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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.

€!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.

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.

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.

[.'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

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,

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.

" 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.

.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

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.

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.

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.

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.

-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.

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

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,

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

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.

, 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.

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

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.

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.

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

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

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

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,

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

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.

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

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.

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.

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."

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.

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

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.

! 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

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.

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

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

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.

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

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.

[ 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.

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.

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

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

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.

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.

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

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.

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

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-

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.

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

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 :)

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

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

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.

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.

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^

. STDTIEaiNO IN WHtfiPEKIHG.

279

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 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

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

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

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.

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

THBATMBTfT OP STUTTEBINO.

307

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.

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.

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

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-

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

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be :r;:i;*:i-:r: .:; ..' •• .f^r . 1..1 ■■ :-..'. ...: ■ .

in '.VIkI* ". . r'f'-'t.,". .i'. lii..'^;'." ■• I ' ■. ■ •• -'- .. • ■■
iwj^.r. »T v. '..'.'". .'J '■ ■•'. /;,"''■" -■/. • • -.1.'. .;i : ,:. •.

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ZnC^"^ t*' i*'''-y '■ '= '•'-' -•■'- ■■ ' ' •''■ "''■ •-■■'• ' •■■ •

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*.n .ii-ii ,:• "•"' '■■■''•' ■■■■ "'' '^' '•'■' ''•■'-■-'"■'■ ' »-***■
**»M* iui? ■•' '-■-•= ''■ '■^■' ■'■■■ ^^•'■■' ^^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.

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

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

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.

Adelxjng, 12
^gineta, 23
Aetius, 23
Amman, 33
Amussat, 129
Angermann, 163
Aristophanes, 203
Aristotle, 17
Amott, 80
Astri^, 62
Avicenna, 24

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

DieffenUch, 126

iBilAH, 15

Duffireaae-ChBBBaigne, 136

Itaid, 51

Jackson, H., 281

EiOH, B, 165, 326

JamiesoD, 8

Eaquirol. 292

Jourdant, 158

JuliuB, 68

FAsaicujB, 126
PerguBson, Sir W., 318

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

Lanbevbeck, 312

FuUer. 205

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

GraveB, 158, 263, 345

MCCOEMAC, 77

Gray, E., 280

Mttgendie. 5. 94

Malebouche. 72, 114

Mark, St.. 15

MarobaU, 183

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

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

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

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

Yatbs, 70
Yearsley, 223

ZiTTEBLAND, 72

^^^^K INDEX

^^^1

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

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

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, 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

IiTHtionale of speech, 122

FitTBaiNS of the aged, 194

laehnophonift, IB, 164

Ftuioles, stutteiini; laaoae.

Inapiration, deep, 2i], 77

S42

Fork of Itard, 55

Xaitjsb, 354

of, 24, 3(1, SI

France, number of Etntterera,

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

H Gjmnaatics, 147, 170

MEDiciL treatment of stut-

^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

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-

^H pedimentB, 8

Savaokb, atntteriag among.

^H Noae, apeakiag through the.

349

^H aoi, 213

Scripture records, 14

Secret remeilies, 291!

Seraeiologjofsoieeandspeenh,

^H Ofebations, surreal, 125;

^M 137

Sigmatism, 20S. 237

Singing, stuttering in, 276

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

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

^M QuACEEBT, Bhiuea on, 304

234

■

different speoiea, 238,

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

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

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

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.

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

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L4?'l Hunl.J. 6i3i

H94 otaJD-t-erinij and etut-

1870 teri.-^;. 7th ed.