations still continued, 
but soon there came a report that a student of Berlin 
operated upon by Dieffenbach died from the efl'ects 
of the operation. By the side of this warning may 
be placed another — the protest of Gueraant.* Gueraant 
affirms that operations had only produced improve- 
ments in the most fortunate cases, never complete 
cures. He states that he operated on ten stutterers, 
following the method of Amussat. In eight of 
these, the amelioration was so slight as to render it 
doubtful whether it were not a mere illusion. One 
spoke well immediately after the operation, but com- 
pletely relapsed shortly after the wound was healed. 
In the tenth case — a child aged twelve — hffimorrhages 
of the most alarming kind, despite the application of 
cautery, endangered the life of the child. After a long 
convalescence, the child recovered from the operation, 
but apoke as badly as before. 

Amussat.f though he had frequently to combat 
violent luemorrhages, says he arrived, without accident, 



• Gaxette Fraiu^iae (ivril 17, 18*1). 
t Qai. dea BSp. (1 Juin, 1841). 



136 



THEOKIEB Ain> MODES OF TBRA^THEST. 



at his eighty-fourth operation, when there super- 
vened a submental abscess. In the eighty-fiftli case, 
operated upon before the Commission of the Academy 
(April 29th), there appeared an enormoiis abscess 
under the chin. There escaped from it pus and dots 
of blood, and the patient died May 17th. 

Dh. Claessen,* a distinguished German sui^eon, 
after having perfonned a variety of operations for" 
impediments of speech, says : " Although the resnlta 
of my experience would lose nothing by comparing 
them with those published, assuming them to be 
strictly true, still I am so little satisfied, that I have 
undertaken no operation of tliis kind since Jime 
11th, tliough a number of afflicted persona vehe- 
mently desired it. I consider it my duty to dis^ 
Buade all from performing such operations, as it is 
exceedingly rare that the fault is in the action of 
the muscles, or that the evil ia remedied by dividing 
them," 

Baudens is said to have operated on twenty-one 
persons, aU of whom were considerably improved or 
cured. But M. Or^, in 1865, met with a certain De 
Nonn^ who stuttered frightfidly. On being ques- 
tioned as to his infirmity, he said that he, together 
with two comrades, when in military service, had 
been operated on by M. Baudens, and that their stut- 
tering became so much worse that they were all three 
dismissed the service. 

Dufrosse-Ciiassaigne asserts that in seventeen 



" Caaper's Woehmichrift, 1841, 



PAlLrRES. IH7 

operations he obtained seven complete ciirea, fi\'e 
ameliorationa, and five failures ; while, as we have 
seen. Bonnet, out of seventy operations, only cites, 
as examples, ten as perfect cures. Of these t«n, six 
only were seen by him aft^r the operation. Of tlieae 
six, one relapsed after a fortnight. The five re- 
maning were tree from stuttering after two months. 
One of them was free after five months. In fact, 
these cases were only seen once or twice after the 
operation. 

Phillips, in a work dedicated to his master, Dieffen- 
bach, protests loudly against these operations. Ho 
asserts that from his own practice and that of otlier 
operators, he felt convinced that not five per cent, 
yielded satisfactory results. Those who stuttered at 
the labials were complete failures ; while those who 
stuttered at the Unguals were generally successful. 
But he affirms that the life of the patient is endan- 
gered by hfemorrhages. He also accuses the surgeons 
who have so loudly proclaimed their successes, with- 
out mentioning the accidents, of knowingly mislead- 
ing the practitioners. 

The efforts made by the late Mr. Thomas Hunt to 
put a stop to such operations in England, supported 
by the unsatisfactory results obtained, proved after a 
time successful, so that at last the practice was dis- 
countenanced by all the most eminent members of 
the profession. In support of which, I may (luote 
the following passages from a leading medical 
journal : — * 



138 



THEOBIES AND MODES OF TBEATMEST. 



" Tlie aangTiinary operations which have recently 
been devised and executed, with the view of curing 
stammering [stuttering], are one of the greatest out- 
rages upon modem surgery. Although some of them 
had their origin in legitimate motives, most, we fear, 
serve but to show what ruthless expedients will be 
occasionally resorted to for the purpose of acquiring 
professional fame, however short-lived, and to what 
extent the ignorant and the credulous will become a 
prey to craft and subtlety. If our indignation was 
awakened at the barbarous cnielties practised upon 
dumb animals for the sake of elucidating the truth 
of physiology, how much more ought it to be when 
we consider the multitudes of our feUow-beinga who 
have suffered themselves to be maimed and mutilated 
at the instigation of individuals more remarkable for 
their reckless use of the knife than for the soundness 
of their medical science. 

" It is ascertained that persons who have stammered 
in the highest degree, have been remarkable for the 
perfect integrity of conformation and structure of aSl 
tlie organs of voice and speech ; while others who 
have laboured under a faulty or diseased condition 
of these organs have preserved their articulation un- 
impaired." 

Mr, Bishop also says, " It appears to be wholly 
unjustifiable for surgeons thus to inflict wounds and 
mutilate oi^ns upon mere hypothesis, more especially 
when the practice is at variance with the physiology 
of the part concerned in the defects of speech intended 
to be relieved." He also well obsen'es, " It is not. 



BISHOP. — BUSCH. — GUTLLAUME. 



139 



\ tiien, Burprising that the extirpation of portions of the 
F tongue, tonsils, uvula, and velum, should produce such 

a degree of mental excitement aa to control for a time 
[ the vocal mechanism; but after the excitement of the 
I operation has passed away, the unhappy sufferers re- 
I lapse into their former state of imperfect articula- 
[ tion," 

Busch,* speaking of Dieffenhach's and other me- 
' thods, says, " Most of them spoke iluently, or, at least, 

more fluently than before ; but this lasted only for a 

short time. A few days after, stuttering returned, and 

leached its former stage. The subcutaneous division 
■ of the genio-glossi equally failed. Blood was vainly 

spilt in these operations. The operation effected a 
I Toetter innervation for the moment, but it was not 

lasting. 

I conclude this chapter with the words of Dr. Guil- 
I Uume, who, after dispassionately weighing the aigu- 

menta and facts for and against the suigical question, 

comes to the following definite conclusion : 

" In the presence of these facts I reject operations 

for stuttering under any form as useless. I reject 
I them also as dangerous. The cases of Dieffenbach, 
' Amusaat, and Guersant, show the danger. But as- 
I Burning that future operations may be leas injiirious, 

I reject them as irrational." + 

• Lekrbuth der ChirurgU. Dr. W. Buscli. Berlin, 13 60. 
t DictionTuiire £nci/clop^digiis des Sciencei 3Ii!dicale3, Paria, 



CHAPTER V. 

mSTORICAL ASD CBmCAL REVIEW OF THB TH20RIE8 JiSD 
MODES OF TREATMENT OF STAMMERING XSD STIT- 
TEUIKO, FROM TOE EABLtEST HlSTOHiCAL PERIOD. 



BoDDet. — ManbaQ Ha.IL — Wright. — Colorobat. — Beesel. — 
XerkeL — B&hring. — Licbtin^er. — Blume. — Hagemum. — 
BecqnereL — Qraves. — Bacc. Med. Oxon. — Bishop. — Anger- 
mann. — Bom berg. — Eich. — Leubuacber. — Kosentbol. — Wolff. 

— Violette.— Beclard.— Klenke. — Schali. — CherTin. — Mar- 
shall. — LehweBS. — Wjneken. — Holmes Coote.— Orfi. — Oiiil- 



" The prooesaas of tbe medical art are even now mostly em- 
pirical : then efficacj is concluded in each instance torn a 
special aad most precarious eiperimeiital generalisation : bat 
aa science advances in diacoTering' tbe simple laws of chemistry 
and physiology, progress is made in ascertaiiiiiig the inter- 
mediate linka in the series of pbeuDmena aod tbe more general 
lawi on whioh the; depend ; and thus, while tbe old processes 
are eitber exploded or their eScacy in so far as real, explained, 
better proceBsea, founded on the knowledge of proximate canaee, 
are continaallf suggested and brought into use." — J. S. Mill, 
Syttcm of Logic, vol. i, p. B37. 

Bonnet" saya the elementary phenomena of stut- 
tering are : 

affection which was the primary 



* Traiti del Bteliont Tendineme* et M-aiciilaires. & PartU. Ihi 
Br'irai0mnv(, p. SZ5. Paris, 1841. 



BONNET. 141 

2. Tlie fuDctional disorders of tlie organs of speech. 

He does not hesitate to say, that although the disease 
of the nervous system may have preceded that of tlie 
oigana of speech, and have been the real cause of it. 
when once cured it no longer takes part in the stut- 
tering to which it has given rise. The Iatt«i' is, then, 
only a local affection fixed in the respiratory or arti- 
culating oigans. It is in certain respects like de- 
formed feet, which, though they may have resulted 
Ironi convulsions and nervous diseases, are, after 
these have been cured, local affections. 

By following up these analogies, we perceive that 
stuttering ia only a local functional disorder of the 
oi^ans of speech, and that this functional derange- 
ment has an existence independent of the nervou.s 
system, which nevertheless was the primary cause. 

This point being established, Bonnet reviews the 
local phenomena of stuttering, which consist of dis- 
_ordered movements of, 1. Respiration; 2. Lips and 
cheeks ; and, 3. The tongue. 

From his investigations Bonnet arrives at the con- 
clusion that in most cases disoi'dered respiration, and 
the apparently spasmodic movements of the lips and 
cheeks, are the consequences of the difficulties which 
' exist in certain movements of the tongue. 

It is therefore in a functional disorder of the mus- 
cles of the tongue, that the real cause of stutterii^ 
resides. 

Commentary.— I fully agree with Dr. Bonnet when 

he says that stuttering may become localised in the 

I Cleans, hut it is too sweeping an assertion to say that 



142 



THEOHIES AND MODES OF TREATMENT. 



disordered respiration and the "apparently spasmodic " 
movements of the lips and cheeks result from dis- 
ordered movements of the tongue. The spasmodic 
movements of the lips and cheeks are as really spas- 
modic as those of the tongue, and vice versa.. They 
are in fact both functional d^orders. Their action is 
perfectly normal when engaged in acts foreign to 
speech. The same may he said with regard to re- 
spiration ; but according to my experience disordered 
respiration is more frequently the cause of the dis- 
ordered movements of the tongue than the latter of 
the former, as Dr. Bonnet asserts. Our author is one 
of those who attempted to remove stuttering by the 
aid of the knife ; and, as we have seen, he invented a 
'new operation by dividing the genio-glossi beneath the 
chin. Though his operations were confined to those 
cases in which the tongue alone was affected, and 
even then only when it was inclined to assume a 
position downward and forward, and moreover, though 
he resolutely declined to operate on other than young 
persona, he frankly confessed that he was imable to 
solve the problem of the propriety of surgical inter- 
ference. 

Maeseail Hall* says ; " In stutteringf the act 
of volition is rendered imperfect by an action inde- 
pendent and subversive of the will, and is of true 
spinal origin. In some instances, an act of inspu-ation 
is excited at the same time, which is etiually involun- 

• IHaeasea of (Jie Jfemous Syilem. 1841, 

t The word need ia the original is stammering. I have 
chimgod it to prevent confuaion. 



MARSHALL HAIX. 



143 



I tary ; but in geaeral, there is a violent effort of ex- 
I piration, and, in the worst caaea, the disease is of an 
w Almost convTilaive character. Stuttering as a disease, 
I ia sometimes induced by a morbid condition of the 
I .intestines, acting through the incident nerves." 

" Stuttering is very like a partial chorea ; it is not, 
I I think, as Dr. Arnott supposes, an affection of the 
[ glottis or larynx, that is, of the organ of voice, but 
I of some of the different parts which constitute the 
I machinery of articulation." 

Further, he observes*: "All results prove that tha 
F. larynx is not closed in stutterers, and, indeed, that its 
closure and stuttering are totally incompatible with 
each other. Where articulation is interrupted, it is 
' ty the co-operation of a part anterior to the larynx ; 
I it is, in a word, not an interruption of the organ of 
I voice, but of speech." 

He asks the following questions : " Are incident 
nerves, regulators of articulation, excited in articula- 
I tion ? And are they unduly so in stuttering ? And 
is stuttering not only an undue spinal action, but au 
■ undue reflex spinal action ? These interesting ques- 
tions," be adds, " time and long investigation alone 
can determine." -f 

For the removal of the impediment he advises a 

stutterer " always to speak in a continuous, Jlotving, 

manner, avoiding earefuEy all positive interruption 

in his speech ; and if he cannot effect his purpose in 

' this way, let bim even half sing what lie says, until 






THKORIES AND MODES OF TBEATHEN'T. 



he shall by long habit and effort have ov 



liis 



Commentary. — Dr. MaxshaU Hall, in denying that 
the apaamodic closure of the glottis ia the cause of 
stuttering, is no doubt, in a great measure, correct. 
But he falls into the opposite extreme, when he says, 
" the closure of the larynx and stuttering are totally 
incompatible with each other," and when he places 
the seat of the evil in a "part anterior to the larynx" 
Tills is to deny the co-operation of the respiratory 
organs in the causation of stuttering, and to place the 
Beat of the evil exclusively in the articulating oigana ; 
both of which theories are quite opposed to my ex- 
perience. 

The recommendation " to speak in a continuous, 
flowing manner, avoiding carefully all positive inter- 
ruption in his speech," is the result to be arrived at, 
but not the means of doing it, neither is, indeed, the 
substitution of singing for speech. The stutterer can 
generally sing without trouble ; what he wishes to do 
ia to speak in a natural tone. 

Wright* asserts "that, provided the respiration 
be unembarrassed, and perfectly free from protracted 
inteiruptions, indistinct, or substituted artieulations 
{stammering), however deranged, confused, imperfect, 
and contrary, will never engender stuttering ; and that 
the principal mechanical and pliysiologicol cause of 
stuttering arises from a sluggish, taixly, and contrary 
action of the organ which closes the nasal passage, 

loSirCharles 



WKIGHT. — COLOMBAT. 



I4r. 



r »nd from the contrary action of those organs which 

are employed for the proper utterance of the mutt- 

conaonauts, and that such inefficient and contrary 

aotious induce a sudden and uutimely closing of tlie 

Lphaiynx on all sidea, and sometimes, perhaps, of the 

■iflottia itself, till the chords of the glottis he deranged, 

■ (be breathing checked, and frec^uently for a second 

r 8o, stopped; when the lungs lose their orderly 



—Mr. Wright's assertion, that defec- 
Stive articulation, confused, indistinct utterance, will 
■ftever produce stuttering while the lungs continue to 
lact nomi^y, requires some modification. That such 
■ defects do not necessarily engender stuttering 1 fully 
I admit. I also hold that there must he a certain pre- 
fc disposition on the part of the stammerer, in order 
1 ttiat stuttering may talie root. But I am much in- 
lelined to think that dilficidt articulation may, in suh- 
Tjecta predisposed to contract the evd, produce hesi- 
Btation, stoppage of the respiratory acts, and, finally, 
■Aonlirmed misuse of the respiratory organs, which 
iannot fail, joined with the difficulty of articulation. 
I to end in real stuttering. 

Mr. Wright seems also to have fallen into the coin- 

Bon error that stuttering occurs esclusively at the ex- 

Kplosives, when he considers the " physiological cause 

f stuttering as tlie tardy action of the organ which 

Mioses the nusal passages." 

CoLOMBAT* divides stammering as follows : Gras- 



• TraiU lie tous let Vic^ de la Parole e 
Ms^gaiemmt. Paris, l»40-3. 



« FarlieulUr du 



146 



THEORIES AND MODES OF TREATMENT. 



sej/cmeiit, or rhotacism, which is siihdivided into six 
different species, all having as their principal cause 
imitation or bad habit contracted in infancy, by per- 
sons whose conformation of the oigans of speech 
rendered the artienlation of r difficult ; N&i(^, con- 
sisting in the alteration of aotmcis, or in substituting 
others for them, is divided into iotacism, lambdadsm, 
sesstyemejU, ll4sit^, and the bl^sit4 of foreigners ; ial- 
bidiement, which consists in pronouncing words with 
heMtation, interruption, indistinctness, and sometimes 
with repetition, but always calmly, in a low voice, and 
without pi'eeipitance ; this is caused by a want of 
intelligence, paralysis, and general debility; finally, 
hredouillement, or cluttering. 

Of stuttering, Colombat assumes two species, each 
having several subdivisions. 

The first consists of spasmodic motions of the lips 
and tongue, and other moveable organs, and conduces 
to the frequent repetition of the labial sounds.* 

The second, consisting mainly in a rigidity of the 
respiratory muscles and those of the larynx and 
phajynx, manifests itself by a sudden stoppage of 
the breath, owing to the contraction of the glottis, 
and, consequently, affecting the emission of sound. 
The guttural sounds, ff, k, h, are chiefiy influenced in 
this species .-f- 

Tliose labouring under the first-named defect are 
usually persons of a lively disposition, while those 

* Iligaiemeai labio-choTHqve, eo termed on account of its ana- 
logy with chorea, or St. Situs's dance. 

t Tbis he calls hlgaiansnt gutUiro-lelaaiqut. 



COLOMBAT. 



147 



I subject to the second species articulate slowly, and 

I make considerable efforts to produce the disobedient 
sounds. Colombat followed the opinion of his prede- 
eessors, in eissuming as the proximate cause of stut- 

' tering the want of hannony between the nervous 
influx and the muscles of the organs of speech. 
He, therefore, devised a series of orthophonic exer- 
cises, in order to restore the harmony between nei'- 
vous action and the oi^ns of articulation ; the most 
effective agent in these exercises being the applica- 
tion of rhythm in speaking. 

The orthophonic gymnastics have the advantagt! 
of acting physically and morally ; tliey act physically 
upon all the respiratory muscles; upon the lungs, 
the larynx, and specially upon tlie glottis, the tongue, 
and the Hps. The respiration, effected in the mode 
indicated, has for its object to relieve the spasmodic 
constriction of the vocal cords by opening the glottis, 
■while, at the same time, the cheat ia expanded by a 
large quantity of air, which escapes slowly by an ex- 
piration which should be gradual, and only sufBcient 
to produce the so\md. 

By placing the finger upon the pemnm Adami, 
every one can convince himself, that when the tongue 
ia raised and its tip turned towards the pharynx, the 
larynx descends and the glottis enlai^-eB, whilst in 
stuttering the larynx ia usually luised, by which the 

I glottis is constricted. The position of the- tongue, 
■as above, renders it almost impossible to stutter at 

I the guttural, dental, and palatal letters, wliilst the 
infirmity ia soon exhibited when it is ih'pressed. Tlie 



t48 



THEORIES AND MOPES OF TREATMENT. 



transversal tension of the lips, aa indicated, tends to 
relieve that species of convulaive tremor which ob- 
tains in ai-ticulating the lahials when tha lips form a 
sort of curvilinear sphincter, Aa different causes 
never produce the same effects, it is easy to conceive 
that the disagreeable repetitions cannot take place if 
the mechanism which produces them be altered in an 
opposite dii'ectioD. In addition to the alwve exer- 
cises, Colombat uses certain mechanical contrivances, 
plates of ivory lietween the teeth, refotde-langue, 
hride-la-nffue, and a whole host of other such ap- 
pliances for the mouth. There is another condition 
upon which he insists, namely, that the patient 
should, for at least a fortnight, not speak with any- 
body else, or only with sucli individuals as are under 
treatment for the same infirmity, otherwise the pre- 
cepts are soon forgotten, and the iniiuence of the 
metliod is only ephemeral 

" After what Las been stated," says Colomliat, " it 
is evident that rhythm ia one of the chief phases of 
my metliod." 

Comvienlary. — ^Although M. Colombat obtained the 
Monthyon prize from the French Academy, it is diffi- 
cult to discover that he has thrown any hew light on 
the infirmity. Colombat's great merit consists in 
having systematised the subject, altho\igh his many 
sub-diviaiona are useless, and some of his principles 
erroneous. Nor ia tliere anything original in M. 
Colombat's classification, which seems to have been . 
adopted firom that of Serre d'Alais. Dr. Becquerel, 
who, according to Iiia account, followed Colombat's 



COLOMBAT. 141) 

method far tieelct yi-an, asks, "Are there any radicnl 
cures etfected by Colombat's method ? I doubt it. 
The pu'pila soon leave off these fatiguing exerciaes," 
Further on, speaking of the originality of the means 
employed by M. Colombat, he says, " Tlie first ques- 
tion is this — have these remedies been discovered by 
M. Colombat ? No ; they were all known." M. Creps 
alao speaks in no complimentary terras of Colombat's 
method and pretensions. " Jf Colombat " says lie, 
" has not perceived that his method is absolutely 
chalked upon those of his predecessors, it is because 
he had no wish to perceive it, in order to make the 

world believe that he had iii\'ented a system 

This physician is the most presumptuous on the 
earth : in his own estimation, he has iuvented, dis- 
covered, and foreseen everything." Perliaps more 
justly Dr. Klenke obser\'es : " Stammeriny and stut- 
tering, primary and secondary plienoniena, causes 
and symptoms, were all confounded, and if Colomtjat 
j really succeeded in curing a stutterer, it was by blind 
chance ; and he attained bis object by making, in a 
round-about way of twenty miles, what he miglit 
rationally have attained in one straight mile." Co- 
lombat's explanation of the causes, " disharmony be- 
tween the wQl and the oi^us of motion, between 
injiervation and muscular irritability," is identically 
the same as the theory of Ridlier, or rather of Aris- 
totle. 

There can be no doubt that a slow and measured 
delivery aomewliat tends to diminish stuttering, and 
may prove bencficiid iu some cases of defective utter- 



l.=;i> 



TQEOBIEB AND MODES OF TREATMEST. 



ance ; but notliing can he more erroneous than to 
aasiime that rhythm, however skilfully employed, ia 
sufficiently potent to remove permanently a severe 
impediment. From the circumstance that rhythm is 
in some uncomplicated cases a very useful adjimct, it 
lias been by many writers cried up aa a panacea for 
stutterii^. The real fact ia, that it is not the rhythm 
which produces a beneficial effect, but its intluence 
in altering, for the time being, the management of 
the breath ; for the moment the patient begins his 
uvilinary discourse, the defect immediately reappears. 
Unless, therefore, the vicious respiration be first at- 
tended to, 80 as to establish a synchronous action 
between the respiratory, vocal, and articidating organs 
under all eircuinstanees, rhythm alone, or in the com- 
bination of Colombat, wdJ produce little or no effect 

Beesel* assumes four kinds of stuttering— 1. With 
the larynx too much raised, and closed glottis ; 2. 
With depressed laryus and open glottis ; 3. Stut- 
tering with tongue and lips ; and 4. A mixed stut- 
tering, 

Beesel gives the following instructions : The teacher 
must first make the patient pronounce all individual 
sounds of the langiiage, so as to convince the pupil of 
liis ability to do so. If in the enunciation of some of 
them, the teacher observes too much pressure of the 
lips or tongue, it must be remedied, and the pupil 
nmst be made to pronounce them with the least 
pressure and effort. The pupil must be particularly 
r, Verhvtaitg und Hrilung dtt 



BEESEL. — ^UEREEL 

exercised in the somids difficult to him. We must, 
however, be cautious uot to reprimand liim too 
much. Tlie teacher proceeds tlien to syllables and 
words, then to sentences, especially such as are 
ditticult. 

Commentary. — Beesel's assiunption of four species 
of stuttering, according to the position of tlio larynx, 
etc., rests upon no physiological foundation. His in- 
structions woidd be unobjectionable were he not, like 
many other writers, to recommend that the pupil 
should be exercised in the sounds specially difficult 
to him. This is a practice from which I to a great 
extent dissent. 

Merkel* attributes stuttering to an adynamia, or 
debility of the presiding muscles of vocalisation. 
" But," he adds, " this adynamic state or inability, 
which manifests itself in the vocaUsation function 
during speaking, is not an organic defect, not an ana- 
tomical, but purely and simply lying in tlie |)3ychical 
sphere, specially in the volition, and is oidy so far 
dependent on external and physical agonte that these 
' may influence the mind, It arises from weakness of 
the will, defective courage, which probably originated 
in early infancy during tlie first attempts to speak, 
when, by neglect, the gradually arising speech-defects 
became a deep-rooted habit Stuttering is, there- 
fore, tlie result of a certain unfreedom of -the mind 
in relation to the speech-organs, which may, however, 
gradually extend to the whole nature of the stutterer. 




152 THEORIES AXD MODES OP TKEATUEXT. 

as Speech forms such an essential port of liumati 
nature." 

Speaking of the treatment, he says : " ^liatever 
means are employed, there ia necessary, for perma- 
nent aucceas, that, above all — 1. Tlie energy of the 
contractile power of the respiratory organs should be 
strengthened as much as possible ; 2, The force of 
the aiticulating or speech organs should be lessened ; 
3. The whole body should be raised to a high degree 
of self-dependence, force of life, and activity : only 
when these conditions have tieen fulfilled will there 
be permanent results from 4. Tlie symptomatic means 
which are to effect the reguktion of the speech 
organs." 

Comvi^ntari/. — I fully agree with I>r. Merkel that 
stuttering arises from no organic defect, and that 
volition has a great influence on the causation of the 
evil ; but I am far from asserting that it lies '* purely 
and simply in the psychical sphere." Stuttering is 
not 80 much a psycliical defect that a strong will 
alone would effect its removal. When the speech 
organs have, by long habit and misuse, become tho- 
roughly accustomed to disordered action, they require 
something more than a psychical treatment to be 
restored to their proper functions. 

BdHking* says ; " The process of speaking is ef- 
fected by the most complicated apparatus, which is 
influenced by distinct nervous tracts. These nen'es 



■ Eitract tionx A Contribution to the Therafeatieso/Stattering, 
by Dr. Babring. in Cmpor'* Wochmichrifi. 18«. 



BUHRING. — ^UCHTIHGK. 



153 



fonn, so to aay, an association, fur one object. Their 
action must be isochronous, or, at least, in regular 

succession, if sound is to become articulate It' 

this iaochronism is interrupted either by a too much 
contracted or relaxed muscle, or by some organic 
change in the muscle or nerve, the association of all 
these organs is disturbed, and the production of souiul 
or its articulation impeded. Hence the iniiuite variety 
of the causes of stuttering." 

CommetUart/.—DT. Biihring, unlike most authore 
on stuttering, instead of laying down any definite. 
cause, such as spasm of the glottis, which is to be 
appbed to all cases, baa wisely and truly aclaiow- 
ledged the infinite variety of the causes which may 
produce stuttering. 

LicUTiNUER* assumes as the cause of stuttering a 
predominance of the extito-mofory over the central 
system, showing itself not merely in the movements 
of the tongue, but as frequently in the muscles of the 
lips, lower jaw, velum, glottis, and probably in tlie 
respiratory muscles. 

The predominance of spinal action may be effected 
in two modes— 1. Tlie spinal action is nonnal, but 
the cerebral iniiuence is weakened or abolished; 
2. The cerebral influence is normal, but the spina! 
action is abnormally increased. 

In the first case, the seat of the affection is in 
the brain ; in the second, the spinal system is in 
feult. 



THBOnSB ASD WHlIS OF TBE-^.THENT. 

Blcmb ' says : " The causes are {»^xunate and re- 
mote, or rather primary and secotulaiA'. The pti- 
laary physical causes lie either in defective organisa- 
tion or defective employment of the organs of speech. 
Tlie secondary or direct causes are : second dentition, 
a retarded derelopment of the body up to puberty, 
bad education, imitation, and injories to the nervous 
system. 

" In point of fact, all causes leading to stuttering 
may be comprehended within the two cathodes : 
Ouses within the vocal and articulating oi^anisnt; 
causes outside the vocal and articulating organism." 

With reference to physical causes, he observes that 
after many years' experience, he had arrived at the 
conviction, that the proximate cause of stuttering lies 
in a disharmony between thought and speech acting 
in two ways. In the first case, the mental operations 
are too rapid in proportion to the action of the speech 
organs, so that they do not proceed at the same pace. 
In the second case, the mental operations are sluggish 
compared with the action of the speech organs, so 
that the latter outrun the former. 

Blume advises that before a pupil be admitted to 
treatment, he should be made to sing ; if he stutters 
in singing, tiie cure is hopeless. 

He also advises that he sliould be made to speak 
whilst ascending a liill or the stairs. If the patient 
stutters as violently during the ascent aa he does 



BttTME. — HENRIETTE HAGEMANN, 



155 



I when Btanding still or walking slowly, there is again 
I no hope for the cure of the evil ; so that if both these 
1 trials fail, the sufferer should he dismissed at ouce. 

Comtihenlary. — I sliaU pass over the author's theory 
I as regards the etiology of stuttering, as he adopts, in 
almost identical terms, the theory of Voiain, although 
he saya that he anived at this conclusion from hia 
I own experience. I shall, therefore, confine my re- 
I marks to his mode of treatment. In the first place, 
I entirely dissent from his opinion that persona who 
stutter in singing, or whose infirmity is worse whilst 
ascending a hill than wlien at rest, are incnrahle. I 
have had such pupils, and their cure upsets this gra- 
tuitous assertion. There are many valuable remarks 
scattered through this work, for Blume spoke from 
considerable experience, as he conducted an estab- 
lishment for the cure of atuttering. The great defect 
of hia method ia, that it is overloaded with more or 
leas trifling rules and contrivances, which confound 
both teacher and pupih I hold that, apart from 
some few exceptional caaes, mechanical aids should 
he avoided. Whatever benefits may be derived they 
will, in most caaes, be found to be only transitory. 
Moreover, in many cases, mechanical obstacles alter 
only the form, but not the nature, of the afi'eetion. 

Hesrtette Hagemann* adviaes, in addition to the 
upward position of the tongue, that the difficult syl- 
lables should be preceded by the letter n. In addition 



* Vnir&glvihe Htilvmg Aes Stalter-nnd Slammel-UAtla. Bi-es]B.u, 



156 



THGORIBB AND MODES OF TKKATMRNT, 



to tlua, she uses the trick recommended by Dr. Ai'iiott. 
In such words as bread, blue, she makes the stutterer 
insert an c sound thus, b-e-read, i-e-lv^. 

Mrs. Hageinaun remarks : " The tongue is the es- 
sential instrument for articulation. It forme all the 
speech sounds according to the position it occupies, 
aud may in this respect be compared to the use of 
tlie lungs as a musical instrument." The cause of 
stuttering, she observes, "lies in the defective em- 
ployment of the organs of speech, the tongue, and the 
lungs." Tiie latter, namely defective respiration, she 
considers rather as the result of the faulty use of the 
tongue than as an original cause of the evil. " It ia 
a symptom of this defect," she continues, " that the 
glance of stutterers is always unsteady, as if they had 
a bad conscience. This is explicable, inasmuch as 
they generally find in the countenance of the listener 
surprise or ridicule. They must be accustomed to 
look into the eyes of those they converse with, so 
that they may he no longer affected by the looks of 
strangers." 

Com./nentary. — Mrs. Hagemann's procedure being 
entirely based on that of Mrs. Leigh, without any 
material addition but Dr. Amott's intercalated e, an 
analysis of her method is unnecessary. 

Becquerel* believes that the cause of stuttering 
is a dynamic affection of the respiratory muscles, 
having, probably, its primary seat in the nervous 
The con\*ulsive movemeuta of the vocal and 



BECQITEKEL, 



157 



I articulating organs ; the difficulty of pronouncing 
1 certain syllables and their frequent repetition, are 
I niCTely the consequences of the premature escape of 
I ibe air which is not employed in the fonnation of 
I «oitnd. It ia, therefore, necessary to prevent this 
I escape of air, by retaining it as much as possible 
I daring speech. In stiittering it will be seen that the 
I -walls of the thorax sink too often, to expel the esceas 
f air introduced. The result of this is, that a larger 
I quantity of air escapes than is necessary for aiticii- 
' lation, and a sensible current of air arriving in the 
buccal cavity at the moment when the tongue, the 
, and the buccal jarietes contract for articula- 
tion, it impedes their free action, and produces stut- 
tering. Such being the case, the loss of air must be 
. prevented by retaining it as much as possible, aiul 
I employing it in the formation of articulate sound. 
I He says : " The primary cause of stuttering lies in 
I the defective action of the thoracic niuBclea ; the ■ 
[ secondary, ui the articulating muscles, which are 
I consecutively affect«d." 

Commentary. — Dr. Becqnerel's theory, though de- 
I fective, contains much that is true, wliich, under 
[■careful guidance, may be earned out in practice. 
r But it is a mistake to suppose that suclt a theory is 
universally applicable. Though, in many stutterers, 
the breath requires economising, it is unfrequent 
that such a quantity of imemployed air escapes as to 
mechanicaUy interfere with the action of the articu- 
lating oi^ns. It appears that Dr. Becquerel himself 
laboured under an impediment in speech, and he 



158 



THEOniES AND MODES OF TSEATMENT. 



accordingly placed himself imder Colombat. Aft-er 
undergoing a abort course of treatment, he was cited 
by Colombat as cured, and, in fact, waa pronounced 
cured by the commission which sat for the purpose of 
awarding the Monthyon prize, ■which Colombat ob- 
tained. The latter, according to his first account, cured 
Dr. Becquerel in eight days ; subsequently, however, a 
slight relapse occmTed, and he was cited as cured in 
fifteen days. But Dr. Becquerel, in this memoir, as- 
serts that he had been treated unsuccessfully for 
" twelve years" by the method of Colombat, but had 
been subsequently cured in " twelve days " by M. 
Jourdant. It is this method of Jourdant that our 
author has ampUfied and developed in this work. In 
a later work pubUshed by Dr. Violette, we learn that 
Dr. Becquerel had lost all liope of being cured, and 
admits that the method of Jourdant merely gives the 
stutterer the power of speaking well when he wills it ; 
but the habit can never be permanently acquired, and 
consequently the cure is never complete. 

Graves* says : " Stammering has been explained as 
depending on spasms of the muscles, which are em- 
ployed in modifying the column of air as it rushes 
through the narrow aperture of the glottis. At certain 
times, and under a vai-iety of circumstances, those fine 
muscular organs become spasmodically affected, the 
vocal cords no longer undergo the same steady and 
exact tension and relaxation, and speech becomes 
interrupted in consequence of frequently recurring 
closiu-e of the <;lotti3." 

• Clinical LectHrfe, edited by Dr. Neligiin. London, IB'IS. 



GRAVES. 159 

With respect to the cure of stutteriiit;, he aiys ; "■ I 
I have recently diaeovered a method hy wliich the 
P most inveterate stutterer may be enabled to obtain 
I iitt«raiice for hia words with tolerable fluency. It is 
simply by compelling him to direct hia attention to 
» Bome object, so as to remove it from the effort he 
I makes to speak. Ttnia, I direct him to hold a nile 
[ or a bit of stick in hia right hand, and with it to strike 
the foreiinger of the left, in regular time with the 
I words he ia uttering ; the eye must be fixed, and all 
tlie attention directed to the finger he ia striking, 
[ and the time must be strictly kept This method 
1 have tiied in several instances with complete suc- 
cess, and Dr. Neligan informs me that, since I first 
mentioned it to him, he has found it completely 
effectual in numerous cases. Although, of courae, 
when thus employed, this plan can only be regartled 
as a means of aifording temporary relief, I have no 
doubt, that if it were peraeveringly followed out with 
young persons who stammer, both in reading and 
speaking, it would cure them permanently of the un- 
pleasant affection. Its efficacy would seem to pi'ove 
that stammering is altogether a nervoua affection," 

Comtnentary. — With regard to the above discovery 
of " a method," it ia simply the old story of the sub- 
stitution of one trick for another. Dr. Graves, how- 
ever, fairly admits that it is only to be considered as 
I affording temporary relief. If it produced temporary 
I rehef, without seeming to more firmly engraft the 
defect into the system, tliere would be no harm in 
tida plan ; but all these tricks only tend to com- 



ICfl 



mEOMES AXD MODES OF TEEATMEST. 



plicate what is often a very simple misuse of one or 
more uf the organs of articulation ; and no "method" 
can be of any real benefit that does not remove this 
faulty action. 

Bacc. Med. Oxos.* says : " My belief ia that stam- 
mering originally arises from an infirmity in the 
motor nervous powtr; that there exists in some indi- 
viduals an idiosyncracy, amoimting probably to a too 
jitreat irritability or sensibility of fibre in that part of 
the brain or ganglia, as well as their efferent nerves, 
which control the motions requisite for speech, and 
that this peculiarity exposes it to be moat easily 
deranged, and driven into spasmodic adion by tht 
ordinary mental desire to sptak.^ I tliink it prob- 
able that in some cases of adults, the motor weakness 
may have really vanished, and yet stammering con- 
tmve frmn the force of habit and association, added 
to the excess of mental ajuyiety on Hie subject of 
speech." 

The author divides his treatment into physical and 
moraL Physical remedies are to be applied when 
tlie stuttering is continuous, while moral treatmait 
is best adapted to tlie intermittent kind. 

With regard to the physical means, be says : " I 
think it right for any stammerer to take advantage 
of any artifltiial means by which spasmodic utterance 
may lie warded off for the moment," These may be : 

" On Stammering and iti 'J'reatment, bj Bace. Med. Oxon. 
London, 1860. Ibis work ia ueDa'ly attributed to Dr. Monru. 
but it ia not known as o. certainty who wiia llie rvol uutLor. 

+ TUu Italics ar« iii the original. J. H. 



BA.CC. ICED. OXOK. 



161 



Dr. Arnott's remedy, or the stream of sound, omitting 
' obiiosiuus letters, keeping the mouth open, uttering 
' a slight gruiit before speaking, holding a linndker- 
\ chief before the mouth, imitating the voice of anothisr 
I -peraon, squeezing the back of a chair, adopting some 
I jusition of the body, etc., etc. About all these eon- 
; trivancea, he says : " Use them while they continue 
to be elficacioua, hut do not depend on them too 
much." 

His moral remedies are as follows : 

" 1. To reduce mental emotion by a daily, hourly, 

habit of abstracting the mind from the subject of 

stammering, both while speaking and at other times. 

" 2. Not to excite mental emotion by attempting 

F "mmecessarUy to read or speak, when the moral sense 

1 iiasurea any one of not being able to accomplish these 

I things without great distress. 

3. To elude mental emotion by taking advantage 
I of any little artifice to escape Irom stammering, su 
tUovg as the artifice continues to he a successful one, 
■$tnd not to listen to the observations of ignoraut 
■people on this head. 

"4. To strengthen physical power by any means 
Iwhich conduce to the general health."* 

Cummentan-i/. — It would thus appear tliat our 

* An apology is due to this able writer. la the previous 
editions of thia treatise the above suggestions were attributed 

' to Dr. W. B. Carpenter. I now find that Dr. Carpenter in the 
fifth edition of hlB Principlea of Huvnan Phyaiolegy, 1855, simply 
tranacribed and adopted them, without, however, the usual iu- 
dioations shewing thatthey are merel; quotations troai another 

I Kuthor. 



162 



THE0RIE9 AND MODES OF TREATMENT. 



author looks upon stammering (which word he uses 
synonymously with stuttering), rather as a psychical 
affection, which must be combated by psychical 
means. That there are some stutterers who are more 
free in their utterance when not thinking of their 
difficulty, or when their attention is, during speech, 
directed to another object, is very true ; and in such 
cases the act of abstracting the mind from the subject 
of stuttering might prove teneficial if the pupil had 
the power to do so ; but the difficulty consists in 
reducing such a theory to practice. Nothing is eaaier 
than to advise the patient to withdraw liis attention 
from his affiiction — nothing more difficult to the stut- 
terer than to effect it. 

To exercise a voluntary power over the direction of 
o\ir thoughts when we are, hj actual sensation, con- 
stantly reminded of our affliction, requires a mental 
effort which but few ai« capable of And if the caae 
be really merely psychical, and the patient have 
sufficient mastery over his mind, would it not he 
more rational to advise the patient to do just the 
reverse ; that is to say, to direct his attention to his 
affliction, and to overcome it by concentrated firm- 
ness of purpose ? 

Bishop* believes that the most common form of 
stuttering is produced when persons attempt to ai'- 
ticulate the desired sounds witliout putting the 
glottis into vibratory action. He says, "that it is 



• On Arliailate SoMtids, and the Causes and Cure for Imp*di- 
fnis in Speech. By John Bishop, F.E.S, London, 1851, 



BISHOP. — ASGZRMANN. 



16 



necessary to direct the patient to vocalise the breath 
80 as to utter a eontinuoua sound, as by singing u 
note in music." Mi-. Biahop seems to have arrived 
at this conclusion from the fact that stutterers do 
not generally hesitate in singing. One great object, 
he continues, is " to enable him to exercise a volun- 
tary control over the mental and vocal function 
simultaneously." As to the exciting cause of de- 
fective speech, Mr. Biahop says : " The most fre- 
quent cause of stammering is the imperfect education 
or training of the organs of articulation, and a de- 
ficiency in that sympathetic association which 
ought to subsist between the articulating and vocal 
organs," 

Commentary. — Mr. Bishop seems to lay much 
stress on the alleged fact, that there is no stuttering 
in singing. It wHl elsewhere be seen that I do not 
admit this as a constant fact, as I have met with 
persons "who did stutter in singing. Most stutterers 
know that they generally speak better in an aasiimed 
or chanting tone ; what they desire is to speak freely 
in a natural tone. 

Angermans * says : " The primary cause lies in 
the defective volition of the mind upon the organs 
of speech. The mind, the central organs, the nerves, 
and the muscles which set the speech organs into 
action, are disturbed in their mutual fimctions. This 
perturbance may originally proceed either from the 



f Heilimj. By Dr. P. 



1G4 



TUEOIilES AND MODES OF TREATMENT. 



mind, from the central organs, from the nerves, or, 
finally, from the muscles." 

He diatingiiishea tliree causes ; 

1. The mind is too excited to be the regulator of 
the speech organs, as in rage. 

2. The mind is too much turned inwards to he 
the regulator of the speech oigana, as in melancholy. 

3. The mind is not (juite clear in its volition, as 
in fright and confusion of sensations. 

With regard to the treatment, he aaja: "This is 
first directed to make the stutterer acquainted with 
the whole process of the formation of speech, with 
the fimetions of the different organs in the production 
of single sounds and in connected speech, so as to 
enable him by practical artifices to overcome his 
faults." 

Commmtary. — Dr. Angermann, as will he observed, 
looks upon stuttering rather as a psychical affection, 
and consequently requiring, so to speak, psychical 
remedies. He is one of those few authors who pro- 
perly discriminate between stammering and stutter- 
ing, and adapt the treatment accordingly. It ia in 
this that the chief value of this author's short treatise 
consists. 

EOMBEEG* places ischrtophania, or arrest of the 
voice, in his Class II, Neuroses of Motility, under the 
head of Vocal spasms. He says i " An interruption of 
the voice in pronouncing single sounds or syllables is 



moua DUecues of IHant Vol. I. 
y Ed. H. SicTBiing, M.D. 



Loudon, 1S63. TraUB- 




[ tflriiied slitlteriiiff. It generally occurs wlion a cou- 
1 aonaiit is combined with a vowel at the commence- 
I nieut or in the middle of a, word, soraetimea also 
' when an attempt is made to pronounce a single letter. 
The preceding sound or syllable is repeated in explo- 
sive sounds, untd the impediment has yielded. This 

ia not done where tlie sound is continuous The 

convulsive obstacle only oceura in sonorous speech ; 
there is no difficulty in articulating il' the individual 
Mnfinea himself to a whisper. It is this that essen- 
' tially distinguishes stuttering from stammering, wliich 
I consists in an inaptitude, an impediment to the arti- 
' culating movements, and with which it is frequently 
I confounded." 

Comvientaiy. — It will be seen elsewhere tliat I do 
not assent to the doctrine that there is no stuttering 
1 in whispering. I grant that several— perhaps most — 
Btutterei-s find a sensible amelioration of their infirmity, 
some even find no obstruction, when thus speaking. 
This shows that the evil is caused principally by 
the faulty association of vocalisation and articulation. 
But there are cases, by no means exceptional, in 
which respiration ia at fault; and these frequently 
stutter even when whispering. They may at first 
speak without interruption, from the novelty of tliia 
mode of speaking ; but if continued for any length 
of time, they invariably experience the same ditli- 
culty aa when spesiking in the ordinary manner. 
ElCH * says : " It is generally assumed that the 

•Die Beilung daa Stottcf-UebeU unit tatuHger Sprachfehler. 
By Dr. Eich. PeBth, 185a. 



116 THE0BIE8 AKD MODES OF TREATMENT, 

chief cause of thia evil is the more or leas abnormal 
physical quality and abnormal functions of the direct 
organs of speech. My experience has, nevertheless, 
shown me that in many, nay, in most stutterers, the 
oi^ns of speech open to examination are in a healthy 
state, though the infirmity was present in a high de- 
gree. The abnormal function of these oigans must, 
therefore, arise from other circumstances. In most 
of tliese cases, tlie infirmity dates from early cliild- 
hood. The tender infant, not yet exercised in speak- 
ing, finds it difficult to produce certain sounds ; it 
enunciates them in a faulty manner, and consequently 
all words in which they occur. With the advance of 
intelligence, or in consequence of admonitions, the 
child now makes efforts to articulate more correctly; 
but both the relaxed state of, and the excessive strain 
upon, the oigans of speech weaken them, and stutter- 
ing results. The defect must then be remedied ac- 
cording to the cause that has occasioned it. 

" If some persons cannot properly enunciate a word, 
it is not this particulai' word, but mostly a single 
sound which occurs in it. When, for instance, indi- 
vidual letters, such as k, r, t, z, cannot be pronounced 
correctly or fiuently, the patient cannot enunciate 
easily the words in wliich these consonants com- 
mence the words or occur repeatedly. We do not 
assert that the evil which has arisen in thia manner 
can be immediately removed by directing our atten- 
tion to the correct enimciation of the defective 
sounds, unless the treatment has commenced in 
early childhood, when the evil is confined to but a 



I 



EICH. I fi ( 

faults, and has not yet extendeJ to all the organs 
of speech. 

" If the stutterer has reached the second quinquen- 
nium, the abnormal functioua have already become 
so much subject to habit, that the treatment must 
then embrace all the sounds, aa well as those which 
are peculiarly difficidt 

" With regard to the question as to the origin of the 
abnormal functions of the organs of speech, a variety 
of causes may be enumerated. In some cases, ttie 
evil arises from malformations of all kinds in the 
organs of speech ; in otlier cases, from an abnonnal 
process of thought in the stutterer ; and in earliest 
childhood, from fright, anxiety, or mental weakness ; 
hut still more from tlie circumstance that parents 
force their children to pronounce words and phrases 
of which they have no notion, without giving them 
time to meditate on them. In all these cases, stutter- 
ing depends on abnormal functions, whatever may 
have been its cause. It is evident that for a rational 
and radical cure, the natiire of the evil and its cause 
must be known. The causes of the abnormal func- 
tion of the respiratory organs can be explained by 
the disordered function of the organs of speech, 

" The stutterer frequently eomplaius of a pressure 
upon the lungs, of a tightness about the chest ; and 
many assert that the stutterer attempts to speak 
during inspiration, in which he fails, so that he can- 
not pronounce a word. But, on strict examination, it 
is evident that no man can speak during inspiration. 
Every man effects the enunciation of words whilst the 



168 



THEORIES A.ND MODES OF TREATMENT. 



air escapes irom the lungs, "whicli is equally the case 
with the stutterer. That the respiratory process is in 
many stutterers abnormal cannot he denied, but we 
must not confound the form of the evil with the 
evil itself, or with its cause. Instead, therefore, 
of saying that stuttering arises from a wroug mode 
of respiration, it should be said abnormal respira- 
tion arises from stuttering, and this, again, irom 
abnormal functions of the direct oigans of speech. 
The truth of this assertion ia easily ascertained, in 
observing a stutterer at the moment he attempts to 
speak, and fails. He sets in motion all organs of 
speech, yet tlie intended word is not produced. 
During this effort, his breath ia stopped, and he feels 
pressure, either from the lun^ being empty, or from 
their being filled with air. He then either gasps 
for air, or endeavours to expel it : in the latter 
case, he usually succeeds in enunciating some word. 
The disturbed respiration causes in these cases con- 
tortion of the facial muscles and other morbid affec- 
tions." 

He continues; "After what baa been said, it is 
evident that stuttering arises from a variety of causes, 
rather psychical than physical, and that a correct 
diagnosis in regard to their mental and bodily rela- 
tions requires a sound knowledge of anatomy and 
psychology, without which all treatment would be 
groping in the dark Hence it may he also explEiined 
why the evil cannot be cured by one pharmaceutic 
remedy, one surgical operation, or one method of 
instruction ; but that the number of existing means 



EicH. ir,o 

of cure must be adapted and correspond to indhidual 
caseB and tbeii' causea. 

" This can only be efiected in the best and surest 
manner in institutions devoted to this special object, 
where the pupil passes moat of hia time under the 
personal auperintehdenee of his teacher, and wliere 
the corresponding means, which must be daily 
changed according to the diminution of the evil, 
are daily applied." 

Co'rmM'niary. — The above remarks show that Dr. 
Eich has had some personal acquaintance with stut- 
terers. Hia opinions, on the whole, are sound and 
judicious. Dr. Eich seems, however, to have fallen 
into a rather common error in hia supposition that 
it is impossible to speak during inspiration. The 
inspiratory voice is but rarely used ; but atill it is 
employed, and may frequently be detected by its 
being about an octave higher than the ordinary 
voice. The first part of the cry of the donkey 
ia inspiratory, and ventriloquists occaaiunally speak 
during inspiration. With this exception, Dr- Eich'a 
remarks are valuable. His pamphlet, though con- 
taining nothing new, is written with common sense, 
— rather an uncommon thing with very many writers 
on this defect. 

Leubuscheb* says : " The spasmodic afi'ections of 
the organs of speech occur in the tracts of the hypo- 
glossus, the facial and accessory nerves, whereby the 



Haiidbuch der JIfedtcti 
ProfeBsoi of Pathologf, ii 



iscften KUnik. Bj Dr. LtubuB';be 
the UniTaisitf of Jena. Leipzig, 



170 



THEORIES ASD MODES OF TEEATMEST. 



tongne, the lips, and the pakte are drawn into abnoimal 
motions, producing stuttering. We must not con- 
fonud this with stammering, in which the sound is 
imperfectly produced in consequence of the motion 
of the tongue being imperfect, either on account of 
some mechanical obstruction or imperfect inner\-a- 
tion. Stutterers have, in most cases, only to overcome 
the first impediment — that is, to direct the stream of 
innervation into the right channel. There are seen 
tremulous motions of the lips and the tongue ; the 
pharynx and the glottis are spasmodically constricted; 
there are convulsions of the facial muscles ; then issue 
some words or sentences, until some syllable or words 
present an obstacle, when the subject stops short, and 
repeats the same process. The embarrassment of the 
patient increases his irritabiUty 

"The cause of stuttering may be in the brain; is 
frequently psychical, and the peripheral affection 
which certainly may, in some cases, be the primary 
cause, does not generally constitute the affection. 
The main remedy is methodical gt/mnastics, which 
regvlate innervation — a method which is successfitUy 
applied hy special practitioTters." 

CommeniaTy. — ^The reader will not have &iled to 
observe how, nearly every year, clearer and more cor- 
rect views are entert.ained of the nature of stutteriug 
by difi'erent writers. It is now not only special prac- 
titioners who liave embraced sounder views, but we 
find tliat, throughout the whole of Europe, writers on 
physiology and patholi^y are more or less deserting 
the old track, and adopting the views of those who 



S03ENTHAI-. 171 

I oonteucled that nature, and not medicine, or sui^erj", 
I can alone be calltid upon to remedy this defect. 

Rosenthal* says ; " In weakly children with flat 
chests, the respiratory muscles are frequently but 
faintly developed. The respiratory motions become 
unequal and interrupted, and so the requisite quan- 
tity of expiratory air is -not furnished. If once this 
I has become a habit, the disharmony in the respirn- 
I tion grows worse, and the influence of the will upon 
the respiratory process becomes fainter. 

" Thus it comes to pass that in stutterers who have 
become habituated to short and unequal expirations, 
the greater portion of the air in the thorax ia, under 
any psychical excitement, uselessly lost before it can 
be expended in the formation of words. Now, instead 
of supplying the lost air by a deep inspiration, the 
I stutterer, in his anxiety, tries to assist the interrupted 
expiration by drawing in his abdomen. But during 
this pressure, by means of the abdominal muscles, the 
I larynx is closed, the arytienoid cartilages approach 
each other, and the vocal chords are nearly in con- 

I tact Many other muscles are contracted, the con- 

I vex cushion of the epiglottis is pressed upon the 
I lajynx, the tongue remains fixed to the hard palate, 
the pharynx ia narrow and rigid, its communication 
with the bucccd and nasal cavities interfered with ; 
■ the expiratory current finds, therefore, no exit, and 
the articulation is rendered difficult, if not impos- 
sible." 



172 



THE0RIE8 ASD MODES OF TEBATMEST. 



Corrmteniary. — The above theory of Dr. Rosenthal 
no doabt holds true in some casea, but his observa- 
tions apply almost exclusively to one case, and it was 
for this ease, that had been recommended to his care, 
that he applied himself to the study of the literature of 
stuttering. He accordingly adopted, with some mo- 
difications, the rhythmical method of Colombat ; and 
he appears to have cured his pupil by the constant 
apphcation of rhythm. However, he does not assert 
that he had seen him after he was dismissed as cured. 
He further says that he was aided in this case by the 
',^KsX perseverance of the pupd, and that he did not 
arrive at the same result when treating a cliild aged 
nine, on account of the want of energy and perse- 
verance. 

Wolff,* who formerly advocated the use of the 
knife in some caaes of Psellismua, by a division of 
the nervus hypogloasus, has more recently puhhahed 
his present ideas on this subject He now says that 
" stuttering is no disease, but a morbid disposition, or 
an abnormal action of the organs of voice and speech. 
The cause of stuttering may either be in the nerrea 
which govern the respective organs, or in the oi^ana 
themselves ; thus the partisans of either doctrine 
are right, but it is only on close examination of each 
particular case that we can determine the original 
cause." He now heheves " that in stuttering we 
may, in most cases, obtain a cure without operation. 



.B Beiiutig, By Dr. Philippe Heinrioh 



WOI.FF. 173 

. Ill stuttering no deformity is generally percept- 
ible . . , The more material the disease, the more 
material the treatment. Whether the cause of psel- 
lismus Vie in the nerves, or in the oi^na themselves, 
may soon l>e discovered by au attentive experienced 
person, provided he be fully acquainted with the 
physiology of voice and speech, for that is absolutely 
requisite to give a just opinion on abnormal action.'' 
Dr. Wolff contends that there are three species of 
stuttering : first, that afi'ecting the respiratory oryana ; 
second, the vocal oi^ns ; and third, the articulating 
oi^na. The last species, he says, has five sub-divi- 
aions. He fiMher observes, " In such cases, which 
resist all other treatment, I should nevertheless not 
hesitate to try the operation indicated by me, namely. 
the division of the nervus hj-poglossua instead of the 
section of the tongue. I must, however, coufess I 
have not met with such cases," There is little further 
worth mentioning, except that the author seems to 
advise the trial of a little of everything. 

Commtniary. — Dr. Wolff says the sncceaa of the 
gymnastic orthophonic treatment is undeniable ; but 
nevertheless he seems inclined to recommend the 
trial, as adjuvants, of half the drugs iu the pharma- 
copceia. Our author appears to know just enough of 
the subject to mystify liiraself as well as his readers. 
There are, no doubt, some afTections of the voice for 
wliich Dr. Wolff's treatment woidd be beneficial, 
but beyond this his brochure does not indicate thf 
I slightest advance on the opinions which were in 
vogue in the year 1700, and publicly expressed liy 



174 



THEORIES AND MODES OF TREATMEST. 



Amman. He only seems to have treated two cases of 
stuttering, and he says that in the second case he 
merely succeeded in enabling the subject to read or 
speak before persons known to him, but that he could 
not speak to strangers. That is very eaaUy done in 
most cases ; but it would be most unfortunate for 
society if this were the only benefit that eould be 
rendered. Very many of my pupils, when they first 
come to me, are always able to talk to their friends, 
and it is just tlie power to speak to strangers that 
they desire. 

VlOLETTE* says, " Stuttering is a complex affection ; 
but there is only one cause which resides in the brain 
acting on any of the organs concerned in the pro- 
duction of speech. Hence it results that in some, 
the respiratory organs act inordinately; in others, 
the muscles of the pliarynx, larjmx, etc,, interi'ere 
with speech by their abnormal contractions ; in others, 
finally, the functions of the buccal organs are in fault." 
With regard to his method. Dr. Violette says, that it 
consists entirely in vocal gymnastics, and specially in 
gesticulation. He also observes that treatment in 
classes generally succeeds best, as stutterers are then 
not afraid of making use of certain artifices apt to 
regulate their mode of expression. He adds, "one 
of the most important conditions to effect a cure con- 
sists in the frequency of the visite of the teacher to 
the stutterer." 

Commentary. — Dr. Violette'a mode of treatment is 



" Etvtda <«r la Parole et aes Drfavts. Paris, 1 



TTOLFITE. — BECLA.RD. 



175 



almost entirely founded on that of Prof. Serres d'Alais, 
to whom, indeed, the work ia dedicated. But whilst 
Serres and others recommend that gesticulation and 
enunciation should he concomitant, our author lays 
it down as a principle " that every stutterer shoidd 
gesticulate first and pronounce afterwai-ds." This is 
about the only claim for novelty of treatment made 
by the author, and must he taken for what it ia worth. 

As regards the frequency of the visits of the teacher 
to the stutterer, it is entirely a mistake to suppose 
that the stutterer can hope to he cured in this way. 
As the reader wdl see, in other parts of this work, the 
residence of the stutterer in the institution of his 
instructor is, in the generality of cases, an indispens- 
able condition of success, 

EicLARD,* in the last edition of his Physiology, 
devotes the foUowuig short paragraph to stuttering. 

"Every one knows that this imperfection of the 
pronunciation consists in a particular difficulty in arti- 
cidating certain consonants. Hence result stoppages, 
followed by explosions of sounds. This difficulty 
occurs sometimes at this, at other times at that con- 
sonant The affection, moreover, is not constant, but 
manifests itself in special moral conditions. The real 
seat of stuttering is not in the muscles of the tongue, 
but in the nervous system, which sets them in motion. 
The section of the muscles of the tongue which some 
surgeons have appUed to the cure of stuttering may 
indeed induce paralysis of some portions of that or- 



• Phytiologie Humome. By J, Beclard. Paris, 1962. 



176 



THEORIES AKD MODES OF TSBATUENT. 



gau by the section of the respective nerves, but will 
not restore to the stutterer the articulation of sounds." 

KLESCKE"f- says, " in stuttering it ia the expiratory 
current which is obstructed ; for momenta it ia not 
developed at all, so that the will is not the master of 
the organs. The harmony between the volition and 
the respiratory system ia wanting, and as the arti- 
culating organs are in action, but the vocal organs 
impeded, the harmony hetween the organs of vocalis- 
ation and articulation, so requisite for speech, ia 
absent. 

1. " The object of the teacher should, therefore, be 
directed to the following points : he must not lose 
sight of his pupil, tut must as frequently as possible 
be with him, to ser\'e as a mental and moral lever. 
Stutterers are either of a sanguine temperament, and 
in early youth careless about their infirmity, nor 
have they the firmness to direct their attention to the 
faults they commit ; or, especially when they have 
stuttered for a long time, they are of a retiring con- 
templative mood. Tlie mind has then acquired a 
relaxed type without any elasticity. I have, there- 
fore, never seen a patient cured where there has not 
been some psychical preparation. We must acquire 
the confidence of the pupil, draw his attention to his 
faults ; but we need not present to him the cure as 
verj- difficult, otherwise we should discourage him . 
His mind must be roused. Biit as the mind is inti- 



- wtd SprocfiorjiHw 



niately connected with the physical organism, it must 

be our endeavour to act on the mind hy the organisn;i. 

2. "The respiratory organs must be systematically 



Thus wrote this author in 1844 ; but an experience 
of twenty years induced hira to modify his primary 
views, as will be seen in the subjoined extracts from 
his recent work.* 

" In medical subjects every theory is usually more 
or less artificial and complicated ; it establishes much 
more than may be useful in practice. How compli- 
cated and circimistantial was not the formerly re- 
commended treatment of stuttering, founded upon 
imperfect experience, and how have I not bothered 
myself with ajrpareTitly important, but in reality 
Irifiing, phenomena ! My experience during the last 
fifteen years has proved to me that with theories we 
effect nothing in stuttering; that we must observe 
•many stutter cases, must compare the natural pheno- 
mena, and must treat defects of speech as undeveloped 
capacity, in which we have to remove the cause and 
to regulate the nervous system by psychical power- 

But as every practitioner finds out that, with 

all Ills theory, he frequently is quite helpless at the 
lied of the patient, and gradually perceives that he 
must adopt some empirical method ; so it is with the 
physician who is about to treat stuttering according 
to his scientific theory. I have as yet seen no stut- 
terer who has been cured by a scientific treatment 



178 



THEORIES AND MODES OF TREATMENT. 



according to causal indicatinns, An individual, for 
inatftnce, is treated for spinal irritation, or some other 
central or peripheral disorder: he still stutters as 
hefore ; what have all medicaments and operations 
effected ? Nolhitig as far as I know. And of what 
use to the stutterer ia the improvement in his nervous 
system, so long as he has not learned the technics of 
speojcing? Would it ever occur to a physician to 
make a man a singer by drugs, without any instruc- 
tion in singing ? I also doubt whether a physician 
can inmiediately form a correct estimate of the causes 
of stuttering, aud treat it therapeutically, by looking 
upon the sufferer merely as a patient, that is, by see- 
ing him once a-day, and prescribing for him. , . The 
reUef we have a right to expect is, not the cure of 
stuttering, but merely the removal of the predisposing 
causes, which conditioned stuttering either directly 
or indirectly. The stuttering itself will always re- 
quire a special didactic treatment, in order to alter 
the condition of the respective oi^ns, and to develop 
their acquired freedom by practical activity. "When- 
ever a decided medical treatment of the general 
system was requisite, I always acted in concert with 
such physicians as previously knew the patient or 
such as attended at my institution, . , We must 
not imagine that we can treat nervous stuttering, 
whether it be erethic or paralytic, by drugs, which, 
like nitrate of silver, strychnine, etc., produce a 
known effect upon the nervous system. I am not 
aware that they have been of any use in such cases. 
They may in particular indications serve to alter ab- 



17!) 



uonnal functions, but can only in some few favour- 
able cases be useful as a preparatory cure for the 
treatment of stuttering. I have noticed that nervous 
irritation which favours stuttering can ouly be con- 
(^uered by attention to diet, and by the restoration of 
the noiinal functiou of the irritable oi^ns. . . I have, 
averse aa I am to the employment of drugs, especially 
with scrofulous and debilitated individuals, arrived 
at the conviction that a proper diet mostly suffices to 
improve the mu.^cular and nervous system. Where 
the nutritive functions were oppi^ssed by the pre- 
dominance of an instable nervous system, a corre- 
sponding alimentation was effective ; where great 
senaibihty disturbed the normal harmony of the 
functions, a regular regimen, combined with mus- 
cular activity, proved very advantageous. When a 
weakly organic Ufe manifested itself by a particular 
indolence and mental weakness, approaching some- 
times the character of cretinism, a methodical excita- 
tion of mental activity proved an adjuvant in the 
cure of stuttering. The mental condition plays, espe- 
cially in adults, an important part in the treatment 
of stuttering. Tlie endeavour and ambition to get 
rid of an evil which leads ta ridicule, exercise a 
beneiiciai influence upon adult stutterers, provided 
we know how to make use of these feelings. In such 
cases I always present to the stutterer his evil as 
specially a mental one, which may be conquered by 
hia Jinn will. He now du-ects his attention to him- 
self, he is vexed at hia stuttering, looking at it as a 
weakness of the will, and by doing so he au]iporta me 



THEORIES /JtD HODES OF TBCATVESX 

niucb in his treatmeDt. ThiB finnness of the will is 
a powerful regulator of the nervous system, it forces 
irregular innervation into the normal channels. I, 
therefore, endeavour in all stutterers to rouse this 
finaneaa of the will and to keep it in constant 
action 

" The physical exercise is to become a mental act. 
In the same way as the child learns to apeak, so will 
the stutterer, in many respects comparable to a. deaf- 
mute, learn to place Ms language under the judgment 
and dominion of the ear 

" I have myself, many years ago, thought that a 
physical ajfeech-practice was sufficient to cure stut- 
tering; experience has taught me better 

" I then learned that this method was not a natural 
method; that a child does not learn to speak by 
being exercised in individual conaonanta, but that 
from the very beginniiiq he learns by the ear and the 
mind to imitate and to develope speech as an ex- 
pression of thought and feeling 

" How the brain or the spinal cord is primarily or 
secondarily concerned, I cannot cleariy say, and it is, 
therefore, better that I pass it over than to increase 
the number of suppoaitive theories. As regards the 
practical treatment of stuttering, it is enough for us 
to know that some general disorder has altered tlie 
nervous and mnscular life." 

Co7Rmentary. — It cannot be but gratifying to my- 
self to find that the results arrived at by Dr, Xlencke, 
after twenty years practice, are nearly identical with 
the leading riews promulgated by my late father and 



KLENCKK — eCHULZ. 



181 



myself for maoy years past. At the beginning of 
his practice, Dr. Klenoke mRde use of a variety of 
instruments tlieo in vogue, so repeatedly denounced 
by me in former treatises. At present Dr. Kleiicke 
has relinquished them altogether, and adopted that 
■natural method long since insisted upon and prac- 
tised by my late father and myself. But whilst 
^;reeing with this author's general opinions respect- 
ing the nature and treatment of stuttering, I difl'er 
from him as regards both hia classification and specific 
treatment of the various kinds of stuttering. There 
are some inconaiateneies in Dr. Klencke's work, which 
it would be ungracious to dwell upon, cordially agree- 
ing, as I do, in moat of the able author's conclusions. 
SuHULZ,* after reviewing the various methods pro- 
posed for the cure of stuttering, arrived at the follow- 
ing conclusions ; — 

1 . Stuttering properly so called, in which no organic 
defects are perceptible in the articulating organs, has 
its seat in an augmented excito-raotory action, or 
predominating influence of the spinal cord upon the 
respiratory and articulating muscles. 

2. The treatment of stuttering must begin with 
diminishing this predominating action of the spinal 
cord, and thus to obviate the peripheral or central 
stimuli. We must treat each case according to cir- 
cunistancea. 

3. The influence of the brain or the will upon the 
respective muscles must be strengthened. 



182 



THEORIES ASD MODES OF TREATMENT. 



4. Finally, we must by gymnastica and great per- 
severance overcome the stuttering which has become 
habitual 

Comm-eniary.^—The views of Dr. Schulz are nearly 
identical with those expressed twenty years ago by 
Lichtinger and other writers, and present no new 



Chekvik* contends that the cause of stuttering 
has its seat in the brain, and in some of its agents. 
" In point of fact," he says, " speech has its souree 
in the irradiation parting from this centre, and trans- 
mitted by tlie cerebral nerves to the muscles; the 
ijrganic or voluntary movements concur in the pro- 
duction of sound caUed voice, or in the modifications 
of the sound called speecli. K then the cerebral 
irradiation gushes out iiTegularly either too slowly or 
too rapidly ; without continuity ; without energy or " 
precision, from a sluggish inteUigence ; if in this 
vehicle of intelligence there prevail certain perturb- 
ations, then the organs of speech present an anomaly 

which is the reflex of perturbation Stuttering 

resides either in the brain itself or in certain cerebral 
organs, or simultaneously in both. In the act of 
speaking, the brain commands ; respiration, the glottis, 
the tongue, and the lips obey. K the order is vague, 
undecided, the vocal organs want harmony in execu- 
tion, and speech will be hesitating, jerking, and diffi- 
cult." 

He says that in the treatment " we must pay mora 

a da PrononaaliiMt B; 



CHEBTIN. — ^MARSHALL. 



183 



Bttention to the moral state of the pupil than to his 
physical condition," and he strongly insists that a 
firm will is indispensable to success. Speaking of 
the methods of his jjredecessors he asserts that he 
has tried them each separately, and that " all of them 
after more or less time have yielded satisfactoiy re- 
sults." He therefore affirms that the whole secret 
lies in the application of the procedures. 

Contmentary.—M. Cheri-in may be, and no doubt 
is, a very excellent schoolmaster, and a good teacher 
of elocution ; but being neither a physiologist nor a 
psychologist, he tabes the theory and practice in re- 
lation to speech impedimenta from his predecessors. 
He, in fact, admits that there is nothing original in 
his system, that he uses all the remedies previously 
employed ; but he claims great skill in their applica- 
tion, — a claim which cannot easily be refuted, 

Marshall* says a few words on defective speech : 
" Imperfections of speech, such as liaping, sCam^meriiig, 
or stuttering, are due to errors in the action of the 
organs of speech. Stanamering is almost always caused 
by some irregular action of the nervous centres, and 
is chiefly produced by temporary spasm of tlie glottis, 
associated with embarrassment iu other part^ con- 
cerned in articulation. It may originate in nervous- 
ness or fright, and sometimes in imitation or affecta- 
tion. By patient and per.severing practice, founded 
on an accurate perception of the erroneous movement* 



•s of Phytiotasy, p. 26S. By Jylin Maraholl Londpn, 



18^ 



THEOKEEa AND MODES OF TRIATMENT. 



and their correct substitutes, or by the recovery of 
self-confidence, these imperfectioiia may generally be 
remedied." 

Commentary. — It will be seen from the above ex- 
tract that Professor Marshall uses the terms stutter- 
ing and stammering synonymously, an error which 
haa taken too deep a root in the minds of English 
writers to be easily eradicated. With this exception 
his remarks, though few, are so much to the purpose, 
that it is to be regretted that more space waa not 
dedicated to this subject, for it certainly requires 
more than a passing remark from physiolc^sts. 

Lefiwesb* says that the etiology of stuttering con- 
sists — 1. In an improper function of the respiratory 
oi^na : 2. In anomalies of individual muscles of the 
speech oi^ns, e.g., of the larynx, pharynx, tongue, 
and mouth, the modifications of the attached tube of 
the speech apparatus, by which anomalies the action 
of the will on the muscles is disturbed ; 3. In an 
abnormal psychical condition or dynamic conflict be- 
tween the will and speech movements. 

The whole of his treatment consists in rhythmical 
exercises, which, he says, remove all the efScieiit 
causes of stuttering. 

Commentary. — We were unable to find in this trea- 
tise any original views. The author simply adopts 
the current opinions touching the etiology of stutter- 
ing, and falls into the common error of considering 



LEHWESS, — WTNEKEN, 



18.1 



rhythm to be a panacea for all sorta of speech im- 
pediments. 

Wyseken* considers stuttering as a neurosis. He 
agrees with Schulthesa, that the chief seat of stutter- 
ing is in the larynx ; and as there are no anatomical 
alterations, he considers stuttering, not as an organic, 
but as a functional affection. 

He says : " As it is one of the chief characters of 
neurosis that in the absence of any organic lesion 
we observe a functional vice, the greater or lesser 
manifestation of which and its disappearance depend 
in many neuroses upon the psychical condition of the 
patient, we cannot do otherwise than consider stut- 
tering as belonging to the class of neuroses. If we 
attribute the fault to some individual nerves which 
are withdrawn from the inHuence of the will, we 
might name the vagus or some other respiratory 
nerves." 

" Concerning the essential agent of stuttering, he 
expresses himself as follows : Stuttering consists in a 
temporary inability, conditioned by various influences, 
to impart to the vocal ligaments the proper d^;ree 
of tension for the production of vocal sotmds, wliich 
allows the expiratory air current to pass through 
the glottis without causing the vocal ligaments to 



" If I can trust to my own impressions," be con- 
tinues (he was himself a stutterer), "and observations 



1S6 



THWIBIES AND MOD» OF TREiTMENT. 



in fonmng an opinirin, I Bhonld assign to defectiTe 
inflnence of ihe will the proximate psychical cause 
of stuttering. 

"Why individual muscles are witlidrawn from the 
influence of the will cannot easily be explained, as 
we know bo very little of the meclianical action of 
the will ufxm the nervous filaments...... 

" If I attempted to give an explanation, 1 should 
say that in the stutterer the will as regards the 
muscles of speech is more or less intetfered with hy 
doubt." 

Wynefcen tlien ppoceeda to the description of hia 
method, which, he says, he learnt during three yeais 
residence at the institute of Hen- Katenkamp, Del- 
menhorst. The pupil, he says, while under treatment 
must observe the strictest silence, which is of great 
importance, " inasmuch as the stutterer is thus pre- 
vented from losing his faith in the method." TMs 
" faith" seems to be the main object of Wyneken's 
method, for he further says, " we must deprive the 
stutterer of his doubts and replace it by conviction, 
that is to aay, by faitli in his capacity to do every- 
thing. If once we succeed in convincing the stutterer 
of the certainty of a method, he will speak well so 
long as he believes it." He continues; "Nothing 
is here to lie done by precepts. The cure of stut- 
tering requires, in my opinion, the full devotion 
of the stutterer; his whole mind must be directed 
to the cure of tliis evil, and he must certainly be 
under supervision. The treatment is best effected in 
an inatitution." He advises the exercise of respira- 



187 

tdon, of voice, aud of speech, subjected to rhythmical 

i, time-beating. The piipd is theu sent on messages 
or commissions to speak with strangers ; if he suc- 
ceeds, and after continiung the rhythmical speech for 
some months, he is dismissed as cured. But, he adds, 
that "few are permanently cured, and most suffer 
from a relapse, and the stuttering sometimes becomes 

, TForae than it was before." 

Commentary. — Dr. Wyneken's contribution is so 
far interesting as it is entirely practical, and gives an 
account of the system pursued in a noted establish- 
ment for the cure of speech -impediments. He is, 
unfortunately, another instance of an uncured stut- 

, t«rer, and consequently we cannot he surprised at his 
opinion that pennanent cures of stuttering are very 

, pare. 

H0LME8 COOTE* says : " Stammering proceeds from 
timidity; from want of familiarity with the con- 
struction of sentences ; from some temporary defect 

I of the tongue. It may be cured by patient instruc- 
tion, aided by time." But " stuttering implies a want 

I of power to co-ordinate action ; and I fear we must 
c its source in the seusorium. "Wlien the word is 

I .applied to limbs or oi^us we must refer to the spinal 

r cord." For the cure of stutt-ering he recommends the 
patient to litter some easy sound, and then to speak 
slowly and distinctly, and to desist from speaking 
until the spasm has passed away. " By the study of 
language a greater command of words will be obtained, 

n SMteriitg and. Stammermg. — 



188 THKOBIES \SD MODES OF TBEATMEST. 

and by this a coiresponding advantage of selection 
in the means of expression will be gained." 

Commtnlanj, — I have much pleasure in addii^ the 
name of Mr. Holmes Coote to the list of authors on 
defective speech, as it affords pleasing evidence that 
the confosion, hitherto existing in this country, re- 
specting the words Stanunering and Stuttering, bids 
fair to be removed by the teachings of such men as 
our author. 

Oue and GinLLAOME. — I shall conclude this peri- 
scope of the literature of Psellism by noticing two 
recent articles on this subject, which specially desen'e 
attention, inasmuch as they are intended for permanent 
references in two standard works. 

The article " B4gaie-r>ient" in the Nouveau Dktionr- 
naire,' bears the signature of Dr. Or^ of Bordeaux, 
and that in the DictionTtaire £ncj/dapMique-f- is by 
Dr. A. Guillaume of Paris. 

I may state at once that the respective authors 
arrive in the main point at opposite conclusions. 
Dr. Or^ theoretically approves of surgical opera- 
tions, while Dr. Guillaume rejects them on every 
ground. Fundamentally Dr. Or4's theory is founded 
upon that of Dr. Bonnet of Lyon. He agrees with 
the latter in considering that although the primary 
cause of stuttering must be sought for in the nervous 
system, yet this primary cause having disappeared, 

• Nowvtau IWeHonnaire de Midnine et da Chirurgie Pratiqnei. 
Paris, IRGB. 
t Dictianywuri Encj/clopSdique des Sdtncet Uddicalet. Fans, 



ob£ and guillaume. 189 

Btiittering hecomea localised, and must be treated 
accordingly. And as this local affection has chiefly 
its seat in the abnormal contraction of the genio- 
gloasi, or in the structure of the frsinulum, he advises 
the section of these parta according to the diagnosis. 
As I do not find that Dr. Ot6 speaks from personal 
experience, much importance cannot be attached to 
mere theoretical aasumptiona. Dr. Ore's article is 
short and meagre, and almost exclusively devoted to 
surgical operations for the cure of stuttering, a pro- 
cedure we thought long ago exploded. 

With reference to Dr. Giiillaume's treatise, I feel 
bound to speak of it at some length, both on account 
of its merit, and because he himself" suffers or suffered 
from an impediment of speech, and ranks, there- 
fore, in this respect witli Drs. Astri^, Serres, Voisui, 
Becquerel, Ch^goin, Warren, Merkel, Wyneken, etc. ; 
all of whom have been led to write on tliis subject 
chiefly because they themselves were thug afflicted. 

Dr. Guillaume, I have already stated, is altogether 
opposed to operations, and he recommends, accord- 
ingly, the didactic method in a long and elaborate 
essay. 

Guillaume defines stuttering to be a vice of pro- 
nunciation, with an irregular intermittent type, chiefly 
characterised by the two following symptoms : I. Con- 
vulsive repetition of the same syllable ; 2. Convulsive 
stoppage before this or that syllable, the stoppage 
chiefly taking place at the beginning of a phrase. 

The infirmity is owing to defective association in 
the action of the muscles, the concurrence of which J 



190 



THEORIES AND MODES OF TREATMENT. 



is necessary for pronimciation. Tlie cause of this 
disorder resides evidently in the apparatus which 
co-ordinates tlie contractility of the above muscles. 
But admitting that the co-ordinating principle of the 
movements of speech resides in the anterior lobes, 
our author leaves it to more enidite physiologists and 
pathologist-e to determine the spot. 

Dr. Guillaume remarks: "The sole difference be- 
tween loud speech and whispering (pavoh ti voic 
hasse) consists in the number and amplitude of the 
vibrations. In whispering the vocal cords do not, 
however, reach the amplitude and the number of 
vibrations retjuisite for the emission of the least in- 
tense and gravest tone of loud speech. It is, there- 
fore, false to say that tlie laiynx does not intervene 
ui aphonons speech; — the laryngoscope proves the 
contrary." 

This fact forms the basis for utilising in the treat- 
ment of stuttering exercises d voix basse. 

I agree with Guillaume that in aphouous speech 
the vocal ligaments are, probably, in some state of 
tension, and, possibly, of vibration. I, moreover, 
believe, as I have long since stated elsewhere, that 
this may be the ease even in (if we may so call it) 
thought-speaking, or thought-singing, but I dissent 
from him in his assumption that the larynx is always 
concerned in aphonons speech. Numbers of cases 
are on record, shewing that aphouous speech may 
take place despite an occlusion of the larynx. In 
short, articulate speech may be said to be indepen- 
dent of the laiynx ; and hence we can whisper both 



ORE AND OTJILLAUMB. 



191 



during inspiration aud expiration, wliilat loud speuk- 
ing during inspiration is much more difficult, and 
much leas distinct. 1 shaR only quote one case 
of tliia kind, which Dr. Guillanme should have 
known, as it is cited by M. Boui^et,* and is again 
referred to fay M. E^elard in the last edition of his 
Physiology. 

A man, intending to commit suicide, cut his throat. 
The surgeon introduced a canula into the trachea to 
keep up respiration. The patient did not lose his 
power of speech. When he wished to express his 
desires, he performed some particular movement with 
hia cheeks to gather the external air, as none passed 
through the vocal tube, and his tongue, lips, and 
mouth entered into energetic action, and he spoke 
distinctly both during inspiration and expiration, 
and without interruption, as in fact his articulating 
organs had for the time no connexion with his vocal 
apparatus. 

"With reference to the improvements which Dr. 
Guillaume claims to have introduced in the treatment 
of stuttering, they consist, by his own showing, chiefly 
in more developed lip-gymnastics, and, specially, in 
the recommendation of whispering exercises. I know 
from experience that these latter may, for various 
reasons, into wliich I cannot here enter, be very use- 
fid ; nor can the lip-gymnastics do any harm, although 
I am far from attaching such importance to them as 
our author does. 



iy2 THEORIES AXD MODES OF TKEATME>"T. 

On the whole. Dr. Guillaume s essav is a verv 
Taluable contribution to the liteiatuie of Psellism. 
As a periscope, it is veiy defective ; for whOst it is 
exhaustive as i^aids French authors, it ignores with 
but trifling exceptions most that has been done in 
this field of inquiry by foreign writers. 



CHAPTER VT. 

STAMMKnrao; rrs causes axd TARirrrES. 



Chief CanflBS of Stammering^. — I. PaycJiieal Siammerijig ; 1 . Ser- 
nionia tiimultua. — Baryloquula. — II. Speech Sinmnimnj .- 
I. Lftlltttio,— 2. BlfflBitas einoUiena.— 3. Blfflsitas jadnraiiB.— 
4. QammaoiamiiB.—S. lotAcismuB. — S. Bhinopbouin. — T.UniTli- 
Boophonia.— III. Min^yr Defects : 1, Rliotaoiamna.— 2. I.ambda- 
fiiamuB. — 3. Si gniatiBmua.— Negro. — Polynesian. — Enaaian. — 
Stuinmerinif of Forai^nera. 

The causes of stammering in general are either in- 
trinsic, extrinsic, or functional. 

The chief intrinsic causes are morbid affections of 
any part of the vocal or articulating apparatus. When 
the organs of speech are in a normal condition, but 
are impeded in their action by mai'ked affections of 
the parts situated outside the vocal and articulating 
apparatus, the causes are said to be extrinsic. Finally, 
the causes are functional, when the impediment is 
merely the result of habit, imitation, or affectation. 

Chief Intrinsic Cavses of Stammeritig. — Among the 
intrinsic causes may be enumerated : defects of the 
lips, which may be too short, too thick, too rigid, too 



194 STAMMERING: ITS CAUSES ASD VARIETIES, 



distant from the teeth, or hare-lip; want, or defective 
position, of the teeth ; disproportionate size of the lower 
Jaw ; stiffness, or approximation of the same ; aper- 
tures or fissures in the hard or soft palate ; ahnornml 
length, thickness, or absence either of the velum or of 
the u^Tila ; nasal cavities constricted or obstructed by 
jwlypi, inflammation, cold in the head ; inflammation 
or enlargement of the tonsils ; excessive or defective 
length, breadth, thickness, or laxity of the tongue ; 
loss of the whole or part of the same by cancerous 
diseases ; abnormal fixture of the tongue to the 
iiienum ; tumours on the tongue or in the buccal 
cavity, etc. 

Extrinsic causes. — Paralysis; spasms of the organs 
of speech, produced by local or general affections of 
the nervous system, general debility, intoxication, 
congestion, the cold stage of fever, loss of blood, nar- 
cotics, etc. ; — all these may, by deranging the action 
of the various muscles, more or less tend to produce 
stammering. It may also be caused by defective 
heai'ing, weakness and suppression of the mental 
functions, as in partial idiotcy or imbecility. These 
conditions, when present in a high degree, may even 
produce alalia or dumbness. 

The dyslalia, or rather faltering, of the aged chiefly 
arises from local or general debility. Sudden emotions, 
by affecting the brain, frequently cause a transient 
stammering. Children stammer.or rather " lall" partly 
from imperfect development of the organs of speech, 
and partly from want of control over them, and also 
from deficiency of ideas, and imitation. 



•J 



195 

^■actional Causes. — Laatly, stammering may result 
from habit, imitation, or affectation. Thia especially 
applies to slight defects, sucli aa rhotaciam, liaping, etc. 
Some assert that these may he inherited, in the shape 
of organic defects, which is quite possible, but, in my 
opinion, they are in most auch cases owing chiefly to 
imitation ; thus whole families are sometimes noticecl 
aa affected with a peculiar species of stammering. We 
find an instance of this kind noted by the ancients — 
the Sempronian family, the members of which re- 
ceived among the Romans the nicknames of Balbus, 
Balbutius, Balbinus, etc. 

M. Rampont, in a treatise on speech (Paris, 1803), 
records a curious case of a whole family being unable 
to pronounce the palatine and guttural letters. The 
head of the family, M. Cuervo, apothecary to thtj 
hospital St. Jaques, his grandfather, and liis children, 
with the exception of the youngest son, were in this 
condition ; the latter was taken to Madrid in early 
infancy, and brought up there. This shows, at all 
events, that the defect was not necessarily heredi- 
tary, but may have been the resxdt of imitation and 
neglect. 

I purpose treating of the numerous defects consti- 
tuting stammering under the following heads : — 

I. Those arisii^ from, or associated with, organic 
or functional disorders of the brain or nervous system. 

II. Those arising from organic or functional de- 
fects of the buccal or nasal cavities. 

III. Those which are the direct result of habit, 
imitation, or affectation. 



i 



10(3 stammering; its causes and varieties. 

1. Psychical Stammeking. 

1. Sermonis twmuUus; Cluttering (German, Pol- 
tern; French, Brediytdllement). — This is an anomalous 
enimciation, which consists in the pronunciation of 
words and sentences with such rapidity and confusion 
that they are only half articulated, and the speaker 
thus becomes unintelligible to persons not possessed 
of an acute ear, or who have not long been accustomed 
to hia rapid enunciation. Clutterers are usually 
very lively and animated in their conversation ; their 
thoughts flow with such rapidity, and they are in 
such a hurry to commimicate them, that they scarcely 
ever finish a word, and they leave such slight intervals 
between them that the sounds become necessarily 
confused. Thus the proximate cause of this defect 
is at once perceptible, — namely, the extreme rapidity 
of thought, with which the utterance does not har- 
monise. Some speak plainly and distinctly when ad- 
di-essing the public, but clutter violently in familiar 
conversation, Others,again,when speaking to strangers, 
especially to their superiors, regulate their expression 
in such a manner as to render their natural cluttering 
imperceptible. The same occurs when speaking in a 
foreign tongue. 

Pattering must be distinguished from cluttering. 
The former is an art which may be acquired by 
great practice, and is assumed by some of our actors 
and entertainers for the purpose of diverting their 
audience, their speech being not necessarily indis- 
tinct, though uttered with extreme rapidity; the 



PArrEEDIG. — BAETLOQUELA. 



197 



latter, ou the contrary, is a vice of careless, indistinct, 
half-articulate speech, which, unless checked at the 
proper time, may become habitual. With regard to 
natural pattering, or abnormal rapidity of utterance, 
it will generally be found that short persons, of a 
sanguine temperament, are much more inclined to it 
than the tall and pldegmatic. The reason seems tn 
be tliat, in the former, the circulation and respiration 
are more rapid, and their ideas, possibly, present 
themselves more readily, while in tall and plegmatic 
persons, the pulse being slower, and the respiration 
proportionally less frequent, the utterance keeps pace, 
and is more sedate. 

2. Baryloquda. — Baryloquism or tardiloquence is 
frequently the result of habit ; but generally speaking 
it is the symptom of excessive slowness of thought, 
in the same manner as cluttering is the symptom of 
extreme rapitlity of the same. Persons thus affected 
wotild say, " I think-MA-wA-wA-of-itA-jiA-go-o-ing to 
MA-wA-Paris-T(ftr-MA-to-morrow ;" or, rather, I thinlc, tlie 
French e (as in gue) would represent the sound more 
correctly. Sometimes they prolong the last vowel of 
a word, thus rendering their speech very disagreeable 
to the listener. At others they continually intermix 
such sounds as hem, ha, or repeat several times the 
article the, or any other unimportant word ; as " Take 
this-this-cbess-board into the-the-the-drawing-room," 
This is not intended to represent those convulsive 
repetitions which characterise stuttering ; for the 
stammerer in this case is quite calm, and it is owing 
lerely to a temporary failure of memory, that he re- 



108 STAMMERING; ITS CAUSES ASD VARIETIES. 

peats the word tumecessarily. Children are frequently 
affected with tardiloquence, owing to the imperfection 
of their ideas, and when neglected this becomes ex- 
ceedingly difficult to remedy. General affections pro- 
ducing wealtness of memory frequently cause tliia 
defect. 

Besides the preceding species of psychical stammer- 
ing there are impediments or loss of speech caused, 
as asserted, by disease of a limited portion of the 
cerebral convolutions, in which the so-caUed organ 
of articulate speech is supposed to be situated. Of 
such cases recorded under the name of aphasia and 
dysphasia I do not intend treating here, but refer 
the reader to ray treatise On the Localisation of the 
Functions of the Brain, with special reference to the 
faculty of LaTiguage, in which a succinct account is 
given of the literature on this subject, with the re- 
sults of my own obaer^'ationa. 

II. Speech Stammering.* 
1. Lallatio; Lalliiig ;-f Defective Enunoiation of all 
■ or many Sp6eck~Sou7tds (German, Lallen). — This vice 



• The term speech itammenngiB of itself not very eiplnDfttoty, 
but I have here used it to indicate tboee defects arisiag from 
abnoriDal Btructure or functions of the ariictilaling organi. 

t Lalling. There eiists in English no equivalent term for 
the indistinet enunciation of infants. As it cannot be called a 
defect of speech it does not pcoperly come ander the denomina- 
tion of Btammering, althongh it is frequently applied to infants. 

" And stammerins babea nro taught to liap this name." — 



LALLATIO — BL.E8ITAS EMOLUENS. 



loy 



(called by Amman and Foumier Jlo(tentotism), which 
is mostly noticed in the first attempts of children to 
Bpeak, consiste in the inability of enunciating many, 
or all speech-sounds, and in the omiasion of several 
consonantal sounds, for which children substitute in 
most cases I (whence the name) ; others substitute 
t QT d ; the vowels are likewise confounded, and tlie 
speech of the individual is iu most cases perfectly 
unin telligible. In children it is caused not so much 
by defective bearing as by the want of tlie power oi' 
appreciating sounds by the ear ; but in adults (who 
are but rarely thus affected) the evil aometimea de- 
pends on the degree of their defect of hearing,* or it 
may be, and often ia, purely the result of partial 
idiotcy, It may also be caused by the excessive dry- 
ness of the buccal parts in high fevers, 

j emoU'lens; Indistinctness (Greek, atro- 



The term tallation is applied to the deteative enanciiLtioii of 
the letter [, and is therefore in Boice reapect synonymous vritL 
iomidacism. I shall therefore use the word laUing for infnntilL' 
miEenunciatioD. The Latin lallare means to sing ' la-la' to chil- 
dren, and also to speak indiatinotl; like children ; English, lull, 
lalliiby. In Qreeic ^i^iid means both to speak to excess, to 
babble and prattle, and also to talk iaarticulatelj. In the 
latter senae I alao use the term lalting, when inarticulate 
speech is the result of defective hearing or partial idiotcy, also 
when cauaed by ulcerous affectiona, or drjneaa of the buccal 

• Otto, a teacher of deaf mutes in the Etfart loatitute, 
follows the gradation of deafness described by Itard [Trail/ 
des Maladiei cie l' Oreille, Paris, IS3!), namely, hearing of speech, 
voice, tones, noise, and perfect deafness, and thns places this 
defect between the first and aecond degree. 



200 stammering; its CAGSES ASD VABIEtlEB. 

(fuia). — Thia vice consists in softening the hard con- 
sonants, as TO, h, /, or V for p; n, d for t; s for s ; zh 
for sA. It is frequently caused hy general debility of 
the articnlatiDg organs, want of eneigy, partial intoxi- 
cation ; but more frequently by carelessness, habit, 
or local dialect, aa in Somersetshire, where the x is 
iised freely for s and c (soft), v for /,- thus, sitw; a 
soTiff would be pronounced sing a zong; five wonld 
be vive; three, dree, etc. Those who have harelip 
are also obliged to pronounce v for &, / for p, etc. 

3. BlcEsitas indurans; Hardening Soft Consonants, 
such as p for b, / for v, is generally the result of 
vicious habit or local dialect. The Welsh are pro- 
verbially addicted to this inelegance, of which Sbake- 
peare seems to have been well aware ; for he makes 
Sir Hugh Evans, in the Merry Wives of Windsor, say, 
" Jferry goof ; I will make a yrief of it in my note- 
book." Some laughable examples of this are also 
given in Valentine Vox. Tliis may also result from 
a weak and tremulous state of the Ups, in which 
case the labials are often (though not convulsively) 
repeated ; so also with blobber-lipped and intoxicated 
persons. 

4. Garnmacismus; Gammacism; Defective Enuncia- 
lion of g and k. — This vice, which is common in 
children who substitute for the above letters t or d, 
if not checked, will render the enunciation of the 
gutturals very difficult in later life. Adults are like- 
wise subject to this defect, though in a less degree 
than children ; it generally results from defective 
mobility of the root of the tongue. 



lOTACISMDS. — BHniOPHOSIA. 

5. Iotacism\t»; loiadsm. — This is a vice in the pro- 
ntmeiatdou of the consonants j, g (soft), and ch, for 
which 3 or a is UBoally suhstituted. Thus Jaimiary 
is pronounced Zanuary ; gesture would be zesture; 
China, Sina, etc. like gammacisnij the immobility 
of the root of the tongue is usually the cause of this 
defect. 

"There prevailed lately," wrote Foumier in 1819, 
" a ridiculous afl'ectation, or rather a sort of careless- 
ness orllaziness, which induced a number of persons 
to substitute z for j and g (soft). Thus they said 
pizeon for pigeon, zalovs fovjaloux; others again said 
serser for chercher, etc. We must nevertheless dis- 
tinguish between such affectations and the inability 
of pronouncing these letters, whether it proceed from 
a vice of conformation or from a vicious habit con- 
tracted in early infancy." 

6. Rkinopkonia,BaliutiES nasalis; Jili/iniem (French, 
Ndsilleme7it). — In the normal state of articulation, the 
sounds escape more or less both by the mouth and 
nostrils. When, however, either of these passt^es is 
closed, or when any person attempts to sp^ftk or sing 
more than usually through only one of these channels, 
the soimd acquires that disagreeable quality — the na- 
sal timbre, which may arise from two opposite causes. 
When, for instance, the soft palate, either from exist- 
ing apertures or from inactivity of its muscles, cannot 
close the posterior nares, so that the oral canal may 
be separated from the nasal tube, there results what 
is commonly termed the nasal timTU/, and the expres- 

n " speaking through the nose," is sufficiently cor- 



202 BTAUUBBIKG; ITS CAUSES AND VARIETIES. 

ract. Erom imitation and habit, there are whole na- 
tions who rejoice in this peculiai twang, which cliarac- 
terises the genuine Yankee. But an analogous eifect 
may be produced by the opposite cause, of obstruc- 
tions existing in the nasal cavitiee either from inflam- 
mation of the mucous membrane, tumours, holding 
the nose, or colds in the head; in these cases the 
ai-ticulation of the consonants is variously affected, 
but it is clear that the person does not speak through 
his nose, as generally asserted, but through hia mouth. 
In the former of these conditions, 5 and f assume the 
sound of an indistinct w; d and t sound somewhat 
like nig and h hke ng; while in the latter the very 
reverse is the case, and a child wishing to say, "Annie, 
nin and tell mamma I have a cold in my nose," would 
say, "KM\%, rurf ^M. tell 6ai6a I have a cold \A 6y rfose." 

7. UTaniscffphonia; Palatine Speech. — This vice is 
caused by a fissure or any other aperture in the palate. 
Several consonants are improperly articiilated, but 
especially k. Before a, e, i, it is pronounced like h, 
and before r and I like t, so that instead of lea, ke, ki, 
we hear ite, ke, hi, and for oroion, cloton, we hear 
trmim, tlowii. The letters b, p, d, t, etc., are combined 
with a hissing sound, because the air partly escapes 
through the above-mentioned aperture. This defect 
is frequently combined with rkinophonia, mentioned 
above. 

III. Minor Defects. 

1. liholaci»m,us; Se/eciive Enii/nciation of the Con- 
sonatii t; Mattlmg, Burriiig (French, graaseyement, 
parhr gms; German, Schnarren). — The mechanism 



KHOTACISMUS. 



203 



in the production of tloia consonant is very compli- 
cated, requiring considerable efforts of various organs.* 
This may be one of the reasons why in some lan- 
guages, as for instance in the Chinese and Mexican, it 
is altogether wanting, and I substituted for it. The 
consonant may be produced in two ways, in front or 
behind ; so that we have a lingual r, and a guttural r, 
for which the Arabs have a peculiai- letter {(/hain or 
ruiJi). The former is the result when the tip of the 
tongue touches and vibrates against the hard palate, 
while the latter, the guttural t, is produced by the 
contact between the posterior part of the tongue and 
the soft palate, when the vibration of the uvula is 
effected by the passing air current. The hngual r 
18 considered as the legitimate speeoh-sound, whilst 
the guttural enunciation is looked upon as a fault, 
especially in public speakers. From the difficulty of 
its enunciation, r is the last letter cliiidren learn to 
articulate ; they at first pronounce I instead of it until 
at length the sound is mastered. 

The defective enunciation of this consonant has 
not escaped the notice of the ancients. Plutarch says 
of Alcibiades " He had a lisping-f- in his speech, which 
became him, and gave a grace and persuasive tone to 
his discourse." Aristophanes, in those verses in which 



• See Pfiiiosopfti/ of Voice ond Speech. 

+ To translate TfaiAnntra lUping ia scarcely correct according 
to the meaning we attach to the wordi Tpm/Aoi, -rpaahirti', evi- 
dently refer to the inability of articulating the letttr r, though 
TjjouAifo, TpouAiiTfWi, are frequently aaed for Btammering in 
geaeral. 



204 STAMMEKING ; ITa CAUSK AND VARIETIES. 

he ridicules Theoms, takes notice that Alcibiadea 
lisped, fgr inatead of calling him eorax (raven) he 
called him colax (flatterer), from whence the poet 
takes occasion to observe that the term in that loBpiog 
pronimciation waa apphcable to him. With this 
agrees the satirical description which Archippus gives 
of the son of Alcibiades — 

" With aauntering- atep to imitate his father, 
Tiie vain joctli moTea; hia loose robe wildly floats; 
Ub bends the neuk— he liapg."* 

The correct artaculation of r seema to have been 
one of the difficulties encountered by Demosthenes. 
Cicero said his speech was so inarticulate that he 
was unable to pronounce the first letter of the ait he 
studied, viz., rhetoric. By practice he effected so 
much that no one is thought to have spoken more 
distinctly. Demosthenes was, therefore, not of opinion 
that the defective enunciation of r gives, as Plutarch 
observes, a persuasive turn to a discourse. The fact 
is, that though tolerated in an Alcibiades, rattling is 
a grave fault in a public speaker, often very dis- 
agreeable to listen to, and in some cases insupportable. 

Ehotaciam is more common among the northern 
than among the southern nations.-f- The defect is 
rarely met with among Spaniards and Italians. It 
was common among the ancient inhabitants of Eretria, 



• Langhocn'a Plntftrcti. 

t la Home places it is uaiveraal, aa in Denmark, in MorseilleH, 
Eonen, and also in Piiris, where the euunciatioii of the r seema 
to some I'ltent subjei;t to the fashion of the day. Dondera aa^'s 



HH0TACI8HUS. 



205 



and is endemic among the Proven^Aux. All northern 
languages seem to favour it, siicli aa the Flemish, 
Dutch, German, etc. Owing chiefly to imitation, 
there are whole provinces which use the guttural r. 
In our own countTy, we may mention Northumber- 
land (the Newcastle burr).* It is comparatively 
rare that a person can neither pronounce the guttural 
nor the Ungual r; but such instances do occur ; such 
persona then substitute for it I, the German g, or 



I 



that an impure pronunciation of the r id unijoraal in Njn 
»ege«. whilst it rarely la heard outaide thnt town. How far 
wingenital conform atioit or imitation ma; be the catiao of ii 
he could not tell. 

■ The following extract in relation to rhotaciam may, per- 
haps, interest the reader. It ia taken from Thomas Faller'a 
ITorfAiBt 0/ leJMsfersftvre, London, 1G62, p 12fi: — 

"There ia a Tillage ia this oonnty named Cbarleton, 
named Curley, and all that are bom herein, have a harsh 
wratling kind of speech, uttering thoir words with much diffl- 
cnlty, and wharling in the thront, and cannot well pronotince 
the letter r. Surely this proceedeth not from any natural 
peifeotion in the parents (whence, probably, the tribnal liifvug 
of the EpAriiuntfes did arise, Judg xii, 6], because their children, 
born in other places, are not haanted with thnt inSrmity. 
Rather it is to be imputRdto some occult quality in thee!e)n«nt> 
of that place. Thus, a learned author (J. Bandin, Slethott. Bisl. 
cap. S) infonneth us, that some families at LaMoi-a, in Ouyen, 
in Prance, do naturally stut and stammer, which he taketh to 
proceed from the nature of tha waters. 

" As for the inability distinctly to pronounce r, it ia a 
t«t«hing di'ease in other counties, t knew an Essex man 
(Mr. Job. Mede), as great a scholar as any in our age, who 
could not, for his lil'e, utter Carolns Rax Biitatiniis, without 
stammering. The best was, the king had from him in his 
hearty prayers what he wanted in his plain 



208 STuacERixc; its causbs and tarieties. 

Greek eh (x), iig, or w, or omit it altogether. The 
main cause of the production of the guttural, instead 
of the lingual r, is, that the tongue is kept in a convex 
position, and vibrates at the base instead of being 
concave towards the palate, and vibrating the tip of 
the tongue against the roof 

In our own language, either from inability to pro- 
nounce the canine letter, from habit, imitation, and 
in many cases, from pure affectation, w is frequently 
substituted for r. Roman is pronounced Woeman; 
rublrish, vmbhwh, etc. — a vicious habit which still 
obtains amongst our would-be exquisites. In justice 
to modem dandyism or, as we may now call it. Dun- 
dreanj-ism, it must be stated that affected rhotacism 
is not of recent origin. Lentilius, a famous physician 
of the seventeenth century, remarks on tliis snbject 
that, although no sane man can subscribe the stupid 
opinion that there is anything graceful in stammering, 
yet he remembers ha\Tng known in Saxony some 
noble young ladies who, though well able to pro- 
nounce the canine letter, made the greatest effort to 
iiequii* a stammering (dropping the r) enunciation 
which, in their opinion, was more graceful, and a sign 
of gentility.* 

As there is nothing new under the sun, so we find 
that old Ovid-f already complained that some study 

• LenWiug, R. Med. Piact. Sliiceli. Tllmae. 1693. 

t DiBcant lactimare decenter 

Quocjue volunt ploraiit tempore, qnoqce modo 
Quid ? cum legitime fraudatnr littera voce, 
Blffisaqae fit jasso subdolu lingna Bono ? 



KHOTACKMDS. — LAMBDACISHUH. 



207 



to weep with. propriety, and can cry at any time aiul 
in any manner they pleaae. They moreover deprive 
the letters of their legitimate sounds ; they contract 
the lisping tongue, and seek for grace in a vicious 
articulation of the words. They learn to apeak worse 
than they actually can. 

Besides the incorrect pronunciation of r, I may 
mention that in England, in London especially, the 
sound of that letter is entirely dropped at the end of 
words, such as altar, for instance, which in London 
would be pronounced altah. But in the nortli of 
England, among the poorer classes, as well as in Ire- 
land and Scotland, the legitimate sound of the letter 
is retained. Tliia is also the case in most of the 
continental languages, with the exception, perhaps, of 
the East Prussian. 

2, Lmnbdacismus ; Defective Pronunciation of I; 
Zamhdacisni. — ^After r the pronunciation of I is most 
frequently defective. It is often pronounced r, ng, 
or II). The Japanese have no I in their language, 
and pronounce for it r; thus for Holland they stiy 
Hiyi-rand. 

Sometimes the / is sounded too thin, too tingling, 
when the tip of the tongue is bent too much against 
the palate ; or it sounds too thick, when not merely 
the tip, but a portion of the surface of the tongue, la 
pressed against the palate, or when too powerful a 
vocal sound is combined with the articulation. This 

In vitio dQcor est, quicdam mole reddere verba 
Diauunt poaaa minna, nuam potuere loqui. 

Ov. Ak Am 3, 203. 



defect is common in the canUm Augsa ami othv 
put* of Siritzeriaiid. Stalder* njrs on this soligeet : 
" 17110 mnf^lar tramfonnatioB ma^ pn>faaUf be De- 
thing else than infantOe stanimeniig hecome a habit, 
irtuch afterwanlfl became a dialeet." In the Bnann 
lant^nage there are tvo sounds for / ; one is thin and 
tangling and the other thick, as in the Aargaa dialeet 
mentioned above. Moreover, Wailis tells us there is 
a direct among the Americans adjoining Xew £ng- 
land, who can neither pronoonce this letter nor r, and 
suhotitate for it n. 

3. liigmM-lwrnAUi, BUtiitag; JAspitng (Greek, -^^Aitr- 
^toc, TpavXuTfio^ ; Anglo-.Saxon, wligp; French, aes- 
«yw; German, li^peln). — The word lispiiuf, osed in 
a restricted sense, means a more or less disagreeable 
hissing sound accompanying tlie pronunciatdon of 
most aonndfl, arising from too large or too long a 
tongue, wliich comes in constant contact with the 
teeth. However, the word, as generally applied, and 
as nsed here, designates a particular kind of atam- 
mering, which comprdienda the various defects in 
the enunciation of the sibilants or hLssing sounds, *, 
**., z, zk, etc. Oiir own word, to lisp, is probably 
derived from the sound. When the upper incisors 
are wanting, the » becomes obtuse, and is sounded 
somewhat like sh. The most common form of lisping 
is the suljstitulion of the sound th for a, or vice vena, 
caused by inappropriate action of the tongue against 



*Z>if hania-SfTOthm Sm Schvitix,oitr 8chvi»i*rriK}taDialeki/i- 

gif. Aargaa, 1819. 



tbe teeih. If the urticulAtJon ait ia quite impossible. 
t is usually substituteil In Bome peraoos the tongue 
is oot witbdrawo from the palate ; thus s takes the 
eoimd of the Welsh II, which is, so to speak, an 
a^tirated or hisging I. Those who cannot pronounce 
tlie sk, use for it s, as do the Piedinontese and th^ 
North Gennans, especially the Holsteiiiers ; the in- 
habitants of Bilndlen, on the contrary, frequently 
say ah for s. 

In the High-German pronunciation the sin sp and 
«^ is, at the Itpg inning of a syllable, pronounced sit. 
but at the end s. The North Germans pronounce it 
s also at the beginning, while the Swiss pronounce it 
as sh both at the beg innin g and the end. Tlie Danes. 
East Frieslanders, and Westphaliaiis separate the 
sound sch (sft) into e and ch (somewhat like the 
Greek x), thus s-chon for schon (beautiful) ; some 
pronounce it harder, like sk; others like sg. Ac- 
cording to Forster. the language of Taheite and the 
Society Islands has no hissing aotmds, and conse- 
quently the organs of speech of tlie natives become 
incapable of producing such sounds. For tha sibi- 
lants and other sounds which they think to be ton 
difficult for them, they substitute otliera* 

* TMb difEcolty of prouuiiaiatioii in variaua raoes of men is 
very auriouB. It was noticed long ago b7Ca.pt, Cook, Bir Joaei'ti 
BiinliB, aad otherB, that the negro oouLd pronoimoe everj liing- 
liali word while tbe PolyaesianB could not pconoonoo any Kng- 
liah word of more thaa one BjUable. In strango oontrast to 
the latter we may place the EuBsiana, who in t^air language 
have not only a and ih, but also lih, and oven icklicK This 
difflcnlt combination of oonsonanta p&rtl; aooounta for tbe fbot. 



210 STAMMERING-; IT3 CAUSES AND VARIETIES. 

If lispii^ does not proceed from an abnormal con- 
ditioa of the tongue or position of the teeth, it is 
the result of habit or affectation. This vice of pro- 
nunciation (for it is certainly no beauty, as some may 
imagine) is often affected, although not to the same 
extent as the vicious enunciation of r, and is equally 
ridiculous. But it is not only among civilised nations 
that this folly is practised, — even some of the natives 
of the Gold Coast of Africa, we are told, consider it 
fashionable to stammer, 

It should be borne in mind that the peculiarity of 
pronunciation of the English language, so frequently 
noticed in foreigners, can scarcely be called stammer- 
ing, although it presents the features of a species of 
that defect. Thus our th seems to be the Shibboleik 
of all foreigners who do not possess this sound in 
their own language. In their attempts to produce 
this sound, they either drop the h, and pronounce 
linker for thinker, or add an s, and say, tsinker or 
tlsinkeT. 

that a BoBHian learns a foreign langoage in an incredibly 
short time. An Engliahman, Frenchman, or German requires 
years to acquire the Russian language, and never becomea 
master of it uoleea be has learned it in Buaaia in childhood- 
No language, at least no European language, requires such 
mobility of the articulating ot^ons ae the Sueaian, bo tliat in 
the acquisition of that language the muscles of the buccal 
cavity and other organs are brought to a high state of per- 
fection. 

Amongst some of the American Indians it is said the labials 
cannot bo produced in consequence of their habit of wearing 
rings in their perforated lips, conaequenti; these aouad:) are 
.not to be found in tbeii languages. 



LISPING. 211 

I am well aware that the above enumeration of 
the varieties of stammering is far from being ex- 
haustive. It would, however, have been useless to 
multiply the species, nor would it be possible to 
adopt a division which would meet every case ; for 
instance, those arising from debility and cerebral 
affections present innumerable varieties both in phe- 
nomena and origin. 



CHAPTEE Vn. 



as TB£ TSEXnaSJ ot stahhesixg. 



" It win alvBjB be foand tiMt % Sttiie Aowtng m worth 
«4ame> of writUa inatractiaiM." — Joskfb Waivok, LLJ>. 
riud-Krfion o/(A« Dtq/and Ou^, ISOft. 



Correct Diagnorix Indiipeiuable. — Treatment of Prf ehuol 
Slmnm^rin^ : Cluttering. — Bairloqnels.— 5p«cA StamnKru;.- 
Mombling. — Hardenii^ Soft Consonaota. — GamnuuBm. — 
lotaciim, — BbininD. — Surgical OperationH.^ Cleft Palate. 
— Sir W. Fergnawni.— H. KiUton — Herr Kmg.— Tonguft 
OpeTatioii*. — Pare. — Dirimon of Frxnum.— Eicieion ^ 
the Tonsils.— Hr. Haney.— M. Bennati.— Mr. Tincent.— 
Sir George Dnncan Oibb. — Dr. Yearaley. — Uinor D^etii: 
BboUMnsm. — H. Talma. — Lambdacism. — Slgmatiam. 

With regard to the treatment of etammeriiig, it 
will readily be perceived that the probability of a 
cure greatly dejiends on forming at the veiy outset 
a correct diagoosia of each individual case. After 
what hae been stated of the etiology and pathology 
of this affection, to think of applying one method of 
instruction, or one special treatment, to the whole 
range of defects con-stituting stammering, would be as 
itGnselesB and parailoxical as is the boast of quacks, 
who announce, in their advertisements, that they have 
discovered an infallible remedy for every disorder in- 



i 



PSTCmCAL STAJtfMEHnTG. 213 

cidental to the himian frame, in tlw shape of some 
draught or pill 

Taking these defects in the order I have classified 
them, I commence with 

Psychical Stammering. 
Cl-uttcrmg. — Clutberera must be made to articulate 
slowly, to read precise riijthmical exercasea, and thus 
he prevented from gluing their words together. The 
great difficulty to be overcome in clatter^is, ia tu 
bring them to reason on tho subject; they tale no 
notice whatever of their vice of speech, till tliey find 
that it renders them unintelligible to the listeners ; 
and when they do really wish to rid theanfielves of 
their unpleasant mode of speech, they rarely consent 
to subject themselves to a strict discipline for a suffi- 
ciently long period, to overcome their bad habits. 
Tlie study of foreign laagua^a \\sb been reoom- 
mended witlj success. Some persons, indeed, do not 
cluttar when speaiking in a foreign tongue, aa tlie 
time occupied in translating their thoughts readew 
their expression less hasty, and, consequently, leas 
indistinct. Colombat cites the case of a clergyman, 
who was an excellent speaker while in the pidpit, 
but who clutteied painfully in ordinary converaation. 
Another case be also mentions, a professor of law in 
Grenoble, who cluttered wlulat lecturing in his native 
language, French, but showed no signs of his defect 
wlulat lecturing on the Eoman law in the Latin 
tongue, Thva it appears that, when tlie clutterer is 
forced to direct his thoughts into a definite channel. 



214 



TEEATMEKT OF 8TAMHEEING. 



his imagination is restrained, hia volition strengthened, 
and hia power of controlling hia utterance greatly 
ameliorated. 

This ia a useful indication in treating this vice. 
Speaking in debating classes, pntlic speaking, should 
be used, and other exercises of a similar nature, that 
tend to restrain the flighty imagination, and to 
strengthen the volition and power of control in the 
clutterer, 

Baryloqwela, a slowness ot heaviness of speech, 
which is generally the result of habit, or a slight 
natural slowness of thought, may be combated Jn 
early life by appropriate intellectual training, calcu- 
lated to restore to the thinking powers of the pupil 
their proper vigour, and to overcome that habitual 
drawling which is so disagreeable to the eara of the 
listener. The difficulty of curing this disorder, as, 
indeed, all others of a similar nature, increases con- 
siderably with the years of the pupil ; and, in ad- 
vanced age, when the intellectual process is still 
more impeded, the speech of the person thus af&icted 
becomes unbearable. 



Speech Stammehing. 
Lalling. — Persona afflicted with 1 tillin g must be 
treated according to the cause which gave rise to it. 
If the hearing of the pupil is but sKghtly deficient, 
oral inatruction and the use of speech gymnastics will 
suflce. But in severe cases of this kind, when the 
pupQ has nearly lost the sense of hearing, we must 
nearly the same as is done with deaf-mutes 



SPEECH-STAMMERING. 



215 



— by explaining the various movements necessary for 
speecli, and by placing the pupil hefore a mirror ; 
thus enabling him to judge more correctly the various 
positions of the organs. It need scarcely be added, 
that every means should previously be resorted to 
wliich tend to improve the power of perception, both 
in time and tune, in the hearing of the pupil. 

Cases of lullin g, caused otherwise than by defective 
hearing, are rarely met with. A similar defect is 
certainly caused by idiotcy, dryness of buccal parts, 
as in high fevers and similar disorders ; but this need 
not occupy ua here, as in these cases it is merely a 
ajTnptom. Neither shall I treat of infantile lalling, 
as it usually disappears with advancing years, 

Miimhling. — Habitual indistinctness of speech can 
only be combated by perseverance and attention, not 
only to the oigans of speech, which frequently are 
only secondarQy concerned, but also to the action of 
the brain and spinal cord. This vice is more fre- 
quently a symptom of a more serious affection than 
is generally supposed, and invariably indicates a 
want of energy and perseverance. It may be usually 
overcome in cliildren by careful education and by 
training them in the free and distinct expression of 
their ideas, and by invigorating the whole frame. 

Hardening Soft Consonants. — Hardening soft con- 
sonants, such as pronouncing putter for butter, fre- 
quently indicates misdirected energy, and, in most 
cases, simply requires attention to the articulation. 
The pupil shoidd be made to articulate the sounds m 
and p — as, for instance, ma and pa — when ia, is re- 



TBEATHZJIT of aTAKMXRDfG. 

ijuired, and he vill sood perceive, mtder jodtcioiis 
instmction, that there ia a mediiiia aoimd between 
the Utmi m uu) the sharp p. By ptactdce, be will 
be able to nender the ie<|aiTeii sound instinctively, and 
m on vitb tJie other consonanlo, », d, t, etc 

Oammaeum. — Gatninacina u eanly remedied in 
early tnfancy ; but the difficolty increases as the pnpil 
Ndvances in yeara, when it CCTiseqoently reqaiies 
moiB teouble and practice to be remedied. In cases 
of ^mmaciam, when t bt d is pronounced for toTff, 
it may be corrected by keeping the tip of the tongne 
tixed behind the inferior incisora, and the mouth 
open ; t)ie aiched tongue should then be pressed 
it^ainst the roof of the mouth near the soft palate ; 
and then, in vocalising, the tongue should suddenly 
be lowered. 

fotacimn. — lotaciam, which consists in the subeti- 
itition of « or a for cA, j, and g (soft), may be overcome 
Iiy studying the articulation of the latter consonants. 
Tlie tongne should be raised, not the tip only, as 
in tlie formation of « or :^ but an much as possible 
lit' the wliole urgau, aud applied to tlie palate ; it 
liaving previously been retracted, so as to bring the 
fiurt'ace applied to tlie palate half on the hard and 
lialf on the soft jtalate. Both in ganmiacism and 
iotacism, there is reriuired a certain mobility of the 
root of the tongue, wldch, if not already possessed, 
may generally be acquired by practice. 

Wiinimi. — When rhinophonia is the result of an 
obstruction in the nasal Ibssie, from inflammation 
of tliu luncona membrane, cold in the head, or 
|">!y[ii, tin; voice will become clear on the removal 



EHINISM. 217 

of the canae. Rliiniam, when simply a hn.bit con- 
tracted by imitation, is frequently very difficult to 
cure ; but it is by no means impossible, provided 
the will of the pupil be brought to aaaiflt tlie treat- 
ment. Occasionally we meet with cases of rliiiiism 
complicated with a, fissure in the soft palate ; this 
must be remedied, where possihle, by appropriate 
surgical or artificial means, but these must not be 
exclusively relied on as I shall show when speaking 
of aurgical operations. 

Surgical Operations far the Cwre of Stammering. — 
The majority of those malfonnationa and organic 
defects which are considered as repairing surgical aid 
are amenable to a systematic course of instruction, 
founded on sound physiological principles, aided by 
time, flmmess of will, and constant attention of the 
pupil, which is, in fact, indispensable. Under what- 
ever malformation the pupil may labour, his case must 
be treated according to general principles calculated 
tu restore the defective organs as far as possible to 
their proper function, or, if that be impossible in con- 
sequence of malfonnation, to train them, so to speak, 
to adopt other functions which will answer the pur- 
pose of distinct articulation. The general principles 
in these cases must be governed by a sound know- 
ledge of the mechanism of articulation ; but as they 
require to be modified to suit the requirements of 
each individual case, it would be useless, il" not im- 
possible, to enter into details concerning theii appli- 
cation. 

It must not, however, be supposed that all mal- 
formations or vicious habits of the organs of speech. 



218 



TlIEAT%rENT OF STAMMERKG. 



produce atammering ; on the contrary, to quote tlie 
words of a distinguished writer on this suhject, "one 
may see every day persons who, hy all rules, ought to 
fltammer, with weak jaws, upper teeth lapping over 
tlie under, flaccid diftphragms, the habit of talMng 
with closed teeth, of pouring out their words rapidly, 
of breathing irregularly, speaking with empty lungs, 
even (what, seemingly, would make a stammer cer- 
tain) of speaking during inspiration as well as expir- 
ation, who do not even hesitate. Verily, Nature is 
kind."* Even where such organic defects as before 
mentioned exist, and cause stammering, the impedi- 
ment may often be removed vrithout interfering 
with the physical structure of the organs themselves. 
And, again, where severe malformations exist, and are 
remedied by surgical or artificial means, the patient 
still suffers from defective articulation tili he is in- 
structed in the proper use of the artificial organ. 

Cleft Palate. — When, for instance, a person has a 
cleft palate, science can supply the defect by an 
artificial one, after which the patient still requires 
to be instructed how to make a proper use of the 
foreign substance ; the same holds good after the 
patient has undei^one a surgical operation ; in illua- 
tratiou of which I quote tlie following case : — 

"Mr. D, P., Eetat. 17, has a genital fi.ssure in the 
palate ; articulates very imperfectly. The sound of 
liis voice was very unpleasant, and many of his words 
are unintelligible. Six months after the operation. 



• IrraEunale of Speech. LongniniiB anU Co. Prii 



BttKGIOAL OPEBATIOJre. 



219 



Mr. P. had made no improvement in his speech, when 
he put himaelf under the tuition of Mr. Hunt, In 
the course of a few weeks, an extraordinary change 
was effected ; and ere long the artieidatiou waa so 
different that little more could be desired,"* 

M. N^laton, it appears, however,-f- "declines all 
surgical interference in cases of this kind, and rests 
content with obturators and artificial palates. The 
chief object of the operation is to improve the arti- 
culation of sounds. It is a fact, however, that the 
opening may be closed without any very appreciable 
improvement in the utterance of the patient, and 
that this is the coromon result. This is the case 
equally whether the opening be closed by operation 
or by some mechanical contrivance, and this diffi- 
culty is only to be overcome, if it is to be overcome 
at all, by long and patient practice under a competent 
teacher. Is it not more judicious, therefore, if the 
same end can be attained with obturators and arti- 
ficial palates, to spare tlie patient the pain and peril 
of an operation ? M. Nelaton, for his part, is fully 
convinced of the advantages of the prudent line of 
conduct," 

Herr Krug, a German schoolmaster, inl805, enabled 
a girl, aged seven, who siifl'ered from cleft palate and 
entire absence of the velum, and who coidd not pro- 
duce any articulate sound, to speak, by very simple 



■ Sxtracti/rom Obaervaliona oiv CUfl Palate. By Sir 'Vrilliam 
FergnBBon, Bart,, F.B.S., FrofeBBor of Surgery, KiDg'a College. 
The detula of the case ore givaii in vol. xviii of the lUedico- 
Chirargieal Tranaactiana. 

+ From Journal of Pract. Med. and Surg. 1862. 



TRBATMEKT OP STAMMERING. 



means. He advised her to compress the nostrils with 
the thumb and index of the left hand, in ftrtictilating 
such sounds which do not require the air to pass 
through the noae ; thus supplying the place of the 
velum and uvula. By this means she succeeded, 
after considerable laboiir, in not only speaking dis- 
tinctly during the appljcation of her finger and thumb 
to the nose, but also without this artificial appliance. 

ToTtgueOperaiions. — Defects of the tongne requiring 
the aid of sui^ry are rarely met with. Par6 gives 
an account* of a man who, in order to remedy de- 
fective speech arising from the losa of a portion of 
the tongue, invented an instrument by which he was 
enabled to express lumself intelligibly. This iustni- 
ment consisted of a concave plate of wood, which 
he placed in the mouth before the incisors. Par4 
applied it liimself to a boy whose tongue was cut off, 
who spoke by the aid of it perfectly well. 

I shall have elsewhere to touch upon the pernicious 
practice of tongue operations for the cure of stutter- 
hig, which were undertaken chiefly on account of the 
confusion of that defect with stanunering, and partly 
on account of the ignorance of the laws of physio- 
logy. That tongue malformations requiring the aid 
of the knife do exist, I do not deny; but such cause 
indistinct articulation or stammering only, and can- 
not be ranked with stuttering. I have also always 
been opposed to the baneful practice of cutting the 
frtenum Imgum in the treatment of children, I shall 



BDBGICAL OTERiTTOKS. 



221 



niyw simply state that it is rarely necessary to re- 
sort to the nse of the scissors or knife iu cases of 
tongue-tied children, as articulation may he rendered 
free and distinct hy patient, persevering practice and 
instruction. Several cases of severe stuttering have 
come under my notice which took their origin from 
an operation of this kind. 

Exdsion of Tonsils. — The enlai^geraent of the tonsils 
(which was formerly considered as the cause of stut^ 
tering), -when excessive, may he remedied by excision 
of the tumefied portion. The same may be done with 
tJie elongated uvula. But here, also, surgery has over- 
stepped all reasonable bounds. One case of this sort 
r may mention, which came under my own observa- 
tion. Mr. W. D. was operated on, several years ago, by 
having his tonsils entirely extirpated, and the whole 
of his uvula taken off. For some days after the 
operation he was unable to swallow, in consequence 
of inHammation ; it had also made him slightly deaf. 
Moreover, the operation increased his infirmity, and, 
in addition to his former stammering, he was entirely 
unable to pronounce the letter r, whicli before offered 
liini no diffioulties. After alxjut three weeks' tuition 
and residence with me, lie conquered his infirmity ; 
but the absence of the uvula prevented liim Irom 
getting rid of his unpleasant manner of speaking, 
caused by his being obliged to inflate his lun^ 
through tJie nose when speaking, He infonned me 
that his impediment was slight and his geaeral health 
excellent prior to the mutilation, and he did not believe 
the tonsils were enlarged or his avula elongated. 




A ■ 



222 THEATMBNT OF STAMMEEINQ. 

The whole subject of operations of this nature, 
especially the effect produced by the excision of the 
toQsils, is ably handled by Mr. Harvey, in his work 
on the Tliroat* I would strongly advise all persona 
to consult his book before they allow themselves to 
be thus operated on, for whatever cause. 

Bennati relates two cases. One of M. le Comte de 
Fedrigotti, who had two-tliirda of his tonsils excised, 
on account of their enlargement, which was supposed 
to injure his voice; the consequence was that he 
gained two additional tenor notes, but lost four of the 
falsetto. The second case was that of M. Carcelli, 
whose tonsils became enlarged by chronic inflamma- 
tion, which produced an increase in his voice of five 
felsetto notes. Thus, it would seem that these glands 
influence the voice considerably. Mr. Harvey asserts 
that the muscles of the pharynx increase in size in 
proportion as the tonsils enlarge. It has fi'equently 
occurred to him, he continues, to witness the atrophied 
appearance of these same muscles after excision, 
which, in a measure, accounts for the diminished 
power of voice, as well as for the difficulty of deglu- 
tition. The same author represents, in an engraving, 
a case of enlarged tonsil almost closing the pharyngeal 
opening ; it existed for nearly twenty years without 
affecting audition in the least, or causing any incon- 
venience either in speaking or singing. 

This state, so frequently found in young persona. 



■ On the Exnaian of the Enlarged Tonsils and ita Ooniegveiuei. 
Wy Wm. Harney, F.E.C.S. London, ISfiO, 



SUBGICAL oraRATIONg. 228 

is owing to no direct caiise, but to a general scrofulous 
condition, and generally disappears mth advancing 
age, combined witb sea air and good diet ; but when 
any inconvenience ia felt, causing difficult speech, 
this spontaneous disappearance should by no means 
be relied on. The treatment must then consiat in 
constitutional remedies, assisted by local applications, 
but recourse need rarely be had to sui^ery. Mr. 
Vincent says on this point : " I have seen very many 
exceedingly enlarged tonsils, producing the greatest 
annoyance, in patients at fifteen or twenty yeaM of 
age, "wlucb have gradually shrank, or assumed the 
natural size, by the time that the subject had arrived 
at the age of thirty. If we consider the great utility 
of these glands in secreting a mucus of a peculiarly 
lubricating kind, so valuable in the economy of de- 
glutition, I cannot regard it as a good practice to 
remove these parts so unsparingly as I have known 
it to be done." 

Sir Geoige Diincan Gibb agrees, in the main, with 
Harvey and Vincent on the desirability of leaving 
the tonsils, "unless they cause serious inconvenience."" 
Dr. Yearsley,"!' however, maintained that the re- 
moval of the tonsils causes little inconvenience, and 
is not followed by any unfavourable constitutional 
disturbance. Some observers have contended that 
the enlarged tonsil arrests the growth in youth, and 

* JHseasei of the Throat and WmdpipB, Seoond Editios, ISdi, 



224 TRBATMEST OF BTAHHESING. 

interferes in later life with the full development of 
the body. Sir Geoi^ Dunean Gribb is opposed to 
this view. The subject is one of much interest ami 
importance, and deserves much further observation 
and consideration. I may, however, here observe that 
enlarged tonsils may, and often do, co-exist with 
arrested growth ; but they are not necessarily related 
to one another as cause and eft'ect I have seen so 
many cases of enlarged tonfiils, without the develop- 
ment of the body being at all Mrested, that 1 am 
disposed to surmise that eolai^ed tonsils have no 
direct influence on the development of the body, al- 
though, in some eases, they set injuriously upon the 
lungs. Whatever means may be employed for the 
decrease of the size of the tonsils, it is certain that, 
if speech is injuriously affected by their enlargement, 
the removal of these bodies will not at once produce 
correct utterance. I fully agree with Sir Duncan 
Gibb that the " thick gutttiral voice which enlarged 
tonsUs often give to young children is not easily got 
rid of" Enlarged tonsils need not, however, be asso- 
ciated with a thick guttural voice. I have had many 
cases of children who have been made to speak with- 
out any peculiarity, despite a very considerable en- 
largement of the tonsils. Some species of defective 
speech (dependent on a misuse of the respiratory ap- 
paratus) most assuredly produce enlargement of the 
tonsils. The removal of such misuse will frequently 
efl'ect a considerable reduction in the size of the ton- 
sils. This is a matter of daily observation, and is 
founded on experience. As to what other causes may 



produce or remove enlarged tonsils, I must refer tlic 
reader to the works above q^uoted. 

MmOK DEPECT8. 
Bfiotacism. — Stammering, the result of habit or 
affectation, such as rhotaciam, etc., is frequently less 
curable than any other species ; not on account 
of the complexity of the cases, but from the disin- 
clination of persons labouring under slight defects 
(aa these usually are) to submit to any rigid disci- 
pline, by which means alone they can possibly be 
remedied. As a rale, it may be laid down that the 
greater inconvenience they cause the stammerer, the 
more probable it is that a cure will be effected. I 
may safely say that, in cases of this sort, we rarely 
meet with any that are really intractable. Tlie more 
confirmed the vicious habit has become, the greater, 
of course, the difficulty — children are more easily 
cured than adults — but the main difficulty is to bring 
the will of the stammerer to bear upon the treat- 
ment. This, and the instructions of one intimately 
^acquainted with the physiology of speech and the 
'foimation of all the speech-sounds will overcome any 
. difficulty. 

A well-known and very useful plan for conquering 
rhotacism is that said to have been devised by Talma, 
the celebrated French actor. It is as follows : — 

Choose for the first exercise a word in which there 
is but one r, preceded by a t— travail, for instance. 
Write tdavail, by substituting d for r. The pupil 
will then pronounce i and d separately, thus t-, d-, 



226 



TREATMENT OP STAMMEKING. 



avail; inaensibly he will add tlie mute e and pn>- 1 
noimce te-davail; by inducing him to pronounce more I 
j-apidly he will nearly drop the mute e and say tdavaU. 
The pupil must now he urged to pronounce as rapidly j 
aa possible, uniting the sound of ( with that of (2) ] 
giving more force to the articulation of (. By this I 
proceeding, the lingual r is insensibly articulated, | 
seeemingly produced by the rapid union of t and d. 
Other exercises must follow until the vicious habit is 
abandoned. This method is said to have been, long 1 
before, used to teach the pronunciation of r in the In- < 
stitution for Deaf-mutes in Erfurt. By thia simple 
method, observes Foumier, num!>er8 of cures have 
been effected, and he cites as an in.?tance, — the pretty 
and accompUshed actress, MUe. St. Phal, who had, 
owing to her defective artieidation of r, to retire from 
the stage for a time. Wlien she re-appearei 
the gallant professor, her enunciation was so much I 
changed that she would not have been recognised by ] 
the spectators but for her charming face. 

The same result may be arrived at by carefully ] 
studying the articulation of this letter, by placing 
the tip of the tongue very lightly against the hard 
palate, a little beliind the superior incisors, and ex- 
peUing the breath from the lungs with considerable 
force, and thus making the tip vibrate. This should i 
be practised continually till the necessary pliancy of ] 
the tongue is acc[uired, "When the habit of substi- J 
tuting other letters, such as v or w, has been con- 
tracted, the lips should be carefully kept asunder, and J 
the tongue only used. 



[BiiAnsM. 227 

Zambdacism. — Larabdaj^ism, or defective pronun- 
ciation of /, which is generally caused by wrong action 
of the tongue against the palate, being either too 
strongly used or not forcibly enough, reqxiirea, like 
other similar defects, the attention of the pupil to the 
articulation. The position of the tongue is very 
similar to that in the articulation of r ; the tongue, 
however, is applied to the palate rather differently 
and more forcibly than in the articulation of that 
letter ; the action of the breath must be as slight aa 
possible, no more force being used than is necessary 
for the production of the sound, otherwise the sound 
will approach that of r, by the vibration of the 
tongue. The tongue must retain the above position 
for a time, and, at the same time, allow the sound to 
escape at tlie sides. It is this that constitutes I a 
liquid sound ; for, were the sound to be retained and 
allowed to escape suddenly, the I would be changed 
into ( or d, as is sometimes the case, 

Sigmatism. — Lisping, which is sometimes caused 
by an abnormal length of the tongue, or, more fre- 
quently, by the wrong action of the same, is ao easily 
cured that it is remarkable that so many persons thus 
affected are to be observed. When th is sounded for 
s, it is plainly owing to the protrusion of the tongue 
between the teeth; and as long as the tongue ia 
allowed to act thus, the lisping will continue. In 
order properly to pronounce the sibilants s and c 
(soft), the teeth should be almost closed, and the tip of 
the tongue applied to the palate slightly enough to 
I allow the breath to pass with a hissing sound between 



228 TREATMENT OF STAMMERING. 

the points of contact. It is difficult to conceive how 
our th should puzzle the tongues of foreigners to such 
a degree as it manifestly does. That sound may 
easily be pronounced without protruding the tongue 
between the teeth ; but, if any difficulty is found in 
that manner of pronunciation, if the tongue is placed 
in the least degree between the teeth, the sound is 
produced by itseK, without any further effort, provided, 
of course, that the front teeth are sound. 



I 



I 



CHAPTER Vm. 

STinTEillNG ; ITS CAUSES, VAEIETIES, CHAEACTEKISTICS, 
AND ASSOCIATED PHENOMENA. 



" In tbe act of speaking we mast diatiapiub two diffarent 
pheuomeDa, viz., the faculty of oreating wordi as tha nigae 
of our ideas, and coDserving their memoiyi and that of arti- 
culating the same. There exists, so to speak, an inner and 
an outer speech, the latter being only the eipreaaion of the 
former."— Da, Botjiluud, Arch, Gen. de Med., Toh viii, p. 43, 
1325. 



Characteristic Phenomena. — Causes of Stuttering.— Different 
Degrees. — Different Species. — Vowel Stuttering. — Con- 
sonantal Stuttering. — Inflnence of Imitation. — Influence of 
Age. — Influence of Education. — Inflnenoe of Temperature. — 
Influence of Time of Day. — Lunar Influence.— Influence of 
Vaiious Disorders of the Body.— Psychicial Influence. — Stut- 
tering in Singing.— Stuttering in Whispering. — Is Stuttering 
Hereditary F — Be-action of Stuttering on the General Heolch. 

The main features of Btuttering consist in tbe 
difficulty of properly conjoining, and fluently enun- 
ciating, certain or many elementary aoimds, in the 
articulation of words and sentences. A frequent, 
but by DO means constant, result of this difficulty 
the repetition of the obnoxious syllable untU its 
eniiDciation is effected It is for this reason that the 
repetition of the initial sound has generally been 



230 STUrTEMEfO; ITS CATOES, TABIETIES, ETC. 

looked upon as constituting the essential character 
of stuttering. This repetition is, nevertheless, not a 
constant feature of the defect Some stutterere do 
not repeat the initial sound, but pause before any 
difficult syllable until they feel that they are able 
bi surmount the obstacle. Subjects who act in this 
way are usually of a phlegmatic tempemment. It is 
in the stuttering of subjects of a sanguine or nervous 
temperament that a rapid repetition of the initial 
.sound is heard : they seem determined to attain 
their object by any means, which partially accounta 
for their violent gesticulations and contortions. 

Not unfrequently the stutterer becomes momen- 
tarily mute, which generally occurs at the explosive 
consonants b, p, t, d, k, g, especially at the hegimiing 
of a word or phrase. He exhausts his whole force, 
the face is terribly contorted, becomes flushed or 
livid, perspiration exudes from hia forehead, but 
being still unable to produce the desired sound, he 
is obliged to "give it up," sometimes with a sigh, or 
with a convulsive sob. At the explosive labial con- 
sonants the stutterer closes his lips, but is unable to 
effect the recLuisite opening for its enimciation. The 
air is, so to apeak, in some cases masticated in the 
mouth by a movement or puffing of the cheeks ; the 
jaw is then opened with a convulsive jerk, but the 
labial sound is not produced. 

Again, the sound is sometimes prolonged. This is 
usually at the continuous consonants m, n, etc. In 

the formation of the word nine, he commences n , 

but is unable to open his jaw, or to detach hia tongue 



CHARACTElilSTIC PHENOMENA. 231 

from tlie palate. An inatance of this kind was 
afforded by a youth, who having occasion repeatedly 

to say nine, invariably commenced tlie n , but 

being unable to finish the word, woiJd say, " You 
know what I mean." Generally, however, stutterers 
become irritated, and make spaBmodic efforts to sur- 
mount the difficulty. 

In some cases the stutterer separates the initial 
sound from the rest of the word. He would thus 
say, ( all, or he produces the whole word in a 



Stuttering occurs, according to Sauvages, Frank. 
and several other authors, chiefly at the gutturals 
<j and k, caused by the difficulty of moving the 
velum, uvula, and the root of the tongue. This is 
not quite correct. Some stutterers pronounce these 
consonants easily enough, but stutter at the dentals 
and labials. Nevertheless, in the early stt^ of stut- 
tering it usually affects, at first, the gutturals and 
linguals ; it afterwards extends to the labials, tmtil 
at last it may affect all the articulate sounds. In 
some cases the impediment takes place one day at 
the gutturals, another day at the labials, or possibly 
at the dentals, depending, no doubt, on their com- 
bination with the succeeding sounds. " In fact," 
says Aatri^, "a syllable which I pronounce easily 
when preceded by one which leaves my tongue in 
a favourable position, offers less facility when it 
follows another which does not present the same 
advantage, or when it is at the commencement of a 
word or phrase." 



BTUTTKKNG ; TTB CAOSES, TA&IlfTlKS, ETC 

A good deal has been 1*7111611 concerning the 
occurrence of stuttermg exclusively at the com- 
iiiencement of words and phrases. Bansmann says, 
" It ia a constant phenomenon that stutterers hesitate 
only at the first letters of a word, so that when they 
have mastered the initial sound, the rest of the word 
follows easily, or, in other words, there is no stutter- 
ing in the middle of a word." This is quite incorrect. 
The initial sound, as shown in the preceding case, ia 
uot always the difliculty of the stutterer. It is more 
generally the conjunction with the following sound 
that constitutes his difficidty. There is no general rule 
to determine this, for the hesitation may take place at 
any syllable of a word. With regard to the position 
of words in a sentence, the stuttering does uot neces- 
sarily take place at the first word of a phrase, though 
it certaiuly does in most cases; and again at the 
commencement of an expiration — ^the first word after 
an inspiration. The organs then pass from a state of 
repose into action, and consequently the difficulty is 
greater. 

A very general occurrence is that the emphasised 
word offers the greatest difliculties to the stutterer. 
It is characteristic of this aflectiou tliat the imagina- 
tion has a great influence on the emission of sounds, 
and the emphasised word is the one that the stutterer 
can foresee more clearly than the rest; he consequently 
examines what sounds it is comjxised of, and if he 
finds imfavourable elements in it he is sure to stutter 
at it, whereas if he had not thought of it, or if the 
word were unemphasised. he would probably have 



CAUSES OF STCTTEKING. 



233 



passed over it without difficulty. So great ia tlie 
influence of imagination on the speech of stutterers, 
that I have known them to fix upon the first word 
that they intended to say in an interview with a 
stranger even weeks previous to the meeting, and, 
of course, fixed upon one that was usually easy for 
them. However, tliiough constant thought, this word 
became diflicult also, and the same with any other 
words. Imagination rendered them difficult I 

Causes of Stutterinff. — Among the exciting causes 
of stuttering have been enumerated : aifeetions of the 
brain, the spinal oord, and of the intestinal canal ; 
abnormal irritability of the nervous system j aohtary 
vices, spermatorrhoEa, mental emotions, mimicry, in- 
voluntary imitation, and stammering. 

The question is by no means settled, whether the 
exciting cause of stuttering is of centripetal or cen- 
trifugal origin. This is an interesting physiolt^cal 
problem, and its solution is not so easy as it at fii'st 
appears. We may obtain some hght on this subject 
by carefully watching the gradual development of 
stuttering from early cMldJiood. Many cliildren 
begin with a simple difficulty in articulating some 
elementary sounds, a difficulty which may eventually 
end in the most complex species of stuttering, Thus, 
although stammering and stuttering art essentially 
different, they are frequently combined in the same 
individual; hence the confusion that has arisen. 
When stammering thus co-exists with stuttering, it 
invariably tends to aggravate the latter ; and severe 
cases of stuttering have frequently come under ray 



254 8TDTTERIHO; FTB OAlTSKB, VARIETIEB, ETC. 

notice which began with infantile stammering, which, 
aided by a certain individual predisposition, gradually 
degenerated into stuttering, and eventually co-existed 
with it. Such an individual has been likened by 
Schulthess to a short-sighted peraon who at the same 
time squints. My experience leads me to believe 
that stammering, more or less pronounced, generally 
precedes stuttering in young children. 

BiffeKvA De^ees of Stuttering, — Stuttering by no 
means obtains to the same degree in all persons. In 
the most simple cases the affection is but little per- 
ceptible ; the person speaks nearly without interrup- 
tion, and merely hesitates at, prolongs, or repeats 
certain conaonants, vowels, or syllables. This alight 
stuttering is, according to some, so far from injuring 
the expression, that it is said to impart to it a cer- 
tain charm. But whatever others may think, tha 
stutterers themselves, even when thus slightly af- 
fected, consider it a great annoyance ; for, unlike 
the stammerer, the stutterer can never hide from 
himself hia fault, whatever may be its degree. Stut- 
tering invariably indicates want of composure, — a 
nervous disposition. Slight stutterers greatly differ 
from stammerers, as they can, with some exceptions, 
speak well when alone; and it is only in the pre- 
sence of others, especially strangers, that they mani- 
fest their infirmity. 

In the second degree the impediment is more 
marked and much more unpleasant both to the 
listener and the sufferer. The hesitations, prolonga- 
tions, eonvTilsive stoppages, or repetitions, are more 



DUrnOtENT DEOBEEB OF BTUlTBBIlfG. 



23S 



I 

I 



frequent ; the discourse is kept up with manifest 
efforts, and frequently accompanied with gesticula- 
tions, the words and syllables being thrown out in 
jerks. Hence the speech of stutterers has been by 
Shakespeare* (and by Plutarch before him) aptly 
compared to the pouring out of water from a bottle 
with a long neck, which either flows in a stream or 
is intermittent. 

Of stutterers of thia class Voisin has remarked, 
" They sometimes hesitate at one syllable, and pro- 
nounce the following with precipitation. At other 
times they repeat the syllable already pronounced in 
order to join it to the succeeding one, and then pro- 
nounce the whole rapidly. From thia stuttering there 
results a battering noise, which the Greeks, so rich 
in picturesque expressions, have well depicted by the 
name ^arrapi^eiv, and the latins by hattarismvs. 

Sometimes the efforts of the stutterer are truly 
formidable.-f and the sufferer emits sounds which, in 

• " I pr'ythee, tell me, wbo is it ? quicily, and Bpeai apace. 
I would thou oould'et Btammor that tLoa migbt'Et pour this 
concealed man out of thy month, ea wine comoa out of a, Domivr- 
mouth'd bottle, either too much at once, or none at all. I 
pr'ythee take the cork out thy month, that I may drink thy 
tidings." — As Yov. Like it. Act iii. So. 2. 

The lute Lord Campbell pleaded that ShakeBpeare won a 
lawyer, from ilia great legal knowledge ; Dr. Bucknill, that be 
with medicine ; and 



was B medical man, from his acqnain 
a hoat of other pvofeasions have put i 



L their plea. Iw 



aldn 



from bia acquaintance with impedin 

t The following ia a curious ace 

Louis XIII : — "The king osHured 1 



nt of the stuttering of 
a reciprocal affection to 



236 BTDTTERmO; ITS CAUSES, VABIBTIB8, ETC. 

the words of Magendie, resemble more " the roaring 
of a wild beast than human speech ; " or at other 
times the stutterer fails to produce any sound at all, 
and renounces his efforts as useless. In these casea 
the stutterers themselves, unfit as they are, generally 
speaking, to judge of the nature of their affliction, 
may be allowed to give a description. Voisin says, 
"At the moment the afflicted desires to speak, his 
tongue, as if chained, denies its service. During the 
efforts the stutterer makes, the tongue is seen to rise. 



the ting mj master, and of m; particular weloorae to liia 
court; hia tFords were □ever mao;, cis being bo extrema a 
Btntterer, that he nauld BometimeB hold liia tongue out of hia 
mouth a good while before he could apeak so much aa one 
word; he had beaidea a double row of teeth, and was observed 
seldom or never to apit or bloir hia nose, or to aweat much, 
though he were vary laborious, and almost indefatigable 
hia exerciHes of hunting and hawking, to which he was much 
addicted."— I>i/b of Lord Herbert of Cherbury. 1826. 

There ie an anecdote told of this monarch which shows that 
atutterers are not only sutiject to ridicule, but that more serii 
mishapB maf occaBiouallf befall them ;— The Marquis de Maurey 
being, with other lords, in the apartment of the king, stuttered 
in reply to a question addressed to him by the sovereign. The 
latter, thinking himself ridiculed, became furious, and ordered 
the offender to be put to death. This sentence would have 
been carried out but for the fortunate interference of the Mar- 
quia de Bicheliea, who informed his M^jeaty that the nnfor- 
tunate Marquia could not express himself diSerently. 

i. somewhat similar acene occurred when the king was ont 
on a falcon chaae, on asking Marahal Thoiraa, " Oil etait t'oi> 
roi-l'oiaeaii ?" " Si-Sire le voi-roi-voiei," replied the marshal) 
on which the king threw his glove at the offender's head; but 
aiterwarda, however, he apologised, on being told that tha 
marshal was a stutterer. 



DIPESBXtrr DEGREES OF SITJITERISG. 



237 



and to call, so to speak, to its aid the muscular forces 
by which it is surrounded. The muscles of the chest, 
and even those of the diaphragm, are strongly con- 
tracted ; the heart palpitates ; the respiration seems 
temporarily suapended; the surface of the hoJy is 
covered with perspiration ; the veins of the neck 
swell ; the face is contorted, and loses the nobility of 
its expression. The greatest efforts frequently in- 
duce only the pronunciation of one or more syllables, 
and the unfortunate stutterers who are unable to 
express their ideas by such a paucity of words, make 
new efforts to finish the phrase they have so pain- 
fully commenced." 

Another physician, writing to Dr. Schulthess, says 
of himself, " In putting into action my muscles of 
the oi^ns of speech there arises a spasmodic eon- 
traction, by which a hissing sound is produced, in- 
stead of a definite tone. In vain does tlie will act 
upon the organs of speech ; the breath fails, the head 
becomes congested, the abdominal muscles contract, 
and sometimes pain is felt in the abdomen caused by 
the pressure upon the bowels. All this takes place 
when the will is strong and when, so to speak, I 
desire to bring the word oiit by force. I then feel 
obliged to give up the attempt." 

It is indeed a melancholy spectacle to behold such 
a stutterer ; not only are the speech and respiratory 
muscles thrown into spasmodic action, but the move- 
ments of the hands, arms, feet, legs, and even the whole 
body, join in the general commotion. Even in slight 
cases the eyelids and eyebrows are frequently in- 



^ 



238 sTDTTEsma ; rrs ca.it&es, tabieiibs, Era 

voluntarily contracted. The sufferer also occasionally 
gives a violent hiccup or stertorous sigL Schulthesa 
has attempted to give a division of these different 
d^rees according to the efforts of the stutterer : — 
1. Ischnophonia, when the voice is arrested; 2. Hasi- 
tatis, when the stutterer hesitates ; 3. Repetens, when 
he repeats the initial sound ; 4. Nictitans, when he 
winks ; 5, SingvMiins, when there is heard a sigh or 
sob ; and, 6. Cowmilsiva, when he is seized with con- 
vulsions and spasmodic contortions. 

Schulthess, however, does not seem to attach much 
importance to tliis elassiiication ; for he adds that " it 
would he impossible distinctly to separate the various 
forms and degrees of stuttering." 

Different Speeies of SUitt^-ng. — Several authors 
have attempted to divide stuttering into a host of 
different species, according as the stuttering mani- 
fested itself. But as no two cases can he found ex- 
actly similar, it cannot be wondered at that they have 
been obliged to continually add to the division as 
their experience and observation increased. It is not 
my intention to attempt to estabUsh a classification 
of so chameleon-lilie an affection ; hut I may, never- 
theless, notice several different ways in which the 
infirmity manifests itself. When I say different, I do 
not assert that every case of stuttering belongs to 
either of them exclusively. On the contrary, the 
infirmity must consist of at least two of them, to 
constitute it a case of stuttering; wliilst frequently 
all of them are combined in one individual. The 
s phenomena of stuttering manifest themselves 



DIFFERENT SMICIEB OF BTUrTEEING. 



239 



in the faulty action of the lungs, larynx, tongue, jaw, 
and the lips. 

Let U3 take a simple case ; when the stutterer 
cannot produce a vowel sound, — a vowel stutterer. 
In this case two actions are requisite ; first, the air 
must be expelled from the lungs ; next, the vocal 
cords in the larynx must he in a position to vibrate. 
The difficulty in this case is caused by the inability 
to Eissociate tlie action of the muscles of expiration 
with that of the vocal cords. The stutterer can nee 
either of these actions separately. When not speak- 
ing he can expel' air from bis lunga aa freely as an 
individual with normal speech. So also he feels-no 
constriction in his larynx. When not speaking he 
may not have any direct power over the action of the 
vocal cords, but he lias at least as much as his non-stut- 
tering friend. To take a more complicated case; — The 
stutterer can produce the sound, but cannot articulate 
it so as to form the desired vowel. Here the lungs 
act normally, but the disharmony lies in the co- 
ordination of the action of the vocal with the articu- 
lating apparatus. For instance, take the word Ilow. 
His lungs being supposed to act normally, he sounds 
the aspirate k and a part of the vowel Here we 
must observe that the sound ow in the above word 
is a compound sound — au and oo. He produces the 
sound au, but fails in conjoining it with the succeed- 
ing sound 00. Tliis requires the retraction of the 
tongue and the protrusion of the hpa The same 
difficulty of co-ordination is visible here. A stutterer 
of this kind, unless his respiration is at fault, in 




240 STUTTEIUNG ; ITS CAUSES, VAHIEnES, ETC. 

which case no sound can be produced, 
difficulty in producing the pure vowel sound, neith^ 
has he any difficulty in the movements of the lips 
and tongue when not speaking ; but when these are 
iec[uired to be associated for the formation of speech- 
sounds, he hesitates and stutters. The difficulty in- 
creases in proportion as the required movements be- 
come more complicated — when the consonant ia placed 
before the voweL More complex still are the com- 
pound sounds, such as str, spl, to say nothing of som6 
Kussian words, unknown to English tongues and palatea. 

But to return. Stuttering may at the outsat have 
been purely a nervous affection; but this nervous 
affection may have disappeared, and the stuttering 
become to a certain extent localised. Or, again, the 
nervous affection may co-exist M'ith the stuttering-, 
which would certainly aggravate the disorder, and 
prove a new obstacle to be overcome in the treat-, 
ment. Stuttering may, in fact, be called an inteiv 
niittent mania of the oigans concerned in the pro*" 
dnction of voice and speech. 

In the beginning the difficidty only occurs at a 
few words, and only at these under special circum- 
stances. In its development, stuttering always obeys 
a definite law. In some cases, where no effort has 
been made to arrest the evil, it arrives at a stage trf 
nearly complete inability to produce speech sounds 
without morbid contortions of all the muscles con- 
cerned. I thus describe stuttering as a lallomania—^ 
a mania of the organs of voice and speech. 

Stuttering may be divided into three chief species :) 



I 



DIFFERXNI SPECIES OF STDlTEKmG. 

1. \Vlien it is raanifeated in whispering, and is caused 
by the defective Eiaaociation of the muaclea of respira- 
tion with those of the organs of articulation ; 2. When 
it is caused by the defective association of the muscles 
of the respiratory and laryngeal apparatuses with those 
of the articulating organs ; and, 3. When the respira- 
tory apparatus is unconcerned, and the difBculty arises 
from the defective association of the muscles of the 
larynx with those of the articulating organs. 

A.— Stuttering cadsed by Defective AssociATinN 
OF THE Muscles of the Eespiratory Organs 

WITH THOSE OF THE SPEECH ORGANS, 

1. Pner/mo-gnathomania, — This kind of stuttering 
9 the result of the defective action of the respiratory 

\ apparatus and the jaw, as required in all the vowel 
sounds, but more especially a (ak). 

2. FTieuvw-glossomania. — Difficulty of combin lug the 
action of the respiratory apparatus and the tongue, as 
required, for instance, iu the word rfiy, 

. Pnewmo-cheilomania. — Difficulty of combining 
the action of the respiratoiy apparatus and the lips, 
' as required in the word haby. 

4, Pneumo-glosso-cheilomama. — Difficulty of com- 
bining the action of the respiratory apparatus, thp 
tongue, and the lips, as required in the word tabbif. 

6. Piiieumo-gTiAtko-glossonmnia. — Difficulty of com- 
bining the action of the respiratory apparatus, the 
jaw, and the tongue, as required in the word car- 



6. Pnevmo-gnaiko-cheUomaiiia. — Difficulty of com- 



' 242 STU'ITKHDTG ; ITS CAUSES, TAKIETIES, ETC. 

bluing the action of the respiratory apparatua, the 
jaw, and the lips, as required in the word iaby. 

7. PneuTno-gTuitho-gloem-cheilomania. — Diificultj of 
combiniiig the action of the respiratory apparatus, the 
jaw, the tongue, and the lips, as required in the word 



B. — SxUTTEItlSG CADSED BY DEFECTIVE ASSOCIATION 

OF TUB Muscles of the Respiratory and 
Vocal Appakatcses with those of the 
Speech Oegans, 

1. pTKUttio-la/ryngomania. — DiEGculty of producing 
sound caused by detective action of the respiratory 
apparatus and the larynx. 

2. Pneu7nf>4aTyTtgo-gnatkomania, — Defective action 
of the respiratory apparatus, the larynx, and the jaw, 
as required in all the vowel sonnda, especially a (ah). 

3. Pn&>imo4aTyngo-glossomanfia. — Defective action 
of the respiratory apparatna, the larynx, and the 
tongue, as required in snch syllables as at, all. 

4. Pnewmo-laryngo-eheilomania. — Defective action 
of the respiratory apparatus, the larynx, and the lips, 
as required in ab, happy. 

5. Pneumo-laryngo-glossO'Cheilomania. — Defective 
action of the respiratory apparatua, the laiynx, the 
tongue, and the lips, as required in lap. 

6 . Pntnimo-laryngo-yna tho-ijlossomania. — Defective 
action of the respiratory apparatus, the larynx, the 
jaw, and the tongue, as in at, all. 

7. Pneutno-laryngo-gnatho-ckeilomB.nia. — Defective 
action of the respiratory apparatus, the laiyux, the 
ja.w, an ! t!ie lips, as required in ci6, happy. 



DIFFEBEHT SPECIES OF STCTTEEING. 243 

8 . Pneum o-laryngo-gnatko-glosso-cheilom an ia .■ — D e- 
fective action of the respiratory apparatus, the larynx, 
the jaw, the tongue, and tlie lips, as required in lap. 

C. — Stuttekisg caused by Defective Association 
OF THE Muscles of the Vocal Apparatus 

WITH THOSE OF THE SPEECH ORGANS. 

1. Laryngo-gnathomania. — Defective action of the 
larynx and jaw, aa in all the vowels, especially a (ah). 

2. Laryngo-glossomania. — Defective action of the 
larynx and tongue, as in allenf. 

3. Laryngo-cheUomania. — Defective action of the 
larynx and lips, as in afAey. 

4. Laryngo^losso-ckeilotnania. — Defective action of 
the larynx, tongue, and lips, as in atom... 

5. LaryTigo-gnatho-glossamania. — Defective action 
of the larynx, jaw and tongue, as in lall. 

6. Zaryngo-gnatho-cheilornania. — Defective action 
of the larynx, jaw, and lips, aa in ai)bey. 

7. Zaryngo-gnatho-glosso-cheilomania. — Defective 
action of the larynx, jaw, tongue, and lips, as in ac- 
ciemulale. 

The utihty of this classification may, perhaps be 
called in question, hut it has the practical merit oi 
directing our attention at once to the organs which 
require regulation. This, in fact, must be the object 
(rf any method of treatment that can hope for auccesa. 
On the other hand, all divisions and subdivisions 
previously made by authors who have written oa this 
defect have not the slightest practical value, and are 
by their nature endless,— for no two cases of atutter- 

; r.re exactly alike. 



Vmiiel Siuttei-inff. — That stuttering only occurs when 
the iuitial aound of a word ia a consonant, as alleged 
by moat ancient, and not a few of modem, authors, 
ia as erroiieoua aa the aasumption of some recent 
writers, that stuttering only occura at the vowels, for 
the affection may extend hoth to vowels and con- 
aouanta. Some stutterers, indeed, have come under 
my notice, who hesitated chiefly at the vowels, whether 
they formed the initial or intermediate sounds of a 
word. Dr. Wolff cites the case of a boy wlio stuttered 
at no consonant except at the spirans A (improperly 
called a consonant) ; whilst the enunciation of any 
vowel caused him great difficulty, especially the vowel 
a. (ah). On attempting to articulate the vowel sounds, 
spasmodic contractions of the musclea of the face, 
the neck, and the respiratory organs ensued, so as to 
threaten suffocation. In this ease, I have no doubt, 
the infirmity was due to a defective mode of respira- 
tion, which required regulating. •■ 

It is not strictly true, as is asserted by some, tliat tlie 
vowels are entirely formed in the larynx, and require 
no inter\'ention of the articulating organs. I am well 
aware that most of the vowels and diphthongs may 
he produced without the full j^articipation of the 
tongue or lips ; even the so-called labial vowels o 
and M may be produced, though not very distinctly, 
without the motion of the lips and tongue requisite 
for distinct pronunciation. Thua persona, who have 
had the toi^ue or lips totally or partially destroyed 
by disease, are still able to produce these vowel 
sounds ; but there can be no doubt tliat for distinct 
t^Iocution tlie vowels must be carefully articidated ; 



VOWEL STUTTEKING. 245 

for altliniigh primarily produced in tlje larynx, they 
cannot be said to be entirely formeil there ; for they 
receive their specific character in the oi'al canal. In- 
deed, the laryns itaelf can make no modification in 
the different vocal sounds beyond the alteration of 
the tone. 

Some stutterers cannot at times produce any sound. 
This may be owing to the abnormal action of the re- 
spiratory apparatus — the difficulty of expelling the 
air at the instant the vocal corda are in a position 
to vibrate ; or to the difficulty of placing the latter 
in the proper position; consequently the air is ex- 
pelled from the lungs without being vocalised. This 
frequently arises from ignorance as to where or how 
the sound is produced. Some stutterers have the 
idea tliat the sound comes from the lungs already 
vocalised ; others fancy it is produced in the mouth. 

According aa the position of the tongue, which the 
articulation of the vowel would require, is liigh or 
low, it is frequently fixed in that position, or con- 
tracted by the stutterer the moment he feels any 
difficulty in producing the required voweL Thus in 
the production of o or m (more especially the latter) 
the stutterer so contracts the tongue as to close the 
isthrnvs fmidum,, the larynx is depressed, and the pi'O- 
duction of sound is rendered impossible. In forming 
a {ay) and e the tongue is pressed in a spasmodic 
state to the palate, the larynx is raised, and the enun- 
ciation of the vowel becomes similarly impeded. In 
the production of the fundamental vowel a {ah), which 
requires simply the opening of the mouth without 
altering the articulating organs from their normal 




246 STUTTEEraO ; ITS CAtrSES, VARIETIES, ETC; 

position, the spasm, ■when the stutterer feels a difG- 
culty in producing the vowel, seizes the tongue, ajid, 
without moving it from its natural position, renders 
it and the adjacent organs, the glottis, etc., rigid and 
immovahle, and the production of the vowel becomes 
impossible. In each of the above cases the spas- 
modic condition, when it continues for some time, 
produces congestion of the blood in the head and the 
veins of the throat ; and, unless the stutttrer ceases hLs 
efforts, symptoms of suffocation manifest themselvea. 

Sometimes the vowel can only be produced in a 
whisper. For instance, when the spasm of the organs, 
as described above, is somewhat relaxed, the air is 
allowed to escape, hut the spasm may still be strong 
enough to prevent the formation of the vowel in loud 
speech ; the consequence is, that the stutterer repeats 
the prodiiction of the whispered sound till the required 
vowel is formed. In others, again, the vowel can be 
formed in the larynx, hut the stutterer is unahle to 
complete its formation, or conjoin it with a con- 
sonant, by the intervention of the articidating organs. 
This is especially the case with the sounds i, a (ay), 
ow, etc. 

Consonantal Stuttering. — Thoog^i^ij|i|Bfctering, as has 
been shown, extends also to the vowele, yet it chiefly 
occurs at the utterance of the mute or explosive 
consonants and their medials, as at p, t, k, h, d, g, 
etc. The aspirated and continuous sounds, as /, m, 
n, I, r, 10, s, etc., offer fewer difficulties, the oral canal 
being then not so completely closed as in the forma- 
tion of the explosives. 



CONSOSASTAL STUTTEHING, 247 

A syllable or a word may commence with a vowel 
followed by a conaonant, or it may commeoce with a 
consonant followed by a vowel. At first aight.it may 
appear to matter very little whether the vowel or 
the conaonant be the initial sound. A little reflec- 
tion, however, will show that it is not unimportant. 
In commencing a syllable with a vowel, the oral 
canal is opened before the formation of the eon- 
sonant, and in forming the syllablea ap, ebb, ott, etc., 
all that is necessary is to close the buccal cavitv 
to produce the consonant, the chaige in the mouth 
being easily adjusted, and stutterers (unless they are 
also vowel stutterers) rarely find any difficulty in 
enunciating such syllables. But when a consonant 
commences a syllable the meclianism is reversed ; 
the speech organs must be placed in the position re- 
quisite for the formation of the conaonant, and then 
suddenly released from their state of contraction to 
allow free passage to the vocal sound. This it may 
appear could be easily effected, if it were merely re- 
quisite to give free vent to the interrupted air current 
by opening the mouth. But it must be considered 
that in the articulation of the explosives there is in 
fact a double obstruction of the sound, not merely in 
the mouth, but also in the glottis, as in their enim- 
ciation the thorax is fixed, which is not the case in 
the other consonants. Both these ohstnictiona must 
not only auddenly be removed, but (and this is tlie 
greatest difficulty) at the moment when the oral canal 
is opened in front and behind, a sound must be simul- 
taneously produced in the larynx by forcing the air 



yj 



248 BTUTTEHIHG ; ITB CAUSES, TARIETIES, ETC. 

from the lungs ; that is to say, during the formation 
of the explosive, the vowel sound must be ready 
to follow and to overcome it. If this cannot be 
effected, the muscles which close the oral canal may 
continue in a. state of contraction, and the fonnation 
of the syllable is retarded until repeated attempts 
prove more successful in liberating the articulating 
organs. It is the disturbed relation and the anta- 
gonism between the vocal and the articulating me- 
chanism which give rise to consonantal stuttering. 

In some cases, then, the vowel which is to follow the 
consonant cannot be produced; the articulating organs 
approach each other, and the stutterer is powerless to 
separate them while the stuttering lasts. This is the 
case both with the explosives and continuous con- 
sonants. 

In other cases the vowel sotmd can only be pro- 
duced in a whisper, and the stutterer repeats the 
consonantal formation in a whisper till he overcomes 
the difficulty ; as in the word butler, he whispers hu- 
hii-bti-hu-, and says aloud butter; four, fo-fo-fo-fo~ 
jowr. Here, however, there is a difference between 
the continuous consonants and the explosives. In 
the former the pronunciation of the word sand would 
be s-s-s-s-sss- (in a whisper), and smid (aloud). The 
H would not be repeated, but the hissing sound would 
be continued, and so on with the other continuous 
consonants. At other times the difftculty lies in the 
formation of the vowel — the whisper is freely pro- 
duced, but is repeated, as in Jot, he saya, ho-o-o-o-o-o- 
(in a whisper) ox (aloud). 



TOTfLUBNOE 07 IMITATION. 



249 



Again, the vowel soimd is freely produced in tlie 
larynx, but cannot be articidated, or joined to the 
succeeding consonant. Tliis is especi^y the case in 
Buch words as hind, bound, gave, where tlie vowel 
requires a distinct movement of the articidating or- 
gans in addition to that necessary for the articulation 
of the succeeding consonants. 

Injluenee of Imitation. — It may be questioned 
whether there is in human nature a principle so inti- 
mately connected with our intellectual development 
as imitation. But we mtist at the outset distinguish 
between two kinds of imitation; the one congenital 
and instinctive, or unconscious and involuntary; the 
other voluntary, or a deliberate act, determined by 
Tarioua motives, and more or less acquired. 

The inborn propensity to imitate ia by no meana 
confined to man, but is possessed by many animals. 
The imitative power of birds, and especially of mon- 
keys, is so well known, that we have a special word, 
"to ape," indicative of the propensity so strongly 
manifested in the anthropoid apes, and in which 
they are only surpassed by man. 

This congenital propensity to imitate the actions 
of others, being, no doubt, connected with our bodily 
organisation, is a phenomenon of which neither phi- 
losophy nor physiology has hitherto given, nor is 
just yet likely to furnish, any satisfactory explanation. 
It may be admitted that imitation in certain cases 
results from the sympathy between two living or- 
ganisms. That such a sympathy exists is unquestion- 
able. Thus ner\-ou3 persons feel (as already pointed 



250 BTnTTEBING ; ITB CAUSES, TASIETIES, Era I 

out by Adam SmitL) when looking at the sores ex- 
posed by beggars in the streets, and many other 
unpleasant sights, an uneasy sensation in a corre- 
sponding part of the body. The history of epidemics, 
religious revivals, etc., and the medical records, 
furnish conclusive proofs, not only of the physical 
sympathy between the bodily organisms of different 
individuals, but of the infectious nature of emotiona, 
as well as of their physical manifestations. Assuming 
for the present that the propensity to imitate ia an 
ultimate fact in our nature, it possesses in relation to ' 
many cases of defective speech a special practical 
interest; for the acquisition of articulate speech hy 
infants is solely the result of instinctive imitation. 

The tendency to imitate exhibits itself in its 
greatest intensity in chQdhood and early youth ; and 
only diminishes with advancing age, when under the 
influence of the will the propensity ia restrained. 
Individuals of weak will remain imder its influence, 
perhaps during life ; whilst persons of a strong will 
emancipate themselves, to a much greater extent, 
■ from its influence. In short, the propensity varies 
according to the temperament In women, who par- 
take more of the infantde temperament, this propen- 
sity is generally stronger than in males. 

Like every other propensity, imitation may de- 
generate into a sort of mania. In an extract of a 
letter by Mr. Geo. Garden, dated Aberdeen, Feb. 17, 
1677,* a eurious ease ia recorded of one Donald 



ISFLUESCE OF iJUTATION. 



251 



Jloiiro, " very remarkable for somewhat peculiar in 
his temper, that inclines h'Tn to imitate unawarea all 
the gestures and motions with whom he converseth." 
"When Mr. Garden, in company of some friend, went 
to see him, they found him " a little, old, and veiy 
plain man, of a thin, slender body," who, as he told 
them, " had been subject to this infirmity from his 

very infancy." When they held both his hands, 

and cau.'ied another to make any motions, he pressed 
to get free. " But when we would have known more 
particularly how he found liimself affected, he could 
only give ua this simple answer : ' Thoi it vexed his 
heart and brain.'" 

" I shall leave it," continues the writer, " to your 
consideration, what peculiar crasis of spirits, or dis- 
temper of imagination, may cause these effects ; and 
what analogy they bear to the involimtary motion 
of yawning after others, and laughing when men are 
tickled (which some will do if anybody do make 
that titillating motion with their finger, though it lie 
at a distance from them) ; and whether, if liia nurse 
have accustomed him to the frequent imitation of 
little motions and gestures in his infancy, this may not 
have had some influence to mould the textm^ of his 
brain and spirits, and to dispose bim to this ridiculous 
apiahness." 

Pinel* cites a similar case of automatic imitation 
in a young female idiot, who had the most irresistible 
inclination to imitate everything she saw, and to 



mtale. Second EiiUon. 



232 STUTTEHraO ; ITS CATOES, VARIETIES, ETC. 

repeat all she heard. She imitated the | 

and actioos of the other patients with the greatest 

accuracy. 

It is a fact which has been frequently noticed, that 
persons habitually aaaociating together gradually ac- 
quire a similarity of manner, — the result of imitation, 
both voluntary and involuntary. This has forcibly 
been pointed out by Shakespeare, when he causes 
Falataff to philosophise : 

" It is a wonderful thing to see the semblahle co- 
herence of his (Justice Shallow's) men's spirits and 
his : they by observing him, do bear themselves like 
foolish justices ; he, by conversing with them, is 
turned into a justice-like serving man It is cer- 
tain that either wise bearing, or ignorant carriage ia 
■caught as men take diseases of one another; there- 
fore let 'men take heed of their company." 

The imitative propensity, as already stated, exhibita 
itself in its greatest strength in earUest childhood, so 
that nothing is more common than to see infanta 
assume the gestures, habits, and modes of pronun- 
ciation of those by whom they are constantly sur- 
rounded. Such being the case, it is beyond question 
that both stammering and stuttering may, and in 
many cases do, arise from unconscious, or mther in- 
stinctive, imitation. One stammerer or stutterer in a 
family ia quite sufdeient to infect others ; and so 
rapid is the contagion to a susceptible child, that I 
know of more than one case in which the infirmity 
wa,s contracted by a single interview with a stutterer. 

Schulthess cites a similar ease of a boy who at a 



INTLUEKCE OF IMITATION. 



253 



I 



Swiss watering place contracted the haljit of stut- 
tering from a girl in wliose company he was for duly 
a day or two. Despite his immediate removal, it was 
a long time before the defective utterance coiild .he 
remedied. 

That this unconacioiia imitation is not entirely 
confined to childhood has already been indicated. 
Thus "Wjmeken q^uotes the case of a married couple, 
of Bremen, of whom at the marriage only one party 
stuttered, but before long both suffered from the 
infirmity. 

Kaau-Boerliaave* gives an instance of a squinting 
school-mEister who infected all hia pupils aftsr the 
first month of his appointment, so that it became 
necessary to diaiuisa him. 

Erachetf cites tlie case of a boy, aged 12, who 
contracted the liabit of winking from sitting opposite 
a boy at school who was thus affected. 

There ia also abundant evidence that speecb- 
inipediments may arise from mimicry or voluntary 
imitation. 

A clei^tyman of the church of Scotland writes; 
" I was entirely free of it till I was five years of age, 
when at that time of life there was a gentleman who 
was in the lialiit of occasionally frequenting my 
father's house, who indeed stuttered very badly, and 
I distinctly remember one afternoon trying to imitate 
him, when unfortunately he lieard me, and was very 
indignant, and so ashamed were my parents at my 



* Quoted by Schnlthesa. 



fibid. 



254 BTUTTEEnTG ; ITS CAUSES, VARIETIES, ETC. 

conduct, that after he had gone, I was taken to taak 
and punished severely for it, and ever situx ihai ; 
night I have been abided with this most tUslTeasinff j 



I am in a position to adduce numerous im 
of thia kind from my own experience. The follow- 
ing tM-o cases are graphically described by Pro- 
fessor Kingsley:* "I knew of a young man, who 
used, for liis little brotliers' and sisters' amusement, 
to act some stammering relation. One day he found 
that his acting had become grim earnest. He had 
set up a bad habit, and he was enslaved by it He 
was utterly terrified ; he looked on his sudden stam- 
mer (by a not absurd moral sequence) as a judgment 
from God for mocking an afflicted person ; and suf- 
fered great misery of mind, till he was cured by a 
friend of mine, to whom I shall have occasion to 
refer hereafter. 

" One of the most frightful stammerers I ever knew 
began at seven years old, and could only be traced 
to the child's having watched the contortions of a 
stammering lawyer in a Court of Justice. But the " 
child bad a brain at once excited and weakened by a 
brain fever, and was of a painl'ully ner\'ous t«mpera- 
ment." 

I trust enough has been said to warn all young 
persons against stuttering in mimicry, lest they should 
raise a ghost which they cannot get rid o£ Old 
Montaigne has said already in bis quaint languf^e : 

• The Irrationa'e <>f f'peeeh. Bf a Minute Pbiloaopher- 



INFLUENCE OF AOB UPON STUTTBRrao. 



^56 



" Children should be well mauled when they mimic 
stuttering, squinting, lameness, or other personal de- 
fects ; for besides that the body so stretched may 
receive a bad crease, it seems that nature sometimes 
takes U8 at our word-" 

Injluenee of Age upon Stuttering. — Stuttering gene- 
rally commences about the third, fourth, or fifth year ; 
it increases up to puberty, when it is supposed by 
some to diminish. But I agree with Br, Klencke, 
that this is but rarely the case except where stutter- 
ing is merely a temporary symptom, and never when 
the habit has become deeply rooted in the system. 
That stuttering should generally (not always) dis- 
appear in advanced age must in some cases be attri- 
buted to the fact that the will becomea firmer, and 
tlie sufferer, perhaps, has acquired certain tricks which 
aid him for a time, but generally the defect remains, 
though its manifestation be less violent. 

Tliis appears also to be the conviction of Merkel, 
who says ; " The more speech is developed and fixed 
by corporeal and mental development, the more must 
stuttering increase, because the contractions of the 
articulating organs become so mach stronger, the more 
the muscular movements become firmer. Moreover 
the gradual development of the respiratory and vocal 
apparatus, in conjunction with the mental excitement, 
contributes at this period (puberty) to render the 
stuttering very severe. When at a later period the 
' mental excitement yields to calmness, then stuttering 
■will not manifest itself by such violent symptoms. 
The stutterer is more composed ; he has by experience 



2S6 STDTTEaiNG; 178 CADBES, VAMETIE8, EEC. 

acquired certain artifices wMch aid Lim; still thgi 
defect remains ; it has become more inveterate, and] 
is at this period more difficidt to lie cured" 

Colomliat, who adopts the theory of Aristotle and J 
Kulher, attributes the disappearance of stuttering in I 
advanced age to the fact that " In aged persons the I 
cerebral irradiation moves more slowly, the nervous f 
influx is lesa impetuous ; their ideas succeed each I 
other with less rapidity. The result is, that the organs I 
of speech are able to execute their movements with- 1 
out confusion, aa their rapidity ia in proportion to 1 
the exciting cause." This is, no doubt, an excellent I 
reason why its manifestation should be lesa marked, I 
but it cannot be said to account for its entire digT 
appearance. 

Another, and, perhaps, the chief reason why veiy I 
aged stutterers are rarely met with, is expressed by 1 
the eminent author already quoted, in the following I 
words : " A stammerer's life (unless he be a very J 
clodj is a life of misery, growing with his growtli, | 
and deepening as his knowledge of life and aspira- I 
tions deepen. One comfort he has truly, that the I 
said life is not likely to be a long one. Some readers I 
may smile at this assertion. Let them think for I 
themselves. How many old people have they ever I 
heaixi stammer ? I have known but two. One ia a I 
very slight case ; the other a veiy se^'ere one. He, a I 
man of fortune, dragged on a painful and pitiable J 
existence — nervous, decrepit, effeminate, asthmatic — I 
kept ali^'e by continual nursing. Had he been a I 
lahoitruig man, he would have died thirty years sooner I 
than he did. 



nmCEHCX OF EDVCATIOS OS BTUTTEBING. 

" The cause ia simple enough. Continued depres- 
sion of spirits weara out body aa well as mind. The 
lungs, never acting rightly, never oxygenate the blood 
sufficiently. The vital energy (whatever that may 
be) continually directed to the organs of speech and 
used up there in the miserable spasms of misarticula- 
tion, cannot feed the rest of the body : and the man 
too often becomes pale, thin, flaccid, with contracted 
chest, loose riba, and bad digestion. I have seen a 
stammering boy of twelve stunted, thin as a ghost, 
and with every sign of approacliing consumption. 1 
have seen that boy, a few months after being cvired, 
upright, ruddy, stout, eating heartily, and beginning 
to grow faster than he had ever grown in hia life. 
I never knew a single case of cure in which the 
health did not begin to improve there and then." 

Influence of Education twi Stuttering. — Much has 
been written on the influence of education on stutter- 
ing. " The stutterer who has cultivated hia mind," 
says Astri^ " and increased his sphere of knowledge, 
feela how important it is that he should acquire a 
free enunciation. His lot, hia calling, especially if 
he intends to become a physician, renders it necessary 
that he should be in constant intercourse with others. 
Self-love and his interest sustain and stimulate him, 
and he arrives after much labour, if not at a perfect 
cure, at least at a sensible amelioration. 

" Behold, on the other hand, that uul'ortunate stut- 
terer, born in misery and remaining ignorant. Not 
being stimidated by the desire of communicating his 
ideas, as he has acquired none, he scarcely desires tu 



BTOTTIiBpiG ; ITB 0AU8E3, VAHIETIEa, ETC. 

be cured of his infirmity. He shims the intercourse 
of men, he falls, so to speak, into a state of idiotcy." 

There can be no doubt that a well educated person 
who feels the necessity of communicating his ideas to 
others, and who brings a strong will to bear on his in- 
(inuity, may, under proper instruction, eventually suc- 
ceed in ameliorating it. But that educated stutterers 
caa by their own unaided exertions cure themselves 
is refuted by the singular fact, which cannot too often 
be repeated, that, with few exceptions, all modem 
writers od stuttering were themselves subject to this 
infirmity, and yet all failed to cure themselves, so 
that most of them cut the Gordian knot at once by 
Iwldly laying it down, that a radical cure of stutter- 
ii^ was impossible. 

Ivfiuaice of Temperajnent upon Stuttering. — I have 
uo intention of entering here into particulars on the 
doctrine or the nomenclature of those physical dif- 
ferences between men which iniluence their animal 
functions and their actions. I take the terms as I find 
them, however objectionable in many respects they 
may be. Having said thus much, I admit that the 
so-called sanguine and nervous temperaments furnish 
the majority of stutterers, but that they belong ex- 
clusively to these glasses, as asserted by many authors, 
is an error. I fouud, and so must all practitioners, 
who have had an opportunity of observing a sutBcient 
number of cases, that all temperaments yield their 
quota. 

Indeed, some of the severest cases I had to treat 
were subjects of a phl^matic temperament. As a 



iE. 259 

general rale I found that stutterers of this claaa re- 
quired a longer treatment to be relieved of their 
infirmity than persons of a sanguine temperament. 
On the other hand, when once cured, the phlegmatic 
subject had that advantage over the sanguine, that 
he was leas liable to relapse, and that for reasons 
which win appear in the sequel. 

InflMenee of Temperature. — The fact that sudden 
variations of temperature, changes of the season, ex- 
treme heat or cold, have some influence (as in most 
nervous affections) either in increasing or diminishing 
the infirmity, simply indicates that stuttering is a 
functional disorder. Voisin states that his infirmity 
in some measure served him as a barometer ; for he 
could frequently pretlict from the greater embarrass- 
ment of his speech that considerable changes were 
about to take place in the atmosphere, and his pre- 
diction "was always justified by the event." 

Colombat asserts that stuttering increases in winter 
and summer, and diminishes in autumn and spring, 
provided the latter seasons are temperate and moist ; 
he further observes that dry air, in frost and great 
heat, acta inversely. 

" This peculiarity," he adds, " which may seem void 
of foundation and chimerical, offers nothing surprising 
to those who know the incontestable influence wiiich 
atmospheric variations have on diseases generally, 
and especially on affections which, like stuttering, 
are essentially nervous." 

Otto also says : " The weather and the seasons have 
a perceptible influence on stuttering. Stuttering ui 



STirmiEIKG ; IIS 0AUBE8, VAHIETIH8, ETC. 

I'onsequence of relaxed nerves is greatly increaaed l)y 
(lamp air, as I observed in a, boy who when t 
was damp could not produce a sound despite all his 
eflbrts. Tliat tlie (Quality of the air baa some inSiience 
upon the vocal nerve is proved by experience : thua 
singing does not succeed so well in damp weather as 
when the air is dry."* 

According to my own experience, these statements 
are often more fanciful than real : no definite rules 
can be laid down in tliis respect. The dry or damp 
state of the atmospliere, its electrical condition, and 
the changes of tlie seasons, influence stuttering ac- 
cording to the idiosyncracy of the subject, so that the 
same external influences produce, among a number 
of stutterers collected' under one roof, frequently op- 
posite effects. 

Infliienee of Tittif. of Say. — ^Another supposed in- 
fluence on speech-impediments is the time of the day. 
Many authors assert that the infirmity is worse in 
the morning than during the rest of tlie day. Thus 
Ur. Eecquerel states that he stuttered more in tlie 
morning, and that ]ie Irelieved this was generally 
tlie case. Dr. Astiie says tliat stuttering is more 
perceptible on awakening in the morning, and he 
endeavours to account for it by the toipor of the 
iier\-ous system and by the fact that the will is not 
snliicently roused at that time. Klenclie also aaaerts 



" JEtna was verj furions when «h passeii, or she iiaeth to be 
FiOuietimeH more tboji otbers, specially wben tLe wind ia aonth- 
wtir<1, for then she in mors Bubjeut to beloliing out flakes of fire 
Dfi atuUertr uaed to sbinimfr more wlieo thv wind ja in tliat liole. 
— /JouibCj Letierj, 1665. 



ISTLUENCE OF TIME OF DAT. 



2G1 



that stiitterinf!; iiiei'easea in tlm moriiiiij,', and he 
ailda moreover that it also iucreasea al"tar meals and 
at t ill moon. Voiain attempts to account for it liy 
aav nti ^^^^ '■ ' appears to arise from the rigidity 
in wlucl tl e i ervous system remained during the 
t m of repose — a rijjidity participated in by all 
\ tal m scles c nuected with it, and which a still, 
undecided wdl is yet unable powerfully to set iu 
motion. In tlie evening, on the contrary, all the 
phenomena of Ufe concatenate with greater rapidity. 
The excitations during the day have augmented the 
pulse and increased the sensibility. The functions 
of the intellect act with greater rapidity, the will is 
firmer, and therefore the pronunciation is less im- 
peded. 

"All authors have justly olaerved that mental 
labour is easier in the morning than at any other 
part of the day, and my view by no means con- 
tradicts tins assertion ; it merely jiroves that stut- 
tering diminishes iu proportion as the brain gets 
more excited. Tina is ao true that stutterers can 
even express themselves with facility when they 
receive impressions strong enough to affect and ex- 
cite the brain more powerfully than those received 
during the day." 

Diametrically opposed to this opinion is that of 
Colombat, who while admitting the fact of stuttering 
being worse in the morning, accounts for it by aaserting 
that the intellect is then more free, and because tJic 
nervous influx from the brain is more rapid at that 
time of the day, and there is thus etlected ii dln- 
hjj'utouy between the rapidity of thou'^ht \\.\\^i. 'O^n^ 



2C2 



STTTTEFlIfG ; ITS CAUSES, VARIETIES, ETC. 



action of the oi^na, so that the tongue, ■when trying 1 

to execute the mandates of the train, ia unable to do ] 
80, and failing in its efforts, causes stuttering." 

Schulthess says, " The fact that stuttering ia ■worse 
early in the morning than in the evening, is easily 
explained, when ■we assume with Himly that the 
factors of irritability differ in the morning and the 
evening ; that in the morning the receptivity pre- 
dominatea, and in the evening energy ; hence feveia 
with irritable debility and of a nervous character, i 
exacerbate usually in the morning, and those ■with 
heightened irritability in the evening." 

According to my own observation I admit that in 
many, perhaps moat, cases stuttering is more per- 
ceptible in the morning than later in the day. I may 
also state as a mere matter of fact, without entering 
here into the cause, that I have specially noticed 
this matutinal exacerbation of speech-impediments 
in youths, aged between sixteen and twenty. Still 
I am far Irom admitting it to be a genei-al rule. 
I have found the exceptions too numerous to assent 
to such an axiom. A great deal I alao found depends 
on the how the stutterer has passed the night. 

Lunar Infliienee. — A popular writer" has recently 
observed : " I am pleased to see that the question of 
lunar influence has of late years been considered 
unsettled," and that "lunar action, despite northern 
scepticism, is ever3Tvhere in the tropics a matter of 



LUNAR INPHTENCE. 



!63 



faith." Tlii3 subject is now open to unbiassed in- 
vestigation ; but at present there does uot seem to 
be much evidence to support the faith of the tropica. 
Every affection of the human body has been supposed 
to be under the influence of the moon, and stuttering 
has been no exception. Dr. Mead* records a caae of 
a girl who for a long time " lay always speeclilesa 
during the whole time of the flood and recovered on 
the ebb." He saya that the father, who waa a boat- 
man employed on the Thames, knew when the flood 
had turned in the night by the cries of the daughter 
on coming out of the fit. We have nothing recorded 
so apparently wonderful as this, but there are many 
cases given by difl'erent authors in which the in- 
fluence of the moon on the speech oi^na is asserted 
as real. Thus Klencke says of nervous stuttering 
that it increases at fidl moon. Such an authority 
upon this subject would certainly be expected to 
give, or attempt to give, some real or supposed reason 
for this occurrence, but he merely states it as a 
matter of observation and does not attempt to ex- 
plain it in any way, I strongly suspect that this 
J8 one of the many delusions extant. 

A physician, writing to Schulthess, says, "That 
the changes of the moon have any influence (on 
stuttering) I do not believe. It is true that it got 
worse during these changes ; but sometimes at full 
moon, and sometimes at new moon, and sometimes, 



• The Injluen 



o/the Sun and Moon upon Huma: 



264 



STDTTERISa ; ITS CAUSES, VAHIETIES, ETC. 



again, there was on such occasions no alteration at 
all But always when the evil became worse at 
these changes there was a change of the weather, 
and the more sudden, the worse was the pronuneia^ 
tion. This also occurred at rapid changes of the tem- 
perature when they occurred between the changes 
of the moon, so that I can only admit the .influence 
of the moon in so far aa it may he connected with 
changes of the weather." Schulthess adds : " But 
if it be tme that convulsions, goitrt, etc., are some- 
times connected with changes of the moon, I should 
not be inclined entirely to deny its influence upon 
affections of the larynx in stutteiing." Frank re- 
lates of a lady of Wilna who always stuttered at the 
approach of the catamenia. But," he adds.^and 
here probably is the key to the supposed influence, — 
" stuttering, as a rule, always increases with bad 
health." 

Injluenee of VnHous Disorders of the Body on Stut- 
tering. — Schulthess cites several cases in which stut- 
tering ceased on the oecuirenee of other affections, 
such as haemorrhoids, suppurations, etc. One case 
is that of a stutterer whose stuttering ceased three 
distinct times during other affections— once when he 
suffered from haemorrhoids, the second from consti- 
pation, and the third from apoplectic symptoms, 
Another case was that of a young workman who had 
the misfortune to get his left arm entangled in the 
wheel of a spinning mill, in consequence of which 
amputation was rendered necessary. When suppura- 
tion commenced the stuttering gradually diminished. 



I 



INFLUENCE OF VAEIOUB DIB0RDEE8 OF THE BODT. 265 

and finally disappeared ; the vvotrnd acting, Schulthess 
says, as a derivative setou. In this case, as in the 
former, the stuttering reappeared after the affectiona 
ceaaed. 

The following case, recorded by the late Dr. Graves 
of Dublin, 8bows that stuttering may be diminished 
by affections of the vocal organ :— 

A young gentleman of delicate constitution, and 
when about six years of age went to bed one night in 
health, and without any unusual symptom; but on 
getting up in the morning it was observed that he 
had lost his speech and was unable to utter a single 
word. The boy, after taking some internal medicine 
and using a stimulant gargle, recovered his speech in 
a few days, without the occurrence of any symptom 
of laryngeal inflammation or cerebral disease. But 
what was remarkable in the ease was this : the boy 
who up to this period had spoken well and distinctly, 
now was a terrible stutterer. This resisted all kinds 
of treatment, and for ten years he continued to 
stammer in the most distressing way. In the month 
of May (tbe boy was then sixteen years old) he got 
an attack of chronic laryngitis. But what is curious 
in the case (eontinuea Dr. Graves) is this ; after he 
got the laryngitis a very peculiar change took place ; 
the laryngeal inflammation modified the tone of his 
voice so as to make it a little husky, but the stavi- 
'aisring had completely ceased. 

Commenting upon this case, which Dr. Graves con- 
sidered as an extremely curious one, and doubting 
whether a similar one be on record, he suggests the 



266 STDTTEHING ; ITS C&UaSS, VAHIKTIES, ETC. 

foUowing explanation ; " The inikinmation taking 
place ill the mucous membrane covering these deli- 
cate muscular fibres (the vocal cords), you can con- 
ceive that either the thictening of the mucoua mem- 
brane, or the alteration in the state of ita vitality, 
may have so modified the disposition of tlie parts, 
that they became incapable or indisposed to undeij^ 
those rapid eontractiona, necessary to produce stam- 
mering, by inducing closure of the glottis at the 
moment its aperture ought to remain open," 

Tins case, I may state, is by no means a solitary 
one ; there are numerous cases on record in which 
stuttering ceased alter the supervention of some 
accidental lesion of the larynx, or even of other parts. 
It will also be perceived that as Dr. Graves uses the 
t«rms stuttering and stammering syaonymoualy, it is 
difficult to decide whether the patient atanunered or 
stuttered ; perhaps he suffered from both these defects. 

Timeus gives the history of a stuttering chdd who 
recovered the free use of his speech in his eleventh 
year, after a quotidian fever. 

Wyneken cites a case of a boy who applied to him 
for otorrhagia, and informed him that previous to the 
discharge he had been a stutterer, but that since that 
occurrence he had been free from his infirmity. As 
the hearing of the boy was affected during the dis- 
charge, it might have been owing to the fact that the 
hoy was more composed, and consequently stuttered 
less ; but the hearing of the patient continued as bad 
after the discharge had ceased as it was before, and 
still the stuttering returned. 



PSYCHICAL INFLUENCES. 



267 



Tlie same physician tells us that he himself, when 
out travelling late at night, was once over-fatigued, 
and when he arrived at an inn he could not even 
stutteFj so much was his infinnity increased. Nor 
was this spell broken till a servant of hia father 
carae to fetch him home. 

Psychical Ivjluences. — Every passing emotion in- 
fluences, more or less, the action of the heart and tlie 
respiratory functions, either by accelerating or re- 
tarding them ; and as the production of the voice is 
intimately connected with the act of respiration, it 
is not surprising that the vocal apparatus and the 
organs of speech should be instantly affected by our 
sensations and thoughts. Thus voice and speech 
may be suddenly lost and as suddenly recovered 
under the influence of powerful emotions. 

Touching the influence of the emotions on stutter- 
ing, it may be stated as a general rule, that whilst 
comparatively slight emotions, such as timidity, in- 
crease the infirmity, profound emotions may, for a 
time, entirely remove it by the excitation of cerebral 
action, and the consequent infusion of greater vigour 
into the motor agents of the articulation. 
■ The subjoined cases, presenting opposite effects of 
the influence of fright on the speech of stutterers, 
may serve as illustrations. 

Herodotus (484 B.C.) says that theTherean Battos,* 
who had been a stutterer and a stammerer-f- from hia 




268 STTTTEKISC ; US CACSrs, TAKieilES, ETC 

yoeSh, cansnlted Uie oracle at Delphi. The onde ! 
asid : " BatUis, tbem amtest on accmoBt of tbr speedi, i 
bat King PtuElms Apollo sends thee tu lit^^ to 
dwell in the Uni) of sheep," 

After having fonnded the oolmy Oyreae, be was, 
according to Pansanias, cured by the unespected 
9tght of a lion. Henxlotus also obsenes that Battos 
meant, in the African language, a king. 

M. Chen-in remarks : " A nurse entering a railway 
tunnel says to a child ' Void le dkihlt' (Here's the 
dei-il). The child is terrified, — he is a stutterer," 
The same author asserts that he has seen a stuttering 
child thrown into the water in order to cure its 
infirmity. He does not, however, definitely state 
whether the chUd was cured. 

One of the most severe cases of stuttering I ever 
saw was caused by the parent stamping and catling 
out " Silence !" His son, aged eight, who was running 
across the room, fell on liearing his father's voica 
\Vlien he got up he l>egan stuttering very violently. 
Another pupil stated that this infirmity was caused 
by the fright of being run after by an Irish tramp. 
Tliese instances might be greatly multiplied.* 

There are many other psychical InHiiences worthy 
of notice, among which may be mentioned the fact 
that some stutterers manifest thuir inlirmity less 
when they speak in the dark. Itard mentions a case 
of a young stutterer who suddenly ceased stuttering 
when speaking before a large assembly ; this he 

• Seu infra, CLapler on Staliatics. 



I 



209 

attrilmted to t!ie room being sufficiently darkened 
to hide his contnrtiooa fi-oni his listeners. It is said 
that he was hUndfolded in order to get rid of his 
infirmity, hut without success. 

Another fact somewhat analogous to the preceding 
is, that stutterers do not hesitate so much in their 
speech when masked. The reason of tliis is, that, 
in addition to their coutortioiia being concealed, they 
generally assume also a feigned voice, and are tliia 
enabled for a time to overcome the impediment. An 
additional cause of this temporary respite is, that 
theii' attention is for the time withdrawn from their 
difficulty. This also applies to the comparative 
fecihty with which stutterers can repeat difficult 
words enunciated by another person. Many stutterers 
experience no difficulty in imitating any peculiar 
mode of ai'ticulation, hut no sooner is the model to 
be imitated withdrawn, than the stutterer relapses 
into his own faulty mode of articulation. 

It ifl well known that when stutterers are roused by 
indignation, a sense of wrong, etc., they are fcec^uently 
released from theu' uifirmity, or at least the latter is 
considerably diminished. 

The following is one of these instances, recorded 
by M. Colomhat. 

Three gentlemen, stutterer? to a painful degree, 
went to the French Academy of Sciences, for the 
pi;i-]ioBe of being examined by a commission before 
tindergoing treatment hy M. Colombat, then a can- 
didate for tlie Monthyou prize. On leaving the 
academy they entered a tobacconist's shop to puixihase 



270 STUTTERING ; ITS CAU3E3, VAEIETIES, ETC. 

some cigara. The least timid among them accord- 
ingly addressed the tobacconist, Booo do doo donnez- 
Tnoi des ci- des ci- des ci- des cii/arres." It so happened 
that the tobacconist was himself & terrible stutterer, 
and was by no means surprised at having a com- 
panion in affliction, but he was certainly far &0111 
imagining that the other two were similarly affected. 
When, therefore, after asking the gentlemen, " De- 
dede-de-dede-quel quel qua-qua-qim-qualUi vou-voti- 
voulez voua les-les-ciffarres ?" all three began horribly 
to stutt«r, he flew into a violent rage, thinking that 
they merely came to have a lark. He therefore 
seized a stick to belabour them, whilst he swore at, 
and threatened them in the most energetic terms, 
without the least impediment in his speech, For- 
tunately the arrival of M. Colonibat at tlds moment 
put an end to the scene, by iuforming the enni^d 
tobacconist of the real facts of the case.* 

A similar residt follows other emotions; for in- 
stance, when the stutterer becomes greatly excited 
in a discussion which animates him, his speech is 
rendered iluent. 

I have had ample opportunity in my establish- 
ment of noticing during the debates on a variety 
of topics in which my pupils take part, that when 
any subject under discussion specially interests the 
speaker, and when in a state of excitement he vehe- 
mently enforces his arguments, he sometimes aa- 



;e rilBO The Unspeakable; or Life and Adiieittare 



P8T0HICAL INPLUBNCES. 

tonishes hia fellow pupils by the temporary fluency 
of hia delivery. As already stated, two elements 
combine to produce this effect, viz., the cerebral in- 
fluence on the motor agents and the momentary 
oblivion of his infirmity. 

The following caaea show another peculiar mental 
influence on the speech of the stutterer. 

W. G. (aged nineteen) writes : " The case you de- 
scribed as Mr. E.'s approaches nearest my own ; for 
instance, he says that ' If he had once stammered to 
a person, he could never apeak plainly to him again." 
I have frequently, when conversing with persons for 
the first time, not stuttered at aU, or very slightly, 
but when once I find that they know me to be a 
stutterer, I never speak plainly to them any more. 
If alone, I could read all tlie part^apli relating to 
Mr, E.'a case without hesitation, but place a person 
before me, and I could not read a single sentence 
without stammering very badly. And again, when 
I know that I must have an interview with any 
person, I am in a state of the moat nervous excite- 
ment untQ it is past. Many are the kind invitations 
I have declined, simply because of my impediment, 
when, God knows how dearly I should have loved to 
have joined the merry circle of my companions and 
friends." 

The following is an extract from a description of a 
case of stuttering, in a pupil's own words. There 
are many who will doubtless recognise the truth of 
the description, with some modifications, from their 
a experience. He saya that he can remember the 



STUTTKBDtG ; ITS CAP3BS, TAWETIES, ETC. 

time wLen he did not Btntter. It gradually came on 
wlieu a youth, and increased until the twentieth year, 
with periods of mitigation, during which time he 
says, " I spoke for weeks together with comparative 
ease, so that a casual stranger who eouveraed witli 
me would be unaware of my having any impediment, 
though he might have noticed a certain hesitancy and 
discomposure in my manner." Coming to reside in 
London tlie stuttering monthly increased, " till it has 
become almost painful to me to speak at all" He 
then continues : — 

" Yet at the present time, as always since I re- 
inemlter, in private and alone, I can read and speak 
Ti'ithout stuttering at all; and not only so, but in 
church can join in all the responses of the congrega- 
tion without hesitation, my voice being borne along 
8S it were by theirs ; for if their voices suddenly 
were silenced, I should become perfectly speechless. 
(I have experienced this, when it has sometimes 
happened that they have finished their responses he- 
fore me). I think, too, if I could persist in always 
using a most affected drawl in conversation, I should 
})ut a stop to the stuttering; though I have often 
found that I have succeeded in various contrivances 
for a time, and until a certain consciousness that 1 
must stammer affected me while practising tliem also. 
and I have stammered immediately. I have naturally 
a great ' tendency of words to the mouth,' and could. 
I think, but for my stammering, become an easy and 
ready public speaker. I am naturally of a most 
delicate constitution, with a tendency to pulmonarj- 



PSYCHICAL INFLUENCE. 273 

disease, at least that is mj own impression. I attri- 
tute my stuttering. I say, to the posaession of a very 
eensitive and nervous organisation, as much of the 
body as the mind, producing hesitation in the first 
place, and now, through time and habit, spasmodic 
contraction. 

It is clear to myself that, inasmuch as I can read 
and speak when alone, I ought to be able to do so 
publicly; but that I cannot do so is the very secret 
of the complaint. I have tried self-cure, and failed 
from this very fact. Irresolution, incapability of per- 
aistence is the very cause, I fancy, not only of the 
atammerer'a being a stammerer, but of his continuing 
to be one. A stammerer possessing a resolute and 
indomitable will might cure himaelf; but for myself 
I feel the want of discipline outside, as it were, and 
beyond myself, and a sense of reliance on some 
other's means of cure and not on my own ; while at 
the same time I feel confident that a stem discipline 
to speaking would in time bring such a control 
over the organs that stammering would entirely cease 
to be." 

Another case I may mention, — that of Astritf. He 
says : " Wlien I am alone, and read either in a low 
or in a loud voice, I scarcely ever stutter; I speak 
■with considerable facihty with my friends. 

Intimidated by a person whom I respect or fear, 
I am embarrassed in the eommimication of my ideas. 
In a numerous circle I am silent and reserved. It is 
sufficient for me to have a preaentiment that I shall 
stutter at certain words which ordinarily are difficult 



274 STUTTEKOra ! BM 0AU88S, TABISTIES, ETC. 

for me, and my etutteriog becomes woi-se. I believe 
that I shouH stutter very little oould I pereiwide my- 
self that I dou't stutter at alL" 

It would thus seem that, generally speaking, stut- 
tering is -worse when the stutterer is speaking in 
public or before strangers, but such is not invariably 
the caae. On the contrary, several persons have come 
under my observation, who were far more affected with 
their infirmity when alone or with their own family 
than when speaking before company or in public. 
The fear of rendering themselves ridiculous acts as 
a stimulus, strengthening the psychical element ; and 
the firm will to overcome the dllheulty actually gives 
them, for the time being, more control over the dis- 
obedient organs. 

The following letter,* written more than a century 
ago, to the editor of the G&ntlemnn's Magazine, when 
the phenomena of Pselliam were but little understood, 
gives a case in illustration : — 

"As I have seen many odd cases inserted and 
accounted for in your Magazine, I beg leave to make 
known the following, which I am at a loss how 
to account for, and therefore shall be highly obliged 
to any of your correspondents that wiE determine 
for me. 

" Not long since I was introduced into the com- 
Ijany of a very worthy clergyman who stammered as 
much in his common conversation as any person I 
ever met with; insomuch as frequently not to be 



PSYCHICAL INFLOENCE. 



275 



able to get out a word for near the space of a minute. 
I thought to myaelf thia impediment in his speech 
lilust certainly be a great uneasiaesB to a gentleman 
of his profession, when in the pulpit, and extremely 
tedious to his congregation. But on the Sunday 
following, when I attended him to the parish church, 
how great was my surprise to hear him go thrhugh 
the whole fhvine service without the least hesitation ! 
And I am informed that whenever he makes a little 
mistake in his discourse, he recovers himself with 
as much ease as any one the most eloquent of his 
function can do." 

In this case, no doubt, stuttering was combiiied 
with rapid enunciation or cluttering. Probably, in- 
deed, the former was caused by the latter ; and it can 
easily he imagined that, on the disappearance of the 
cause, stuttering should be less perceptible. Never- 
theless the case is a rather striking one, and deserves 
notice. Tliere is another circumstajice which may 
account for this seemingly mysterious phenomenon. 
It is well known that stutterers iind leas difficulty in 
reading than when speaking extempore ; and in all 
probability the reverend gentleman availed himself 
of the aid of tiis manuscript. 

One of ray pupds, a talented clergyman, before 
coming to me, had occasion to deliver a sermon — a 
task which, under the circumstances — being afflicted 
with a severe imj^diment of speech^he would have 
been very glad to avoid. Perceivii^ at the beginning 
of his discourse, that the pecuharity of his enuncia- 
tion caused an nnseemly merriment among liis con- 



27fi STUTTKRISG; TTS CitTSES, TABIETIBB, ETa 

gregation, hia feelings were roused to such a pitch, 
that he inwardly vowed to give them no further 
oauae for it, and he fully succeeded ; for he went on 
with his diflcourae to the end without once faltering. 
But the excitement proved too much for liiin : the 
concentration of mental energy was, as usual, fol- 
lowed by reaction, and he felt utterly prostrate for 
several days, and stuttered fearfully until fie plficed 
himself under my tuition. 

StvtteriTig in Sijiffing and Recitation, — Singing 
differs from speaking, insomuch that in the former 
the vowels are formed of a given number of vibra- 
tions, with a fixed time, and that the syllables and 
words follow each other in a definite rhythm. 

Hecitative (twitativo), speech-song, holds an inter- 
mediate place between singing and speaking. It 
differs from singing in having no fixed time or measure, 
bnt allows the reciter to regulate the length of the 
notes according to his own notion of the emphasis 
Inquired, and thus approaches common speech. 

Recitative, however, difi'ers from common speech, 
insomuch that it is language delivered in musical 
tones, and that the accents required by the text more 
definitely predominate. 

Again we miist diatii^uish dcdatnation from reci- 
tative, as declamation may be marked merely by 
accents, whilst recitative is marked by musical notes. 

These differences point out at once that stuttering 
must obtain less in singing tlian in recitative, and 
less in declamation than in common speech. 

All authors agree that stuttering obtains much less 



STtJTTEHING IX SraQING AND HBOTTATIOS, 277 

in singing than in common speech. The reason ia 
obvious enough, la the first place, the glottis is 
open ; the expiratory air-current is not merely better 
regulated for the formation of the syllables to be 
articulated, but it ia strong enough to overcome the 
obstructions oEFered by the organs of articulation. 
In addition to this, the attention of the stutterer is 
partially withdrawn from the mode of articulation, 
and directed into a new channel, that of rliythra 
and melody, the articulation becoming subordinate to 
the latter. For this reason, namely, the subordina- 
tion of articulation to rhythm and musical intonation, 
stuttering is less perceptible in recitative and de- 
clamation than in common speech. I cannot, how- 
ever, assent to its being laid down as an absolute 
rule that there is no stuttering in singing ; for I have 
met with some few subjects who formed exceptions 
to this rule, 

Schulthess compares the phenomenon that stut- 
terers do not hesitate, or at least much less, in singing 
than in speaking, to piimphobia, which consists in 
this — ^that the swallowing of hquids is impeded by 
irregular spasmodic contractions of the throat, and is 
effected either by repeated efforts, or by the ejection 
of fluitfe through the mouth and nose, whilst soUd 
substances can easily be swallowed. "Just as the 
deglutition of solid food, which by ita mass expands 
the gullet, and gives its muscles a firm hold, is much 
easier, so it seems that song-tones have, so to speak, 
more mass or consistence than speech -sounds, and 
more easily overcome the spasm of the glottis." 



278 stuttehinq; ira causes, VAEiETiBa, ira 

Something analogous takes place in intoxicatioD ; 
an ineliriated man is sometimes able to nra, but flnds 
it a difficult matter to stand at ease or walk steadily. 
The same singular phenomena oeciir now and then in 
rheumatic and nervous atfectiona. Gaubins cites t^ie 
caae of a man who could run, but not walk steadily ; 
and Astrie had a lady under his care who walked 
lame, but danced elegantly. 

Angermaun says, that at least ope-half of stutterers 
show thejr defect in recitation, though in a less 
degree than in conversation ; and still less in singing. 

Klencke admits tliat the stutterer can sing and 
recite, but he asks }^(yyl ? " Either with a voice 
which Hire^tena ^) vanisji every instant, hoarse, noisy, 
Trithout timbre, tremulous, or with a disagreeable, 
dialiarmoniou8,6rM(ai voice, little distinguishable from 
l)^OWing." 

In opposition to Klencke's assertion, Wyneken saya 
his experience is decidedly opposed to it. " I have 
always been able to sing," he says, " tolerably well, 
and I have known several stutterera, much ■^orsc 
than myself, who always duripg singing manifested 
an harmonious voice of considerable coiflpass." 

Neither can I fully agree with Dr. KIe^lcke's aa- 
gertion. At the same time it is certain that coi;- 
firmed and long-continued stuttering does act most 
^^Uurioysly, not only on the quality and timbre of the 
voic^, bt;t also on the ear. In such cases there ia 
po.t only a want of harmony in tlie voice, but also a 
defect flf rhythm in their readings ^nd recitations. 

Stuttmng in W/it^^erin^.^TrrT^ii^ ^e^a ^^j th^ 



I 



. STDTIEaiNO IN WHtfiPEKIHG. 



279 



f 



is generally lesa stuttering in whispering is that in 
this mode of utterance there is not necessarily a 
synchronous action of the muscles of the larynx and 
the oral canal— frequently the cause of stuttering — - 
the hreath being articulated without the full parti- 
cipation of the vocal ligaments ; hut if the fault lies, 
as in some cases it does, in combining the action of 
the muscles of the respiratory apparatus with those 
of the articulating organs, there will be, and there is, 
stuttering in whispering, as I frequently have occasion 
to convince myself. This class of stutterers furnish 
a less proportion of cases than "those where the vo- 
calisation is at fault, and this may account for the 
erroneous assertion of authors that there is no stut- 
tering in whispering. 

Articulation is altogether independent of the larynx. 
By merely expelling the air through the mouth, with- 
out permitting any laryngeal sound to be formed, all 
the letters may be articulated in a whisper. 

M. Deleau* has illustrated this fact by putting an 
India-tubbet tube through the nostrd, so as to reach 
the posterior portion of the moulsh, suid causing 
another individual to blow gently through it ; wliUe 
the organs of the mouth are silently thrown into 
those positions necessary for the utterance of any 
particular sound, that articulate sound wiU at once 
appear in whispers ; but if, while this is doing, the 
larynx is permitted to yield a sound, two voices are 
then heard, one in audible speech and one in whisper, 



• Humaii Physiology, p. 357. By Jolin Draper. 1801. 



580 STOTEKISG : ITS CXCSTS, TAKIETIES, BIT. 

ibe one belonging to the owner of the larynx, and the 
utber arising Fnnn the air which his companion is 
Mowing into the tube. 

We can whisper during inspiration quite plainly. 
Lrrad sounds msT also be thus produced, tliougb tbey 
are not so agreeable aa those produced in a normal 
manner. Even short words may be produced daring 
inspiratioiL We may continue whispering for a long 
time during inspiration, provided it is done slowly ; 
we can also speak in whisper ^■ithout being inters 
rnpt«d by inspiration. Some interjections are used 
with good effect by actors during inspiration. 

It has been asserted by some authors tliat even in 
whispering there is a necessarj' participation of the vo- 
cal cords ; but this requires some explanation. When, 
for instance, we wish to be heard at a distance, we no 
doubt call in the assistance of the vocal ligaments. 
It is said that the celebrated actress, Mrs. Siddons, 
when enacting the character of Lady Macbeth, could 
whisper so distinctly and forcibly as to be heard in 
the remotest parts of laige theatres, " and produced 
a greater thrill than the loudest bawl of those who 
t«re a passion to tatters."* Now this is a physical 
impossibility, supposing the sound to be solely pro- 
duced by the action of the breath gainst the pharynx, 
palate, and other speech organs. But we have no 
reason to suppose that the vocal cords are necessarily 
concerned in low whispering. 



■ The Tongue and ill Traimng, p. 28. W. E. Graf. I.oiidon, 



1 BTnTTEEING HKBEDITAHT? 



281 



I 



I have already, in another place, cited caaes sliowiuy 
that persons can distinctly whisper when the laiynx 
has heen injured by disease or accident. A more 
recent case of the kind is mentioned by Dr. Hugh- 
lings Jackson • " I saw," he says, " a few months 
ago, in the London Hospital, under the care of my 
colle^;ue, Mr. Hutchinson, a patient who could whis- 
per, so as to be understood across the ward, when 
at t!ie same time his vocal corda could be seen tlirough 
a wound in his throat." 

Is StiUteriTtff heredilary? — That a predisposition 
to special affections or diseases is transmitted from 
parent to offspring, as well as external resemblance, 
and that the sins of the parents are visited upou 
the children for several generations, is both a very 
old and very true doctrine. Hippocrates evidently 
believed in the transmission of a predisposition to 
certain diseases. " If," he askSj-f" " phlegmatic, bilious, 
consumptive, and splenetic parents procreate phleg- 
matic, bilious, consumptive, and splenetic children, 
why should not the children whose father and mother 
are epileptic be more specially liable to that disease ?" 

In recent times the transmission of disease has not 
Ijeen seriously questioned. But it is one tiling to 

* Clinical Lettarei and ReparU of the London Hoipitai, vol. i. 
1864. 

+ Si enim ei pituitoao pituitpaus, et er bilioso bilioauB oritur, 
et ex tabido tabidus, et ex splenico aive lieDOBO lienoaus, quid 
vetat, ut oujus pater et mater hoc morbo oorrepti fuerJut 
etiain poatororum ac nepotum aliquia corripiatar? — Hippoo. Da 
ilorbo Socrn, v^ T. Ojpeia Omnia, Grace et Latine, Lug J. Batav. 



382 STUTTERING; ITS CAUSBa, VAKIET1K8, ETa 

admit the facts, and another thing to explain them. 
We find, therefore, that in the year 1 748 the Academy 
of Science of Dijon offered a priae for the solubiod of 
the following question : 

" Comment s^ fait la iranmiission des maladies h4r4~ 
ditaireai" 

I api Bot aware that the priae waa awarded ; there 
was, however, one competitor who deserves notaoe, 
namely, the celebrated Antoine Louis, one of the 
luminaries of French surgeons. In his DissertatJOB 
on the question as to how the transmission of diseases 
is effected,* he says (p. 12) : 

" Before entering ui>on tlie solution of this question 
we ought first to examine whether really hereditary 
diseases exist, and what is to he understood hy them," 
Instead of answering the question at issue, he pointr 
blant denied the existence of hereditary diseaaea, on 
the sftmewhat specious grounds that the source and 
the principle of all oui diseases lies in our tempera- 
inents,*t" and as the diversity of temperaments is not 
hei'editary, neither can the diseases be resulting from 
them. 

I know at preseflt of po physiologist of note who 
denies the transmission of diseases. The esaniples 
furnished by pathology are too nimieroua to gainsay 
the doctrine. Some affections are less, others are 



u fail la Trayut- 
l'H6pital Gsn^ml 



* Diiseriation iv la QueaUon, " Com 
taiaton." eta , by SA Louifi. Chiriirgiei 
de P&riB, etc. Paris, 1T49. 

t C'eat BpaaiaoinB dans notie tBmp^niment que ae truQTeiit 
roe et le principe de toutes noB tualudius (p. i 



I 

I 



IB STUTTEIUKG HERErDITABT? 

more tranamiaaible. To select only one d 
we find that Dr. Garrod* states, that he found in his 
hospital practice hereditary influence in fifty per cent, 
of the cases ohserved, and the percentage would he 
still higher if the private cases were added. Nor 
doea pathology furniali less numeroua exaiuples of 
the transmission of cerebral and purely nervous af- 
fections. Indeed, it may he questioned whether the 
tranamiaaion of cerebral disease doea not furnish the 
higheat percentage. 

But, as already hinted, the admission of a fact and 
its explanation are two different things ; and conse- 
quently we find that the obscure and great problem 
of hereditary transmission still awaits solution, 

GeofEroy-Saint-Hilaire, in hia History of Anomalies, 
confesses that the explanation of the extraordinary 
facts of hereditary transmission was beyond the actual 
state of science. This he wrote iji 1833. In a very 
able summary in the Gazette MMicale (Aprd, 1844), 
the author says that the question, as it then ^tood, 
belonged less to science than to that mass of em- 
pirical knowledge which frequently fonns the w^ole 
lu^^e of practical medicine. WTio knows under 
what conditions hereditary ufifluences are propagated? 
Who can determine the exact part played respectively 
hy the male or female, or to what extent tlieir union 
by marriage may increase, alternate, or destroy tlteir 
respective participation ? 

In point of fact, all is uncertainty, obscurity, and 



■ TreatUe on Iht NaUre und Cure o/Soai. London, 18S9. 



284 BTOTTERING; ITS CAT79E8, YARIETIES, ETC. 

vagueness touctiug hereditary transmission. And.! 
finally, one of our most distinguished naturBlistal 

wrote, some years ago ;* " The laws governing in-J" 
lieritance are qiiite unknown ;" and in his latests 
work-f- he observ'es on the same subject: "It is-V 
safer, in the present state of our knowledge, to look j 
at the whole case as simply unintelligible." Ittl 
another place, he remarks ; * " But the power of trans- I 
mission is extremely variahle ; in a number of indi- 1 
viduals descended from the same parents and treated f 
in the same manner, some display this power in gjm 
perfect manner, and in some it is quite deficient, and| 
for this difierence no reason can he assigned." 

Now, whilst we may admit with Mr. Darwin that 1 
the cause of the non-recurrence of some, and the I 
transmission of other, affections is at present un- I 
known, and that the whole question of hereditary I 
transmission is as yet in its infancy, we still hops I 
that fresh facts may throw more light on it. When I 
nature hides her mode of action, we must try to a 
prise her, so to speak, inflagratUe delicto, and here 19 1 
the difficulty ; for we should have to trace the trana- I 
mission through all the stages of development i/n J 
uta-o. No one now adopts the doctrine of chance. | 
Transmission is, therefore, auhject to certain Uwa, I 
which, though at present but Uttle understood, aw I 



• On (fta Origin of species, p. 13. 
F.E.S., etc. 1859. 

t The Variatiam of Animals and 



Bj Chaj-lea Darwrin, H.A.., I 



under DomeiHcaUim, 1 
* [hid., p 27. 



IS STUTTKBING nEREDITABr? 285 

All that I tUiuk can be safely asserted at pre- 
I sent is, that there are some constitutiuna in which 
rvous affections, eapecially, are more or less trana- 
j miasible. Hereditary influence may thus be at work 
in causing a predisposition to contract the habit of 
stuttering, whenever the subject is placed in certain 
oircumstancea favourable to its development. As 
f Dr. Wyneken recently well said, " There exists a 
certain innate disposition for stuttering, which can- 
not be obviated by the moat careful education." 

But while I admit this, I am far from considering 

tliat when the ali'ection can be traced to a father, 

grandfather, or other stuttering relation, the infirmity 

must necessarily l>e hereditaiy. The enormous in- 

r fluence of imitation," of which I have already treated, 

I will, in many cases, be foiuid to ofi'er a probable 

I solution as to the exciting cause. 

I nevertheless do not doubt for a moment that 
I stammering and organic defects may be directly and 
[ collaterally transmitted ; and that the exciting cause * 
I of a large amount of the stuttering prevalent may be 
L. found to have its primary cause in hereditary trana- 
I uisaion. 

" Nothing ia more ooromon," Bftjs Mr. ThelwaU, " than to 
f liear talk of nervons impediments, and oonstitutioniil impedi- 
I ments, and hereditary impadimente. Aa for horeditary im- 
J pedimenta, what ace the; bat habits of imitatioa p or, if you 
I please, of early, diaeased anBociation. If little master baa a 
1 papa, or little miss ii gi-andpapa that staiuuiors, or thai gnbblea, 
IT that throttles, is it extraordinary that the one abould imit^ta 
l.thiB defaot?"— A Letter to Henry Cline, Eaq., On Imperfect 
Mpevelopment, etc., by John Thelwall. London, ISIO. 



286 sTinTEBiNtt ; its cadseb, vambtibs. Era 

Astriii says, " My great-gmndiiither was a sliittet^r. I 
It is veiy singular that of all the menibera df oiir 
iiiiineh)iia fmhily, noiie stutter but myself and my 
twin brotlier. AVe both possess in tlie same degree 
the difficulty of enunciation. Is it in us the result | 
of original modification, or the consequence of vicious 
habits contracted in infancy ? Noitrished by the aasoB 
mili, brought up together, has one of us become a 
stutterer by imitatiou ? I know not. But what ia 1 
certain is this, — that we liave both made the same 
progress in the art of expressing ourselves." 

Colombat seems to have devoted some attention 
to this subject. He says, " The difficulty, or rather 
imi>o3sibiUty, df giving a satisfactory explanation ' 
of physiological or pathological transmission &offl 
parents to children has induced a great number of 
physicians to deny its esistenoe, as if to admit a fkct 
it were always necessary to state tlie reason of it. 
We may, however, observe that by a curious contra- 
diction those authors who refused to acknowledge 
hereditary organic affections and dispositions, have 
never ventured to deny the external resemblances of 
children to their parents, although this is as difficult i 
to explain as pathological transmission. It is true 
that at the present day few deny the existence of i 
hereditary affections; for in our century science is 
founded on observation, and theories on experience. 

" Pujol de Castres says, ' that the same hand which 
traces so scrupulously the features of the son upon 
those of the father and mother, must extend to in- 
ternal resemblances, and render with the s 



IDlT.UtY ? 



287 



actneas, oi'gaii for organ, viscus for visciis, constitution 
for constitution.' We must, however, admit that the 
exceptiona are by no means rare." 

Colombat aimimariaea his conclusions on this sub- 
ject thus : " The so-called nervous affections, such as 
mania, epilepsy, chorea, hysteria, hypochondria, etc., 
have by most authors been conaiiiered aa moat aua- 
ceptible to be transmitted. It is no doubt for this 
reason tliat stuttering, being in its nature essentially 
a nervous affection, so frequently assumes an here- 
ditary character. In fact, nearly two-fifths of the 
stutterers we have treated told us that their difficulty 
was a disagreeable inheritance. In 1831 we treated 
a young man named Joseph Bard, who was afflicted 
with severe stuttering, and whose mother, herself a 
stutterer, had five other sons equally afllicted, and a 
sisth who was deaf and dumb from birth." Another, 
a young Irishman, who stuttered much, had a father, 
three brothers, and four sisters thus afflicted. A thu'd, 

Madame de Saint L , aged twenty-four, whose 

father, mother, brothers, and sisters were afflicted 
with cluttering, iotacism, lambdacism, and lisping. 
Colombat adds, that if neither the father nor the 
mother were thus afflicted, tlie infinnity frequently 
existed in some grandfather or great-grandfather, or 
some other paternal or maternal relation in the direct 
or collateral line. "We thus see," lie continues, 
" that when the filiation, or physiological, or patho- 
logical transmission is separated by an inteival more 
or leaa wide, it is with this as with family resem- 
blances, which may be interrupted during one or 



BTUTTEBINO; ITS CAUSBB, VABIETIEa, ETa 

several generations, but whieli ordinarily Booner or 
later re-appear with all their peculiarities and primary- 
activity." Otlier persona, he mentions, whose parents 
did not stutter, had some membera of their families, 
such as uncles, cousins, or nepliewa, thus afflicted. Of 
stuttering brothera he found in three instances that 
they were twins. "Although," he continues, "the laws 
of physiological transmission which govern all or- 
ganised beings are hidden under a veil which can only 
partially be lifted, it seems to us that their existence 
cannot be denied when we admit the hereditary 
stamp on the structure and form of the organs. In 
fact, as a cliild frer[uently faithfully repeats tlie whole 
physic^omy of its father or mother, why should it 
not be possible that there is a liiie resemblance in 
the internal organisation ? The facts of nature in 
favour of tliia truth are too numerous and coneluaxvB 
to deny their endence." 

Beaciion of Stuttering on the Oeneml ffcalth. — The 
influence of stuttering on the general health has long 
been a f|uestion of discussion. Eacli writer on the sub- 
ject has looked upon the question irom his own stand- 
jioint, and lias advocated views in accordance with 
his own jjet theoiy. The time is now past when we 
need enter into a discussion as to whether stuttering 
be a disease or merely a ^ice of speech. Assuming 
it to be merely a vice of speech, and acquired in 
most caaes by voluntary or involuntary imitation, we 
have yet to consider what is the result of a long- 
cuntinued vice of speech exhibiting the phenomena 



^B REACTION OF STUTTEHING ON HEALTH. 28i) 

^1 of stuttering ? Can local morbid action exist in 
^H organs 80 intimately connected with the brain as 
^H thoae of speech without producing some injurious 
^H effect on the mind ? Assuming, also, stuttering to be 
^^ centripetal in its origin, must it not become centric 
by long continuance ? 

Several authors agree in stating that stuttering is 
highly injurious to the action of the heart. Mr. Bishop, 
speaking of the exhaustion of the chest in public 
speakers when they are greatly excited, says, "the 
prolongation of the inspiratory movement thus oc- 
casioned tends to cause an engorgement of the lungs 
and of the right cavities of the heart, impeding the 
arterialisation and free circulation of the blood." The 
action of the limgs in stuttering is often similar 
to the above, consequently a similar result may be 
expected. Rulher says of severely afflicted stutterers, 
" They are then seen to suffer Irom twitchings of 
the stomach, nausea, a feeling of strangulation which 

■ forces them to give the tongue a forward position." 
In a very remarkable and su^estive article,* Dr, 
Paget says that stammering in speech may bo taken 
as the type of a class of similar affections of other 
organs, and that we may apply to all the same 
generic name of " stammering." "f 

I* Remarki on Stammering v>ith other Organs Ihan those of 
Sfeeth, by Jamas Paget, F.B.S., D.C.L. Oion., Brit. ISed. Jo-am., 
Oct. 24, 1 B68. 
t MendelBBObn (aee p. 4S) eipreBBed a Bimilor idea, tha± aCnt- 
tering; may occur in other organs of tbe body suttject to volun- 
taiy motion. 
- 



290 STtnTEBING; ITS CAHSEB, VAHnrros, FTC. 

" stammering," he says, " in whatever oi^ana, ap- 
pears due to a want of concert tetween certain muscles 
that must contract for the expulsion of something, and 
others that must relax to permit the thing to be ex- 
pelled Numerous as are the varieties and modes of 

speech-stammering, this discord of muscles is in them 
all. Its dependence on the nervous system and the 
mind is in fact plain enough, in theory very diffieulti 
Perhaps it may help the study of speeeh-3(«,mmering-, 
if similar disorders be watched in other parts of the 
body." 

After comparing speech- stammering (evidently 
meaning stuttering) with "stammering urinary or- 
gans," Dr. Paget continues : " It may suffice to aay 
that nearly all the phenomena of stammering speech 
find in them their parallel. In both alike are ob- 
served the strong influence of habit and association 
of ideas ; the effect of transient changes in the vigour 
of the nervous system ; the need of a justly and yet 
almost unconsciously measured exertion of the will, 
thfit it should be neither more uor less than enough ; 
and the influence of distraction of mind. And eq_ually, 
in both classes of patients, may he noticed the coin- 
cident general sensitiveness of the nervous system, 
and the family relations with persons who suffer trGm 
various other forms of nervous disorder." Dr. Paget 
concludes, that, as far as he had seen, long-continued 
" urinary stammering" did not produce organic disease 
of the urinary organs, and that after years of trouble 
nothing appears wrong but the manner of action of 
these parts. 



REACTION OF STDTTEltlSG ON HEALTH. 291 

Tlie pernicious reaction of stuttering on the sufferer 
s well pointed out by MerkeL He says: "The gieat 
efforts made by the suS'erer during speaking, the 
retention of the tlood in the thoracic organs, the 
cerebral congestions, may gradually induce a pre- 
disposition to cardiac disease, aneiirianis of the aorta 
and the carotids, and may, secondarily, produce bron- 
chitis and pulmonary disease ; and may also give rise 
to serious disorders of the nervous system, which is 

' irritable in the stutterer. Still greater is the 
injury done to the psychical life of the sufferer, As 
the stutterer is partly deprived of the bond which 
links men together ; as lie is deprived of social con- 
tact with other men, there arises in him a certain 
inclination for solitude and contemplation, which 
may, according to his temperament, degenerate into 
melancholy." 

The indueuce of stuttering on the psychical life of 
the sufferer is much more marked than that on the 
bodily health. 

The intimate relations of body and mind, and 
their mutual dependence upon each otlier, are con- 
stantly manifested in the pheuomena of utterance. 
Thus in many cases the infirmity is increased or 
diminished, according to the impaired or healthy 
state of the digestive and otlier functions. Whilst 
it camiot be denied that nervousness may produce 
stuttering; it is not leas true that stuttering may 
produce nei-vousness. In such cases, the cure of 
stuttering will tend greatly to re-establish health. 
I liave known it an-eat the progress of pulmonary 



STUTl'KKLKO ; ITS CAUSES, TABIKTIES, STC. 

disease, while in every case, its removal has hod tlie 
effect of calming and invigorating the whole syatem. 

A friendly critic has intimated that I have paint«d 
the distress which stuttering sometimes induces in 
too strong colours. He save, " A terrible picture is 
given of the consequences of the disorder, moral and 
physical, but rare indeed must be the case where 
stammering ALOSE causes either abject despondency, 
dyspepsia or hypochondriasis: on the other hand, 
how frequently are persons of a happy and merry 
disposition to be found among stammerers !" 

No doubt it is quite true that persons who have 
some impediment in speech are often of a happy 
disposition, hut they are not psychical stutterers. It 
is also true that stuttering is only the remote cause 
of physical and mental disorders. The whole atten- 
tion of the psychical stutterer is directed to "self." 
How many mental and physical disorders are pro- 
duced by constant direction of the attention to one 
subject ! Esquirol, and all other authorities who 
have written on tlie influence of the mind in the 
production of disease, fully admit that abnormal 
physical action is frequently the result of oneness 
of thought.* It would be easy to prove, were it 



* " OaoneHB of the affoction and tliongbt Tenders tbe actira> 
of tlie oielaiicbolio unirorml; Blow. Ho r«fuBeB, indeed, ml] 
motion, and pa^sses his days in solitude and idloneaB. The 
lecretiotu are no longer performed, or preient remartudile dit- 
orders, tbe akin ia arid, with a, dr; and luiruing heat. Tran- 
Bpication bos ceased (in tbo bodj), whiln the extremities of th<) 
limbH Kte bathi'd in sweat." — Esquirol, On Mental Slaladiet. 
Translated b; Miss E. K. Hnnt, M.D. 



SEACnOK OP BTUTTERISCJ ON HEALTH. 



293 



necessary, that I have not overstated the injurious 
influence of psychical stuttering. Dr. Klencke ob- 
served, in his first work on the subject, "that over 
and above the nervous uTitation which stuttering 
induces, it influences injuriously the moral character. 
This is less perceptible in the lower classes, such 
as day-labourers, artisans, etc. ; but it is very dis- 
tressing for those who have much intercourse witli 
their fellow-beings, and is a perfect bar to many pro- 
fessions. Persons so situated become peevish, avoid 
society, and neglect their business." He further 
saya; "Whatever form stuttering may exhibit, and 
from whatever cause it may have arisen, it always 
exercises upon the whole individual a pernicious in- 
fluence, and gives a specific expression to the mind 
and character. The abnormal mode of expression 
reacts upon the mode of thinidng, the search for easy 
words, tlie incapacity of finishing a sentence, gives 
to thought an illogical, flighty expression, and im- 
presses upon it the character of uncertainty. The 
habit of speaking and thinking only by fi'agments, 
gives to the character of the stutterer that capricious 
disposition, which renders it difficult for him to per- 
severe. I, at least, have as yet had no stutterer in 
my institution who exhibited firmness of purpose 
and perseverance. Tliis explains why stutterers dis- 
like a rational conseq^nent mode of treatment, why 
they gladly embrace the opportunities of consiUting 
travelling stutter-doctors and charlatans, provided the 
cure can be easily effected ; and I liave even known 
intelligent persons so affected who have paid dearly 



294 BTtlTTERING ; ITB CAUSES, VARIETIES, ETC 

for some gai^Ie water which a medical swindler sold 

for the cure of stuttering." 

Eomherg also says, " there is an undeniable re- 
flex action on the mind, for atutterera are irritable 
and shy."* 

If the te-stimony of stutterers themselTea were of 
any value, I have more than enough to convince any 
one. I quote the following extract from a letter — 
one of very many of a similar nature — as a case in 
point. I would only observe that the case described 
is not that of a man of education, but of a poor 
shop-lad. He writes, " I am sony to say that I am 
no longer in a position to think of applying to you 
tor aid, for since I saw you my father has died. My 
impediment is even worse now than it was then. 
The change is caused, I believe, by my having to 
speak more, for I am now in a situation, and I find 
it very hard, very hard indeed, to get through my 
day's duties, bo that I am always glad when night 
comes : but on the morrow I am just the same, and 
the mocking jeers of my ahopmates add to my miseiy, 
' Hope deferred makes the heart grow sick,' and I 
think it does. Sometimes I find a little rest and 
peace in solitude, other times in drin/Cjf neither of 
which do me any good ; unfit for buaiuesa, shunned 
by society, or rather I shun it, the world appears to 
me like a desert, till at last I have come to the con- 
clusion that nothing but death will end my misery." 



• ^ervoiM Diseatea n/H/an, vol. i, p. 301. Svden 

io8. 

t The ItaliCH aj'e in t.he oiHi,-ma1. 



u Soo..tj-, 



REACTION OF STUTTEBIKG ON HEALTH. 205 

Tlie reaction of stuttering on the young is in some 
cases very marked, often stopping the gi'owtL.* I 
liave known youths, after they have been cured, to 
grow two inches in three months ; which may be ac- 
couiiteil for by the nourishment actin;^ afterwards in 
a natural manner on tlie system, wliich before was 
unduly appropriated to the support of the misused 



* " We bare some reH«on to believe that the formative powoi' 
□f tbe tiasnea themBelveH m&; be dioiinisliod, so as to aheck the 
proceai of nutrition, evea when the plastic material is supplied j 
and a dimiuatioa of it in that irritable state of the ejetem 
which reaultB from esceHsive and proloogiMl bodilj exertion, or 
aniiety of mind." — Carpenter's Human PliyaiolosTl. 



CHAPTER IX. 

OS TlIE TREATMEST OF STUTTERISG. 



" la the trentment of no other complaint is 
essential tban in this. I need not mention also, that un- 
wearied induatry and patience are reqaiaite on the part oT tlis 
teacher aa well as on tbat of the papil. This fact ma; afford 
aome light as to the reason why a method Bnccessfol in the 
bands of the inventoF fails in the hands of othei-s. No methods 
invented for the cure of Btammering have met with general 
success, because such methods are incommunicable— at least, 
in writing." — Db Edwabd Wabbem, Eemuiki oti Siammenug, 
.4mn-. Jouni 0/ Med. Science. Boston, lti37. 



Pn^udice against sect 

necesBBry. — Eiperi 
i for the Ca 



3I Eciuedies — The secret of the AQthoF*B 
the Application. — Viivl Toco lustmction 
ince. — Imposaibla to give Written Di- 
of S buttering:. —Bene fit ^ ^^ derived 



&om Books on Stuttering'. — Eiperienoed Inatractor indis- 
pensable. — Dr. Klencke.— Quackery.— Dr. KosenthaL — "Ap- 
pliances." — Ubaz<>B. — Treatment. — Diagnosis. — Method of 
Ihe Author. — Luryngoaoope. — Sir Duncan Gibb. — Medical 
Treatment.- Gelliua. — Ulpian. — Dr. Klencke.— Prof. lAn- 
genbeok.— Medi.:inal Bemedies but rarely noeesBory. — Dr. 
Palmer. — Cliorea cured by Gymnaslics. — Eleottieity of no 
avail..— Psychical Treatment. — Dr. Paget.— Dc. Klenoko. — 
Ben^Gcial Effect of the Kemoval of Stuttering. — Firm Will 
indispenaable — Timenecessary for Cure.— Otto. — Dr.WfUTBIi 
^Dr. Klencke.— Ii«lapaea. — Banamann.^M. Malobooolw, — 
Mi. Bishop. — Concluding Eomarlis. 

There exists, perhaps, a well-founded prejudice against 
secret remedies. We may, in the abstract, admit that 
a person in full possession of a remedy tending to re- 
Hove any of the Ols incidental to the human trame ia 



TBEATMBtfT OT STDTTEEniO. 297 

morally bouiid to divulge it, and to look for a reward 
in hia own conscience ; although a. professional man's 
experience may he hia stock in trade. 

I have never made any mystery of the general 
principles of the system I adopt. The great secret 
of my practice conaiatB in the application, and not 
in the system itself. My duty is to do all I can to 
effect cures of stuttering ; but I firmly believe that to 
enter into any particulars of treatment would, in most 
cases, have the effect of depriving sufferers of that 
confidence which they can alone obtain by viva voce 
instruction. I believe, therefore, I am consulting the 
best interests of those suffering from impediments in 
speech, when I refrain from entering into minute de- 
tails of ray mode of treatment. This course does not, 
certainly, receive the approbation of the inquisitive 
or indolent ; hut it has gained the approbation of all 
competent scientific men who have paid attention to 
this subject. 

Secrets, however, though they may be divulged, 
cannot always be easily communicated ; for many 
secrets consist simply in the employment of superior 
tools, in the skill of the workmen, and in the in- 
genious mode of combination requisite for a variety 
of purposes. 

The mainstay of my system is fa^rimoe; it neither 
consists in an operation, in a chann, nor a potion ; its 
name is legion, according to the legion of shades 
which the infirmity exhibits ; for there is no afl'ection 
which is so capricious, and so much defies correct 
I description. I believe there is no one term which 



presents such extremes of differences, both in degree 
and in kind, as the expression, '■impedimenta of 
speech," used in a comprehensive sense. Even if 
there were in the treatment a uniform system of rules, 
it would not be applicable to all cases, as there are 
no two persons who are physically and mentally 
constituted alike. 

The stutter of one never exactly resembles that of 
another. Each case has its peculiar symptoms and a 
physiognomy of its own. Just as the timbre of the 
voice differs in every person, so does the character 
of one case of stuttering differ from that of another. 
Simple of application as my system may be in one 
case, it is intricate and complicated in another. But 
were it even possible to describe all the miimtifB of 
a mode of treatment adapted to all imaginable cases, 
it would be useless, if not productive of mischief, 
unless the individual who applies it has qualified 
himself for the task by an extended practical ex- 
perience. 

When I first published my views on this question, 
there was, as already stated, a general clamour amongst 
many inquisitive persons, and also with some few well 
informed critics, because it was thought that I might 
have given a fidl detail of my mode of treatment. But 
each year, both the public and my critics have com- 
plained less on this head. Indeed, it is now generally 
understood, that I can no more give specific direc- 
tions for all cases of defective utterance than an 
honest and scientific medical man can give one set of 
prescriptions for all forms and cases of any particulai 



I 



TREATUEKT OF BTUTTEIUNa 

(Usease. It hna heon my endeavour to explain to 
the public the nature of defuctivu utU)raiioi\ and to 
Minovo tlio mystery liy which it has hoeii attempted 
to bo Burniuiided by pretenders and charlatans. Tliis 
object haa been partially attainud ; but thoro in yet 
tavich to bo done before paroiits, guaniiftim, and even 
itntterers thorasolvoB, can be made fully to appreciate 
tile neceaeity of rigid attention to general laws of 
physioloKy- Althoni^li for Bunio years I stood alone 
in my declaration, tliat it wan impossible to give 
written instructions for the cure of stuttcrinp, I am 
happy to find that this position is now admitted by 
■ome of the best autlioritioa, not oidy in tliis country 
tut also on the Continent and in the United States. 

All that I i'onntsriy pretended to, was to bo rigidly 
JbUowini^ in the footateps of my lato father, who, by 
unshackling himself from preconcoivod theories and 
hy taking nature as liis guide, establishe<i the basis 
of a method which has since stood the test of tiino ; 
the soundness of which becomes more and more 
confirmed by our daily increasing knowledge of tho 
etruoture and functions of tho vocal and articulat* 
ing organs. To the basis of the method estalilislied 
by him I have added tho results of observations 
during nearly twenty years' continual jivactice; and 
while amply proving the general corroctnosB of tho 
fundamental principles laid down by my late father, 
I have adopted such improvements and modifications 

Iaa have been suggested by tho progress of science in 
relation to the physiology of the organs of voice and 
^eoh. 



300 

My teaching, it should be remembered, interferes 
neither with the practice of the physician nor that 
of the surgeon. I pretend to nothing more than 
the employment of instruction and reason to remedy 
those painful impediments wiiich constitute not only 
a harrier to the common intercourse and enjoyments 
of life, but to individual advancement in any class 
of professional pursuits. 

This brings me to the consideration of the benefit 
that has heen and may be derived from the perusal 
of hooka, professing to lay down definite rules for the 
cure of stuttering, from whatever cause or cauBes it 
may have arisen. 

In my Manual of the Philosophy of Voice and Speech, 
I have given ample rules touching the formatiou of 
speech, the cultivation of the voice and the regulation 
of the respiratory action. By studying these rules, an 
intelligent person possessing tenacity of purpose and 
self-control, may succeed in freeing himself from 
certain minor defects. But where there are severe 
faults of articulation, vocalisation, and, worst of all, 
of respiration, confirmed by long habit, the mere 
perusal of written rules and their application in at- 
tempts at a self-cure, Avill not only fail, but will 
actually aggravate the disorder, and render it more 
complicated hy the contraction of other bad habits. 
I know as a fact that the great majority of sufferers, 
who have applied to me for relief, had previously 
read and tried the multifarious plans recommended 
hy a great variety of authors, and I had always more 
trouble in curing these than such as were free from 



« 



TfiE&TUXNT OF STDTTEBDia. 

any preconceived theory. Some of these books have 
done great harm, especially to nervous and sensitive 
sufi'erera. This is the experience of many of my 
pupils, who studied every accessible work respecting 
■their affliction, and eagerly tried the various systems 
therein laid down. The effect has beeu to produce 
such a morhid and confused state of mind, — from con- 
tinual disappointment, — as to render theui, in must 
cases, sceptical as to the existence of any reuieily 
Ukely to relieve them. Some writers have been induced 
by the best and most charitable motives to publish 
their opinions, being quite unconscious of any harm 
that could possibly result from their books ; yet, I 
have not the least hesitation in asserting, that the 
mischief they have done far exceeds any benefit that, 
in a few exceptional cases, may have been derivod. 
Each author gives entirely different directions on the 
course to be pursued for the desired end ; yet each 
asserts the infallibility of his own theory, while some 
writers give sucli a complicated description of the 
subject, as greatly to perplex the general reader. 
All this produces mystification, and thus tends to 
envelope the subject in greater obscurity than ac- 
tually surrounds it. In the history of the different 
theories and modes of treatment, will be seen tlie 
vast difference of opinion which exists on this sub- 
ject ; but I trust that my remarks may contribute to 
the explanation of many of the iucousistencies and 
contradictions which are apparent to those who have 
studied the causes and ctire of stuttering. 

Nothing is more certain than that in inveterate 



302 



THEA.TMENT OF STDTTERKG, 



and severe cases of stuttering, tlie pupils require, far 
a, certain period, the constant aid of an experienced 
teacher, who, having traced the cause of the evil, 
adapts the treatment accordingly. " But if the pa- 
tient cannot ohtain such aid," says Dr. Warren, " what 
course is he to pursue ? I am not sure but what it 
would be best for him to endeavour to banish the 
subject altogether from his mind." This is exactly 
my own opinion ; for the sufferer invariably increases 
his anxiety and difficulty by continually worrying 
himself with unsuccessful attempts at self-cure. 

Dr. Klencke, who is certainly the best continental 
authority ou this subject, well says that the cure of 
stuttering should not be undertaken by " teachers, 
elocutionists, decayed actors, and music-masters, who 
possess no physiological knowledge, have no notion of 
the causes and complications of functional derange- 
ments, and apply only a mechanical method, without 
reference to individual cases. But it is equally la- 
mentable when we see physicians, travelling from 
place to place, drum the stutterers together like the 
recruiting officers, see them perhaps only once or 
twice, sell them some bottles for good payment, give 
them some advice, and then depart for other towns. 
Such physicians prove that either they have no idea 
of what stuttering is, or that their object is merely to 
get money." 

Dr. Mor. Eosenthal, of Vienna, has well observed 
that, " In the arena of large cities individuals travel 
about as stutter-doctors, with but scanty practical 
knowledge, or, perhaps, speculate on the credulity 



TBEATHEKT OF BTUTTERING. 



303 



' of the public with receipts and charms, Such pre- 
I tenders, who praise their doings in advertiaeraenta, 
I have done much harm to patients, and rarely give 
any relief."* 

My attention has been recently called to the doings 

I of several impostors who advertise their ability to 

cure defective speech, and I have met with several 

persons who have been duped of their money by 



at toucbiag oertaiD aontrlv- 
:hibitBd in 1807, appeared in 



• The following amuBing' aco 

icea for the uuro of atuttering, 

[ the .Medical Time*. Aug. 10, 1867 :— 

" Among tbe eccentricitieB of the American Eihibition are 

I the iDBtTUmeDtB invented by the ing^emous Mr. B. Follow- 

I Ing the example of DemoBthenes, the inventor causeE amall 

' bite of gold and silver to be inserted between the teeth, iind 

thereby reatorea the organa of apeech to their normal condition. 

I Three kinds of stammering, and three only, are recognised 

In the claaeificatioa of Mr. B. The first corrcsponda to tbe 

lingnaJ letters — tit, lit, tit; the second to the labial conaominta 

— pifi. f i;'. pip. Tbe third takes place in the throat, and ia 

expressed bj gng, gag, gog. 

" For eaoh of these Mr. B. boa invented a, special apparatus. 

Tit, he BBjB, te readil; cured by inserting a little plate of gold, 

perforated at its centre, betneen tbe two &ont teeth. Pip ia 

■come by inaerting into tbe mouth a silver disc connected 

I vith a Jong tube which projects from tbe iipa like a fUnnel, and 

a disguised hy means of a quill ; the wearer thus appears toi 

[ liave B tooth-pick in permanent employment. 'An eicellent' 

f habit,' attjB Mr. fl., 'and one which ought to be univeraollf 

[' Adopted in polite society.' J$ there not aomotbing quite Trans- 

f fttUntia in this delightful nuggestion F As to gog it is easily 

I cured by compresBing tbe throat with a narrow cravat, with 

m plate in front, whiob ia pressed down by a sorew. By sub 

V mitting to this permanent process of atrangulatiun. the wearer 

ire t& become a fluent speaker, and ui:iy. Tor aught I know, 

Uimt a, flgnro in CongresB." 



304 



tbeatmest of srrmEiSG. 



fmjiag tar Btane " iiifallibl<e af^lUnoe." The fuDoir- 
ing IB an exttact &obi a letter I reoeiTed frtnn a 
joang man thus nctimued, vliich Tould be nmimipg 
were it not melancholy . — 

" I have staraniered erer since I can rememher ; I 
am now seT^iteeQ rears of age. I hare two younger 
brothers, two uncles, and two cousins, who all stam- 
mer. I went to ^lancfaester when I v»s fifteen yeais 

old, to . I dare say you will bare heard of 

him. He told father that he was the only one that 
could cure stammering. He examined me, and said 
that he could cure me in about seven operations. 
I will tell you the operation as well as I can. I 
went in the morning at about eleven o'clock, and he 
had two pieces of stick, and thrust them under my 
tongue; then I held some hquid in my mouth, which 
burnt the skin off the roof of my mouth : then I had 
a vapour bath I held my face over a basin of hot 
water, with some herbs in it, for half an hour, till my 
face was as red as it really could be ; after that, I 
had a piece of India-rubber in my mouth under the 
tongue, and that was the whole of the operation, and 
I am not any better now."* 

■ Quocker; eemna to have been aa rampant a thousand years 
ago UB it IB nuw. RliazeB§ coiupUinB of it in the following 
tormB : — " A whole book wuold be insufficient to oontain the 
inapoaitionfl pcoctised by individuals, who gave themselvea out 
aa phjaiciane. Some aay they can cure epilepsy, and cut u 
cross in the occiput, and do as if they took aomethinif which 

§ Khazpfl (about 939 A.D.), one of the greatest, if not the 
chief, of Ai'ab physiciaiw. Co«ii?ie?iB. Venet. uincvn. Die 
Itadiein ier Araber, by Dr. S'inkenatein. Dattache Klinik, 1862. 






(I 



I 
I 



TBBATUENT 07 STUUSKUTO. 

There are other impostors who have had t^w. 
I efi'rontery to declare that they were acquainted with 
I my system, and under this pretence have induced 
I persons to advance sums of money which they dc- 
[• dared they would return il' the cure was not effected. 
I Ihe melancholy result, however, is not the waate 
of money: hut when caaea of stuttering are thus 

tliey bad long in their bands. Otbers tnka snnkes anA liKorda 
ttoui the DOBa. Othera pretend to draw troga and worms fl^om 
the tongue and toatb. Otbers perauade patients that they 
hare taken stoneB rroiii tbe bladder. If they find none, thsy 
etJU sbov tboia to the pntitint. Others pretend to dnvw luuciin 
from tbe penis whtob they have first injected. Ot^ers persuade 
the patient that he has swallowed glass i they then tioklo him 
with a feather, bo that he vomits, when tbey show him thu 
gleu which they themselves hod concealed in the pen. liy 
these tricks many have loat their lives, and uo one ought tt> 
trust thuao fellows." 

It would, perhapa, be difficult to find an advertisement in 
ftny papun of the present day, to equal in Impudence tliu 
following, which appeai'ed in the Spartator, at tbo beginning of 
lost century: — "An admii'aljle confect," ao runs tbe advertise- 
ment, "which assuredly cures atittteriag and Btammering iu 
children or grown persons, though never bo bad, causing thetn 
to apeak distinct and free, without any trouble or diffloulty. 
It remedies all ma4iaer of impediments in the apeeuh, or dis- 
orders of tbo voice of any kind, proceeding from what cauau 
soever, rendering those peraons capable of spoaking easily and 
ftee, and with a clear voice, who before were not capable of 
uttering a sentence without beeitation. Ite stapendouB effects 
is so quickly and infallibly curing stuttering and atammering 
and all disordera of the voice and diffloulty in the delivery of 
speech, arc really wonderful. Price 2b. Rd. a pot, with diroctionp. 
Sold only at Mr. Osbom's toy-shop, at the ' Boae and Crown.' 
under St.DunBtau's Church, Fleet Street. ■■—A'jpo(!!o(or,No.c»xii, 
July aoth, 1711. 

X 



TtKirUEUT or STDTTESDEd. 

trifled with, they become very difficult to cure, and, 
indeed, sometimes the total enidicatioD of the defect 
ifl thus rendered impoaaible. 

TreatmefU. — The main thing ia to form a correct 
diagnosis ; but this can only be awjuined by long 
practice. The distinctive marks are frequently so 
blended that the superficial observer may consider 
two cases of stuttering as identical which have 
scarcely any analogy to each other, and require an 
essentially different treatment. The common saying 
"a man who is Iiis own doctor has a fool for his 
patient" apphes equally to the stutterer. 

It has ever been a fundamental error to assert 
that there is but one cause which produces the 
various d^reea of stuttering, and, conseqiiently, biit 
one remedy to be applied. The result has shown 
that all systems which have been propoimded on 
such a narrow basis have been rendered useless. 
On the other hand, there ia perhaps no afUictioij 
to which tlie human frame is liable, which has been 
attempted to be cured in so many different ways, 

The famous pebbles of Demosthenes ; a bullet in 
the mouth ; a roll of linen under the tongue ; tJie 
fork of Itard ; the bride-la tiffue and other contrivances 
of Colombat ; the whale-bone of Malebouche ; the 
stick behind the back ; intoning ; speaking tlutiugh 
the nose ; talking with the teeth closed ; all these 
(and more) have iwen successively advised and ap- 
])lied to remedy faults which existed only in the 
imagination of the advisers. And if thoy produced 
liny effect it cunaisted frequently in creating new 
defects. Onp thinif is certain, that every one of these 



i 



THBATMBTfT OP STUTTEBINO. 



307 



I 



contrivances seemed to loae its efficacy as soon as 
the secret waa divulged. 

Before determining upon tlie treatment to be 
adopted, I make it a point of inquiring wliether 
any relatives of the pupil labour under the same 
infirmity, and whether he stutters in singing, Al'ter 
a careful examination of the buccal cavity, the air 
passages, etc., and inducing the patient to move Lis 
tongue in every possible direction, I ask a few ques- 
tions, and desire bini to read passages of poetry and 
prose, in order to observe whether his chief diffi- 
culty lies in the enunciation of the lingual, labial, or 
guttural sounds, and also to see what mannerism or 
tricks have been acquired. The motions ol' the lower 
jaw, tlie elevation and depression of the larynx, the 
rhythm of the respiratoiy organs during enunciation, 
and the action of the heart, require particidar atten- 
tion before we are enabled to form a correct diagno.iiB. 
The constitution, age, sex, the duration of the in- 
firmity, the original cause of the defect, the mental 
disposition and moral habits of tlie patient, must all 
be taken into consideration before the treatment can 
be decided upon. 

It will, in most cases^ be found that the infirmity 
is mainly owing to the misuse of one or more organs, 
which are employed either with too much force, ot 
not used at all ; the necessary result of whicli is dis- 
harmony between vocalisation and articidation — one 
.of tlie chief sources of stuttering. Ai'ticidation may 
:be normal, and vocalisation defective, and vice vcrad. 
To estalilish the requisite harmony between all organs 
coneenied is the object to bo aimed at. 



IBEAmEKT OF sxiTrxGBisa 

If the question be aaked : How can it be ascertained 
that the infirmity is not the result or concomitant 
of defective organisation ? the answer is : By first in- 
specting the respective organs as far as we may be 
able.* Another proof that there Qjcists no organic 
disease, may be obtained by placing the pupU under 
certain new conditions, and observing whether his 

* In a formor adition of this work, when comnieiiting on the 
laryngoBcope, I ventured to predict that, although hj the aid 
of this most naeful InBtrnment we might be enabled to form n, 
mora correct diagitosia in throat diseases, yet I did not expect 
that much light would thereby be thrown on the causes of 
Btnttering. Since that period there baa sprung up what might 
be teemed a literature of laryngoscopy; but I am not aware of 
a single eaae in which the larynx of the stutterer was found 
to present an abnormal organic structure, beyond, perhaps, n 
congeatiTe stAta of the lining membrane, the consequence, pra- 
bably, of violent oSbrta during articuUtion. What I always ia- 
listed upon was, that in stuttering there was abnormal action 
in tha vocal or artieulatiog apparatus, and not necessarily 
organic disease. In confirmation of this view I eitraot tlie 
tollowing obsorvationa irom on interesting work by one of our 
most eminent phjaicians. 

" I have examined cases of both stuttering and stammering 
with tbs laryngeal mirror, with the sole view of observing the 
action of the vocal cords in the utterance of sonnda. As con- 
trasted with the double voice already considered the action 
of the cords is very different. Constant and irregular con- 
traction and rapid approiimation of the cords, with a tendency 
far the glottis to. remain shut, are the phenomena noticed in 
cases of stuttering before undergoing treatment. These irre- 
gular spasmodio actions are decidedly less in degree in oases 
of stammering. When the person inspires and utters a, con- 
tinuons humming noise, the vocal cords resemble in their action 
a conpla of strings being alternately and rapidly pulled towards 
one another, and striking their free borders with such ap- 
parently spastic rigidity as to produce a distinct flapping noise. 



i 



TREAT8IENT OV STITTTSHING, 309 

speech becomea more free. Does the pupil both 
stammer and stutter ? Does he stutter whilst singing 
or reciting? Is hia articulation leas difficult when 
reading alone, or talking to himself? What are his 
most difficult letters of the alphabet ? la the dis- 
order intermittent or permanent ? Now, whenever 
we find defective utterance yielding to altered cir- 
cumstances, we may fairly take for granted that the 
atructure of the organs has nothing to do with the 
impediment ; for actual organic disease ia known by 

All the larjtigeal iDDacles are no doubt id acoBditionthat ir 
almoit be compMed to Bt. VituB'ii dance, involuntarily 
tTHcting and relaxing under tlie inSnencea at work. 8e' 
'tiinea this action boa extended to the oryteno-eptglottic 
culiLT fibres, and the epiglottis baa been suddent; pulled down< 
ttorda and baekwarda. Bat tbo action of tbe tbyrO'Srytenoid 
muades ia sometimes to energetic as to oauae the projection in 
the middle of the larjnx, and actuoU; to conceal the tnin vocal 
ooi-ds beneath. If a long or full breath ia taken, to aee tbe 
eipanaion of the glottis, the view ia only momentary, Tor the 
tendeccj ia bo Htrong to irregulai coatraction of the muscles 
that it is almost instantly closed. In persona who have under- 
gone aome amonat of treatment, there is more control ovat 
the laryngeal rouaelea, although the tendency to irregular con- 
traction, I believe, long remains, which really proves the meana 
to elt'ect a cure must be peraeverfnglj and energetically carried 
ont."~On Diieaaes o/ths Throat andWindpipe.hj Sir a.D.Oibb, 
Sai't., M D., etc. London, 1864. 

We thua leam from actual inapection : fli-at, that in cusca of 
stuttering before undergoing treatment the action of the vocal 
oorda ia irregular ; aeoondly, that in persons who have under- 
gone aome amount of treatment there is more control over the 
laryngeal musclea,' and finally, that from the tendency to 
irregular contraction which long remains, the moans to etfect 
a cure must be perseveringly carried out. 



310 



TEEATMENT OF STUTTEBINO. 



the permanence of ita symptoma, so that tlie subject 
ought then to speak with difficulty under oil circum- 
stances. 

There may he nearly continuous stuttering without 
any oiganic defect. Some kinda of stuttering present 
aE the symptoms of an intermittent affection, while 
others appear chronic. The intermittent form is pro- 
duced hy psychical influences, and persons who have 
this kind suffer far more than tliose who have a con- 
tinuous or chronic tj-pe of stuttering. The chronic 
species, is, however, very disagreeable for strangers 
to hear; but at the same time, it does not produce 
that painful sympathy with the sufferers which we 
feel in psychical cases. 

In seeking for the cause of stuttering we must 
bear in mind that the original cause is of little con- 
sequence, inasmuch as the exciting cause may have 
ceased to exist, and the defect still continue through 
association or hahit. A writer* on this subject has 
well observed : " Suppose you could remove aU the 
ultimatfi causes of stammering [stuttering], free speech 
would not, I imagine, be the immediate result ; for 
old habits have to he replaced by new ones, and 
association of ideas would still affect the speecli, even 
were it possible to remove all mental emotion." 

This is true in some cases, but only a qualiiied and 
partial assent can he given to it as a general pro- 
position. The ultimate and the proximate cause may 
be co-existent, No one, however, can gainsay the 



* On ataiamenng. Bac. Med. Ozon., 1850. 



I 



MEDICAL TREATMENT. 311 

proposition, that old habits must he replaced hy new 
ones. Just as Dr. Chalmers speaks in the moral 
world of the " expulsive power of a new affection," 
80 must we uae the expulsive power of a new habit. 

MediceU Trea.tment.~lt is remarkable that tlie 
question whether defective speech be a disease had 
already been discussed by the ancients. Thus we 
find in GeUiua that " stuttering and stammering are 
rather vices than diseases, just as a biting and kicking 
horse is vicious, but not diseased."" 

Ulpian says, " It ia asked whether the stammerer, 
the lisper, and such as hesitate in their speech, and 
the lialting, are sound i 1 am of opinion they are."-?- 

It may be safely asserted that no idiopathic stutterer 
was ever cured by a mere therapeutic treatment. I 
have frequently noticed the fact that most of the 
authors who wrote on stuttering suffered themselvea 
fiom this infirmity ; yet 1 am not aware that one of 
them succeeded in curing himself Astri^, Ch^oin, 
Voisin, Becquerel, Guillaume, Merkel,Wyueken, War- 
ren, Palmer, etc., were all stutterers, and gave learned 
reasons as to the how and why they and others 
stuttered, but were not delivered from their infirmity 
nntil they condescended to place themselvea under 
the care of a layman, who had made tiie subject his 
special study. 



* BalbuB autem et atypue Titiosi magia quam morbaai, ut 
' eqaua mordsK aut calcitro, ritioaus noa morboaaB a.it. 

t Qnffiaitum eat aut baJbua et bleesua, et atjpus isique qui 
I tardiiiK loquitor el TaroK et vatiua aiLnua ait ? Et opinor eue 



312 



TREATMENT OF STU'ITERING. 



" All stutterers, liefore they came to me" says Dr. 
Klencke, " had been treated by physicians according 
to the excito-motory or irritation theory, and yet 
they stuttered as before. The cure of stuttering is 
one of those cases in which nothing is effected by 
means of the best theory and definition of cerebro- 
spinal life. I know of no cure effected by means 
ijf a direct treatment for spinal irritation. I conse- 
i[uently abandon that scholastic basis which is found 
in my former writings, and rest here upon practical 
empirical soil ; for the cure of stuttering is the chief 
point for the patient, he cares little for theory," 

The fact is, that unless a man has for years devoted 
iill his energy to the subject, and brings to bear upon 
it an ample knowledge of the various phases of the 
disorder, founded upon rigorous deduction and ex- 
tensive experience, combined with an intimate ac- 
quaintance, not only with the physiology of voice 
and speech, but also with the structure of language 
and effective delivery, he is not at all likely to benefit 
the stutterer. 

Most rational physicians now admit, that discipline 
of the vocal and articulating organs, under an ex- 
perienced instructor, is the only means of overcoming 
impediments of speech. 

Professor M. Langeubeck, in his well-known work 
on the subcutaneous application of medicines,* says : 
■' As I formerly considered nitrate of silver to be a 
i-emedy for regulating the perverse action of the 



• Dip. Imiifang dey ATi-adkorper, p. 143. Enaover, 1856, 



MTDIOAL rREATKENT. 818 

\ nervous ayatem, I applied it to the iufra-imriculat 
ion aa a remedy against stuttering, but without 
[ the least effect," 

The following very sensible letter was written to 
Dr. Klencke by a physician of great repute, and is 
•Well worth recording as a specimen of the exi>erience 
of very many medical men. 

" I have, worthy Colleague, heard of your establish- 
' ment for stutterers, and send you a subject, whu haa 
I brought me to despair. I have treated him by all 
hiedicaments against cerebral and spinal irritation, 
spasms, tefflnUB, etc.; in short, accoriUng tn all theoriee. 
I have operated on hia I'rtenum, and an indurated 
I tonsil ; I have sent him to an elocutionist ; hut he 
I *tutters, I believe, now woi-se than before. I per. 
Ceive now that we must have a practical knowledge 
of stuttering, and devote our time to it ; and that a 
physician who ia in great practice, who has no oppor- 
tunity of observing many stutterers simultaneously, 
and cannot devote to them all hia time, cannot com- 
bat this rebeUiouB evil. I have arrived, therefore, at 
the conviction that stuttering is a complex of many 
symptoms, requiring the treatment of the whole imm." 
But while I deny that stuttering is a diseaw, I 

I admit that cases of stuttering do occur, requiring, in 
the first instance, the aid of the physician. Wlien, 
for example, I have reason to presume that stuttering 
is decidedly a symptom of a primary afTection in some 
parts of the nervous centre, 1 never fail to recom- 
mend the applicant to consult a respectable physician. 
We frequently find that stutterers manifest shortness 



I 



cl tceatfa and otfan dJwadua of the i«3|iiTaIoiy o 
guks ; bat ve need not, on A^ aoeouut, taiko for 
gnuited tbst then i» uXinl pnimooaz^ disease whid 
requires medical aid. Tliese linor^n are gsueraliy 
the eoDseqiKitoes «f stotterii^ and will disappear 
Willi tlieir cause, bat will resist the most sktlfol 
medical teeatment while their caoae coBtianes. It 
is therefore to the statteiing that oar chief attentioa 
most be directed. We most regulate the pmceBS of 
respiration, and we shall then see these phenomena dis- 
appear, whilst medication alone leads to no beneficial 
result. The same may he said of the conTnlaions of 
the articulating apparatus. Mlien they occur only 
during speaking, it is manifest that no me<lical treat- 
ment will remove them ; their cnie must be effected 
solely by the didactic method. But if , as is the case 
now and then, the con^ndsions show themselves in 
the quiescent state, & medical treatment may be re- 
quisite, as we may have to do with chorea. Still, 
we must not come to a hasty conclusion, as these 
phenomena are often the consequences of bad habits, 
involving muscular contraction, against which medi- 
cal aid is powerless. It is only after stuttering is 
entirely cured and these convulsions still remain, that 
medical treatment must be resorted to. 

"Medicinal remedies," says Dr. Shirley Palmer, 
" are not essential, as some interested writers have 
lately asserted, to the successful treatment of im- 
peded utterance. Yet, skilfully selected and em- 
jiloyed, they will accelerate the efficacy of a system 
of cure which rests upon comprehensive and pbilo- 



1 



UEDIGAL TCEATUSKT. 315 

I.SOpbical principles. Thus the embarraBsment of arti- 
Iculation will be greatly reUeTed, and ita removal 
liMsisted by the prescription of tonic medicine, in- 
■ ingorating exercise, tlie shower bath, and generoua 
Idjet, — in fact, of every agent that is calculated to 
■SQBtain or elevate the physical powers, and rouse the 
Iqiirit of the atatnmerer from tlie state of morbid 
jsceptibility and depression into which he is almost 
B invariably plunged, 

" Vet no physical treatment, however judicious and 
[ effective, will of itself permanently prevail. Deep 
I and bitter will be the disappointment of those who 
I shall rely on it as a protection from the recurrence 
r of their infirmity. A rigorous system of moral disci- 
I pline, long and imwearied exercise in concentration 
L of the mind upon the process of speech, and in the 
I practice of self-control, will be requisite to burst 
[asunder the mystic hnks of morbid association, and 
effect a revolution in that moral state with which the 
evil habit is ho closely interwoven. Peri'ect freedom 
and fearlessness of mind, insensibility to the ridicule 
and the scorn of the ignorant and tlie vu^r, and 

(generous contempt for popular opinion, such an eleva- 
^on of character and feeling, — such moral courage aa 
9 sense of moral purity can alone in apire,— constitute 
the goal to which the aspirations of the stammerer 
should be unceasingly directed. This gained, recovery 
is no longer desperate. Every remaining obstacle 
will vanish before the auxiliary power of physical 
treatment." 
Xheie ia a nervous affection called t^iorm, or St, 



31f) 



TREATMENT OF 8TUTTBRINO. 



Vitus's Dance, the charact-eristics of wliich are a want 
of control over the movements of a variety of mnsclea. 
Boiiillaud very aptly characterises chorea as a " folic 
de mouvementa." This affection reaemhles stuttering 
in many of ita essential features. Like stuttering, it 
preferentially attacks the young, and usually before 
puberty. Chorea, like stuttering, increases or di- 
miniahes under a variety of extrinsic influences, such 
as temperature, etc. Thus it has been observed that 
in cold and damp weather the convulsions increase. 
The emotions, nervous excitement, influence chorea 
as they influence stuttering. The aspect of sufferers 
from chorea presents sometimes a great resemblance 
to that of stutterers, in relation to facial contortions, 
and, like stuttering, chorea is chronic or intermittent. 
Hence stuttering has not improperly been called 
chorea of the articulating oi^ns, There is, however, 
this difference between the two affections, that fe- 
males are more predisposed to chorea than males, 
being in the proportion of three to one; while the 
reverse is the case in stuttering. As regards treat- 
ment, recent researches have proved chorea, like 
stuttering, yields rather to external tonics, such as 
gymnastics, sea-bathing, etc., than to a strictly medi- 
cal treatment, as wiQ appear from the following ex- 
tracts .• 

"The first who employed gymnastics for the cure 
of St, Vitus'a Dance were the priests. The patients 
were assembled after Mass, and made to dance to 



• Archirei GiniraUt de Mideeine, 1854. 



MEDICAL TBEATKENT. 317 

[ Barred music ; plaints were stmg, whicli oliliged them 
I to dance to measure. Eecamier applied rhythm in 
1 numerous convulsive affections. He was of opinion 
I that if the muscular motions could be rendered ha- 
[ titually regular by alternate contraction and relaxa- 
tion, a cure might be effected. For this purpose he 
I assembled his patients at night at tho Place Ven-, 
dome, and made them follow the di'ummers, beating 
the tattoo. Any other instrumenti for instance, the 
metronome, may be employed. "We commence to 
jnake the patients execute, on command, motions 
I with one arm or one leg, after which we proceed 
to combined movements. Then follow rapid move- 
ments, which are by far the easiest, there being no 
I Buffieient interval for the choreic uncertainty to su- 
pervene, Finally, we mate them execute combined 

, slow movements 

" M. S^e reports that of twenty-two children treated 
exclusively by gymnastics, eighteen were cured in 
twenty-nine days. 

" The results were less satisfactory when medica- 
ments were administered. M. Blache, Physician to 
the H&pital des Enfants, concludes his memoire, read 
before the Aead^mie de M^deeine, as follows: — 
1. That no treatment is so elScacious in chorea as 
the gymnastic, whether applied alone, or in combina- 
tion with the sulphur bath. 2. Tliat the former can 
be employed in every case, whilst other remedies 
are frequently counter -indicated. 3, That in the 
gymnastic treatment amelioration becomes apparent 
during the first few days. 4. That whilst the dis- 



318 



TBEATMIST OF 8TDTTEKING. 



order disappears the constitution generally ia { 
benefited," 

Thus it would appear that even in those i 
■where stuttering either results from, or co-exists "witf 
chorea, systematic exercise of the various org 
judiciously applied, ■will not only cure the atut* 
and the prunary affection, but will greatly imp] 
the constitution. It has ever foruietl part of 
system to combine oral instruction with tlie practi 
training of all the oi^:ans, directly or indirectly c 
cemed in the production of sound and speech, 1 
means of appropriate gymnastic exercises calculate 
to strengthen the respective organs, so as to 1 
them under the control of the pupil ; and I 1 
the satisfaction of knowing that few have left i 
establishment without great improvement in thf 
general health. 

Another thing I may mention before I concltu 
this part of my subject. I have in several iustanoe 
made use of electricity, thinking thereby to impro 
the nervous tracts of the speech organs. But how^ 
ever useful this remedy he to remedy various nervoi 
diseases, I find it is quite powerless to effect any p 
manent amelioration of this affection. The stutt 
whilst under tlie influence of the electric c 
naturally speaks without those obnoxious repetitun 
which sometimes characterise the evd, but 8 
aa the stimulus is removed I have failed to j 
any material difi'ereuee in his speech. Dr. Kleoel 
has arrived at the same conclusion as myself 
says that the idea of acting on the nervous a 



PSYCHICAL TBEATMBNT. 



319 



by induction electricity presented itaell" to him, and 

'' he resolved to try it. " I have done ao," he says, 

" ou a large scale, and endeavoured to make the 

, Btntterer speak under the influence of the galvano- 

electrie fluid, but I have never seen any perrnanrnt im~ 

provement from the application of induction electriciti/, 

not even in paralytic stuttering. The only efl'ect I 

have observed waa that during the passage of the 

, fluid through the ner\'e-trttcta the stuttering became 

, less, but no permanent result followed." 

Psychical Treatment. — It is admitted that the ex- 
! citing cause of speech is the niind, so that perfect 
I idiots are mute from the absence of tlie intellectual 
[ Btiniulant. The mind is thus the master of Bpeecli, 
[ ajid through it alone can we act on the oi^ans necea- 
I sary for the process of articulation. When we lose 
1 our control over the mind, we have none over the 
f "bodily organs under its influence, and an improper 
, action is the result. 

It wUl have been seen that most of the methods 

i-ecommended leave the psychical element nearly out 

of sight, being almost exclusively directed to the 

action of the vocal and articulating organs, and thus 

! want one of the most important means ibr ultimate 

1 success. Dr. Klencke expresses my own opinion 

[ when he says, " Experience haa strikingly sliown to 

I me that stuttering depends as much on the mind 

1 as on the organism, and that nervous affections, ab- 

I nonnal innervation, are under the influence of cere- 

[ bral activity. It has not without good reason been 

seilied that a firm will can moderate organic vi- 



320 TREATMENT OF STUTTERING. 

tality,* and we have seen several remarkable in- 
stances of it. Individuals who had been treated with 
narcotics, electricity, and other remedies, and whose 
stuttering nevertheless remained a constant symptom 
of that nervous condition, lost with the stuttering all 
these symptoms whenever I succeeded in rendering 
the will dominant. The whole individual becomes 
cabner, and all his functions become, so to say, lo- 
gical" 

It is impossible to lay down any precise rules in 
regard to the psychical treatment of the stutterer; 
for it is clear that it must be adapted, not merely 
to the intellectual and moral capacity, but also to 
the temperament of the pupil The sanguine, the 
phlegmatic, the choleric, and the nervous stutterer, 
require each the application of a different method. 
The great object, however, in all cases, is to impart 
to the patient mental tranquillity and self-control 
When that is effected much has been gained, and 
until it is attained, physical and mechanical means 
prove but of small benefit. 

I have already referred to the able article of Dr. 
Paget on the analogy between stuttering with the 

* Kant (Von der Macht des Oemiiths, etc. 1798) observes : 
"Morbid conditions in reference to which the mind has the 
power to master the feeling of them by the firm porpose of 
man as a rational animal, are aU of a spastic nature ; but we 
oannot conversely say that all of this species can be stopped 
by a mere firm resolution. For some of these are of that kind, 
that the attempt to subject them to the power of the will does 
but increase the spasmodic condition.'' To this class, as a 
rale, belongs stuttering. 



PSYCHICAL TSZATMENT. 



321 



urinary organs and those of speech. Mr. Paget aaya 
the difficulties in the treatment of speech and urinary 
stuttering are equally great. On the treatment of 
the latter he ohserves ; " The patient must try to educate 
himself to a calm control of hia muscular power; 
and on any occasion of failure, must get what help 
he can from such mental tricks as I have referred to. 
He should evade all riak «f dilSculty, and should 
avoid all the conditions in which he has suffered his 
worst failures." This advice, applied to the speecli- 
stutterer, will scarcely effect its purpose. The speech- 
stutterer must first lie shown }iow to calm his mus- 
cular power, or, in other words, how to use it. The 
rehellious or insane action of the muscles cannot he 
controlled, for any length of time, by either mental 
or physical tricks ; nor can the speech-stntterer easily 
evade his difficulties, or the conditions in which he 
has suffered his worst failures. The attempts oi' 
some stutterers to evade their difficulties produce so 
ill an effect on their whole character, that the conse- 
quences are far more injurious than the physical 
difficulty of stuttering. 

Stutterers are frequently looked upon as a careless, 
petulant, and indolent class — a set of imhecilea- — 
than which nothing can, generally, be more enBueous. 
The following extract from Dr. Klencke fully corro- 
borates the opinions I have for many years advanced ; 
" The stutterer requires a treatment different from 
that of common patients; he is hothfe)rfi^yandwMMia% 
affected ; a man whose mind, temperament, capacity, 
and character have taken the specific chamcter of 



392 



TREATMENT OP BTUmSRING, 



Ijis infirmity, and if treated like a common patient, 
would leave the institution uncured. The stutterer 
requires & family life, a hoTne, where he feels himself 
surrounded by persona who look indulgently at his 
ftilliction ; but who at the same time encourage him, 
by word and deed, to exert his will to overcome his 
infirmity. 

" Every stutterer is eiflbarrassed, timid, distrustfol ; 
he feels a deaire to attach himself to somebody he 
trusts ; but he is also capricious, thoughtless, pas- 
sionate, and without firmness. His infirmity de- 
presses him, in such moments when he would ex- 
press some Hvely thought, he becomes spasmodically 
excited. In the bosom of a family, surronuded by the 
wife, the children, the relations, and friends of hia 
instructor, both his mind and feelings are favouraWy 
influenced and his equanimity is restored. 

" I have made the experience, that though without 
such an introduction of a stutterer into a (to him) 
perfectly strange family, the evil may apparently he 
cured, yet that relapses frequently occur in such 
cases. 

" Stutterers, chiefly adults, have apphed to me, 
who felt a disinclination to entering a strange family 
and siibmitting to its regulations, and who preferred 
to live in an hotel or private residence, and ■would 
only daily visit me to receive their lessons ; but as I 
liad learned that this rarely led to any cure, I have 
genei-ally, in the interest of the patients themselves, 
declined such offers, and I make residence in 1117 
family an intlispenaable condition. 



PSYCHICAL TREATMBNT. 



323 



" The nature of the stutterer ahsolutdi/ reriuirys 
tliis. Driven from society by his infirmity, there 
arises in the stutterer, according to hia temperament, 
a cross, dreamy, distrustful disposition ; or, perhftps, a 
thoughtlessness, an inclination for secret indulgence, 
a tlightLneaa and indecision, as if the weakness of 
the organs of speech were allied with weakness of 
cliara<!ter. The stutterer has always a feeling of de- 
gradation, through his becoming an object of ridicule. 
I shall show in the setjuel that stuttering is less a 
lodily than a mental evil, ami arises as much from a 
neglected education, as from nervous or pliysiological 
disturbances of the organism. If now the pupil is 
received in a family of wliich liis teacher is the head, 
I and in which family all the arrangements are made 
I subservient to his cui'e, he loses his fear of being ridi- 
I cuted, his mind aetiiiires confidence, and he gradually 
attains that mental condition which, in my experience, 
must always precede all treatment, and witliout which 
all vocal gymnastics remain useless. 

" But it must not be believed that this mode of 
' treatment is an «isy task ; on the contrary, it offers 
1 great dilficulties, and is attended by miich unpleasant- 
ness, resulting from caprice, distrust, inconstancy, and 
[ ingratitude. Stutterers possess certain charaoteristio 
I features, such as secretiveuess, distrust, a passive rt- 
I tisiaTiM against anything inconvenient in the method, 
I and are always ready to adopt that by which they 
can arrive at a cure without any self-exertion. 

" To combat these characteristic features is always 
[■ the most dif&cidt part of the commencement of the 



324 



THEATMBNT OF aTUTreitrNO. 



treatment. If we do not succeed in effecting this 
liy our personal iniiueuce, or by that of our lamQy, 
within the first six weeks, we may send him home 
again ; for his time and money will be spent to no 
purpose. I have dismissed several such individuals, 
who after they had been in the hands of travelling 
medical, or lay stutter-doctors, returned, and after 
acquiring the power of self-exertion, were cured of 
their infirmity. 

" After having imparted confidence to the stutterer, 
and accustomed hira to voluntary self-exertion, the 
physical cure proceeds mpidly ; and, with the growing 
feeling of being liberated irom his fetters, the stutterer 
entertains nothing but feelings of ftiendship and kind- 
ness towards his teacher and his family, which may 
last during life." 

It is quite true that the temper of many suflerere 
has been soured by continued annoyances, and that 
some exliibit signs of indolence which convey the 
impression of stupidity; but this is no more tlinn 
would occur under the same circumstances to any 
other persons. Often have I found excellent qualities 
of head and heart thus obscured ; hnt the cause being 
removed, and sufficient time allowed for the suffen*i 
to regain his bodily health and mental vigour, he, 
no longer restrained by his infirmity, not only fre- 
quently equals, but sometimes rises superior to Lis 
companions, "We behold Iiira now speaking witli 
fluency and pleasure in society where formerly he 
could not utter a sentence. I may illustrate this by 
the following case : — 

A young gentleman, the son of a dignitary of the 



P3TCHI0A1 TEB\TMENT. 

Church of England, labouring under severe stutter- 
ing, became a pupil of my late father. Beiuy of a 
persevering character, he not only in due time con- 
quered the impediment, hut actually acquired such a 
command over his organs that he, shortly after, carried 
off the prize as the beat reader of his year as scholar 
of Trinity College, Cambridge. 

There was, therefore, in this case (by no meana an 
unusual one) uot only a blemish removed, but a 
beauty created where previously deformity existed. 
One of my old pupils thus writes : " Strange to say, 
from once regarding stammering as a great calamity, 
1 am now beginning to look upon it as a real blessing ; 
it has led me to aim at being a correct speaker ; 
without such a stimulant, I should have been all my 
life wliat most people are, careless and slovenly in 
articulation. To all who speak in public I am con- 
vinced your instructions would be of little less value 
than to the actual stammever, and although ' mumb- 
ling clergymen' of the class ao gi'aphieally described 
in the Timee by 'Habitans in Sicco' are, perhaps, 
rare, yet few can be aware how much more powerful 
and sustained their voices would be, were they to put 
into practice the principles you teach." That stut- 
terers who have lieen cured of their infirmity should 
be correct speakers is natural enough ; for a stut- 
terer who has gone through a systematic course of 
treatment must, if perfectly cured, generally be a 
better reader and speaker than such as are usually 
met with, inasmuch as the very discipline requisite to 
overcome impediments in speech leads simultaneously 
to correct reading, and fluent and ready delivei-y. 



326 TBEiTMENT OF STUTTKBISG. 

It thus frequently Iiappens Uiat the cure of stut- 
tering brings out lateut capabilities, whicli might 
have remained dormant had they not been roused 
by the removal of the cause which concealed them. 
It is no uncommon occorreQce to find a tine voice, 
and many other quaUticationa for oratory, hidden 
under a distressing delivery. Under appropriate 
treatment, the enemy is not only vanquished, but 
his post advanta^ously occupied; weakness yields 
to strength, and strength establishes the foundation 
of excellence. 

Dr. Eich has made the following remarks respecting 
his own treatment, with which my experience cordially 
coincides. " My pupils do not speak in broken off 
sentences. No \ tliey read and narrate so fluently, and 
the educated among them with such an expression, 
that they seem to have acquired rather the oratorical 
art than merely the art of speaking. 

" The individual means applied are too multi- 
farioua to he here enumerated, and thoiigh I were 
to give a list of them tliey could scarcely be applied 
by the stutterer himself Some must submit to exer- 
cises for two or three mouths, others succeed more 
rapidly ; but in most, and especially with the lesa 
intelligent, it is requisite, in order to improve their 
minds, to make them acquainted with tliemselves 
and other minds, and to establish a harmony between 
these ; a mode of cure which must be adapted to the 
psychical condition of each individual." 

The ascertained cause of the impediment should 
be explained to the pupU ; for few, if any, stutterers 



FSrCHICAL TBEATKEMI'. 

are aware of the reason why they have a difficulty 
of utteranee. Vocalisation and articulation are in- 
tuitively acquired in infancy ; but the mode and the 
cause of their production are unknown even to many 
adults. Now it is not exactly requisite minutely to 
explain to the stutterer the individual and collective 
action of all the organs concerned. This would de- 
feat our very purpose ; for finding it ao complicated 
a meehanism it would but increase hia apprehension 
that he could ever obtain the mastery over it. But 
it is necessary to point out to the pupil, in the firat 
place, the manner in which voice is produced, and 
articulation effected, and the ostensible reason why 
he has a difficulty in speech. He must be made tu 
concentrate his attention* on the main source of his 
impediment, whether the fault be in the action of 
the respiratoiy, vocal, or articulating apparatus. By 
these means the mind of the patient is acted upon, 
scepticism and mistrust are removed, confidence is 
established, and the subject is inspired with the 
hope that he may ultimately recover his fluency of 



That self-exertion is requisite for the cure of stut- 
terers should be fully understood by all sufferers and 
their friends. More failures in practice and disap- 
pointment to the friends of pupils take place from 



rttll says, " In proporti 

'bich excite tli«u, nam<!ly, the 
eittrnn.! concept i 



sad tbe fov^,.^ -..,... 

tions, and tbe spontc 

in the same proportiuu vuh buhl 

through the nervaa are Tigoroua. 



I the cerebral impreasiunB 

. are powerlul 

wbiob they eii^iii 



928 TREAXMEST OF BTUTTSIQirG. 

a want of definite opinions as to the mental effort 
retjuired in order to be cored than from any other 
cause. I make it my first duty to impress this on 
all persons who consult me for all kinds of impedi- 
ments in speech, especially for stuttering. Occa- 
sionally I bare asked a youth of sev^iteen or eighteen 
vijars of age, "Are you anxious to get rid of your 
defect ?" and the reply has sometimes been, " Oh no, 
1 don't care about it : only the goveraor wants me to 
■;et cured, to enable me to go into the army!" My 
iid^'ice in such cases is: Wait ontil you do care; and 
1 have never known that time not to arrive soooer 
ur later. 

Time for Cure. — Herr Otto makes the following 
very judicious remarks respecting the time requisite 
for the cure of stuttering. He says, " However deeply 
i-ooted the evil may be, it will generally yield to the 
eftbrts of an e.tperienced teacher, provided there axe 
no organic defects beyond the reach of the instructor, 
iind where the pupil is neither deficient in will nor 
in intellect. Tlie intensity of the affection must de- 
termine the duration of the treatment, and as this 
has different gradations, and much depends on the 
etforta of the pupil, and on the number of the lessons 
and eKCrcises, nothing certain can be said as to the 
time requisite for a complete cure. Tliis much may 
lie generally asserted, that there are cases which may 
be cured in a few hours, whilst there are others which 
will requite many weeks or months. In children and 
very young persona we cannot expect to effect much 
I ly mere rules ; constant and continued practice alone 
lian effect a radical cure." 



TIME FOB CUBE. 329 

" Teachers require too little time," says Dr, Warren, 
" and consequently many of the cures are not per- 
manent, A habit that has been confirmed by years 
canuot be eradicated in a very short time. This re- 
mark as to the length of time required for the cure 
of children appUus iu some cases still more forcibly 
to the case of adults. The more confirmed the habit, 
the more complicated it ia, the longer the time re- 
quisite for its eradication. In regard to the discipline 
of the organs, an experienced instructor ia not only 
of the utmost importance, but of the greatest neces- 
sity." 

The advice which Dr. Warren gives to parents is 
80 judicious, and comes from so good an authority, 
that I cannot refrain from quoting it. 

" Seek out a person who has experience in the 
treatment of impedimenta of speech. Place the stut- 
terer under his care, and if be is benefited, do not 
remove him, and tliink to perfect the cure yourself. 
Three months is a very short time for him to re- 
main under the superintendence of an instructor ; 
six mouths is better, and where it is pi-acticable, he 
should remain a year. If this interferes with other 
studies, it is of no consequence ; he will derive benefit 
enougli to compensate for the loss. The age I should 
fix upon lor the trial should be from eight to twelve, 
At this period the loss of a year's study may be a 
gain. If he meets there others who are affected as 
he is, it is all the better ; he will no longer look upon 
Ms case as a peculiar' one ; and if be sees othei's 
whose impediments are worse than his, it will give 
him additional courage." 



330 



TBEATftKXT OF STDTTEBEIG. 



This is very true; for very sensitive pupils are apt 
to d4>ubt tLemaelves, and fail through want of confi- 
dence. But when they observe the successful eifecta 
of the system iu which they are to be instructed, 
the conriction is forced apon their minds that they 
need only follow the same course to reap the same 
benefit. 

Dr. Warren continueB : — " AVTiatever method may 
be employed for the relief of this affection, no per- 
manent advantage will be gained, in the majority of 
cases, unless resolutely persevered in for one or two 
years." 

That there are many stutterers who require for a 
long period the constant and vigilant care of an 
efficient instructor is undeniable. Such intractable 
cases form, however, the minority ; whilst, provided 
the proper means are employed, permanent relief 
may, in the majority of these affections, be gained 
within a comparatively short time. 

" Some wonder," says Dr. Klencke, " that I con- 
sider twenty weeks as the shortest period, and are of 
opinion that four or six weelra might suffice. Even 
physicians and rational people think so. This shows 
a perfect ignorance of the nature of stuttering. No- 
body wonders or complains of the length of time the 
orthopeedic physician requires (may be one or two 
years, or more) to cure crooked bones caused by mus- 
cular weakness. It is also known that many such 
patients are sent back uncured. IMien, now, a person 
tells me that he can permanently cure stuttering, 
which requires a more difficult orthopatdy and more 



active gymnastics tlian a wry slioulder, in four or 
ais weeks. I t^ll him to his face that he never had a 
stutterer under his care, or that I do not believe him, 
I consider as equally untrue the assertions that stut- 
terers have been cured by operations, medicaments, 
or macliines. Such statements deserve as much faith 
as those of a singing master wlio pretended to make 
H prima donna of every girl by means of some 
machine or embrocation. AH such aaaertiona are 
Miinchhausen stories." 

The above extract is, on the whole, most judicious. 
I differ, however, from Dr. Klencke, when he asserts 
that no cases of stuttering can be cured in a month 
or six weeks. I grant it is rare ; but I have had 
pupils who possessed such power of mind, self-con- 
trol, and determination, that they would make more 
progress in a week than the majority of cases do in a 
month. I would not, however, assert that any case 
can be so successfully cured by a residence of one 
month, unless time and attention be given to my 
advice after leaving. The only exceptions to this 
general rule are those slight forms of stuttering, 
which can generally be cured in a few weeks, if the 
pupils possess ordinary determination and power of 
wilL My own experience has been, tliat the time 
required for cure corresponds more with the mental 
calibre of the pupil than with anything else. The 
mere physical severity of different cases is of little 
importance in comparison with the difference in 
mental power. On explaining this to applicants, and 
informing them of the probable length of time re- 



on having acr|^-.iir*^il a f-.t-.r.i'r.i II .■:.,(// ■;:' .:.:.:ri.u'.t:. 
while in other?*, tii*^ rionxtvuir. }<:tLr ^f r^rLn *'•.:! u- v.i.j 
the cau.se of :*-• yu-xnal •jin-.-.irV'-.rjj:. 

Herr Bai'l.-*rilAil:1 ;.«-'». r;;:i.ii"A.;i4 '.i;:t}. '.j.r: '.r-M'.i..f::.\ 

of ca.ses of -tr.i-.r.r.i^ri.-.'j ' v ..; ..!,f. i. v.- / ■. ,.:jn: ■,. , i. 

happy reftT*I«, ;r..t--s?* -^ .:.■',*:;•:< :i.;/: ..-. '.',;. ..,;..r:t: * .... 

perseveraiice. '''':.f,v. i ■.' .:.'.:;•':,•..■. ..,•:•: "..,(•..■: ■.■.■..■ 

■ f 

"* ti'je -'nr.i.r.ji. ni.'... .f.'.r-. , ■ «. ...i .i-. .....•■ :•. .. 

be :r;:i;*:i-:r: .:; ..' •• .f^r . 1..1 ■■ :-..'. ...: ■ . 

in '.VIkI* ". . r'f'-'t.,". .i'. lii..'^;'." ■• I ' ■. ■ •• -'- .. • ■■ 
iwj^.r. »T v. '..'.'". .'J '■ ■•'. /;,"''■" -■/. • • -.1.'. .;i : ,:. •. 

r.eiU'.v.it- .'.it- ''..■.:» i -''■ «■ * ■ •■'- ■'- ■■•■• 

*Lll"lfrr:?* .»'. tii.fc.'. ■■ .- .• ■■ -■■■ ■ ■-''* >.. •' ■;'-■ ■ •- 

ZnC^"^ t*' i*'''-y '■ '= '•'-' -•■'- ■■ ' ' •''■ "''■ •-■■'• ' •■■ • 



jy^l- -^.^ ,.^.^.,. . ; ., III.* ..1 y 1.1-1 . . C.»J. t. y .''l<..lli .... » -, » 

1"'*<*' ' ■ " ■ J 1 ■ '■ ' ' *-' ■ . ■ I*-'" ' » - .i'. ' . . . ' I . ■ t ■ ■: -. 4 1 

*.n .ii-ii ,:• "•"' '■■■''•' ■■■■ "'' '^' '•'■' ''•■'-■-'"■'■ ' »-***■ 
**»M* iui? ■•' '-■-•= ''■ '■^■' ■'■■■ ^^•'■■' ^^i"-*''*--''-^ "*' 



i 



332 



TREATMEfT OF STOTTKRIKG. 



qiiired for a radical cure, I have often been reminded 
tltat I had cured some of their friends in a month 
or six weeks. And here I would remark on the ab- 
surdity of reasoning from one single case. Stuttering 
differs so much, hoth in kind and degree, that all in- 
ference from a few successful cases is only «b 
parte evidence, and is wholly valueless as to the 
i which woulil attend the treatment of other 



—The French and German coram issioners, 
who examined the patients presented before them, 

after having undei^ne the treatment employed by 
their respective tutors, pronounced most of them 
cured of their infirmity. Yet it is certain that many 
of these, after a shorter or longer period of time, re- 
lapsed into their old liahit. The q^uestions, therefore, 
arose whether a radical em-e be at all possible, or 
whether the systems employed were in fault But 
when it is considered that the old habit, which, per- 
haps, has existed for years, is still strong, and can, 
especially in inveterate cases, be controlled only by 
constant attention to the rules for harmonising the 
motions of the articulative organs with the vocal 
and respiratory fimctions, it is wonderful that the 
relapses are not more frequent. 

Those of my pupUs who experienced a relapse, 
candidly imputed it to their own carelessnesSj ox 
gave other good reasons for it. In some cases, oir- 
oumstances prevented the pupil from going through 
the reijuisite discipline. Othera, again, were too 
sauguiac, and considered themselves perfectly cured 



on having acquireil a certain fluency of utterance, 
while in others, the constant fear of relapsing was 
the cause of its actual occurrence. 

Herr Bansmann has remarked that the treatment 
of cases of stuttering " will not always lead to a 
happy result, unless experience is comhined w-ith 
perseverance. Wlien a stutterer la cured, tliere con- 
stantly remains a disposition to relapse into the vicious 
hahit." This is, no doubt, true, especially where the 
treatment is not strictly founded on correct physio- 
logical principles. I will now quote what Dr. Klencke 
t says on this point. 

"When the stutterer returns Lome cui'ed," lie writes, 
" the rational adult keeps in mind that he must still 
be guarded in hia speech, and must exert his will 
in order to escape the danger of a relapse; he must 
forget stuttering by the ^leech-rules, which have now 
become liabitual to him. But, as a mle," he con- 
tinues, " the adult stutterer has, like all otiier stut- 
terers, 710 perseverance. He grasps the method when 
3 begins to feel the increasing freedom of hia iutel- 
lectu^ and organic life, with zeal and enthusiasm ; 
but when he is called upon to proceed step by 
step, to exercise methodically, and to remain, though 
greatly improved, subject to the will of his piiyaiciaii, 
he over-esti7nales his power ; he tlunks that he stands 
on firm ground, believing tliat he can proceed by him- 
seli', and requires no further superintendence. He 
then usually declares his intention of leaving the 
establishment against my advice. Such cases have 
occurred repeatedly ; but, with one exception, they all 



3S4 TRKATMSST OF STUTTBIimO. 

retumeil after three or aix months, in a considerably 
worse condition than when they left. They had con- 
sequently to recommence the interrupted treatment." 
M. Matebouche says that Ma experience was, " that 
those cures which are the most quickl)- effected are 
the leaat durable." 1 have certainly found a tendency 
to the same result ; but only in such cases when the 
individual, deeming himself perfectly free of his in- 
firmity, would no longer subject his organs to the 
discipline requisite for confirming the new habit of 



To eflect a radical cure, it is absolutely necessaiy 
to appeal to reason, and arouse the will to a vigi- 
lant control over all the voluntary muscles. When 
pupils are too indolent or too careless to exercise 
this control, the cure becomes veiy difficult and un- 
certain ; and even, after & cure is effected, attention 
must be paid to the management of the vocal oi^ans 
for some considerable time. 

Mr. Bishop has well observed, that " In this class 
of cases, however, as well as in many others, it is 
not uncommon to find persons too indifferent about 
the results to trouble themselves with the exereise 
of rules, after they had made themselves mastere of 
them. It must always be borne in mind, that wa 
have not to deal with automatic functions, which, 
once set in healthy action, continue like the move- 
ments of a watch ; but with a mechanism, the move- 
ments of which are placed under the control of the 
voluntary system, and subject to the irregular im- 
pulse of the intellectual processes." 



C0NCLUDIN6 BEHASK3. 



335 



Concbidiiig Remarks. — Aa the auljjecta are fre- 
quently young persons witli irritable nerves, and of 
delicate constitution, or extremely shy and timid, it 
ia, in moat cases, requisite that they should, for a 
given time, be withdrawn from home influences. 

When defective articulation ia the result or the 
concomitant of debility, whether congenital or ac- 
quired, a permanent cure can be only effected by 
placing the pupil under such favoural^ circum- 
stances, that whilst the oi^ans concerned undergo 
the requisite training, their healthy action may he 
restored and sustained by the invigoration of the 
whole frame. 

The number of apparently intractable cases, which 
yielded to treatment during my annual temporary 
sojourn on the sea-coast, convinced me of the great 
value of a country and marine residence as an ad- 
juvant in many cases depending upon affections of 
the vocal, respiratory, or nervous apparatus. In order, 
therefore, fully to carry out my system, I formed a 
permanent establishment* for the treatment of every 
species of defective articulation, in which I have 
been enabled to offer residential accommodation to a 
limited number of pupils, who enjoy aU the comforts 
and privacy of a home. The cultivation of the in- 

' teUect and the inculcation of moral habits are not less 

I carefully attended to. 

The age which I recommend aa the most favourable 

' for treatment ia between five and thirteen : what is 



X Haetiii)^. 



TREAXMEKT OF STOTTEHOrQ, 

possilile at this a^e is fi-equently quite impoaaible in 
later years, I have so long beeii convinced of the 
necessity of early treatment, that I have now made 
arrangements I'or receiving pupils from live to thir- 
teen years of age, and for giving them a suitable 
education in conjunction with my treatment. 

The advantages offered by the locality selected, 
considered one of the moat salubrious spots in Sussex, 
are sufficiently obvious. The house commands ex- 
tensive land and sea views ; the air is pure and 
bracing, and the environs offer all requisites for 
health and recreation. 

Physical training, generally so much neglected, re- 
ceives due attention, and all means are resorted to 
for producing hoddy vigour. 

As it is well known that manypersona.who have no 
impediment in speech whatever, find it a most dilficult 
taak extemporaneously to address public assemblies, 
it is certainly no wonder that those labouring under 
defective utterance should entirely fail in any at- 
tempt of this kind. It requires much care on the 
part of the instructor, and determination on the part 
of the pupil, to gain the confidence necessary for 
public speaking. The oi^ana of the stutterer must 
be strengthened before he attempts too much. It 
forms, therefore, a prominent feature in the plan of 
instruction to afford to the pupils constant oppor- 
timities of reading, debating, and speaking on various 
subjects before otliers, tlie frequent practice of which 
being absolutely requisite to overcome their natural 
diffidence, and to impart to them a feeling of confi- 
dence and self-reliance. 



L 



CONCLDBING SKMA.HK8. 337 

It has been surmised by some parents, that the 
association of a numljer of stutterers under one roof, 
must have an injurious effect on those who only 
have slight defects. But tlie reverse of this is the 
case. Indeed it is absolutely necessary, in order to 
effect a cure in some cases, that the pupils should 
be placed where they can see other cases. In the 
first place, it is very diifieult for a stutterer fully to 
understand the cause of hia own defect. As I have 
elsewhere observed, the contuiual misuse of bis or- 
gans produces an altered condition of his nerves, and 
the real state or position of the various organs is not 
conveyed to the mind. For such subjects it is ab- 
solutely essential that they should see and examine 
other cases, and then all doubt and difficulty will 
disappear. Nothing, indeed, ia more beneficial for 
slight stutterers, than to be with others more af- 
flicted ; for tliey see to what degree stuttering may 
attain if they neglect their own case ; they are also 
continually reminded, by hearing others hesitate, that 
it is necessary tor them to exercise that care and self- 
will by which alone stuttering can be cured. Besides 
this, it ia an utter impossibility, and contrary to aU. 
laws of physiology, that one type or species of stut- 
tering should be converted into another. There are 
laws for the development of the different species of 
defective speech as for everything else. These laws, 
although obscure and complicated, are stiU as per- 
manent as the most simple law which exists in 
nature. Baaed, as my practice is, on the laws of 
physiology and psychology, I am nevertheless bound 



338 TREATMENT OF STUTTERING. 

to confess, that nothing so much aided me in curing 
stutterers as the opportunity of pointing out to them, 
by ocular demonstration, the various causes of stut- 
tering in other persons subject to the same infirmity. 

In conclusion, I doubt whether there be toy af- 
fection to which the first aphorism of Hippocrates is 
more applicable than to stuttering : — * 

" Life is short, and art is long ; experience fal- 
lacious, and judgment difficult. The physician must 
not only do his own duty, but should also make the 
patient himself, his attendants, and all external agents 
co-operate." 



•1 



CHAPTEB X. 

STATISTICS OF DEFECTIVE SPEECH. 



" Civilisation, aa extemiLl education, is but h. transition to 
culture, as internal education; and in this firat stage it pro- 
duces ovila for wliicli it fareisliea the remedy in higher atoges. 
It carries the poiaon and antidote in the sanie hand." — Boron 
FevMeraleben, " MeMcal Psychology," Sjdenham Society, p. 2f 14. 



Computation of Colorabat. — Otto. — Chervin. — Map of France. 
— JS^mnber of Stutterers in the whole world.— Number of 
Stutterers in England. — Map of England. — Stuttering among 
Females . — Itard. — Astrii . — Enllier. — Colombat. — Klencke . — 
Norden. — Wjneken. — Penny Cyclopiedift, — Author's Eipe- 
rienoa. — Varioue reasons aaaigncd. — Stuttering in different 
languages.— Stuttering among Savages. 

Colombat, taking as a liasis the particulars he learned 
both at Paris and in several depaitments, prepared 
the following table of statistics of stuttering : 

Male stutterers, computed on 12,000,000 
individuala, in the proportion of 1 to 
2,500 4,800 

Female stutterers, computed on 11,000,000 
individuals, in the proportion of 1 to 
20,000 .550 



340 STATISTICS OF DEFECTIVE SPEECH. 

Infant stutterers, before the age of fifteen, 
calculated on 10,000,000 individuals, 
in the proportion of a seventh of the 
above number ... ... ... ... 764 

French stutterers of all ages and sexes, 
calculated on 33,000,000 individuals, 
in proportion of 1 to 5,397 6,114 

Otto counts one stutterer in 500. Thus in Prussia, 
which in 1830 contained a population of about 
13,000,000, the number ascertained by the ofiBicial 
returns of many places was computed to amount to 
26,000 stutterers for the whole kingdom. 

In a recent work on stuttering by M. Chervin, the 
author, whose calculations are based on the docu- 
ments of the Conseils de Revision, gives 3 in 1,000 ; 
and he even goes further and says that 5 in 1,000 
would be no exaggeration, because such only are 
exempt from military service in whom stuttering 
exists in a high degree. He computes that there are 
not less than 150,000 stutterers in France. 

Between 1852 and 1862 not less than 6,773 con- 
scripts were exempted from military service on account 
of this infirmity. 

It seems also that stuttering is less frequent in 
the north than in the south of France. (See Map, 
which shows the number in each department). 

Taking the population of the globe to be about 
1,000,000,000, the number of stutterers in the world 
would be, according to Colombat, 185,289 ; according 
to Otto, 2,000,000 ; and according to Chervin, 5,000,000. 

It would be very desirable if the registrar-general 



InDICATINO, ICCOBDIHO TO ChHBVIN, THE NUMBEB OV StTITTBBBRS HXBH 
CBOK HlUTAKT SbbTICb IN BACH Di"j)nr£pme?i(. (Sbs page 340.) 







MSP or BsoLAfny. 

a Tas NwMBKB or Stotteebrh in thj: Vjhiious CocNTiEa o 
1750 CABE8 HOTicBD. (See pajf a+l.) 




341 



were, at the next census, to employ the means at 
his disposal to ascertain, as nearly as possible, the 
number of persons labouring xmder impedimenta of 
speech in the United Kingdom. In the absence of 
any statistics on this subject, I commenced with con- 
structing a map of England, indicating the number 
of stutterers in the various counties, out of 1750 
eases which came under my notice. These data, al- 
though necessarily very imperfect, form, nevertlieless, 
a starting point, and may, when further extended, 
eventually enable us to ascertain the actual propor- 
tion of stutterers to the general population of this 
country, and to that of individual districts. 

From computation and general obaeri'ation, I am 
of opinion that the average niunber of stutterers in 
England is at least 3 in 1,000, exclusive of cases of 
stammering and other defects of speech. 

Causes. — ^Among 200 of the best observed cases 
that came under my notice, I found that seven and 
a half per cent, originated during, or iuunediately 
after maladies, such as fever, measles, hooping-cough, 
etc. ; five per cent, were the result of fright or ill- 
treatment at school ; four per cent, were caused 
by voluntary imitation ; nine per cent, by involuntary 
imitation ; ten per cent, were supposed to have been 
inherited direct from the father ; five per cent, from 
the mother; the rest, 49^ per cent., could not be 
accounted for. It may, however, be stated, that 
among the last there were some whose relations, 
such as brothers, sisters, uncles, etc., stuttered, which 
cases may accordingly be attributed either to imitation 
or to hereditary predisposition ; perhaps both these 



342 STATISTICS OF DEFECTIVE SPEECH. 

latter may have had some influence on the causation 
of the defect. 

Stuttering among Females. — It is unquestionable 
that impediments of speech are far less frequent in 
females than in men. Itard declares he never saw a 
female stutterer, although he does not deny that such 
exist. Astri^ also says he had never seen one, but 
he was told, by a friend, of a family in which father, 
mother, sons, and daughters all stuttered. Eullier, 
in the beginning of his practice, denied the existence 
of female stutterers, though afterwards he says he 
had heard that such do exist. Colombat in the com- 
mencement of his practice had grave doubts as to 
females being " disgraced" by this infirmity, though 
later he allows that he has observed female stutterers 
at the rate of about 4| per cent, of the total numbe^^ 
of cases under observation. 

According to Klencke, the difference is not nearly 
so great, there being 33 J per cent, of females. Norden 
has observed nearly 15 per cent. Wyneken 12 J per 
cent. The author of an article in the Fenny Cyclo- 
jpcedia gave his experience as 12 per cent. My own 
practice yielded 12| per cent, up to the time I pub- 
lished an article on this subject in 1860 in the En- 
cyclopaedia Britannica. 

During three distinct periods I noted the following 
results : 

From 1853 to 1860 12^ per cent. 

„ 1861 „ 1866 13i 

„ 1867 „ 1869 12 

Of the total number of cases of stuttering I have 



aXtirrBKING AM0N3 FEMALES. 343 

treated during the last sixteen years, i.e., from 1853 to 
1869, 1 find that of the males 9 per cent, were under 
ten years of age; 19 per cent, from ten to fifteen; 
8 per cent, from fifteen to twenty ; 29 per cent, from 
twenty to thirty ; and 5 per cent, adults over thirty. 

Of the total number of females, 5J per cent, were 
under ten years of age ; from ten to fifteen there 

re 13 per cent. ; from fifteen to twenty, 37 per cent. ; 
from twenty to thirty, 39| ; and above thirty, there 
were hut 5 per cent. 

In his last work Klencke states that of 148 stul^ 
terers he treated during fifteen yews, 97 were males, 
and 51 females. 

Males : 55 boys under fifteen years ; 29 youtlis, 
fifteen to twenty-two ; 8, from twenty to thirty ; 
5, above tldrty years old. Females : 28, under four- 
teen years; 19, between fourteen and twenty; 4, 
above twenty ; 1, married woman age thirty-one. 

Various reasons have been assigned for this pecuUar 
phenomenon. Some advocate the bypotheais that 
women have a finer organisation of the parts con- 
cerned in speech, a quicker apprehension, and a 
readier judgment than men ; and that hence their 
articulation excels in ease, fluency, and volubility. 
The following complimentary effusion from Koiiasean 
has often been quoted as an explanation why stut- 
tering should be rare among females: "Girls" (be 
says) " have their organs of speech more supple and 
flexible tlian boys, they speak sooner and easier, and 
women speak more agreeably than men. Thuy are 
accused of speaking more ; such ought to be the case, 



STATISTICS OF DEFECTIVE SFSECH.' 

and I would willingly convert tliia reproach into 
praise. The whole nervous system is also more 
developed in them ; the impressions they receive are 
mora powerful and multiplied, and hence they have 
a greater numher of sensations and internal feelings 
to make known : anxious to penetrate .the secrets of 
men, and to ascertain the state of their hearts, speech 
is for them the most usefiil instrument, and the most 
indispensable to their happiness." 

Voisin, who quotes the ahove lines, remarks that 
" these delicate appreciations would lead ua to infer 
that stuttering is not so frequently observed iu females 
as in males. The nervous constitution of the former 
well accounts for this difference, as females have less 
masses to move than males, ' It follows, therefore,' 
. says Dr. Eoussel, ' that they can govern them better. 
Another physical quahty,' says this ingenious writer, 
• concurs to render the organs of the female more 
mobile. It is the degree of softness peciiliar to them, 
and which since the time of Hippocrates has been 
conceded to them by all physicians.'" 

Colombat advances as a reason that, " being con- 
demned to remain at home to superintend domestic 
affairs, and thus to lead a sedentary life, woman is 
obliged to speak oftener either for the education of 
her chQdren, or to divert herself by some piquant 
remarks addressed to persons around her, or, finally, 
as is frequently the case, to take part iu small-talk 
about fashions, love affairs, and scandal." 

Dr. Isidore Bourdon says,* " Thaf the voice of 



• Pliysiolosie MMicale, tome v, liv. ii, p. 6 



STnTTEBINQ AUONO FEUALES. 



345 



wonian is infinitely softer than that of man. It 
seems that in her voice is a musical instnuuent from 
which she draws melodious sounds which penetrate 

and move the heart Woman frequently sjieaks 

for the purpose of speaking. She speaks as she 
sings; it is the necessity of a heart too full of in- 
genious devices which inspire her." 

Merkel gives as a reason that women, from their 
psychical constitution, do not so easily contract dis- 
eases of the Ovfio^, because the erridviua predominates 
in them. Klencka explains it by the circumstance 
that the respiiatory system is leas predominant in 
the female organisation, and it is generally known 
that those organic systems, which are predominant 
in their functions, are more liable to functional dis- 
turbance. Hence boys suffer more in their respiratory, 
girls in their generative oi^ans. 

The facts quoted may be admitted, but tliey do 
not, I think, afford a really satisfactory explanation 
of the phenomenon. The proportion of male to fe- 
male stutterers is too great to be so easily accounted 
for. Graves cites the case of a family in which the 
males were attacked with tliis infirmity for three 
generations, and the females spared I do not doubt 
that stuttering showed itself for three generations on 
the male side, and spared the females, but I question 
whether all the males for three generations were 
afllicted with stuttering. It is, at all events, a very 
exceptional case, and it is to be regretted that no 
particidara are given, 

I'eosoning d priori, one would imagine that stut- 
tering should be more prevalent among females than 



STAxumoa or dztsohvi! sfeeoh. 

among malea. K the catise of stuttering ilepends 
upon nervous sHSCeptibility, and if it be nearly allied 
to chorea, females should suffer from it in greater 
numbers than men. Again, if. as some gratuitously 
assume, — without a shadow of reason, — that woman 
thinks more rapidly than man, the probable effect 
should be that the words would not keep pace with 
the thoughts. Aristotle (as already stated) considered 
that one of the causes of stuttering was, that the 
words did not proceed fwri passu with the thougUta, 
on account of the flight of the imagination. Again, 
if timidity be one of the causes of stuttering, the 
fair sex should, from their natural baahfulness, be 
more liable to it. And, finally, if imitation (certainly 
a prolific cause of stuttering) be more developed in 
woman than in man, we have an additional element 
for the production of speech-defects. Yet, despite 
all this, the fact is unquestionable, that impedimenta 
of speech are less frequent in females than in malea 
I know not whether it has ever been noticed that a 
dnular disproportion between the sexes exists in so- 
called cases of aphasia,* which affecta more males 
than females. Setting aside a theory of final causes, 
viz., that nature, in order to compensate woman for 
ber weakness. Las bestowed upon her a powerful 
weapon in the gift of the tongue, we must rest 
satisfied witli the physiological fact, that the vocal 
and articulating apparatus of woman, being more 
elastic and mobile than that of man, is less liable 



8TUTTEHTSG m DIFPERENT LANaOAOEB. 347 

to be affected by some of the cauaea which pivxluce 
the infiiTuity in the male sex. In illustration of this 
feict, it may he stated that the male voice rarely, if 
ever, reaches such a compass as that possessed hy 
some female singers, such as C'atalani, Sessi, etc. 

But whilst subscrihing to the general fact of wo- 
man being less liable to speech affections than males, 
they are, as has been shown, by no means exempt from 
them. Many cases of female stutterers have come 
imder my notice, some of which, of a very severe na- 
ture, required the greatest care in treatment. The 
habitual timidity of women, frequently aggravated by 
a derangement of the nervous system, tends to produce 
more intricate eases than in men, which consequently 
require more time and patience to treat succeasfiJly. 

Stuttering in different Laiiguages.—^t would be an 
interesting subject of inquiry to asccTtain, as far as 
possible, the influence of different languages and dia^ 
lects upon tlie causation of stuttering. At present 
our data are insiifficient to found on them any correct 
theory. It seems highly probable that languages in 
which the harsh consonants predominate, such as the 
German, Polish, and Russian, shoidd furnish far more 
stutterers than soft-flowing languages, such as the 
Italian, in which there is a predominance of long 
vowels. Hence, if this view be coiTect, Germany 
should furnish more stutterere than France. This 
may, perhaps, in some measure account for the dif- 
ference between the computations of Otto and Co- 
lombat mentioned above. Other influences may, liow- 
ever, he at work, in producing such diH'erences. 



348 



STATISTICS OF DEFECTIVS sraBCB. 



"We know aa a matter of fact that pronunciation 

varies in the different racea of man, some of which 
have a. greater or lesser tendency to discard certain 
articulations, and to substitute others for them, either 
from congenital formation of the respiratoiy, vocal, 
and articulating organs, or from cHmatiG influences. 
That climate has a certain influence on the sounds of 
a language is all but certain, and the vowels seem 
specially subjeetto this influence, "The lips, the most 
external parts of the vocal apparatus," says Vaisee, 
" take a more active part in the south, where the lui^ 
freely open to the warm air, while in the north the 
people endeavour by the occlusion of the mouth to 
protect the air-paasages fi'om the cold atmosphere. 
This climatic inflaence is also perceptible in languages 
which passed from a warm into a cold climate." Ad- 
mitting all this, the statistics of speech-impediments 
are atiU too imperfect to enable us to lay down aa a 
general rule that peoples speaking languages con- 
taining many guttural consonants are more liable to 
stuttering than nations speaking idioms in which the 
vowels predominate, 

Colombat mentions tlrnt a son of 11. Chaigneau, 
the French Consul, in Cochin-China, bom of a Chinese 
mother, and who, from his infancy, spoke tlie lan- 
guages of both his parents, expressed himself with 
the greatest facility in the Chinese dialect, but stut- 
tered much in speaking French, which he was chiefly 
in the habit of using, Colombat attributes this to 
the rhythmical structure of the Chinese, and the 
peculiar intonation required to distinguish similar 



BTUTTEEmG AUOK& 8ATAGE3. 



34d 



I 



The assertion which has been made, on very slender 
grounds, that there are no stutterers in China, is re- 
futed by the fact that the Chinese language posaesse,'^ 
a term for impedimenta of speech (see synonyma). 
If, indeed, it be true that stuttering is less prevalent 
in that country, this circumstance seems to me owing 
not so much to the peculiar intonation and the 
ihythmical structure of the Chinese language aa to 
its being a monosyllabic tongue." 

"Where a mixed language is spoken, the majority 
are unable to speak the one or the other perfectly, 
and the result is, that they find difficidties in both, 
whence arises a certain hesitation, the forerunner of 
stuttering. If this be true, we might, a priori, ex- 
pect a large number of stutterers at the frontiers of 
countries in which the languages differ, which I be- 
lieve to be the case. 

Dr. Klencke says he found that most of his cases 
came from heathy and marshy lands, generally from 
plains ; a smaller number came from mountainous 
parts, frequently with a touch of cretinism ; the fewest 
atutterera came from high table lauds and woody 
hills. 

Stuttering among savages. — ^The question, whether 
stuttering only affects civilised people, is one of very 
considerable interest. Most travellers, who have long 
resided among uncultivated nations, maintain that 

• Soma of the North American tribes bave been aaid to be 
free from this dflfeot. This may be accounted for by the fact 
' that their langaagea belong, aa asHerted bj philologists, to 
F tha Chinese or mono-afUoibic oLibh, 



350 



STATIBTIOB OF DHfECTITB SPEECH. 



they niiver met with any savages laliouriiig under an 
impediment of speecli. Aasumiug it to be so, it is 
not easy to say, wliether this immunity he owing 
to the more ample development uf the liuccal cavity 
in aavBges, to the nature of their dialect, or to their 
freedom from mental anxieties and nervous debility, 
the usual concomitants of refinement and civiliaation. 
My impression is, that the latter circumatauce offers 
the best explanation of the alleged fact. 

In the first edition of this work, I made a general 
statement that defective speech was the result of civi- 
lisation, and tliat savages were not thus affected. But 
from the following it will be seen how necessary it is 
that a correct and exact meaning should be attached 
to the words " stammering," " stuttering," " savages," 
and "civilisation," in making such a statement. For 
instance., are the natives of the West Coast of Africa 
savages ? Are they civilised ? Without attempting 
a definition of these terms, it may generally lie stated 
that on the West Coast the natives have had a certain 
amount oi' intercourse with civilised Europeans. Be- 
sides this, at Sieri'a Leone the poor wretches who ara 
captured in slavers are there released. The slaves 
are sent away from the interior with all sorts of 
diseases. I therefore fully expected that at Sierra 
Leone there would he a considerable amount of dis- 
ease. But I certainly was not prepared for such a 
sad picture as that given by Mr. Hobert Clarke, of 
the vast amount of disease which exists ou the West 
Coast of Africa generally.* In the pajiera quoted 

• Bee Rejoarks on the Topography and DiBeases of the Gold 



BTUTTBUmO AMONO eATA,GES. 351 

below, be successfully refutes the prevailing opinion 
that the uncivilised are leas liable to disease than 
the civilised. Indeed, he has clearly estahhshed the 
fact that the negro racCj with the exception of being 
exempt from yellow fever, suffer from quite a3 many 
disorders as the European races. Mr. Clarke writes : 
" The proportion of persons with distorted spines, 
which give rise to the hunchback, and also with 
talipes or club-foot, are quite as often met with as in 
Europe." Oar author also says, that "mania, apo- 
plexy, epilepsy, chorea, delirium tremens, are of 
common occurrence, and that they suffer severely 
from disease of the lungs, skin, and bowels," Under 
such circumstances we are not much surprised to 
read, " Stuttering is a defect very common amongst 
the people ; but it is alfeeted by many among them, 
as it is connideied fasIiionctUe to stammer.* Peisons 

Coast. By B. Clarke, lat« of Her Majeety's Culonial MpcUcal 
Service, in a paper read before the Epidemiologisol Society, 
lg<)0. Also " Short Notes of tlie prevailing Diseases in the 
Colony of Siorra Leone," read before the Statistical Section of 
the British Asaociation at Qlaa^w, Sept. 1856. Staliitical 
Jotirnal, vol. lii, part i, March X860. 

• Wiflliing for further information onthiBintareatingqneation, 
I wrote to Mr. Clorbe, and received the following interesting 
account in reply. 

"At Sierra Leone the black popnlation speai lifty different 
dialects, almost every tribo in West-Africa having repre- 
sentatives there, stammerers and atatterers bein^ quite aa 
numerous amongst them aa in Europe, and, in the m^ority of 
them, these defects had existed irom childhood. On the Sold 
Coast I had the best opportunities of seeing and observing the 
different races inhabiting it, not only in my medical capacity, 
but aa Aot. Judicial Aaseaaor, and I can safely declare that 



352 STATISnOB of rEFBOTITE SPEECH. 

with hare-lip, and tongue-tied infants are quite ( 
common as in Europe." 



feature: 

utter being ii 
" In a g 



scarcely a week pftaaed without mj noting ttie affection in the 
persons of plaintiffs, defendants, or witneases. In several 
instances tlie heaitJincy was so great and prolonged that the 
e to some eitent convulsed, tlie eSbrt made to 
n tbe bigbeEt degree distreBsing, and when over- 
it were delivered in gulps. 
i many persons it has been induced later in life, 
aa at Sierra Leone, from smoking ' diamba' or Indian hemp, 
find both there and on the Gold Coast, perbaps from the bdbit 
of drinhing large quantities of ardent spirits. I do not at 
present recollect any instance of its occurring from flight, bnt 
no doubt such cases do happen from the overwhelming and 
cruel influence exercised over their minds by the Fetish priests 
and priestesses. 

■' The imitative faculty, so strongly developed in the negro 
race, has led soroe of tbe blacks and coloured people to acquire 
stammering, tbinking that becauBe Europeans holding high 
rank upon the Coast sometimeB ore so affected, it is therefore 
an attainment fashionable in Europe. 

" The word ' savage' is not easily, as you justly state, deflned, 
but primarily means sylvan or wild. In my opinion the slaves 
landed at Sierra Leone from tbe slavers' hold, in a state all but 
nude, ace barbarians or uncivilised, and bo, indeed, are several 
txibea upon the Gold Coast. Yet none of these people are 
without a strong sense of natural justice. They one and all 
are governed by rude laws perfectly snit*ii to their condition, 
and which, when they are faii'ly administered, are not repug- 
nant to humanity. Superstition it is that works the mischief, 
being used to pervert their laws, and by false occnsations of 
witchcraft consigns its victims to slavery or to be aacriflced to 
their infernal gods." 

In speoking of civilisation, we must bear in mind that there 
are two different kinds — the healthy and unhealthy. The same 
influence which tends to produce the mental or physical do 
rargcment, will also be likely to produce defective speech. A 



I 

I 
I 



STnTEBINC AHOKG SAVAGES. 

pMLoBOpliicfil pbysiciiui has mado the following remarfci on this 
Bulyect. SpeHkiiig of the increaeo of mental diseases in civi- 
lisation, which he contends is an undoubted fact, he con- 
tinneat'^ 

"It is not ciTilisation, but the increasing want which it 
brings in its train; poiijal education, paBBiona, emotions, etc., 
all which set the mind in passive motion; the forced culturu 
to which thejr lead; the over-indulgence, — these contain the 

reasons of this fact The indnstrial impulse of the present 

tinte, for instance, hj the haxards to which it exiHisea the 
opulent olaasea, is one of the occasioning momenta, white, by 
the BCtivit J which it excites, and bj doing away with isolation, 
it is one of those which is counteracting and salutary. If 
savages sho» such a happy eiemption from insanity, they are 
indebted for it, not merely to the want uf civilisation, but 
probably also to the indomitable energy of their corporeal 
vitality. Of all passions, ambition in men and love in women 
(especially through jealousy), ore the principal springs of in- 
sanity. Goethe eaya »ery Judiciously, 'nothing beings us 
nearer to insouity thou distinguishing ourselves above others j 
and nothing preserves the even tenor of the understanding so 
weU as a general intercourse with many people.' In Kusaia 
the class of oflicei's in which the greatest eagerness for rank 
prevails, comprehends the greatest number of insane peraous." 

An interesting account of a negro girl stuttering, was given 
to me by a Turkish gentleman, who recently consulted me n- 
specting an impediment in speech under which he laboured, 
and who greatly pressed me to go to Constantinople, as there 
were so many stutterers there. He said one of the slaves of 
his wife was a young Afrioan girl, wbo stuttered very badly, 
and who weeps continually because she cannot apeak properly. 
Her defect came on after a iright, produced when she was 
captured before being brought to Constantinople. 

The following interesting particulars of a peculiarity in 
enunciation which exists amongst some African tribes, are 
given by M. Eugene de Frobervillo, who says: — 



354 



STATISTICS OF DEFECTIVE SPEECH. 



" Among the Niambaaa NegroeB,* m the nortt of Caffraria, 
whom I coasalted for mj Tocabulary or the Eastern Nagro 
tribes. I met with one wbose Btuttering eniinoiation wae very 
pecnliar. Tiiia Negro alnaja interpolated in every word the 
pliable ' Hbil.' Thaa the word Kiamiiana became in bis mouth 
Nia-shil-ambana, Knctlele, to sleep, Kqetlfi-sbil-eie, Tnbiini 
(wood) Tahn-Bhil-ani, etc. I, at flrst, thought that the man 
Iftbonred under a defect of speech, and woe about to diamisa 
him as nnauitable for m; object, when I obaerved that, when 
he took the trouble, he coold enunciate the words without in- 
terpolation. I recollected a passage in the description of the 
voyages of Arbonsset and Duinas, who viaited the countriea 
north-east of the Cape Colony, in which it ie said ' Certain 
Negro tribes, with incised nostrils and artificially pointed teeth 
(my Niambana Negro presented the eame peculiaritiea) are by 
the Soathem Kaffirs called atuttei'erB.' Subsequently I ob- 
served among other Niambana Negroea the same tind of stut- 
tering. The intei'polated Bjllable was not the same among all 
tribea, but the principle was the same. The stuttering of 
these Negroes resembles much that of chOdren, who molie the 
first attempts at apenking. It appeared to me that it was 
owing to a certain imperfection of the organs of speech, and 
that they interpolated a strange syllable to gain a point d'appni 
(a folcmm). 

" M. Antoine d'Abbadie writes to me that both the gipsies aa 
well as the Abyasinians insert some arbitrary Byllables between 
two syllables in order to render their language Uniutelligibla 
to the stranger. The Abyasinians call this method, by which 
the Amhara language is rendered unintelligible, Zaboza, and 
insert the syllable ba. Bohoolboys frequently adopt a similar 
method. I have convinced myself that the Niambana N^roea 
do not use this intercalation for such a purpoae.but to facilitate 
their enanoiation. The fact, however, is very singular, espe- 
cially OS the EastecD Negroes have a fine ear and are very 
careful of correct pronunoiation. I believe, therefore, aa I 
stated, that a certain nervousness and imperfect organigation 
may be one of the causes." 

■ Bulletin de la Sac. 0£og., Juin 1B52. 



STCTTBRING AMONG SAVAGES. 



355 



In 1864 Uiere WBfl a diacuBsion between Bome memberB of the 
Philological Soaiet; as to tlie meauiiig and origin of the word 
Hottentot. Some thoai^ht it on onomatopoetic, or imitation of 
the native click or a Dutch atammei- hoi, lot. Jadge 'Water- 
meyer waa appealed to aa umpire, being considered the soundeat 
scholar at the Cape of Good Hope. He anawered by a quotation 
from Dapper, the Dutch Collector of Voyages, wlio about the 
year 1668 reports of the Hottentots ; " Some words they can- 
not utter eicept with great trouble, and seem to draw them 
fi'om the bottom of the throat lite a Turkeycoob, or as the 
people of Germany do, near the Alps, who from drinking snow- 
water have the 'goitre.' Wherefore our countrymen, iu re- 
spect of this defect and eitraordinaiy stammering in language, 
have given them the name of HoltentoU, as that word is or- 
dinarily used in this aenae, as a term of derision (aohimpawyze), 
in this country (hier te lande) to one who atuttera or stiunmera 
in the utterance of his words." This peculiarity of language, 
said the judge, was noticed by all the early voyagers — not the 
Dntch and Engliah only. The Portuguese, who do not know 
the name Hottentot, teota the first obaerved what is called the 
atnttering; and Crosina, in bis description ofDe Qama's voyage, 
speaks of the "incalK qui cum loqanntur aingultire videntnr.'' 
In Zedler's Universal Lexicon, 1736, it is atated, however, that 
the name Hottentot baa been given to this people by the Dutch, 
because that is the word this people frequently utter when 
they are very meny. 



INDEX OF AUTHOES EEFEEEED TO. 



A 

Adelxjng, 12 
^gineta, 23 
Aetius, 23 
Amman, 33 
Amussat, 129 
Angermann, 163 
Aristophanes, 203 
Aristotle, 17 
Amott, 80 
Astri^, 62 
Avicenna, 24 

B 

Bac. Med., 83, 160 
Bacon, 31, 53 
Bansmann, 98, 232 
!^audens, 129 
Beclard, 175 
Becquerel, 156 
Beesel, 150 
Bell, 103 
Bennati, 222 
Berthold, 108 
Bertrand, 74 
Bishop, 162, 289, 334 
Blache, 317 
Blume, 154 
Bonet, 38 
Bonnet, 130, 149 
Bouillaud, 229 
Bourdon, 344 
Bourguet, 191 
Brachet, 253 



Braid, 131 
Broster, 65 
Backnill, 235 
Buhring, 152 
Burton, 262 
Busch, 139 



Campbell, 235 
Carpenter, 1, 161 
Celsus, 22 
Chalmers, 311 
Chauliac, 28 
Ch^goin, 88 
Chervin, 182, 340 
Cicero, 21 
Claessen, 136 
Clarke, 351 

Colombat, 146, 286, 339 
Combe, 64 
Coote,187 
Crops, 149 
Crichton, 44 
Cull, 106 
CuUen, 41 

D 
IVAbbadie, 354 
Dapper, 355 
Darwin, C, 284 
Darwin, E., 45 
Deleau, 83 
Delius, 40 
Demetrius, 20 



mOEX OF AUTHORS REFERRED TO. 357 V 


Detmold, 132 


I 


DieffenUch, 126 


iBilAH, 15 


Duffireaae-ChBBBaigne, 136 


Itaid, 51 


E 


J 




Jackson, H., 281 


EiOH, B, 165, 326 


JamiesoD, 8 


Eaquirol. 292 


Jourdant, 158 


F 


JuliuB, 68 


FAsaicujB, 126 
PerguBson, Sir W., 318 


E 

EAATJ-BOKBHiVH, 253 


Fenchteraleben, 353 
Forater, 209 
Fourniev, 201 
Frank. 49 
Fcolierville, 354 


Kingiley, 122, 354, 256 
mencke, 176, 312 
Krug, S19 
KUstnor, 35 


Froriap, 129 


L 

Lanbevbeck, 312 


FuUer. 205 


G 


LeHneas, 184 


Leigh. GB 


GiLRN, 23 


LentUiua, 206 


Garden, G., 250 


Limbuaeher, IG9 


Qarrod, 263 


Liclitinger, 153 




Listen, 119 


GelUus, 311 


LouiB, A., 282 


Qibb. 223, 80S 




Good, 111 


M 


GraveB, 158, 263, 345 


MCCOEMAC, 77 


Gray, E., 280 


Mttgendie. 5. 94 




Malebouche. 72, 114 




Mark, St.. 15 




MarobaU, 183 


H 


Macaton. 8 




Mead. 263 


HAGBMiNN, 155 


Mendelaaohn, 41 


Haen, 38 


Menjot, 32 


Huhn, 37 


MerourioliB, 20 


Hall. MarahaU, 142 


Merkel, 161, 285,345 


EaxniBoh, 100 


Morgagni, 38 


Hartlaj, 37 


Moaes, IB 


Harvey, 222 


Mott, 132 


Herodotoa, 267 


Miiller, 81 


HippoecateB, 16, 281 




Hoffman, 113 


N 


Horace, 


NfiLATON, am 


Howel, 260 


Noligan, IBS 1 
Norlen. 342 ^^^H 


Hant, TliomaB. 118, 120,137 



358 



INDEX OF AUTHORS REFERRED TO. 



O 
Ob£, 95, 128, 188 
Otto, 101, 328, 340 
OTid, 206 



Palmeb, 86, 314 
Paget, 289 
Parfe, 220 
Philippe, 137 
Pinel, 251 
Plutarch, 19, 203 
Poett, 105 
Post, 132 
Pigol de Castres, 286 

B 

Rampont, 195 
E^camier, 317 
Bhazes, 804 
Bomberg, 164, 294 
BosenthaJ, 171 
Bousseau, 393 
BulUer, 57, 342 

S 
Saint-Hilaise, G., 283 
Santorini, 38 
Satyrus, 19 
Sauvages, 41 
Savary, 52 
Schulthess, 95 
Schulz, 181 
S^e, 317 

Serres d'Alais, 93 
Shakespeare, 200, 252 



Sillani, 131 
Skelton, 8 
Stalder,208 



Talma, 225 
Thelwal]« 50, 285 



Ulpian, 311 
XJnzer, 327 

V 

Vaissb, 348 
Velpeau, 128 
Vincent, 223 
Violette, 174 
Voisin, 235 

W 
Wabbbn, 70, 108, 329 
Watson, J., 46 
Webster, 8 
Whewel, 13 
WoUr, 172 
Wright, J., 144 
Wutzer, 92 
Wyneken, 185, 266 

T 

Yatbs, 70 
Yearsley, 223 

Z 

ZiTTEBLAND, 72 



^^^^K INDEX 


^^^1 


A 

AsiNAKU of the vocaliaing 

muscles, 151 
Africa, stnttermg in. 351 

iDK, 355 
American method. in?Bntion 

and progceaa of, (i9 
AncjglOHaiH, 33 
Apbaaia. 69, 198 
Aphonia, 49 
Aphonoua Hpeeoh, 190 
Applianoea, artifioial, 303 
AmbH, phormaoopcBia of, 27 
ArticuUtion. priniarilj in- 

Btinctive, 5 

the laxyni, 2T9 
Artificial appliances, 303 
Aaaumed voice, Z69 

B 

BALBtrriBa, 39, 32 

Baryloquala, 197, 211 

BiSgaie men t, different forma of, 
84,146 

Biographical notice of Thomas 
rfunt, 118 

Blffisitas, 199 

Brain, its influence on spoeoh, 
57,60 

BiTsk pronunciation of syl- 
lables, 93 




Cebebral irradiation. 57 

China, stuttering 'in, 349 
Chorea, its resemblance to 
stuttering, 316; cured by 

Cleft p&la1>e.2L8 

Clergyman, curious case of a 

stuttering, 271 
Cluttering, I9fi, 213 
Cochin China, stuttering in, 

3*9 


D 

DHaLlKATION, 276 

Definition of term a, 7 
Delivery, alow and measured, 
useful. 149 

32) temediea he applied, 19; 
bia chief defect, 3IJ1 

Dandraaryisra, 206 

Dynamic affection of the re- 
spiratory muscles a. onase 
of stuttering, 166 

Dyalalift, 49; of the aged, 194 

Dysphonift. 19 

E 

E, i(JTBB0Ai,4Ti0K of, betwflfln 

syllables and words, 81 





" 


SCO KDEX OF 


SUBJECTS. 


Edncation, its inflacnce on 


Impediments of apeech in 


Btutteriuff, 257 


general, 1 
IndiatinctnesB of speech. 10, 


Emotion", inflQenee of in stut- 


tering, 2<i9 


199 


En^Und, nnmlier of stutterers 


Inflnenee of age nfwli stutter- 


in, 340 


ing, 2B5 T of edactttion, 257 


EicitOinotorj^3t.em;its pre- 


Influence of various djaorders. 




2C4 


tering, 153, IWl 


Intoiictttion. 22 


Eitrinsio cansea of Btnjnmer- 


Intrinsic causes of stammer- 


ing, 194 


ing, ]!13 




Motftciam.aOl, 21fi 


F 


IiTHtionale of speech, 122 


FitTBaiNS of the aged, 194 


laehnophonift, IB, 164 


Ftuioles, stutteiini; laaoae. 


Inapiration, deep, 2i], 77 


S42 




Fork of Itard, 55 


K 




Xaitjsb, 354 


of, 24, 3(1, SI 




France, number of Etntterera, 


L 




Lallatioh and lalling, 19B, 


Fright, inflnenee of. 268 


214 


Functional cauBes of etamincr- 




ing. 195 






LiuTVCgOGCope, 308 


N, « 


Laryni, 3; injni7 of, 191 


GAM1IAC18*, 200, 216 


Lip gymna^ties. 191 


GargleB, 29, 311 
Genio-gloBsi, divJBJon of. 129 


Liaping. SOW, 227 


Louis XITI, Anecdotes of, 33S 


GloBso-mochlion, 92 


Lunar influence on stuttering. 


Glottis,*; spasmodic affection 


203 


of, 81, 83, 95 


LungB, epeaiing with empty. 


GraBBejement, 202 


77 


H Gjmnaatics, 147, 170 


M 

MEDiciL treatment of stut- 


H 


^H H^aiTANTU, 35 


tering, 314 




Methodical gymnastics, 170 


■ S15 




H Hiatoiical rerisw of theories. 


Moon, alleged influence on 


H etc, 13 


stuttering, 262 


H Eottentotism, 34; deriT&tioa 


Mogilalia, diiferent speoiee of. 


H of name, 355 


49 




Moral remedies, 161 


■ 


Mumbling, 215 


^K luAOiHATiON, exuberant, ZH 


N 
Heqeobs, Btuttering niBOng, 
354 


^K ImitaUon, 249 



^^m INDEX OF 


acBJECTS. 361 


^^M Netrea of the vocal and arti- 




^^1 onUtinK apparstna, 6 




^B Newcastle biirr, 203 


Ehythm, 6, 50. 107, 147 


^B Nitrate of eOver, a renedjr 




^H ^ainat BtatteHng, 3 1 S 




^H Nomenclature of speech im- 


s 


^H pedimentB, 8 


Savaokb, atntteriag among. 


^H Noae, apeakiag through the. 


349 


^H aoi, 213 


Scripture records, 14 




Secret remeilies, 291! 


^H 


Seraeiologjofsoieeandspeenh, 


^H Ofebations, surreal, 125; 


35 






^M 137 


Sigmatism, 20S. 237 




Singing, stuttering in, 276 


^H 


Sooiet? Islands' langonge has 


^H FA1.A.IE, fisBDres in. £18 


no hissing sounds, 20i> 


^H Farapbonia, 49 




^H FatteriB);. 1U6 


tia. 80 


^V Ferfection of speech, 7 


Speech, production of, 3; per- 




fection of. 7 


27 




Pharjni:, its share in articula- 


Stammering, aa contradistin- 


tion, 103 


guished &i)lii stuttering. 9; 


Pinophobia, 277 


its causes and varieties, 194; 


^H Power of the mind. 320 


treatment of, 212. 


^^U Preliminarj inqnirieH, 307 


StatiatiCH of speech impedi- 


^H Production of speecb, 3 




^H Pronunciation, difflooltyof, in 




^B various races, 209 


from stammering, 9 


Prussia, stuttering in, 340 


. no diseaae, 173 


Paelliam. specios of, 41, 111 


— its causes, varieties. 


Psychical stuttering, 196 


etc., 229 


treatment, 319 


its main features, 229 




its early stage, 233 


H 




^M QuACEEBT, Bhiuea on, 304 


234 


■ 


different speoiea, 238, 


^r 


341 


Bkaction of atutteringou the 


caused by defective 


general health. 2S8, 296 


association of the muscles 


Beading, loud and alow, 43 


of the respiratory orgiuia 


Eeasona for not giving minute 


«ith those of the speech- 


rules. 298 


organs. 241 


Eeoitative. 276 


psychical influences 


Belapses, 332 


OD, 307 


Eeapirfttorj apparatus, 3 


treatment of, 296 


Reyiew of theorieB, etc., 13 


in Binging, 276 


^— Uliinopbonia, 201, 216 


in whispering. 278 



362 



INDEX OF SUBJECTS. 



Stuttering, whether heredi- 
tary, 281 

pejchical treatment 



of, 319 



T 



TABDILOQXnSNCE, 197 

Temperament, its influence on 
stuttering, 109, 258 

Temperature, influence on 
stuttering, 259 

Time of day, 260 

Timebeating, 159 

Time required for cure, 328 

Tongue, a broad and equable^, 
best for pronunciation, 18 

its supposed position 

in stuttering-, 73 

Tongue operations, 220 

Tonsils, enlargement and ex- 
cision of, 24, 221, 223 

hypertrophied, 133 

Turkish stutterers, 355 



TObanoscofhonia, 202 
Urinary stammering, 290 
Uvula, elongation and excision 
of, 221 



YxLTju, double alleged cause 

of stuttering, 40 
Vocal cords, 4 
Voice not indispensable to 

speech, 79 
Vowel stuttering, 244 

W 

WHispERiNa, 165, 190 j exer- 
cises, 191; during inspira- 
tion, 280 

Will, defective volition, a chief 
cause of stuttering, 163 

exertion of, indispensable, 

317 



T. BIOHABDS, 87, OUKAT QUBKM 8TBKKT. 



OPINIONS OF THE PRESS 
FORMER EDITIONS 

Dr. HUNT'S TREATISE ON STAMMERINO, &c. 



EjAnbiirgh Medical Journal. 
"Db. Hmn treats his aa^eot in & masterly and compendiooB 



sad sttitteriujt are sODnd, camprt 
portaat practaual value. It in n book, 
are abundflnt evidence of ita hsTing i 



a Bhort, the oonteDta of wbich 
Qumuted from ooe thoroughly 
Bqairing- no suoli aid oa ca "" " 



" Mr, Hirot'H i 



The Standard. 
ie fsroiliar to aoieatific men of tbe preaent geae- 
' " » perfeoi ■ ■■ 



are Uiiety to aee upon the subject. It places in a true light und n 
morea the difGcaltiea which attend the treatment of the impediments 
of human Bpoeoh, aud the priuciplsB wbich gcvera thia treatment are 
aa easily oomprehetiBihle by the ordinary reader as by the mediaal stu- 
dent. Mr. Honfa book marks an era in medical aoienoe, and to msdical 
men and othera wa haaitilj reoommeud it." 

BHtUh antd Foreigti Meilico-Cliiriwgical Review. 
"There are soma disordere and Ticioos habits of the body, the treat- 
ment of which, by reaeon of their comparatiio rarity, and from the 
requirinK for their alteration as much moral aa a physical method, la 
ordinariiy removed from the sphere of the medical man. The habita 
of etammering and atnttering are among such ; and thankful must a 
poreut bo who can tnm to any quarter wheace guidance in curing a 
tendeuny Ihereto may be eipeotcd. We have olready had oocaaion to 
EOtice Mr. Hant'a ManAml of the Pkiloanphy of Voice and Bpefch, a 
work wherein the author ahows Hmaelf so &miliar with hia antgoct, 
that we ore not aorpriaed at hia opplyiuK his knowled^ of the 
natorul couditioua of apaadh and voioa to the cure of derialioiu there- 




364 



OPINIONS OF 1 



from. The preeent -work is in reality a fonrth and enkrgsd edition 
of hia Treatise an the Cure of Btatrnnering, and contains mncb in- 
tcTPBting and discursivo infomiatioa, gathered from all conntrieB aud 
nil ogee, an regards the history aad stadattoa oC the aubject in qneatioii, 
and the nnmerona theories, modes of treatment, etc., whiGh bave pre- 
Taik'd respecting- it, 

" As rcHpcctn the method of cnre adopted by Mr. Hnut ^ihe giune 
npon whioJi the reputation of his deoeaaed father reetod), it ia con- 
fessed that no precise acconntis given in the work. The method isb? 
DO means tie esotorio one apparently, hot provided no orgonio defect 
exist, simply ennsisbs in the patient's being made to understand what 
elements enter into the processes of vocalisation and lUiieuktioD, boir 
the lips, the tongoe, the jan-, and the organs of respiration are tberein 
ooneerDed, in finding out which of these organs ia ^m habit wrongly 
worked, and teaching the sufferer how to regulate the faulty aotion. 
For tbe eiecntion of this metiiod, no exact rules can bo Isjd down; 
Biperience on tbe part of the attendant, following upon suitable phy. 
Biological knowledge, must guide the Iregtment, along nith aptitude 



title of the boolc." 



Morning Post. 

" At first oight^he subject of this book is not one of interest to the 
general reader. Dr. Hunt, however, mokes it ao. It would not be 
earn to find any book of a profosaionnl cbaraoier in which the matter 
in hand is treated more popularly. Few men have studied the sulyeot 
of defeotive utterance te the same extent as the author, and fewer still 
bare the same facnlty of impairing profesaonid information to Don- 
profeasional readers." 

The Reader, 

"To Mr. Hunt (the father of Dr. James Hunt, who now follows ont 
tbe treatment with equal success) those who labour under this vexa- 
tious malady owe moctii for before his time many snfiered at the hands 
of quacks, and even from knife of sorgeons and the drDss of pbym- 
oiana, who, if they had studied the matter more deeply, and as sincerely 
as Hunt did, woold have known that coses for tbeir intflrferenoe ore 
seldom met with. 

"Dr. Hunt's treatise has now reached a fifth edition. It isvety 
ably written, and is eviilontly tho work of a man who has devoted Us 
whole energies fo the task." 



" To remodj and alleviate BOmo one of those raan;^ iHa that Seah is 
hfflr to is an amtiition worthy the noblest efibrta oi^tho most oxaltiad 
' a. They ore but few — one or two in a generation— ivho can attais 



OTlKIOliS Of FBES& 



. s n ihaX bestowed br (tataea <xt colunmB, in being enrolled 

I by Dnicereal scoiffd among the Waefitctoin of their race. Among tliaaa 

e have found mnch ptnmre and ptnSt in the peniral of thu 
I jmrJi, and dose the lolome with a proToimd respect for the raemoiy 
I. of tie late Mr. Hnnt, and with a desire to assist in the eitensioo of a, 
I knowled^ of lahoora, whith hare beeni and ore likely still to be, ao 
I benefidal la those snffering from the infimiitj to wluob be deroted 



I 



Inremess Courier. 

" The anthoT of this Tolnme haa devoted himgelf to the treafment 
of defective utterance a f^evons and distreaailig defect. His plan 
noasiats simpl; in the applicatioa of the known laws of phjsiiJogT 
and psychDlotry. The caoeee beuig aseertuined, and tbe aDatomiau 
conatroc^on of the organs explained to the pnpils, rolea are prescribed 
for regulating* the montbj tongue, reapinitioni and chest. Impedi- 
ments of speocb, he holds, are as amemible to treatment as other dis- 
orders of the human frame ; but the acqoiaitiao of perfect ul 
the result of labour." 



London: Lonshan a 



The Bev. Chahles KiMcaLET, M.A., in t'raser's Magacine (pide also 
I rratioTUila oj Speech, LoDgmau and Co. Prioe Sb.) 

" And now one word OB (o Dr. Runt. . . . I oould say voiy much 
in bis pruise whlflfa be would not care to haTS said, or (he readers of 
Fraser perhaps to bear. But bs to his power of uariug the averagp of 
stammerers, I can and do say this— that I nevar have yet seeu him 
&il where aa wooh attendon was given as a achoolboy gitss to Lis 
lesBOQF. ... A stupid volatile lad will give weary work. . . , 



Extract "JromSUgascaaf the ThTaaiandWi'n^ipe,"hy Bit Gbohbb 
I Duncan Oibb, M.D., Bart., ete. 

I " For tbe Tiewa and Tarions ojiinioni bold npon these diaorders, I 
■wonld refer the reader to Dr. Hunt's admirable work, wharo, iudeil, 
there ia much infarmation anncorning them, includiog tho philono- 
phical opinions of tbe ootbor bimaelf. Of that work I can troly say, 
that seldom indeed have 1 perosedone so fall of useful and really valu- 
able tnBtmetion, and which shows that Dr. Hnnt has paid great atteu- 
„j *-' ~-~ -'avery distreMmg andoartHJuly 



By ike same Author. 
A MANUAL OF TEE PHILOSOPHY 

VOICE AND SPEECH, 



LOSDDS : LONGS] 



*' This boolc trents of so manj branchoB of knowledge, tliat a, donbt 
natorally ariaes ds to tbo corapeterey of ttDj oeb individuBl to dsal 
with them aJl. The cbaptore on the vocal apparatoB, ■ - . - 



theu 



m of the v( 






iQ of Ihe Tl 



eoncolGd witii the hypotheaLB ore those of the falsetto. 
Hunt hna some obs^rvatJoiiB which we belifiTs cepreaent pretty s 
ratalj the preeent stale of the onee,,. Dr, Hunt's nocount of tbei 
of animals coutaiDs a ^ood aammaij of what has been observed ot 
sabjCiAi and is well worthy of perueal. Phtciag ourselv" "" """ " 



tlui 



. of the goneral reader, wbidi in the only one we are entitled to 
Bsanmo in respect to a coaaiderable part of the matters treated of. Dr. 
Hunt's work contains a »uat Taiiety of information, which seems td OB 
of a lesa innccornte chRTOCtcr than that aaoally tc bo found in books of 
Buoh comprolienslve scope." 

From The Medical Timea amd QaaMe, Maroh 1859. 
" A (creat deal of information has been collected and amuiged in 



From Fraaei'B Jfnjarine, July 1859. 
" A book which should be in the hands, not only of euriroo 
pnblio singera, schoolmasters, and above all, of preachera. * 



Coibwm'a Neiv Monthly MagazinB 
" Dr. JaineH Hnnti son and aaccfflHor to Mr, Hunt, who obtaiQod lo 
acb celebrit; by tiia treatmeDb of the diffionltiBB of ul ' - 



and Speech. Tbis wort addrassea itaelf to a far wide 

Bfflicted, and wa have □□ doubt will meat witb each a receptdon at tb 

hands of tbe pablie generally na ite merita entitle it to." 

Prom The AihemsKm, March 19, 1869. 



I 



brouglit etnd; and experiecco of hia life to bear upon a speiual aab- 
jeot." 

From The Examiner, Jaauarj 16, 1869. 
" There are man; coriona detaila and aeneible remarke in Dr. Jamee 
Hnnt'e book on Philosophy oj VoicB a/nd Spsech, The anthor is well 
known as a practitioner to whom many no indebted far tho removal 
of impediments in speech ; bat hia book U not, like BO many of itd 
kind, a mere adveilisemetit of hia ovn proctiae: he is intereatod in the 
salnect of hia apecial atndy, and, out (» hia real interest therein, this 

From The Daiig Telegrivph, Febrnary 19, 1869. 
" Dr. Hunt haa pnhliBhed a work of TBrj great utility, and whioh 
ought to be in the handa of clergymen, barnatari, members of porlia,. 
ment, and all those whoae yocaliona naoeaeitate much public speakinjr. 
It will also be fanni3 nn eiocllent and inatmctivo volume for thoBS 
whose immeiliate duties do not bring them ao proniini>Dtly fbrward. 
None of us, however, can say that ehnrioe may not, at some time, place 
as on a platform, and then the study of works c^ this character will 
not have been entirely throira away. 

From The Beactm, January 13, 1869. 
" ... He traoka tbe footsteps of creative power along ita line of ac- 
tion, and, with a bold hand, lilts the seal of tta operatioua, and distJosoa 
to the eye of eolcnca tbe norkinga of the Almighty in the prodiiction 
of that maTvel of nature, 'the voice divine,' exerciaing its loftiest fnnc- 
tioDS in its most impassioned mode. Oratory, no doubt, Biirpasses 
mnsie^ and to hear good speakiag is the hitj^hest intellectual enjoyment 
of whioh our natures are capable. Superior intelligence may command 
tbe whole of it ut a glancei but it is aa delightful as astonishiog, that 
wa should be able, even by laborious proceasea, to follow and aomfite- 
head it ; and that it is brought to the level of all is due (no hght praise) 
to the ability, energy, and resouniss of the autbar. That be W treated 
B Hubject to which (he whole oxperienca of hia life has been devoted aa 
a labonc of love, aod that the rules he deduces for the mansfement of 
the voice are no empirical nostruma, but the plain dictates of common 
aensej resting on an intimate acientific knowledge aa their foandation, 
ne might have been sure of irom tbe experience and position of so 
aacceastal a practitioner aa Dr. Hunt, and hi? ia fortunate in the pos- 
session of n clear, simple stvle, which is invaluable in a work that luya 



THE IRRATIONALE OF SPEECH, 

BY A MINUTE PHILOSOPHEK. 



Church Times. 

" TJie hiufionalc of Speech ia B reprint of a clover and amusing, 
article on Blammering, wliioli appeared la fran-ir aome half-doien' 
jcara a^. Ita purpose ie to miiiiit&in tbe cnrflbilitj of this vocal de- 
teni bj a course of treattnent or discipline baaed npon commoD sense 
priDciplee. We can testi^, from our own eiperience, tbot pven the 
worst atutterers may be broaght to speak like other men. There are 
witliia onr kuowledge clergymen, whose utterance is con perTectly 
flueat and distinct, who in their earl; days could scarcely get through 
half a doien words witiont a cheek. To those wliom it may onhapjoly 
oonoem, we strongly recommend the peraaal of this pamphlet, which, 
b; the way, contame eone telling remarks on the mauagement of the 
voice in preaching, wliich our clerical readers would mi worthy of 



Socio! 8ci 
" This U a cleverly written tractate — a reprint from Fraaer — supply- 
ing a powerful pretest against the absai^ and oruel treatment to 
which stammering and stuttering children are not seldom snbjeoted by 
their parcuts aud friends, under the stupid notioD that the oidy effea- 
tual rcntr^dy for the evil is systematic scolding, with aa oncosional 
smart dmbbing. Graat odvanoement has been mode, however, in this 
respeot, during the last few years. Education has done moch ; for the 
' Imnh' is not now — at least by the niu^ority— consiilered 






tm^fulp 



heir. The author drans a sad fet 
lenlal no less than physical, which 
I passed the yeuis of childhood but 



which youthful Beah 
3ture of the roiaeries 

_ >rer or stutterer who 

too &egneQtly has to endure. 
I " In conclusion, we may add that the pamphlet is tastefully got 
l-and that the author pays a high, and we thiidc deserved, tribute to 
L, James Hunt, whose work on atammtmn'j and Stttttering, we Lad 



I euioD to sp«ik favoniably of ac 



leago. 



Co., PATEiuiusfrBB Bow. 



ORE HOUSE, near HASTINGS. 



[/>/?. HUNTS EDOGATIONAL ESTABLISH M F.N T far 
the Treatment of Stammering and all defect^ of Speech ani 
Nervoui Affectiont oflheVoiee and the Articulating Organt. 

In accordance with the eiprcsB wiah nnd dceire of the late 
I Dr. Hunt, his ajstera of Treatment tor Impediments of Sp«eah 
V being carried on in its integrity by hia brother-in-law, 
I the Hev. H. F. Ritctb, M.A., Trinity College, Cambridge, hia 
I only qualified and legal encceaaor. 

Defective Articulation being, in itsvarioue formB, frequently 

I the result and concomitant of debility, a permanent cure can 

in these caaes only be effected by placing the pupil under such 

favourable circumstancea that, whilst the organa concerned 

undergo the requisite training, ttieir healthy action maj- be 

restored and sustained by the invigoration of the whole frame 

I The advantages offered in this respect in the situation of Ore 

■.House — one of the most salubrious spots in England — are snf- 

■ ficiently obvious. 

Mr. Kivers graduated in mathematical honours (Sen, Opt.), 
I and has had considerable experience in preparing pupils for 
I competitive examinations. He therefore proposes, in cases in 
■Srhich it is desired and time is important, to combine tuition 

■ with the treatment for impediments of speech. 

Pupils under thirteen yeare of age receive a general Educa- 
1 addition to that special physical and moral training 
te for tlic rernoviil of defective niteranco. 



The domestic arrangements of the institution are superin- 
tended by Mrs. Hunt and Mrs. H. F. Rivers. 

A prominent feature in the plan of instruction is the training 
of the pupils in the art of Public Speaking, the importance of 
which is now universally acknowledged. For this purpose, 
Lectures are delivered by the pupils, and Discussions are held 
on a variety of topics, in which each one is required to take a 
part. 

N.B. — For the convenience of applicants, Mr. Rivers attends 
in London on the first and third Thursdays of every month, 
on which days he may be consulted by appointment. 

Further particulars on application to Ore House, near 
Hastings. 



'■ LAN!': MEDICAL LIBRARY 

To avoid fine, thla book ahoulil be returned 
1 or before tiie date last stamped below. 



, 2-1 m 

2 1933 



L4?'l Hunl.J. 6i3i 

H94 otaJD-t-erinij and etut- 

1870 teri.-^;. 7th ed.