UNIVERSITY r.f CALIFORNIA
STUTTERING AND LISPING
THE MACMILLAN COMPANY
NEW VORK BOSTON CHICAGO
DALLAS SAN FRANCISCO
MACMILLAN & CO., LIMITKD
LONDON BOMBAY CALCUTTA
THE MACMILLAN CO. OF CANADA, LTD.
STUTTERING AND LISPING
2. So Sq-
E. W. SCRIPTURE, PH.D. (LEIPZIG), M.D. (MUNICH)
ASSOCIATE IN PSYCHIATRY, COLUMBIA UNIVERSITY ; DIRECTOR
OF THE RESEARCH LABORATORY OF NEUROLOGY, VAN-
DERBILT CLINIC ; FORMERLY ASSISTANT PRO-
FESSOR OF EXPERIMENTAL PSYCHOLOGY,
THE MACMILLAN COMPANY
All rights retervtd
BY THE MACMILLAN COMPANY.
Set up and electrotyped. Published November. 1911
IT would be difficult to find a group of people more
neglected by medicine and pedagogy than that of
stutterers and lispers. The stuttering children that
encumber the schools are a source of merriment to
their comrades, a torment to themselves, and an irri-
tating distraction to the teacher. As they grow older,
the stutterers suffer tortures and setbacks that only
dauntlessness or desperation enable them to survive.
The lispers that are so numerous in certain schools are
a needless retardation to the classes.
In several European countries the state has estab-
lished special opportunities for treating children with
speech defects, but the matter has not received the
full attention justified by its importance. In most
medical faculties no place is accorded to speech defects ;
the same is true in schools of pedagogy. This was
formerly justified on the ground that a scientific study
of speech and its defects did not exist. In the last
decade, however, the science of phonetics has extended
itself to laboratory work and university teaching ;
moreover, speech clinics have been established in sev-
eral of the foremost medical schools. The treatment
of these defects thus stands upon an entirely new basis ;
namely, that of a carefully developed science of normal
and pathological speech.
The views here expressed as to the nature of stutter-
ing and lisping, and the methods of treatment proposed
are the results of three lines of work. The fir>t is a
long experience in experimental psychology in t lie-
laboratory of the University of Leipzig and later in
my own laboratory at Yale University. The sen .ml
is an almost equally long specialization in experimental
phonetics, beginning at Yale and enntinued fur four
years in Germany under a grant from the Cam. ^i.-
Institution of Washington, D.C. ; some of the results
involved were first stated in my lectures at the ('di-
versity of Marburg (/Jermuny). Finally, the treat-
ment of thousands of patients in the speech department
of the Vanderbilt Clinic and in private praetice has
developed the methods into forms that produce the
maximum result with the minimum expenditure of
This book has been prepared to meet the needs of
physicians and teachers ; both are constantly confronted
with the problem of what is to be done with a lisping
or a stuttering child. By careful study of the symp-
toms as described here and by plentiful experience in a
speech clinic a physician may expect within a reason-
able time to develop the ability to make a correct diag-
nosis. A correct diagnosis by an expert should always
be obtained before treatment is begun. The treatment
of lisping proceeds along such clearly marked lines that
the general practitioner and the regular teacher will
have no difficulty in treating the individual cases that
come to him in practice or in class. The results are al-
ways gratifying ; the parent appreciates the seriousness
of the defect, and the cure usually occurs without
great difficulty. The treatment of stuttering is much
more difficult ; it requires great skill and long experi-
ence. There should be at least one physician in each
town who is able to help the numerous stutterers who
must otherwise be neglected. One teacher in a school
or in a group of schools may be trained as a special
I have to thank Professor H. Gutzmann, of the Uni-
versity of Berlin, for his kindness in specialty modeling
the plaster cast shown in Fig. 39, and Mr. Walter
Robinson for the suggestion illustrated in Figs. 90, 91.
COLLEGE OF PHYSICIANS AND SURGEONS,
COLUMBIA UNIVERSITY, NEW YORK, 1912.
PREFACE . . . . Y
LIST OF ILLUSTRATIONS xi
I. DESCRIPTION. CAUSE 1
-4L SYMPTOMS, FORMS, NATURE 10
III. DIAGNOSIS 42
IV. THERAPY 56
V. METHODS OF TREATMENT 74
*" I. INTRODUCTION Ill
II. NEGLIGENT LISPING 122
III. ORGANIC LISPING ' . 162
IV. NEUROTIC LISPING 173
V. CLUTTERING 18!
I. BREATHING ... 190
IT. MELODY 194
CON T K NTS
III. I'l I \ ir.ll I I Y ]!l7
IV. SLOWNESS \<,*
V. SMOOTHNESS 201
VI. VOICE QUALITY jnj
VII. STAKTINO AND ENDING SKMI \< ( , . . . -jo.,
VIII. KM M'lATION AND Sl'KI.UXi; 207
IX. K\ri:i -VSION
X. l'(>NHI>KX( K 21()
XI. SniN i \M ..I - M I I < if ^li;
XII. THINKING 217
XIII. DESCRIPTION AND RELATION .... i'l!i
XIV. TELEPHONING _>_> 1
XV. TALKING WITH PEOPLE __'_
XVI. KM. \XATIOX 224
XVII. Mr-< i I.AK CONTROL j-j: (
XVIII. WORD LISTS 228
SKKKCTED RKFKKKN'CES 245
TECHNICAL TERMS 210
INDEX .... ,249
LIST OF ILLUSTRATIONS
1. Recording the movements of breathing by the graphic
method '* . .21
2. Breath record during stuttering ,.': .23
3. Recording the pressure of the lips by the graphic method 23
4. Lip record of a stutterer's attempt to say the first letter
in the word " Peter " . . . . . .' ' . 24
5. Recording the movements of the tongue . . . 24
6. Record of a stutterer's cramps of the tongue in attempt-
ing to say " Tommy "....... 25
7. Recording the mouth current 26
8. Mouth record of " papa " spoken normally ... 27
9. Mouth record of " papa " with blowy " p's " spoken by a
10. Mouth record of "papa" with an inspiratory "p"
spoken by a stutterer 28
11. Mouth record of " sleepy " spoken normally ... 29
12. Mouth record of "sleepy " spoken by a stutterer . . 30
13. Mouth record of " stutter " spoken normally ... 30
14. Mouth record of " stutter " spoken by a stutterer . . 31
15. Mouth record of "Peter Piper's peppers" spoken by a
16. Melody plot for " papa " spoken normally (Fig. 8) . 33
17. Melody plot for " papa " spoken by a stutterer (Fig. 9) . 34
18. Mouth record of " papa " in a case of spastic speech . 50
19. Mouth record of " papa " in a case of motor aphasia . 51
20. Mouth record of " papa " in a case of bulbar paralysis . 53
21. Scheme to illustrate the mechanism of stuttering . . 58
xii LIST OF ILLUSTRATIONS
_'_'. Notes indicating how the phrase ' H..w .!<> y.m <!.. '?" N
to be sung 75
Line indicating how the phrase " How do you d" ''. " is to
be sung according to the notes in Fig. 22 . . . 7">
Jl. Line indicating how the normal voice .should rise and
fall in speaking the phrase " How do you do?" with a
melody similar to that indicated in Fi_'. 21 . . . 76
Line indicating the monotony of the stutterer's voice in
speaking the phrase " How do you do?" . . . 7(5
26. Mouth record showing the word " papa " as actually sung 77
.'7. Melody plot to Fig. 26 77
28. Oct;i\<- t\\ Nt in musical notation 78
29. Octave twist indicated by a line 78
30. Mouth record of " papa" spoken with the octavr twist . 78
:>1. M.-lo.ly plot to Ki-. :) 79
:12. Mouth record of "papa "spoken with an unsuccessful
attempt at the octave twist 79
3:!. Melody plot to Fig. 32 80
34. Perfect closure of the glottis 81
35. Glottis during a breathy tone 81
36. Vowel curve with normal beginning and ending . . 82
IV7. Vowel curve with glottal catch at beginning and ending 82
38. Mouth record of the stutterer's correction of the inspira-
tory " p" in Fig. 10 89
39. Median section of the organs of enunciation and pho-
>i at ion 11.'.
10. Artificial palate Ill
11. Palatogram for the vowel " ee " 11~>
42. Candle flame indicator us. -d for the mouth . . . 119
n. Tambour indicator used for the uoae . . . . 1'J"
41. Li p position for "f" aud "v" I'-'J
45. Lip position for " w " !-''
46. Lip position for correcting " w " into " v " . . . 1 L' 1
LIST OF ILLUSTRATIONS xiii
47. Palatogram for forward " t " and " d " . . . . 125
48. Palatogram for backward " t " and " d " . . 125
49. Palatogram for " k " and " g " 125
50. Mouth diagram for " t " and " d " . . . .125
51. Mouth diagram for "k" and " g" ..... 125
52. Mouth record of " water " spoken normally . . . 126
53. Mouth record of " water " spoken by a lisper . . . 126
54. Palatogram for " s " and " z " 130
55. Palatogram for occluded " s " and " z " . . . . 130
56. Mouth diagram for " s " and " z " . . . . 131
57. Mouth diagram for occluded " s " and " z " . . . 131
58. Mouth record of " sun " spoken normally . . . 132
59. Mouth record of " sun " spoken by a lisper . . . 132
60. Tongue record for occluded " s " 132
61. Correcting occluded " s " and " z " 133
62. Making the interdental fricative 134
63. Mouth record of the word " Mitchell " . . . .136
64. Mouth record of the word "nutshell" 136
65. Palatogram for "ch" and"j" 137
66. Mouth diagram for " ch " and " j " . . . . 138
67. Mouth diagram for " n " 139
68. Mouth diagram for " ng " 139
69. Palatogram for " sh " 140
70. Mouth diagram f or " sh " 140
71. Palatogram for " th " 141
72. Mouth diagram for "th" . . . . . . 141
73. Mouth record of " thin " spoken normally . . . 142
74. Mouth record of " tin " spoken normally . . . 142
75. Mouth record of " thin " with occluded " th," by a lisper 143
76. Correcting occluded " th " . . . . '. . 143
77. Mouth record of front rolled "r " by an American . 144
78. Palatogram for English " r " . . . . . .145
xiv LIST OF ILLUSTRATIONS
79. Mouth diagram f or " r " 145
80. Mouth record of English " r " 145
81. Mouth record of uvula " r " by a Parisian . . . 148
82. Palatogram f or " 1" * . 146
83. Mouth diagram for " 1 " 14fi
84. Rod for pushing the tongue 147
85. Pushing the tongue into position for " r " . . . 147
86. Recording the nasal current and vibrations . . 151
87. Nasal record of " sun " spoken normally . . . 152
88. Nasal record of " sun " with relaxed velum ... 152
89. Tissue paper indicator . 153
90. Velar hook , . 154
91. Velar hook in position . 155
92. Mouth record of "dog" 156
93. Mouth record of " dok " 150
94. Mouth record of " dogk " 157
95. Mouth record of " apa " with the explosion of " p " well
96. Mouth record of " apa " with no explosion of " p " . 158
97. Hemiatrophy of the tongue 163
98. Mouth record of " so " spoken normally . . . 175
99. Mouth record of " so " in neurotic lisping . . . 175
100. Mouth record of "silk" spoken normally . .177
101. Mouth record of " silk " in neurotic lisping . . . 177
102. Mouth record of " shoe " in normal speech . . . 178
103. Mouth record of " shoe " in neurotic lisping . . . 179
Plates I, II, III. Mouth diagrams for typical English sounds.
Plate IV. Palatograius fur typical English sounds.
STUTTERING AND LISPING
STUTTERING AND LISPING
As "stutterers" we designate individuals show-
ing certain peculiarities of speech. One stutterer,
for example, will make spasmodic contractions of the
lips, tongue, etc., whereby a word like "berry"
will be pronounced "b-b-b-b-berry." Another will
open his mouth wide and produce an "a-a-a-a-"
before he can say a word. Another will find himself
suddenly unable to speak at all at the beginning or
in the middle of something he wants to say. Still
others are quite unable to speak certain words. One
young man could never speak the name of his town
and was obliged always to buy his railway ticket to
the next town beyond. One lady would find herself
at a ticket office suddenly speechless and unable to
2 STITTERINC! AM) LISPING
tell what ticket she wanted while an impatient crowd
of commuters gathered behind her.
Stuttering is a serious detriment to the person's
welfare. One refined stuttering girl of sixteen was
studying typewriting and stenography, not realiz-
ing that no office would tolerate a secretary who
could not answer when suddenly spoken to or who
could not use the telephone. But what was she to
do for a living ? Even on the lower level of a shop
girl she would be impossible. The examiners of
immigrants at New York City often refuse admis-
sion to stutterers on the ground that they are liable to
be unable to make a living and likely to become public
charges. A law student felt that on account of his
stuttering he must relinquish his ambitions and con-
fine himself to uncongenial work. At the best, the
stutterer's social life is limited and abnormal. He
often retires from social intercourse as much as pos-
sible and becomes more or less eccentric. One boy
grew up in such isolation that his oddities made him
appear feeble-minded, although he was not mentally
defective. Excessive stuttering has been made the
basis of divorce for cruelty.
To most people stutterers seem comical. They
DESCRIPTION. CAUSE 3
are the butts of innumerable anecdotes in the news-
papers and on the stage. The stutterer learns that
people regard him as a kind of involuntary clown and
that his family and friends are ashamed of him.
Few persons realize how terrible life becomes to a
stutterer. A normal person may get a mild idea of
it by supposing that every time before he speaks he
is obliged to wink one eye or to open his mouth and
yawn ; the feeling of embarrassment and shame would
soon overpower him. A stutterer is worse off;
every time he tries to speak he is obliged to make
a fool of himself in such a way as to make other
people want to laugh at him. One religious but
stuttering lady finally demanded to be " cured or
chloroformed." One boy often threw himself on
the floor, begging his mother to tell him how to die.
Another boy asked for a letter to his father, telling
him to keep the other children from laughing at
him. Many stutterers become so sensitive that
they imagine everybody is constantly making fun
of them. The life of a stutterer is usually so full of
sorrow that it can hardly be said to be worth living.
At school the child is tormented by his fellow
mates. He is usually a trial to the busy teacher
4 STUTTERING AND LISPING
and a hindrance to the progress of the class. He is
often excused from oral recitation, but just as often
the teacher constantly corrects him or ridicules
him. Sometimes it happens that the child has a
cramp that keeps him from starting an answer for a
moment, but does not show itself otherwise, such a
stutterer prefers to be thought lazy or stupid rather
than reveal the true nature of his trouble.
Even at home the stutterer is misunderstood and
often tortured from the best motives. He is fre-
quently reproved or scolded as an inattentive 1 or
bad boy because he "could speak properly if he
would only try." Many a parent is often sure that
this is so because the child will speak properly when
reminded to do so. The truth is that no human
being can always think of how he is to speak before
he speaks ; the stutterer simply cannot stop stutter-
ing of his own accord.
Stuttering is, indeed, a serious disease. It is
not as undesirable as mania or cancer, but most
people would prefer to have typhoid or pneumonia
for the simple reason that with these diseases a per-
son either dies or recovers, whereas stuttering is a
DESCRIPTION. CAUSE 5
A very great injustice to the stutterer is the
widely spread notion that stuttering is a bad habit
which is to be corrected by reproof, scolding and
punishment. The treatment is supposed to con-
sist in a kind of schooling, the result depending on
the diligence of the pupil. Lack of progress is
attributed to inattention or laziness. Parents,
friends, and teachers are always alert to test
the patient's progress. Of course, all this simply
makes the stutterer worse, turns a mild case into a
severe one, and drives many a sufferer to despair.
Stuttering is a disease ; it can be properly treated
only on the principles of any other disease. Just as
with all other diseases, some cases get well spon-
taneously and some get well no matter how they are
treated ; yet so few recover permanently under the
treatments in vogue that there is a widespread
opinion that stuttering is incurable.
The most frequent cause of stuttering is a nervous
shock. Ghosts and other practical jokes, and, with
very small children, such terrifying experiences as
are found at amusement resorts (scenic railways,
fire scenes, etc.) are often the causes of fright from
which the child never recovers. Severe falls are just
6 STUTTERINC AM) LISIMM!
a- often the sources of the mental shock. Surgi-
cal operations (for cataract, adenoids, etc.) are
occasionally the sources of stuttering. The cause of
stuttering in all these cases is evidently the intense
fear involved in the shock. In some cases the fear
has developed gradually. A boy of twelve relates
that at the age of seven, on several occasions in the
daylight he thought he heard footsteps of some one
following him in the hall, whereas the noise was of
his own footsteps; thereafter he began to stutter..
He is still afraid to walk in the dark, to be alone or to
go to sleep in the dark. A young man of seventeen
relates that he began to stutter in reading at seven
years because he knew that he would make mistakes
before the class and become nervous about it.
Most of the stutterers from shock show a general
condition of nervous excitability in which the pre-
dominant element is an abnormal state of expectancy
toward persons and events. The patient is often
on the alert for what is going to happen. He watches
other people and replies before they half finish their
remarks ; or he is timid to such a degree that conver-
sation is painful. The same condition of general over-
anxiety I have found in patients who do not stutter.
DESCRIPTION. CAUSE 7
It is a typical psychoneurosis, that may, perhaps, be
appropriately called the " general anxiety neurosis."
In addition to the kinds of nervous shock mentioned
above, it is possible that the cause of the general
anxiety neurosis may lie in shocks of various kinds
occurring in infancy and childhood. This "general
anxiety neurosis" differs from the anxiety neurosis
of Freud in several ways. In the former the anxiety
(or fear) is present at all times ; it is ready to attach
itself to any thought or occurrence for which a fairly
valid reason can be found ; the patient knows that he
is overanxious, but his anxiety always seems fully
justified at the moment. In the latter the anxiety
attaches itself to one particular thing, for example,
the patient cannot cross an open space because he
is afraid to do so; although the fear is irresistible,
the patient usually realizes fully that it is absurd.
A very frequent cause of stuttering is mental
contagion by intentional or unintentional imitation.
A boy thinks it fun to mock a stutterer, and ulti-
mately finds that he himself cannot stop stuttering.
A stuttering parent nearly always has one or more
stuttering children. Even when the parent had
stopped stuttering in youth, there are usually
8 STUTTERING AND LISPING
enough traces left in his speech (e.g. hard voice) to
start the child stuttering. Stuttering has been
known to develop in a child from playing with a
deaf-mute who talked with difficulty.
Stuttering frequently appears after whooping
cough, also after scarlet fever, measles, influenza,
intestinal troubles, scrofula, rickets, etc. The
cause seems to lie in the condition of exhaustion.
One of my cases showed symptoms of spastic
infantile paralysis (spasticity of the legs, weakness
and athetosis of the hands, weakness of the muscles
of speech) with history of difficult birth. The
difficulty in using the muscles of speech may be
assigned as the cause of the stuttering.
A neuropathic disposition or a condition of nerv-
ous exhaustion is present in nearly all cases of
The first suggestion for prophylaxis is that parents
and nurses are to avoid stories and scenes that
frighten children. Nervous children should re<v : \<>
tonic treatment, especially open-air life. If one child
in a family begins to stutter, he should be cured
immediately in order to save the others. A stutter-
ing child in school is a danger to his fellows.
DESCRIPTION. CAUSE 9
The statistics show from 1 to 2 per cent of stut-
terers among school children. A smaller percentage
in the lower classes becomes trebled in the higher
ones. Marked increases are found at the periods
of second dentition and puberty. The relative fre-
quency among boys and girls ranges from 2:1 to
SYMPTOMS, FORMS, NATURE
THE most striking symptoms are cramps or spasms
of the muscles connected with speech.
Abdominal cramps are nearly always present . The
entire abdomen may suddenly become rigid, or it
may make irregular contractions. In one case the
wall just over the navel was drawn into a deep
cuplike cavity. The diaphragm, as seen by the
X-rays, may be suddenly fixed or may move down-
ward in spasms. The spasms sometime:- propel the
abdominal wall outward in jerks. Often both
abdominal muscles and diaphragm will become
perfectly rigid and immovable. These contrac-
tions produce irregular interruptions or expulsions
of the breath instead of the steady current necessary
for proper speech, or they give no breath at all and
render the patient speechless. One patient of mine
often beame suddenly speechless in this way for
ten to fifteen seconds at a time. A frequent phe-
SYMPTOMS, FORMS, NATURE 11
nomenon is the expulsion of the breath just before
speaking. The most frequent case is that of con-
tinual irregularities of breathing during actual
Laryngeal cramps are a never-failing symptom of
stuttering. The muscles in and around the larynx
become tense and fixed. The tone from the larynx
is monotonous, hard, and often husky. It is not un-
usual to find a patient who never has any symptom
of stuttering in the presence of the physician except
the monotonous laryngeal tone. I have never seen
a stutterer without this symptom.
Cramps and spasms of the muscles of enuncia-
tion are the ones most apparent to the observer.
The lips may be pressed tightly together for a short
or a long time when the patient tries to say "p"
or "b." In other cases they will open and shut,
producing a series of "p"s or "b"s instead of one.
The tongue may be pressed so tightly against the
palate that the " t" or the "d" is two, three, or ten
times too long. All the sounds may be similarly
Less frequent but more striking are the contrac-
tions of muscles not ordinarily used in speech. One
12 >TI TTKKIVi AND LISPING
patient will t \\i-t hi- head whenever he stutters
badly, another will screw up one eye, another will con-
tort his whole body, etc. One patient had "pains
that did not hurt" in her legs and arms while speak-
ing. One boy of seven made horrible grimaces and
stuck his tongue like a thick stick far out between
his lips. One girl of twenty-two would spend one
to two minutes in grunting like a pig and whimper-
ing like a dog after which she would say the word
or sentence with ease.
All the muscles involved in speech are brought
into a condition of over-tension or "hypertonicity"
whenever the stutterer begins to speak, although
there may be no visible cramps or spasms or any
stuttering in the popular sense. Hypertonicity is
thus a cardinal system of stuttering. 1 The hyper-
tonicity is psychic (cerebral) and not spinal ; it
appears only when the person intends to speak ;
the reflexes are not exaggerated.
The trained ear readily detects the hard tone of
the voice which results from laryngeal hypertonicity.
The expert can thus tell from the first sound that
'Scripture, "Treatment of Hyperphonia," Medical Record,
March 21, 1908.
SYMPTOMS, FORMS, NATURE 13
the patient makes whether he has started his sentence
correctly or has begun with the stuttering tone that
will cause him to stumble before he finishes.
Another kind of symptom occurs in the "er,"
"well," etc., that the stutterer uses to get started.
Sometimes this "starter" is an inarticulate but
complicated grunt. Sometimes the starter is re-
peated several times ; one young lady would regu-
larly repeat "why" ten to fifteen times before she
could get out the first word of what she wanted to
say, and even then she sometimes failed and had to
begin over again. Often the patient has to make
severe contortions of the face or the head or the
body before he can begin.
An almost constant symptom is excessive rapidity
of speech. In some cases this is to be attributed to
the desire of the stutterer to get his words out before
he is caught or before any one can interrupt him. In
most cases it is the expression of nervous anxiety.
A never failing symptom is the patient's lack of
confidence in his ability to speak correctly. In
some cases the mere thought "Will I be able to say
that word?" is sufficient to make it absolutely
impossible for the person to say it. The stutterer
14 sTI TTKKINC AM) USl'INC
always lives with the fear that his speech may "go
back on him." Many a one is always thinking a
few words ahead of what he is saying, l>eing on the
lookout for some word he thinks ho cannot say.
When such a word is coming, he avoids it by select-
ing another that will serve just as well. One patient
practically passed his life in always avoiding words;
this mental work, being added to that of a normal
man, kept him in a condition of nervous prostration.
The fear of being ridiculous is nearly always
present. The person does not want to "make a fool
of himself." He therefore avoids reciting in school,
he refuses invitations to social affairs, he would
rather live with his father's employees in a mine than
go to college, he shuts himself up with a servant and
becomes a queer-mannered hermit, etc.
A. condition of mental flurry is usually present.
When the patient starts to speak, he ^becomes partly
dazed by his emotion and does not know exactly
what he wants to say. This condition may be pres-
ent even when he does not stutter ; in trying to
answer a question, for example, he cannot make up
his mind just what he wishes to say. Closely con-
nected with this is a habit of hesitating in thought
SYMPTOMS, FORMS, NATURE 15
that sometimes arises. The mental flurry perhaps
explains why some stutterers have most trouble
whenever they are jocular. In some cases they
stutter only when jocular.
With very rare exceptions the stutterer does not
stutter when he knows no one can hear what he says.
Almost as rare are the cases where he stutters in
singing or in whispering.
The embarrassment and sad experiences of the
stutterer often lead to an abnormal mental condi-
tion. The patient is nervous, shy, easily embar-
rassed, retiring, odd in his ways, sad, etc. In some
cases the change does not go beyond an increased
sensitiveness. Many stutterers, especially young
women and schoolboys, acquire a permanent facial
expression that is typical of the profoundest sadness.
The thought of suicide is frequent.
Three forms or stages of stuttering may be dis-
The simplest form of stuttering is that of "pure
habit." Such a case occurs rather frequently where
a younger child unintentionally copies the stutter-
ing of an older one. If the stuttering does not go
beyond the stage of pure habit, the younger child
16 STtTTERINC AND LISI'INC
drops his stuttering involuntarily when the older
one is removed or cured.
The habit stage is often initiated by shock or
exhaustion. The person finds himself making inac-
curate movements in speaking, and speaking a word
or words indistinctly. On account of the excessive
nervous irritability in these conditions, he feels that
he cannot permit himself to speak in an improper
fashion, so he instinctively tries to correct the
inaccurate movements by an extra effort at distinct-
ness. Such an effort produces excessive muscular
tension; his consonants, like "p," "b," "f," "d,"
etc., are too hard and long. This in turn impresses
itself on the memory, so that when he again makes
the same sounds he naturally makes excessive
muscular movements. The excessive tension readily
becomes repetition, so that, for example, instead of a
long "p" he says "p-p-p, " etc. Such was the case
with a patient two and a quarter years old who
stuttered constantly by reduplicating the conso-
nants, saying, for example, " strawb-b-b-b-berries "
and showing monotony of the laryngeal tone and the
usual symptoms. After a few days of correction
whereby the stuttered words were repeated correctly
SYMPTOMS, FORMS, NATURE 17
with melodious intonation by the father each time
after her, she ceased to stutter.
A patient two years old, when seen three weeks
after the stuttering began, could be induced to speak
only with great difficulty on account of the feeling of
shame that was evidently present. When she spoke,
it was in an abnormally low tone, with stumbling and
repetition of consonants. There was no neuropathic
history, but a previous exhausting illness. Being
told to sing what she wanted to say, she stopped
stuttering and spoke naturally after a few days. In
both these cases we may assume that the exhausted
nervous system led to inaccurate movements. These
produced a feeling of uncertainty and insecurity,
which in turn aggravated the inaccuracy and led to
excessive cramplike efforts. Every incorrectness
of action increased the uncertainty of feeling, and
vice versa. The parent's correction soon made the
child feel that it was doing something reprehensible ;
this produced not only embarrassment, but also still
greater inaccuracy and uncertainty.
The stuttering habit may be initiated by embar-
rassment. It sometimes occurs that a lisping child
becomes so nervous over his defect and over the way
IS STITTKKINC AM) I.ISI'INC
other people treat him tliat he brains to stutter.
The lisping in such cases i- u>u:lly due to tongue-
tie; this is the only case in which stuttering is
connected with tongue-tie.
Quite a few cases occur where the stuttering hul>it
is begun at three or four years of age with no history
of shock, exhaustion, or imitation. It i- possible that
the child's awkwardness in using his speech organs
leads him into blunders over which he becomes
The stutterer nearly always goes beyond the
habit stage. People laugh at him, mock him, scold
him, threaten him with punishments, or whip him.
Usually he is obliged to repeat words he stumbles on.
He is made to go through reading and speaking
exercises. Extra hard words are given him to
practice on. Speaking becomes a torture for him.
A new element, the "fear of displeasing and of
appearing ridiculous," produces the "fright stage."
The stuttering is now a distinct psychoneurosis
that may have the most far-reaching consequences.
If the question is asked of a patient in the fright
stage, "Why do you stutter?" he will answer, "Be-
cause I am afraid that I will stutter." Many a one
SYMPTOMS, FORMS, NATURE 19
will say that if he could only forget that he had
stuttered, he would never stutter again. When the
stutterer wishes to speak, the thought of his pre-
vious failures occurs to him and he fears or knows
that he will appear ridiculous to those before whom
he is speaking. This element disturbs his mental
condition. He is seized with a violent emotion that
may be described as stage fright before a single
person. Embarrassment, shame, fear, etc., express
themselves in his face and often disturb his mental
actions so that he cannot think clearly. The emo-
tion may make him absolutely speechless, as in the
case of many patients who cannot say a word when
introduced to strangers. Or it may make him
stumble over his words ; naturally he stumbles in
the way he has learned to stumble, namely, with
The disturbance of mental action during the fright
stage may produce a kind of intellectual paralysis.
One patient was often unable to answer a question,
not because he was afraid of stuttering, but because
the requirement of answering actually paralyzed his
mind so that he could not think of the answer. This
habit had become so thoroughly formed in another
20 STTTTKKINC, AND LI SIMM 5
patient that any excitement might render him
unable to think ; on the football field, where the
system of signals required him to add numbers, he
would, upon hearing the signals "six and four,"
which had to be added together, have to ask his
neighbor how much they amounted to. One st utterer
explained the mental paralysis when asked to give
his name or any exact information as resulting from
the fact that he is overwhelmed by having some
one depend on him for information that he alone
A third stage occurs not infrequently. The
stutterer is no longer embarrassed by his defect. It
is obnoxious to him, and he would like to be rid of it,
but the fright has disappeared. This may be termed
the "stage of indifference." It is usually found in
older patients; they stutter because the habit is
firmly fixed and not because they are embarrassed.
In many cases stuttering seems to be associated
with a peculiarity of character. This cannot be
attributed entirely to the presence of the stuttering.
In one case in my experience the child had previou-ly
developed a condition of nervousness which had
become very extreme on account of lack of training
SYMPTOMS, FORMS, NATURE 21
in self-control. The stuttering habit, engrafted
on this, became very violent. In another case the
stuttering, was associated with slowness of thought ;
FIG. 1. Recording the movements of breathing by the graphic method.
Two metal cups with rubber tops are fixed over the chest by a
band. Expansion over the chest draws air into the cups. They
are connected by a rubber tube to a small recording tambour.
This is a metal cup with a rubber top which moves a light recording
lever. A line drawn by this lever on a smoked surface moved by
clockwork gives a record of the breathing movements. The record-
ing arrangements can be attached to the abdomen also.
sometimes the hesitation in speech seemed to be a
cloak for hesitation in thought. Several previous
attempts at cure had failed to be permanent on
account of lack of moral backbone. In another
22 STUTTERING AND LIsiMN<;
c the stuttering had appeared in a small l><>y
who had never been taught any self-control. Very
often stutterers are shy and bashful to an extent
that can hardly be justified by their painful speech
The stutterer's speech movements may be accu-
rately recorded and studied by the methods of
The movements of the chest during speech may
be recorded by the apparatus shown in Fig. 1.
The " pneumograph " shown in the figure consi-ts
of two metal cups with tops of soft rubber. A tape
runs around the body from one rubber top to the
other. As the chest expands, the rubber tops are
pulled outward. This draws air inward through
the tubes which open into the metal cups. As the
chest falls, the air passes out again.
The "recording tambour" is a metal cup with
a rubber top. It is connected with the pneumo-
graph by a rubber tube. As the air is drawn into
or expelled from the pneumograph, it passes out of,
or into, the recording tambour and makes the rubber
top bulge inward or outward. A lever is arranged
to indicate the movements of the rubber top.
SYMPTOMS, FORMS, NATURE
The registration occurs on a "recording drum''
consisting of a metal cylinder revolved by clockwork.
111 m 111:1 \ 11:1 nl
FIG. 2. Breath record during stuttering.
Around the cylinder a sheet of paper has been
Fia. 3. Recording the pressure of the lips by the graphic method.
A small rubber bulb is placed between the lips and is attached to
the recording tambour.
stretched and smoked over a flame. The point of
the lever of the recording tambour is adjusted to
Fio. 4. Lip record of a stutterer's attempt to say the first lctt r in
tin- wt.nl " lVt<T."
Instead of a single pressure the stuttcn-r m:iki> np.at-.l ,,,.
touch the paper; it draws a white line in tin- -not.
The paper is afterwards removed and the record i>
fixed in shellac varnish.
To record the breath-
ing movements the pneu-
mograph is hung over the
chest or the abdomen by
a tape around the neck.
The record reproduced in
Fig. 2 is from a woman
whose abdomen made
violent movements out-
ward during certain con-
sonants. The records
show the movements for
Fio. 5. Recording the movements
of the tongue.
A small rul.lM-r Lull, la placed
in front <>f (iron tin- torque and ordinary breathing and
is connected to the recording
tambour. the spasms during the
attempt to say "m."
SYMPTOMS, FORMS, NATURE 25
The cramps of the lips may be recorded by inserting
between them a small rubber bulb (Fig. 3) and con-
FIG. 6. Record of a stutterer's cramps of the tongue in attempting to
necting it to a recording tambour as described
above. Pressure of the lips makes the line rise. The
record of the movement of the lips in an attempt
of a stutterer to say " Peter" is given in Fig. 4. In
spite of the long series of convulsive movements the
patient could not get beyond the letter "p."
The cramps of the point of the tongue may be
recorded by inserting a similar bulb behind the
teeth so that the tip of the tongue rests against it
(Fig. 5) ; pressure of the tongue makes the line rise.
The result of an effort to say "Tommy" is given in
Fig. 6. There is first a violent spasm of the tongue
and then a series of smaller ones.
Most interesting records are obtained by a mouth
recorder. A funnel of rubber (the top of a large
.sTI TTKKINi; AM) USI'INC
stomach tube) is held over the mouth ; it is connected
to a very small and delicate registering tambour.
The entire arrangement i> >hmvn in Fig. 7.
A record of the word "papa " in normal -perch is
shown in Fig. 8. The straight line at the start cor-
Fia. 7. Recording the mouth rum-tit.
The changes in air pressure and the vibrations of the voice pass
to a very small recording tambour and are registered on the smoked
responds to the time during which the lips were cl MI 1
for the " p " - the " occlusion." The sudden rise of
the line is the result of the puff of air the " explo-
sion " - that issued from the mouth as the lips were
opened at the end of the " p." The explosion of the
SYMPTOMS, FORMS, NATURE 27
" p " shows two large vibrations. This is due to its
suddenness, whereby the recording lever receives
something like a sharp blow, and vibrates twice in-
stead of once. The small vibrations that follow are
a record of the first vowel, each vibration correspond-
FIG. 8. Mouth record of "papa" spoken normally.
It begins with a straight line because the lips are closed to produce
the letter "p," and no air can issue from the mouth ; this portion of
"p" is called the "occlusion." The sudden rise of the line shows
that a sharp puff of air or "explosion" came from the mouth as the
lips were opened ; the extra wave in this explosion is due to the vi-
brations of the lever, resulting from the sharp explosion. The small
waves record the vibrations of the voice for the vowel "a." They
are suddenly cut short by a descent of the line ; this is the result of
the closing of the lips for the second "p." The extra wave results
from the suddenness of this closure. The occlusion is followed by
an explosion. The word ends with the vibrations of the final vowel.
ing to one vibration of the vocal cords. The vibra-
tions end by a sudden fall of the line as the lips are
again closed for the second " p." The record of the
explosion for this "p " is similar to that for the first
one. The word closes with the vibrations of the final
A record of the word " papa " spoken by a stutterer
(Fig. 9) shows a very long occlusion for the first " p,"
followed by a tremendously long blast of air, corre-
28 STUTTKKIV; AND LISPING
spending to the explosion of the " p." A -low fall of
the line after the first vowel >ho\vs that the lips were
Fio. 9. Mouth record of "papa" with blowy " p" 's spoke by a stut-
The initial "p" has a very lunn orclu.sion. followed t.y a long :md
strong blast of air. The second "p"isan incomplete < -ln-ion fol-
lowed by a blast of air. Comparison with Fin. s shows dearly how
the stutterer's enunciation differed from the normal one.
closed gradually and not suddenly for the second
"p." This " p " also has a blowy explosion.
A record of the word "papa" spoken by another
stutterer is given in Fig. 10. The record shows that
FIG. 10. Mouth record of "papa" with an inspiratory "p" spoken
by a stutterer.
The sudden descent of the line shows that the stutterer drew in
his breath to make the " p" instead of closing his lips. The vowel
vibrations follow as usual.
instead of closing his lips and then opening them for
the initial " p," he drew in his breath for a moment
and then closed his lips, thus making an inspiration
SYMPTOMS, FORMS, NATURE 29
and an occlusion instead of an occlusion and an ex-
A record of the word " sleepy " spoken normally is
shown in Fig. 11. There is a gradual rise of the line
as the air issues from the mouth during " s." This
falls rather suddenly as the tongue changes from the
Fia. 11. Mouth record of "sleepy" spoken normally.
The gradual rise of the line registers the rush of air during the
second "s." The small waves record the vibrations of the voice
during "1" and "ee." The occlusion and the explosion for "p"
and also the vibrations for the final vowel are similar to those in
" s " position to that for the " 1." There is a second
rise with faint vibrations for the "1"; these persist
as the line continues to fall. The rather long "1"
includes the vibrations along the horizontal line.
Suddenly the line rises for the vibrations of " ee," as
the tongue moves from the " 1 " position to the more
open one for " ee." It is interesting to note that the
" 1 " is so much longer than the " ee." The line sud-
denly falls as the lips are closed for the " p " ; it sud-
denly rises as they are opened with a kind of explo-
sion. The final vowel is quite long.
30 STl TTKKIM; AM) LISIMNC
In a record (Fig. 12) of the word ".-Irrpy" by a
stutterer the sinking of the line shows an initial gasp
FIG. 12. M<>uth record of ".sleepy" spoken \,\ :\ -tutterer.
There i.- :i Hasp In-fore the '.*." l-'nr file "p" tin -re i.-, iii) complete
closing <>f the lips and no explosion. The Miiall vil.rations during
tin- "p" show that the larynx continued to vibrate instead of stop-
followed by a rush of air for "s." Thereafter come
the small vibrations indicating the semivowel "1"
Fio. 13. Mouth record of " stutter " spoken normally.
There is first a rush of air for the "s," then a sudden fall as the
breath is cut off by the tongue in producing the occlusion of the " t."
The sharp rise of the line registers the explosion of the "t." The
small vibrations belong to the vowel "ti." The closure for the second
"t" ("tt") and the explosion arc similar to those of the first. The
final vibrations belong to the vowel "er."
and the vowel " ee. " A normal " p " would be formed
by cutting off the breath at the lips for a moment.
In Fig. 12, however, there is no straight line for the
SYMPTOMS, FORMS, NATURE 31
"p" ; that is, the stutterer's lips were not completely
closed. Naturally there is no sudden rush of air at
the end of the "p." The record of the "p" shows
small vibrations, indicating that the larynx continued
to vibrate instead of stopping as it should have done.
FIG. 14. Mouth record of "stutter" spoken by a stutterer.
There is an initial gasp followed by a strong "s" and then an
immensely prolonged "t." There is then another gasp. The rest
of the word is normal.
A normal record of the word " stutter " is given in
Fig. 13. It registers the rush of air for the " s " by
the upward rising line. The line suddenly falls as
the lips are closed for the "t." It rises very sud-
denly as the lips are opened to let out a puff of air,
the explosion of the " t." Then follow the vibrations
of the vowel " u." The line falls as the tongue closes
the mouth for the second "t "-sound (indicated by
" tt "). The word ends with a series of vibrations for
the final vowel which is indicated by " er."
32 STtTTKUINc; AM) I.ISIMMO
A mouth record . I-'iu. II of the word "stutter"
by a patient shows an initial gasp followed by a
strong "s." Then conies an immensely ])rolonged
" t." At the end of the " t " there is another gasp.
The rest of the word shows no marked abnormality.
The beginning of a stutterer's attempt to say
" Peter Piper's peppers " is given in Fig. 15. A short
Fio. 15. Mouth record of "Peter Piper's peppers" spoken by a stut-
The stutterer makes a gasp and a vowel sound foUowed by a
blowing sound before he can say the first " p." Such sounds are
called "starters." The " p"is long and has aviolent explosion. The
" t " is so short as to be almost lacking. The " starter " is repeated
before each word.
gasp is followed by a long vowel that sounds like " u "
in " up." Then comes a blo'wing noise made by the
lips ; it is the same as the Greek sound " ph " which
is similar to the English "f." All this has to be
done before he can say the first "p." The "p"
is long ; it has such a violent explosion that the large
vibrations of the recording lever persist for a con-
siderable time. The very short vowel " e " shows no
SYMPTOMS, FORMS, NATURE
peculiarities. The " t " was made so abnormally
short as to almost entirely disappear. The last
vowel (indicated by "er") was much prolonged.
The " uf "-sound was repeated before each word ; the
entire phrase be- 2
ing spoken about
as follows: "uf-
Peter uf Piper's uf-
between the use
of the laryngeal
tone by normal
speakers and by a
stutterer can be
illustrated by comparison of the melody of the voice
in the two records shown in Figs. 8 and 9. The
length of each vowel vibration is measured under a
microscope. The number of vibrations of this length
that would occur in one second is calculated. This
is the pitch of the laryngeal tone at that instant.
The result is marked by a dot on cross-section paper.
A line connecting these dots shows the rise and fall
of the voice. Such a diagram is termed a " melody
100 200 300 400 500
FIG. 16 Melody plot for "papa" spoken
normally (Fig. 8).
Each wave of the vowels is measured.
The pitch of the tone corresponding to
each wave is then calculated. The results
are indicated by a line, the "melody
plot" which shows how the tone rises
and falls. The melody plot shows that
the voice started at a tone of 170 vibra-
tions in the first vowel and descended to
140. In the second vowel it started at
130 and descended to 95.
STUTTERING AND LISPING
plot." The melody plots for the records in Figs. 8
and 9 are given in Figs. 16 and 17. The monotony
of the stutterer's voice is evident.
The view of the nature of stuttering that I have pro-
posed differs essentially from the prevalent theories.
According to Kussmaul the enunciation of each
single sound occurs correctly; the trouble is in
connecting the consonants with the vowels ; this
Fio. 17. Melody plot for " papa " spoken by a stutterer (Fig. 9).
The firet vowel maintained a tone of 125 vibrations throughout.
The second vowel maintained the same tone for a while and then
fell to 90.
occurs because the respiratory, laryngeal, and enun-
ciatory muscles do not act harmoniously. This is
contrary to fact. In the case of a stutterer, every
sound without exception is made more or less in-
correctly. Even when he is speaking with apparent
smoothness, the hypertonicity of the muscles (p. 12)
is present, and the strained, monotonous laryngeal
tone is heard. The cramps affect the sounds them-
selves regardless of how they are followed. A stut-
SYMPTOMS, FORMS, NATURE 35
terer does not stick on " t " because a vowel follows
it, but because he feels he cannot say that particular
word; for example, he may stick on "stove" but
not on " sto " or " stone."
The statement that stuttering consists purely of
a wrong form of breathing simply neglects all the
other defects in the stutterer's speech. The theory
that it consists essentially in an incoordination of
breathing and speech movements quite misrepresents
the condition ; such incoordination appears typically
in the speech of a person intoxicated with alcohol,
whose speech is different in every detail from that
The theory that stuttering consists in an exaggera-
tion of the consonants in speech merely takes account
of the results. Since the stutterer usually has his
cramps on initial consonants, these sounds occupy a
great deal more time than the following vowels, and
also than the following consonants. There are,
moreover, cases where the patient stutters on initial
vowels, as in " a-a-a-apple." Since in German the
initial vowel really begins with a consonant (the
glottal catch corresponding to the spiritus lenis in
Greek), this might be considered as consonant stutter-
36 STUTTERING ! AM) I.ISIMXO
ing. But in English the initial vowels begin clearly.
Moreover, the cramped laryngeal tone i> present in
every vowel in every case of stuttering. The
lengthening and exaggeration of consonants or
vowels are the results of the cramps, and t hex-
cramps are the results of other conditions.
Every one of the above theories neglects just the
one vital characteristic of the disease, namely, that
the defect is due to the fact that the stutterer thinks
some other person is listening to him. As long as he
is alone, he can speak perfectly. When a stutterer,
who has become so accustomed to me that he speaks
perfectly in my presence, is placed at the telephone,
he will continue to speak perfectly as long as he sees
my finger on the switch that cuts it off ; the moment
it is removed he knows that " central " will hear him
and he begins to stutter.
It has been asserted that stuttering consists essen-
tially in the fear of speaking. This is true as an ex-
planation of why the person stutters as badly as he
does when once the disease is developed. The fear of
speaking is perhaps the most prominent symptom in
stuttering just as in stage fright, but an underlying
cause for this fear must be sought for.
SYMPTOMS, FORMS, NATURE 37
The assertion has been made that stuttering is
related to tics, to compulsive acts, to the phobias,
and to writer's cramp. These conditions are not
only utterly different from stuttering, but also from
The essential of a tic is a persistently repeated
impulse to a special movement that can be suppressed
voluntarily for a short time. The tic movement
always involves more than one muscle; it is the
remainder of a movement that was once purposive,
such as sniffing, twisting the head, blinking the eye,
etc. The tic, unlike stuttering, does not involve
any inaccuracy, uncertainty, or primary embarrass-
ment or fear.
A compulsive act, like that of touching all the
posts as one goes along, or that of never stepping on
the cracks in the sidewalk, etc., arises from an al-
most irresistible impulse to do a certain compli-
cated act. Like the tic, the impulse can be repressed
for a while ; but the impulse is to a definite compli-
cated act, not to a single movement, as in a tic.
Unlike stuttering, the compulsive acts are not pro-
duced by any fear, and do not show any inaccuracy
38 STUTTERINO AND LISPING
The phobias arc characterized by inv-i-tiblc fears
of objects, acts, or places, as the fear of filth, the fear
of committing an act of desecration, the fear of cross-
ing open places, etc. The patient with a phobia
knows that his fear is absurd. The stutterer's fear
is not only reasonable but also thoroughly justified.
Writer's cramp is a fatigue of the nerve centers
due to overexertion in writing. It is a dull pain or
an actual cramp, quite unconnected with any mental
disturbance. The cramp is spastic and not clonic.
There is no mental compulsion, as in tics, compulsive
ideas, and phobias. There is no embarrassment or '
fear, as in stuttering. Penmanship stuttering has
been observed in one case. 1 The embarrassment and
fear were like those of the stutterer ; the cramplike
repeated movements were not like those of writer's
cramp, but were the same as those of oral stuttering.
According to my view, stuttering is a disease
marked by the following cardinal symptoms : 1, psy-
chic hypertonicity and spasms of the muscles of
speech, 2, anxiety (embarrassment or fear), 3, fixation
of these conditions by habit, and 4, the existence of
these symptoms only in the presence of other persons.
1 Scripture, " Penmanship Stuttering," Jour. Am. Med. A*soc.,
May 8, 1909, Vol. LII, p. 1480.
SYMPTOMS, FORMS, NATURE 39
The enumeration of the symptoms does not suffice
to indicate the nature of stuttering. The fact that
one child becomes a stutterer through imitation or
fright or an exhaustive disease, while another does
not, indicates some deeper difference in the mental
or nervous constitution.
Analysis of the stutterer's condition of mind
always shows a serious disturbance in his attitude
toward other people. Most patients are shy and
timid ; the boldness or indifference in other cases is
only a kind of bravado to cover up timidity. Much
of this timidity is undoubtedly due to the effects of
the stuttering, but its intensity is often out of all
proportion to the occasion. It may well be that
timidity is the basis on which stuttering arises. If
this is true, stuttering would then be a condition
in which timidity shows itself by a peculiarity in
Social timidity shows itself in mental symptoms
that are approximately the same in stutterers and
non-stutterers ; there are the same strained feelings
toward other people, the same bashfulness, etc.
The bodily symptoms are also similar ; the muscles
of the body are more tense than they should be;
40 STTTTKKIM; AND LISPING
there is often also the flushing of the face
Tin TO are even resemblances in speech. The timid
person, who is a non-stutterer, speaks with a tense
voice, he often stumbles over his words and some-
times can hardly get them out ; he often sticks or
reduplicates like a stutterer. If this "stuttery, "
timid speech can be supposed to be developed and
firmly fixed in a set of habits, the result would be
The fact that stuttering arises only in some cases
of timidity and not in others indicates that there is
some other element in the disease. The following
observations may perhaps suggest what it is. In
several cases there has been a determined effort to
get rid of the trouble and perfect good faith on the
part of the patient, yet I have had the feeling that
at the bottom of his soul the patient really did not
wish to be cured. This reminds one of some forms
of hysteria, psychasthenia, and neurasthenia, where
the disease is really produced by the patient in order
to obtain some end, although he Is absolutely un-
conscious of this self-production. It may be sug-
gested that stuttering is a defect which tend- t<>
oxrlude the person from the society of his fellows.
SYMPTOMS, FORMS, NATURE 41
and that persons who already have this unconscious
tendency instinctively seize upon such a means of
The same mental condition as that underlying
stuttering is found in many cases of neurasthenia and
psychasthenia where quite other symptoms (head-
ache, tremor, anxiety, etc.) appear instead of the
speech trouble. It is often a cause of wonder why
some neurotic patients are not stutterers. If we
assume that the impulse to segregation from society
will use the most likely and effective means for its
purpose, we understand why it naturally seizes
upon the speech function. We also understand
that it will more readily disturb the speech when
the mechanism of normal speech is less firmly fixed,
as after exhausting diseases, fright, or injury by
imitation. When the normal speech mechanism is
strong, the psychasthenic impulse must find some
Stuttering is therefore a diseased state of mind
which arises from excessive timidity and shows itself
in speech peculiarities that tend toward a condition of
segregation which will enable the person to avoid oc-
casions where he will suffer on account of timidity.
THE mere repetition of a word or of an initial sylla-
ble is often termed stuttering. Such repetitions occur
to every one at times, especially in embarrassing
situations. One stutterer said that every boy in
the class stuttered when reciting Latin. Various
other conditions, such as hysteria, multiple tics, in-
juries to the brain, etc., may produce repetitions in
speech. Such repetitions do not have the same
cause or the same systematic regularity as the repe-
titions due to stuttering in the habit stage; the
muscular movements do not have the cramplike
stiffness peculiar to stuttering. The symptoms are not
the result of embarrassment and fear, as are those due
to stuttering in the fright stage. It is quite im-
portant to distinguish between the disease called
stuttering namely, the disease whose character-
istics have been described in the preceding chapters
- and the repetitions often called stuttering which
are found in various other diseases. These repeti-
tions might be called "pseudo-stuttering."
''Organic lisping" is an inaccurate form of speech
produced by abnormal conditions of the speech organs.
It may be illustrated by the case of the boy who says
"sh" for "s" on account of a very high palate.
Tongue-tie may cause the child to use "th" for "s."
The lisp disappears when the organic defect is
corrected. There is no resemblance between the
sounds of organic lisping and those of stuttering ; in
the former the sounds are incorrect because they
are incorrectly made, in the 'latter because they
are made with too much force. Tongue-tie
never produces stuttering directly. I have had a
small boy with tongue-tie who both lisped and
stuttered. Upon cutting the tongue band he ceased
to lisp immediately, and stopped the stuttering
after three days. The tongue-tie caused the lisp, and
the embarrassment over the lisp caused the stuttering.
A full account of organic lisping is given in Part II.
"Negligent lisping" is a term that may be applied
to those errors of speech that are due to defective
perception and execution of sQujids. Thus "w" is
used for "r" because the child does not clearly per-
44 STUTTERING AND I.I si -ING
Vi-ive the diflVrence and because he does not take
the trouble to produce the more difficult muscular
adjustments required for the "r. " Most frequently
the tongue is pressed a trifle too hard against the
palate so that it closes up the small passages re-
quired for "s" and "th," thereby turning both of
these sounds into "t" and producing "tun," "toap, "
etc., for "sun," "soap," etc., or "tick" for "thick."
Often "t" is used for "k," as "tandy" for "candy."
The defective sounds remain constant, whereas
they change in stuttering. The lisper's "s" is
always defective, whereas the stutterer may have
trouble on initial "s" but not on final " s. " Negligent
lisping occurs in normal or phlegmatic or mentally
dull children, whereas the stutterer is always nervous ;
some lispers, however, become much embarrassed
by their defects, and some even become stutterers on
account of embarrassment. Negligent lisping is
treated in detail in Part II.
"Stammering" is a term sometimes applied to
the speech defects indicated by the German word
"Stammeln" ; these are the same as those just de-
scribed under the term "negligent lisping." Often
the term "stammering" is applied in a confused
way to a case of stuttering where the patient sticks
in his speech rather than reduplicates his consonants.
Most often the term is used as identical with "stutter-
ing." It is better to eliminate the word "stammer"
in order to avoid confusion.
"Neurotic lisping" is a disease described here for
the first time. The person may speak with general
indistinctness, appearing to mumble the words, or
the incorrectness may be confined to special sounds.
One girl of thirteen lisped over all the consonants.
She was an excessively nervous child, and she spoke
with incredible rapidity. As she was gradually
quieted down, the lisping decreased. It became evi-
dent that the excessive nervous tension, combined
with self-consciousness, produced a tense condition
of the vocal organs allied to that of stuttering. She
could not produce the smooth and delicately ad-
justed movements of normal speech because her
muscles were overtense. Another girl of twelve was
afflicted with partial deafness, which had made it
hard for her to learn to speak. Being a sensitive
child, the correction of the parents and the embarrass-
ment and fear before them had caused nervousness.
She spoke improperly because she over-innervated
46 STUTTERING AND LISIMN*;
the speech muscles. Neurotic lisping occasionally
occurs in stutterers. The lisping may sometimes ap-
pear in only a few sounds, the others being distinct.
One case of this kind lisped only on "s" ; the cause
was a fright that had left the person excessively
nervous. The overtension of the speech muscles, the
nervous condition of mind, and the similarity of
causation in some cases point to a close relation of
nervous lisping to stuttering ; they might perhaps jus-
tify the term "spastic stuttering." Neurotic lisping
may be distinguished from stuttering proper by the
.fact that the overtension of the muscles is a con-
stant one ; the mental excitement seems also to be a
steady condition, not varying as in stuttering. Fur-
ther details are given in Part II.
Bad cases of "cluttering" (hasty mumbled speech)
are often confused with stuttering. Although the
clutterer speaks with excessive rapidity and slurs
over the details of his words, and although he breathes
improperly and sometimes sticks in the middle of a
sentence, yet the defects are the result of over-
excitement and eagerness rather than of anxiety and
fear, as in the case of the stutterer. The clutterer
speaks better the more he is concerned about his
speech, the stutterer the less he worries about it
(see Part II).
"Tic speech" or "choreatic stuttering," or the
speech of the "post-choreatic neurosis" (if the terms
may be permitted) is characterized by a system of
spasmodic movements of constant character that
break up the speech in a way somewhat like ordinary
stuttering. The ' trouble originates in an attack of
acute chorea. After this has passed, the patient may
retain various spasmodic movements which are no
longer due to the cause of the original disease, but are
really "tics" derived from the choreatic movements.
Such cases are frequently diagnosed as "chorea,"
whereas they are really "multiple tics." The
patient with this form of speech usually has various
other spasmodic movements of the head, arms, etc.
The speech itself does not show the regularity of
stuttering. The stutterer will stick constantly for
a while on certain consonants ; his trouble is nearly
always in getting started. The tic-speaker usually
begins smoothly and catches and jerks at any mo-
ment ; there is no regularity or system in the sounds
he stumbles over. The mental attitude of the
stutterer is characterized by anxiety and fear ; the
48 STUTTERING AND LISPING
lie pcakcr docs not hesitate to speak at any time,
and is usually unal>a-hcd ly his defect.
The speech defects of "hysteria" have often
been confused with >t uttering. In one case the
patient upon being asked a question would hesitate
a moment, turn her eyes to one side, and make a
movement of the head as if she had just waked up to
the question, and then answer with a slight difficulty
at the start. The symptom was absolutely constant .
Corneal and pharyngeal reflexes were lacking ; she
was readily hypnotized; all of these pointed to
hysteria. Another patient could not say words
beginning with "w" because a word beginning with
that letter had once shocked his feelings. Sometimes
the patient stumbles over all words relating to certain
topics. Such patients do not show the cramplike
action of the stutterer, and do not have trouble all
through their speech ; the laryngeal tone is not
monotonous; the mental attitude is quite different.
They are cases of hysteria, or of "hysterical pseudo-
stuttering," and not of true stuttering.
The diagnosis of "hysterical mutism" has been
made in cases where the stutterer's fright made him
speechless in the doctor's presence. Older persons
that complain simply of inability to speak when
meeting strangers will be found, on close observation,
to stutter more or less perceptibly.
" Hysterical aphonia" results in a whispered or
faint tone of the voice that is present continuously in
a sentence ; there are no cramps in the mouth or face.
The stutterer never has the whispered or the faint
voice; he nearly always has some cramps in the
mouth or face. He may become speechless for a
short time, but this does not occur with the hysteri-
In the " spastic speech" of cases of infantile cere-
bral palsy, the characteristic is over-innervation
of all the muscles used to express the idea. In
speaking a word the patient contracts not only
the muscles of breathing, of the larynx, and of the
organs of enunciation, as many a stutterer would,
but also makes strong contractions of all the facial
muscles. The overcontractions are those that would
be needed to overcome heaviness of movement, and
are often not well coordinated, whereas the stutterer's
overcontractions are those that express embarrass-
ment and are perfectly coordinated for the purpose.
In spastic speech there is none of the stutterer's fear.
50 STI'TTKUINC AND LISPING
The over-exertion is continued throughout the sen-
tence. The syllables are equal in length, and are
A record of the word "papa" made by a patient
with "cerebral birth palsy" is shown in Fig. 18.
Fio. 18. Mouth record of "papa" in a ease of spastic |H-rrh.
Tin occltiMon (straight line) for the "p" is followed by a blowy
explosion (upward curve). The v.w<-l vibrations an- blown upward.
All the sounds are longer than those of the normal record (Fig. 8).
The explosion for each of the " p "s is of the blowing
kind, more like those of the stutterer's record (Fig.
9) than those of the normal record (Fig. 8). The
vowels are also blown, as shown by the position of the
line with the fine vibrations. All the sounds are
lengthened, particularly the last vowel.
In "motor aphasia" the patient cannot find the
words or sounds to express what he wants to say.
There is usually a history of trauma or apoplexy.
Stuttering nearly always begins in childhood ; aphasia
is usually connected with old age or injury. The
excessive nervousness of the aphasic person some-
times resembles that of the stutterer ; it has partly
the same origin in anxiety to get out the words
and in fear of being ridiculous. There is no ex-
cessive muscular tension or cramp of the speech
muscles. The laryngeal tone is normal, and not
monotonous. Words or parts of words or letters
FIG. 19. Mouth record of "papa" in a case of motor aphasia.
The syllable "pa" is spoken gently. A long pause follows. The
word is then spoken correctly.
may be repeated (pseudo-stuttering), but the cramps
of the stutterer do not occur.
One aphasic repeated a word or a phrase over and
over before he could go on ; for example, " Doctor -
doctor doctor Brown told me to come here. I
bring I bring I bring what you told me I
bring bring bring, yes, bring, bring, I bring,
etc;" or "I say to my to my to my I say
that to my niece, I have my girl, I have my girl,
etc." This is pseudo-stuttering. A stutterer does
not repeat a word, but only sounds or syllables ; he
would have said " D-d-doctor," "I b-b-bring," etc.
A record of " papa " by this patient is reproduced
in Fig. 19. The first syllable is spoken normally;
52 STTTTKRINC AM) I.ISIMNC
then- ;m> no cramps. Then follows a pau-e. after
which the word is spoken nirreetly. This >lmul<l l>e
compared with a record of the same word by a stut-
terer in Fig. 9. Sometimes the patient will repeat
the first syllable a dozen times with pauses between.
He says that he is for a while unable to recollect
what the second syllable is.
This aphasic syllable or word repetition i- utterly
different in its cause and its symptoms from true
stuttering. Kussmaul calls it "aphatic stuttering."
It is simply one of the phenomena of aphasia.
In its early stages "multiple sclerosis" sometime*;
produces a kind of pseudo-stuttering ; the later
stages are characterized by a scanning speech in
which each syllable is brought out with a distinct
effort. The characteristic anxiety of the stutterer
In " hereditary ataxia " (Friedreich's) the speech
is slowed, clumsy, and often scanning. There may
be hesitation, but there is no true stuttering and no
In "progressive bulbar paralysis" the injury
to the nuclei in the pons and bulb produees weak
action of the muscles of lips, tongue, pharynx, and
larynx. The sounds of speech become mumbled and
indistinct. The blurred pronunciation can hardly be
confused with stuttering. The weakness of the
laryngeal muscles produces hoarseness, dullness,
monotony, lowering of pitch, and finally loss of
voice. There is no fear of speaking as in stuttering.
Fin. 20. Mouth record of "papa" in a case of bulbar paralysis.
For " p " the line rises steadily ; this shows that the lips were not
closed completely. The strong vibrations for the vowels correspond
to the bellowy character of the voice. For the second "p" the lips
were closed, but the larynx continued to vibrate. The limits be-
tween the sounds are much blurred.
A record of " papa " spoken in a case of progressive
bulbar paralysis is reproduced in Fig: 20. Instead
of an occlusion and an explosion for the initial " p "
there is a steady rise of the line, showing that the lips
were not closed completely at any moment. For the
second " p " there is also only a slight narrowing of
the lips instead of a closure ; the larynx does not stop
vibrating for a moment as it should.
In "pseudo-bulbar paralysis" the speech is im-
perfectly enunciated ; it may be nasalized ; it may
become an unintelligible mumble; it may even
closely resemble stuttering (pseudo-stuttering). The
54 STUTTERING AND LISPING
weakness of the muscles shows itself not only in
speech, but also in every movement ; e.g. panting,
whistling, singing, sticking out the tongue, etc.
Similar disturbances occur in swallowing and cough-
ing. The eye muscles and the extremities are usually
affected. It is characteristic that, although the
voluntary control of these muscles is injured, yet
they act perfectly in response to emotional, auto-
matic, and reflex stimuli ; for example, although the
patient cannot move his lips or the facial muscles
when talking, yet he laughs and cries and expresses
his emotions in an exaggerated manner. In his
speech the muscular action is too weak, in contrast
to the too strong action in stuttering. There is no
anxiety, as in stuttering.
In the speech of "general paralysis" the sounds are
often slurred over, there are no cramps in enunciation,
and single sounds are not repeated. Mistakes occur
readily in the combination of the parts of a word.
For example, the paralytic patient will say "ar-
trallery" or "rartrillery," but it will be said without
cramps. A stutterer would say " a-a-a-artillery "
or "art-t-tillery." The paralytic can often speak the
word correctly by trying very hard ; the stutterer
speaks better as he speaks< gently. The paretic
"syllable repetition" is quite different from true
stuttering; the paralytic will say " hippo-po-po-pot-
musmus," the stutterer would never say anything
like this, though he might say "hip-pop-p-potamus."
The diagnosis of "insanity" with commitment to
an asylum occurred in the case of a very bad stutterer.
When excited, he would go through the most extreme
contortions and gesticulations in the effort to get
out a word, and would finally run up and down the
room in wild exasperation at his inability to speak.
THE prospect of a permanent cure of stuttering is
good, provided the patient is willing and able to keep
up the treatment for a sufficiently long time. The
length of the treatment is variable. With very
young children the cure often succeeds in one, two,
or a few more treatments. Somewhat older children
require three or four weeks or even months of daily
treatment. Older . persons are sometimes cured
rapidly, but they are often very difficult to manage.
When the patient receives treatment only during
visits to the physician two or three times a week, a
permanent cure may require six months or a year.
When there is weakness of character, a permanent
cure can be effected only by remedying the under-
lying defect at the same time.
The first step in the cure of stuttering is to look
after the patient's bodily and mental health. Most
stutterers are anemic, all are nervous. Fresh air
and exercise, proper hygiene of meals, sleep, and
moral habits, regulation of school or office work,
cod-liver oil, iron, arsenic, etc., are indicated. The
treatment of the stuttering is often useless unless the
patient is treated for his nervousness ; the two
troubles aggravate each other, and they should be
treated simultaneously. Nose and throat should be
in good condition; turbinates, polyps, septum, ade-
noids and tonsils should be treated if necessary.
At the outset it is usually necessary to explain to
the parents how the stutterer is to be regarded at
home, or to the patient himself how he is to regulate
his life. The home attitude during the fright stage
should be such that the stutterer should be encouraged
to forget himself. His attempts at new ways of
speaking should not be commented upon. Mistakes
and relapses should not be noticed. The patient
should never be blamed. With rare exceptions the
attempt of a parent to correct or help the stutterer
is an added irritation and a direct hindrance.
The treatment o^ stuttering is based on the follow-
The " principle of a new method of speaking" is
founded on two facts : first, that the stutterer speaks
58 STUTTERING AND LlsiMNG
in an abnormal voice, which we may call the " stut-
ter voice"; and, second, that he does not stutter
THOUGH r TO
Flo. 21. Scheme to illustrate the mechanism of stuttering.
When the stutterer attempts to express a thoughtin hisuxual voice,
he is obliged by the emotions connected with shaking to cramp his vo-
cal muscles. If he expresses his thought by singing, by queer modes of
speech, or in any other way unusual for him, he has no difficulty.
The normal way of speaking differs so much from the stutterer's
voice that it is just as unusual to him as the queerest voice can IK-.
He cannot stutter in a normal voice.
when he expresses his ideas in any other voice, such
as the singing voice.
The scheme shown in Fig. 21 expresses these two
facts. When the stutterer tries to express a thought in
the presence of another person, the action of his speech
is interfered with by the emotional condition (embar-
rassment or fear) that is aroused at the same time.
He therefore speaks in his stutter voice. If he tries
to express the thought in any other way than the
usual one, the emotional disturbance does not arise.
This explains the familiar fact that a stutterer never
has any trouble when he sings what he wants to say.
Since the patient does not stutter if he speaks in
any unusual way, he can be taught to speak in some
kind of an odd voice. The stutterer can at any
time speak without stuttering if he will use an
abnormally low voice, or an abnormally high one, or
if he will drawl the vowels or slur the consonants,
or if he will speak in a choppy staccato voice, and so
on. These are the methods of the "stammer
schools" and " stutter curers." They are objec-
tionable because they leave the patient with a queer
voice. He is likely to have it told him that the
"cure is worse than the disease." He usually gives
up the queer voice after a while and becomes a stut-
terer again because the queer voice itself produces em-
barrassment and he naturally feels like discarding it.
The essential point is that the stutterer feels his
manner of speech to be different from his stuttering
60 STUTTERING AND UM'ING
voice. One patient could never dictate to his
stenographer. I found that he could not di>tin-
guish one note from another in music. I told him to
sing what he wanted to dictate. He did so without
the slightest hesitation or difficulty, in what he
supposed to be a singing voice ; it did not differ,
however, from his stuttering voice, except in being
slightly easier and more natural. As long as he
thought he was singing, he did not stutter, although
he did not sing. The cure was a failure because
he refused "to make a fool of himself by singing to
his stenographer." To have enlightened him con-
cerning the fact that he did not sing would have
destroyed the belief that he was singing and would
have made him a stutterer again. There was no
way out of the dilemma.
There is another way of speaking which is unusual
to the stutterer, namely, the way in which the nor-
mal person speaks. When he speaks in this way, he
does not and cannot stutter. The therapeutic pro-
cedure on this principle will therefore be to teach
him to speak normally. Each of the abnormalities
that appear in his speech has to be determined and
corrected. The result is perfectly normal speech.
This is the only method of cure that should be
The " principle of relaxation" is used to aid in
overcoming the emotional condition of the stutterer.
It is pointed out to him that he speaks in a hard,
strained voice. He is taught to speak softly, melo-
diously, and pleasantly. It is quite effective to get
him to go through various exercises while lying
down and trying to doze; a hypnoid or a hypnotic
doze aids in relaxation.
The "principle of habit formation" implies that
the new way of speaking is to be drilled into the
patient till it becomes a habit. The greatest diffi-
culty lies in the fact that speech is so automatic that
we practically never think before we speak. The
training requires the patient at first to think how he
is to speak each time before he actually speaks. The
first steps require him to repeat sentences, poems,
etc., after the instructor. This is continued till
proper habits are formed. The final result must be
a purely automatic system of speech habits. If the
treatment falls short of complete automatism in
the new form of speech, the patient will probably
drop the habit and become a stutterer again.
62 Ml TTKKINC AM) LISIMNC
The "principle of spontaneity" is mjui-ito be-
cause, when the patient has learned to repeat per-
fectly, he will still be unable to do so when he speaks
of his own accord. A gradually increasing amount
of spontaneous speech is introduced into the treat-
ment. A good method is for the instructor to
speak declarative sentences and quc-tinn- alter-
nately ; each declarative sentence is repeated by
the patient, but each question is answered. Ho i*
urged to speak the answers in the same tone and
manner as the questions Gradually longer answers
and then free conversations are introduced. The
patient should finally talk freely and perfectly.
Another method is to give the patient something to
read. At first the instructor reads with him : soon
\the instructor drops out for an ever increasing
number of words until the patient can read alone.
The "principle of increasing embarrassment"
arises from the fact that, even when the patient has
learned to speak perfectly in the presence of the
physician or the instructor, he is unable to do so
under other circumstances. The patient is taught
to speak properly before a few other persons or
before a class. Still more difficulty is introduced by
making introductions, speaking over the telephone,
buying in stores, reciting in school, etc. For the
introduction exercise the stutterer practices at first
privately and then with gradually increasing num-
bers of strangers. The other problems are met by
exercises to develop confidence.
The "principle of equilibration" responds to the
fact that some patients are abnormally lively and
expressive while others are retiring and depressed.
The former type is quite the usual one among
small boys. They are characterized by excessive
volubility; their speech runs in a stream, they
reply before you have finished your remark, they
continually insert remarks in the conversation of
others, they often talk and act in a way that is
" fresh" or even impertinent. It often happens that
the patient stutters only when he gets into such a
flippant mood, or when he thinks of something funny.
This is the mood expressed in the jokey style of talk
of the mining camp, of the swaggering tough, and to a
lesser degree of college boys. The very essential of
the cure lies in repressing such patients. It is
explained to them not only that their manner is
improper and offensive, but also that their stuttering
8TUTTKKINC! AND LISPING
is due to their lack of self-control. They arc re-
quired to keep silent when others speak, to silently
count four before speaking, to speak in time to a
metronome, to speak no unnecessary word, etc.
The other type of stutterer is ashamed to speak.
or is dejected and depressed. Such are many of the
older boys and the young men and women. They
need to be encouraged. It is explained to them that
there is a chance for them to escape from their
bondage and that life may become bright and happy.
Moreover, they are not to take their defect so seri-
ously; others have the same trouble. It is useful
to accompany such patients to stores, to their homes,
etc. ; a helpful word is inserted when needed. It is
pointed out to them how much their speech improves
from week to week. When a patient has serious
trouble on certain occasions, for example, buying in
a certain store, it is often stimulating to bet him that
he will have the same trouble next time.
The "principle of correct thinking" indicates that
the abnormal habits of thought, which a stutterer
always acquires to a greater or less degree, are to be
corrected by appropriate exercises.
A frequent abnormality is that of getting into a
daze at each effort to think. The patient finds that
he cannot decide promptly. It was typical of one
patient that upon being asked "Which kind of dog
do you like best?" he hesitated, and grunted, and
finally said, "I really cannot say which I like best."
He was cured by being obliged to give some kind of
decision quickly, regardless of whether it was correct
or not. The trouble was due to the mental flurry
or daze that had become a habit. Another patient,
when leaving a house, found himself unable to say
"Good-by" because some friends were waiting for
him. The trouble arose from a conflict between the
motive to hurry after the friends and the motive of
not offending the host; this produced a mental
daze that left the patient speechless.
The school exercises of another patient were
learned in such a hazy fashion that he had a feeling
of uncertainty when reciting ; this made him stutter
violently. The habit of hazy knowledge may extend
to every topic in life ; the patient must be trained
to know perfectly and surely what he does know, and
to recognize exactly what he does not know.
The " principle of correct enunciation" responds to
the fact that some stutterers enunciate indistinctly
(ifi STl TTKKINC AND I.ISIMVI
or incorrectly. This may he due to confused and
incorrect notions concerning sounds ; ,-uch a condition
is a form of "negligent lisping" (Part II, ('hap. I).
It is sometimes due to a general excess of muscular
effort; this is a form of "neurotic lisping" (Part II,
Chap. IV). The exercises for general indistinctness
(p. 157) are to be employed.
An important principle is "belief in the success of
the treatment." When the belief is strong, the
patient makes his readjustments more eagerly and is
bolder in using them in speaking to others; the
consequent success encourages him and gives him
confidence. This in turn leads to still further
success. With a patient who is consciously or un-
consciously doubtful of the outcome, the treatment
becomes laborious. With such patients and with
all who have become doubtful through failures or
relapses, a careful psychanalysis (see below) may be
needed to remove the doubt.
A thorough "correction of character" has to
be frequently carried out in order to produce a
complete and permanent cure of the stuttering.
Whenever possible, the patient should have his
entire life studied and regulated by the physician.
Defects of intellect and morality have to be treated
by the appropriate methods. The neglect to reform
a person's character frequently results in failure of
the cure to be permanent.
The "principle of subconscious readjustment"
recognizes the fact that only a very small portion
of our mental life is conscious. From earliest infancy
our characters have been developed by our surround-
ings and by the experiences we have passed through.
Our past has been mainly forgotten, but its results
are present in our traits of character. The last one
to have any idea of his character is the person him-
self. The cause of the stutterer's trouble is entirely
unknown to him. It is purely mental but it is sub-
conscious, and a cure is often possible only by a care-
ful study of the patient's subconsciousness. This
can be done only by the group of methods known
as " psychanalysis " (Freud) . Some of these methods
are briefly described below.
The usual conditions under which the cure is to
be achieved include, in the first place, individual
treatment at the physician's office.
My method is to give the patient a thorough
mental and bodily examination. The general anam-
liS STITTKKINC AM) LISPING
nesis covers the history of the present illness, its
presumable cause, heredity >t uttering, nervousness,
asthma), past diseases, education, habits (tea,
coffee, alcohol, tobacco, drugs, sleep, food, work,
sex), appetite, digestion. The general status includes
the size, height, weight, general condition (nourish-
ment, anemia, exhaustion), general intellectual
appearance, urinary analysis (albumen, sugar, in-
dican), circulation (heart). Special examination of
the organs used in speech includes the nose (septum,
turbinates), throat (adenoids, tonsils), larynx (ca-
tarrhal conditions), chest (diameter expanded, re-
tracted, capacity by spirometer). The special anam-
nesis can be obtained only gradually as the patient's
friendship is gained. It should furnish all sources
of nervous strain in his life. He is asked to give
a most careful account of his relations to the other
members of his family, to his schoolmates or his
friends, to chance acquaintances, to the community,
and to mankind. On each of these topics he is to
compare his attitude to that of other persons. The
object is to relieve him of all feeling of strain by mak-
ing him realize that all human beings are built on the
same principles as he is, and that they are not strun-
gers before whom he should have any feeling of fear
or distance. Since the patient stutters least before
persons who have the most sympathy with him
and notice his trouble least, he is brought to feel
that the whole world is much more friendly than he
Without waiting to get a detailed special anam-
nesis, work may be begun with exercises, and, in
some cases, with psychanalysis.
The exercises are prescribed at each sitting as
the various faults show themselves. If the patient
speaks too fast, one or more slowness exercises are
ordered ; if too stiffly, melody and flexibility are
indicated ; if the breathing is incorrect or the tone
is husky, the appropriate exercises are noted, etc.
An attendant, who has been listening to the physi-
cian's criticisms and explanations, then carries out
the exercises with the patient.
Psychanalysis is begun by association tests and
the analysis of dreams, as described below. This
immediately brings physician and patient into the
closest personal relations ; the latter will discuss
matters that he would not mention otherwise ; the
special anamnesis is obtained rapidly. Moreover,
70 STITTKHINC AND USl'INT,
it brings to his mind many important events of the
past and calls his attention to many conditions in
the present otherwise overlooked. Finally, it is
used for a study of the patient's subconscious con-
dition. The distinction between the conscious and
the subconscious elements of his mental life are ex-
plained. As he learns to realize the points in which
his mind works differently from what it should,
he involuntarily proceeds to a gradual correction.
The physician should gain the patient's friend-
ship and devotion. His ability to develop the pa-
tient's confidence is one of the chief factors of the
cure. The patient should be willing to devote a
large amount of time to the exercises with the at-
tendant. Office treatment has the advantage that
it does not remove the patient from his business or
school and also that it enables a cure to be gradually
worked out in the environment in which the pa-
tient must live.
The final success or failure of the treatment de-
pends largely on the patient's determination to
persist until the cure is complete. Sometimes a
patient will spend many months with only gradual
improvement ; finally the resistances and ancient
habits suddenly break down and the patient is cured
rapidly. He should make up his mind that at any
cost he will continue treatment until he speaks per-
fectly. When he does speak perfectly, he should not
drop the treatment. He should return at steadily
increasing intervals for examination and for any
needed revision. When he reaches a six-months in-
terval, he should make a permanent arrangement
to return at such an interval ; this is not too much
to ask, even a dentist makes that demand. It is
true that some cases get well in a few treatments,
and that most cases do not have relapses ; but no
one can tell beforehand how any one case will turn
Another form of treatment is that at an institu-
tion. The patient lives with the physician and
attendants in a special house. He suddenly breaks
off all connection with his past life and enters upon
a novel series of experiences in strange surroundings
where people constantly supervise his speech. His
entire manner of life bodily and mental is
subject to regulation. This form is very effective
when it can be carried out. The separation from
the family is often absolutely necessary for a cure.
72 STITTKKI.VG AND LISPING
Treatment by class work has a great advantage
in the feeling of solidarity it awakens and in the
inspiration of being cured together with others. It
is used in the office and institutional forms of treat-
ment by holding daily classes for the various exer-
cises. The interest and enthusiasm that can be
awakened by the various exercises, by the tele-
phoning, by the ticket selling, by the impromptu
vaudeville, by the debates, etc., are most beneficial.
In the speech clinic the treatment must be mainly
in small groups or classes. So far as possible, the
physician should attend to the patients individually
In connection with the public schools a careful
examination should be made by a competent phy-
sician of every child who does not speak perfectly.
Stuttering must be carefully distinguished from the
other nervous defects. In all cases of defective enun-
ciation (Part II) there should be tests of intellectual
development also. Many of the stutterers and some
of the lispers can be treated in special classes con-
ducted by trained experts under direction of the
specialist. Whether these classes are held during
school hours, after school hours, or in vacation is a
matter that must depend on local conditions. Quite
a number of the stutterers and lispers must receive
special individual treatment. The other speech de-
fects can be treated only on directions from the
METHODS OF TREATMENT
THE object of the treatment is to give the stutterer
a normal voice and a normal state of mind. The
following methods of treatment are those that will be
found most efficacious :
Training in Melody and Flexibility
The tone of the voice, which rises and falls as we
speak, is produced by the vibrations of the vocal
cords in the larynx ; it may properly be termed the
The stutterer cramps the muscles of the larynx
so that he speaks in a monotone. The cure con-i-t-
in putting melody and flexibility into his laryn-
By "melody" we mean the rise and fall of pitch
for successive syllables. Melody may be indicated
by notes on a staff or by the rise and fall of a line.
The tones on which the words "How do you do?"
METHODS OF TREATMENT
may be sung are indicated by the notes in
Fig. 22 or by the line in Fig. 23. In speech each
syllable has a rise and fall in
pitch, as indicated in Fig. 24.
The speech of the stutterer
FIG. 22. .Notes indicating
is monotonous and Stiff, haV- how the phrase "How
do you do?" is to be
ing neither melody nor nexi- S un g .
bility (Fig. 25).
A record of the word " papa " as actually sung is
reproduced in Fig. 26 ; its melody plot is given in
FIG. 23. Line indicating how the phrase "How do you do?" is to be
ming according to the notes in Fig. 22.
Fig. 27. Comparison of Fig. 27 with Figs. 16 and 17
show vividly the differences in melody among the
three forms of expression.
The pitch of the laryngeal tone is determined by
STUTTERING AND LIsPlKQ
the degree of tension of the vocal cords. To vary
the pitch constantly, as in Fig. 27, the cords must
change their adjustment at every in-taut ; that is,
the laryngeal muscles must be freely and delicately
Fio. 24. Line indicating how the normal voice should rise and fall in
speaking the phrase "How do you do?" with a melody similar to
that indicated in Fig. 23.
poised and must act readily and accurately. The
stutterer, however, cramps them up so that they can
Fio. 25. Line indicating the monotony of the stutterer's voice in speak-
ing the phrase "How do you do?"
move only with difficulty. He sticks to one tone
as much as possible. His action resembles that of
a child who cramps a pencil tightly in his hand ;
he can draw a straight line with a ruler to guide him,
but he cannot write or draw gracefully.
METHODS OF TREATMENT
The laryngeal cramp may be broken up by the
"melody cure." The stutterer is first taught to
sing a song or a phrase while accompanied by the
FIG. 26. Mouth record showing the word "papa" as actually sung.
The vibrations of each vowel are of the same length throughout.
piano or another voice. His voice will rise and fall,
as indicated in Fig. 23, and he will have no stiffness
or cramps. Then he must speak the word on the
) 100 200 300 400 500 600 700 800 9(
FIG. 27. Melody plot to Fig. 26.
same notes, first with and then without musical
accompaniment. This gives him the idea that he
must put melody in place of monotony.
The patient now learns to make his voice "flexi-
ble." The instructor pronounces various words in
such a way that the laryngeal tone passes over an
octave in the first important vowel ; this may be
78 STUTTKKIM; AND I.ISI-IN<;
called the " octave twist." Fig. 28 indicates the
method in musical notation. In Fig. 29 the general
change is shown by u line.
In going over the octave in
this way the voice passes from
FIQ. 28. Octave twist the chest register to the head
in musical notation. . _, .
register, ror these registers the
laryngeal adjustments are quite different. The stut-
terer always speaks in the chest register. If he
leaves this register, he must relax the muscles, that
is, he must drop the cramp and rq
start a new adjustment. An an- Rrr
alogy may be found in raising a Flo 29.-o.-tav,- twin
weight by the arms from below ""'-^1 by .line.
the waist to over the head One set of muscles pulls
it up to the shoulder, but an entirely different set nui-t
Fio. 30. M<>:ith rr.-ord of "papa" spoken with the octave twist.
Tho waves of the first vowel Income shorter and shorter ; this
indicates that the voice rises steadily.
be used to get it up any farther. The stutterer
will try to raise his voice while keeping to the rhe-t
register ; he will usually stop at the fifth (c to g) in-
METHODS OF TREATMENT
stead of going over the whole octave (c to c')- As
long as he does this, the exercises do him no good
whatever ; he must be persistently trained until the
full octave becomes easy.
100 200 300 400
FIG. 31. Melody plot to Fig. 30.
The voice rises through an octave in the first vowel.
A record of the word "papa" spoken with the
octave twist is shown in Fig. 30. The waves of the
first vowel become shorter and shorter. The melody
FIG. 32. Mouth record of "papa" spoken with an unsuccessful at-
tempt at the octave twist.
Although the vowel waves become shorter in the first vowel, they
do not become as short as in Fig. 30.
plot (Fig. 31) shows that the voice rose through an
exact octave. The word spoken in this way was
much longer than when spoken normally. This is
usually so at the beginning of the treatment, but as
STUTTERING AND LISIMNC
the patient becomes more skillful no more time is
required when the octave twist is used.
The common fault of the beginner who sticks to
the chest register and fails to rise a full octave is shown
in Fig. 32. Although the waves of the first vowel
become shorter, it is very evident that they did not
100 200 300 400 500 600 700
Fio. 33. Melody plot to Fig. 32.
The voice fails to reach an octave on the first vowel.
become short enough. The melody plot is given in
The melodization of the voice goes on day after
day until the stutterer can do it perfectly.
Usually all the other kinds of stiffness and cramps
disappear together with the laryngeal stiffness, be-
cause the stutterer has learned to speak with a new
voice, that is, to use a new set of habits free from
the stuttering impulse. The object of the melodiza-
tion and the octave twist is relaxation of the muscles
METHODS OF TREATMENT 81
of speech. When this has been accomplished per-
fectly and permanently, the person may speak in any
way he pleases.
Correcting the Vocal Quality
The stutterer's voice usually sounds hoarse and
breathy. This is due to improper action of the laryn-
geal muscles whereby the vocal lips
are not brought closely together.
Perfect closure is shown in Fig. 34 ;
one condition for the breathy tone is
shown in Fig. 35.
FIG. 34. Perfect
This ' ' stutterer's hoarseness " can closure of the glot-
be readily corrected by exercises in The vocal cords
.... . . close tightly to-
which the patient sings and speaks ge ther in produc-
"ah" with the glottal catch (coup
de glotte) at beginning and end of
the sound. The breath is held
back by closing the glottis ; the
vowel begins suddenly with strong
F i G. 3 5^0 1 o 1 1 i s vibrations ; it is ended by snapping
during a breathy ,, jrlnttiq oVmt no-ain Fiffs 3fi
.. MM LOLL1& OllvlL (tL-,.,1111. J. !;-,> *J\J
The cords do and 37 iye recor d s of a normal
not come together
completely and English vowel and a vowel marked
the tone sounds
husky or breathy. o ff b y glottal catches \ they were
8T1 TTKKING AND USIMV;
made by the apparatus shown in Fig. 7. Such a
vowel begins like an initial vowel in German. It
is usually not difficult to teach this to the patient.
In a similar way the patient learns also t<> -
Fia. 36. Vowel curve with normal beginning :m<l
The voice starts to vibrate gently and ends in the same way.
vowels. Other exercises include staccato singing and
staccato speaking of words and sentences.
It is a rather common fault of the stutterer to let
the laryngeal tone (tone of the voice) cease before he
ends the last word, whereby the end of the word is
FIG. 37. Vowel nirvr with nlottiil catch at
The vocal cords close tightly together and then open with a sudden
snap as the vowel begins. The vowel is ended in the same way.
spoken in a hoarse whisper. This is corrected by
having him snap his glottis shut as he ends the
Almost invariably stuttering children and women
use a voice that is abnormally low. A child of ten
will sometimes speak on a pitch that belongs to an
adult. For correction a child practices singing
METHODS OF TREATMENT 83
songs of appropriate pitch ; then he sings sentences
to melodies he has learned ; then he half sings, half
speaks them on the correct tones, and finally he
simply speaks them likewise.
The stutterer's voice is usually very poor in
quality ; it sounds thick, as though the throat were
stuffed with cotton ; there is none of the sharp
resonance that characterizes a good singing or
speaking voice. The method of correction is much
the same as for a student of vocal music. The pa-
tient is trained in singing scales, arpeggios, and songs
in sharply resonant tones. The resonant tone is
then carried over into speech.
The bad quality of the stutterer's voice is due to
improper action of the various muscles involved in
speaking. Some of these muscles are not sufficiently
tense, while others are violently contracted. There
seem to be constant relations according to the law
that a lack of contraction of one set is accompanied
by excessive contraction of a certain other set ; thus,
the usual failure to raise the velum (soft palate)
sufficiently is always accompanied by strong con-
tractions of the jaw muscles, a condition which is
not only unnecessary, but also distinctly pernicious.
84 STITTKKlNf; AND USIMXC
Another common defect is underaction of the palato-
pharyngei (rear arch of palate) with overaction of the
palatoglossi (front arch). Very frequently there is
overaction of the mylohyoid and geniohyoid whereby
the larynx is pulled forward away from the backbone.
Correction of such defective action of the muscles
used in speech requires special exercises (Part III).
Correcting the Breathing
Stutterers generally have cramps of the breath-
ing muscles, or they breathe in hurried gasps, or
they blow out almost all their breath before speak-
ing, etc. Usually it is sufficient to train the stutterer
to take a breath before each sentence and not
to let any of it out before he speaks. Exerri-r-
in reciting the alphabet several times in one breath,
trying to say as much as possible of a poem like-
wise, etc., are useful. Passive and active exer-
cises may include the usual special calisthenic
movements; e.g. chest lifting with expansion, up-
ward arm stretching with resistance, standing-breath-
ing with arms front upwards and side downwards,
broad standing neck front side wise bending, same
with trunk twi>ting, etc. These and gymna-t it-
exercises (chest weights, running, and the like) aid
METHODS OF TREATMENT 85
in giving command of the breathing organs and
produce a feeling of confidence in them. The ab-
normality in breathing usually disappears when the
stutterer speaks with the octave twist (p. 78).
Almost without exception stutterers talk too
rapidly. They do not realize this fact, and they
often refuse to believe that they talk as fast as
another person who imitates them. They have two
different measures of rapidity, one for themselves,
the other for other persons. The correction of the
fault is most difficult ; it can be accomplished only by
frequently repeated exercises and continual remind-
ers. Many stutterers are cured in a relatively short
time of everything but excessive rapidity ; owing to its
persistence they repeatedly relapse. Others seem able
to speak slowly only with the utmost difficulty ; in
such cases a cure of the stuttering is often impossible
as long as the excessive rapidity is not overcome.
Exercises in slowness are given by having the patient
read and repeat poems and sentences in time to a
metronome beating 54 times a minute. Conversa-
tion is carried on likewise. Later the conversation is
carried on just as slowly, but without the metronome.
S(, STUTTERING AND LISPING
Speaking with the metronome usually makes the
voice hard, unless special attention is given to soft-
ness. Some kind of pendulum, such as a weight
on a string, may be used instead of the metronome.
Quite useful is persistent drill in speaking with
lengthened vowels, for example, "The su-u-u-u-un is
se-e-e-etting." The voice must be kept soft and
, A stutterer often thinks he gains slowness by
putting pauses between words, whereas each single
word is spoken as quickly as before. This produces
Training in Proper Thinking
A common trouble is the inability to say a certain
word that the patient wants to use. He may be
unable to read the names of a list because he may
stick at any one. Or he is constantly looking ahead
in his conversation for words he may not be able
to say, and he spends much of his mental energy in
substituting other words for them.
Exercises are instituted wherein the patient gives
the names of objects pointed to. This he does
first by singing them and then by speaking them
METHODS OF TREATMENT 87
The most common defect is the inability to go di-
rectly to the point to be brought out in speech. A
series of graded exercises is to be used. A word is
called out, to which the person is to respond with the
first thing he thinks of. For example, when the in-
structor says "rose," he may answer " flower." This
"simple association of ideas" is to be made as quickly
as possible. Measuring the "association time" with
a stop watch in fifths of a second is an effective
stimulus. In a somewhat more difficult exercise the
patient is required to make such associations in a
series, starting from a given word and making as
many as possible in ten seconds. For example, on
hearing the word "shoe" the patient may associate
' ' lace-black-mourning-death-skeleton-medicine-doctor
-cravat-etc." Somewhat greater difficulty is in-
volved when all the associations must be connected
with the given word. Considerable more difficulty
is introduced by requiring each association to refer
to the preceding one in the relation of (a) part to
whole or (6) whole to part. For example, to "room"
the association might be "floor" (6), "board" (6),
"house" (a), "city" (a), "street" (6), "sidewalk"
(6), "stones" (6), "hills" (a), etc.
88 STUTTERING AND IJSI'INC
The indefinite or dazed condition of mind of the
stutterer applies specially to his notions of words.
It is frequently accompanied by inability to spell
correctly ; in such a case exercises in spelling are to
Some stutterers develop the habit of frequently
breaking off a sentence and repeating it with a
changed construction. In such cases this may not
be due to the desire to avoid certain words, but to
a hesitating habit of mind. The patient should be
required to stick to his original sentences. Exercises
in conversation carried on entirely hi short declara-
tive sentences can be readily devised.
The excessive muscular tension of the stutterer is
to be combated by training him to keep his muscles
relaxed. To correct individual sounds he repeats
words with that sound, first with the sound omitted
and then with the sound much weakened. If the
stutterer is troubled by initial "b," he reads or re-
peats words beginning with " b " but omitting that
letter, for example, "-utter" instead of "butter";
then he pronounces the same word with a very faint
METHODS OF TREATMENT 89
"b," thus, "butter." This can be done for all
sounds with which he has trouble. Words may be
found in a dictionary or in the lists in Part III.
The stutterer often places his tongue or lips in-
correctly while stuttering. He may learn the correct
positions for any sounds that trouble him and may
Fio. 38. Mouth record of the stutterer's correction of the inspiratory
"p" in Fig. 10.
A correct occlusion is followed by a fairly successful attempt at an
try to get these positions. On the principle of a
new method of speaking (p. 57) this is often effective.
For many stutterers it is of great benefit to study
the positions of the vocal organs for the vowel sounds,
as shown in the Plates at the end of this volume.
The stutterer's incorrect enunciation, however, usu-
ally does not arise from the placing of the organs,
but from abnormal use of them.
The incorrectness in use can be accurately and
strikingly shown by the graphic method. The record
of a stutterer's inspiratory " p " is given in Fig. 10.
After the nature of the defect had been explained to
90 STUTTERING AND LISPING
him, he tried to correct his mistake ; with the
eighth attempt he was able to change the inspiratory
" p " into an explosive one, as shown in Fig. 38. The
result was not a very good "p," but the essential
fault had been overcome.
The most serious disturbance in the stutterer's
emotional condition is lack of confidence in his ability
to speak when he wants to. The following procedure
is serviceable when confidence in the voice is utterly
gone ; it can be abbreviated as may be necessary.
A tone is produced on a piano, organ, or some
other musical instrument. The instructor sings
"ah" at the same time. The patient then sings
it with the instructor while the piano sounds. This
is repeated until the patient declares confidently
that he is sure he can at any time sing a tone with
the instructor and the piano. Then the patient is to
sing the tone without the instructor. If he hesitates,
the instructor sings also. This is repeated until he
declares that he can at any time sing a tone with
the piano. Thereafter two, three, and more tones
are used in the same way ; a declaration of confidence
METHODS OF TREATMENT 91
is made at each step. Often it is convenient to
begin at once with the arpeggio c-e-g-c' instead of
single tones. The preceding steps are generally
unnecessary, as it is usually possible to begin at once
either with singing or with repeating sentences.
Children are usually ready to sing without hesita-
tion or diffidence, and it is often best to begin the
treatment with simple songs, because the child knows
that it never stutters when it sings. If the child is
at all diffident, the instructor sings a line of it first
alone ; then the instructor and the patient sing it to-
gether ; then, if necessary, both start together, but
the instructor drops out while the patient keeps on ;
finally the patient sings the line alone. In this way
he learns to sing various songs with the fullest con-
fidence. Other words are now substituted for those
of the first line of the song. Sentences like "This is a
very fine day," "My name is Jack Robinson," etc.,
are sung to the notes of the piano. Then the
instructor sings a question and the patient sings the
answer; for example, "What is your name?" "My
name is Jack Robinson." The patient becomes
fully convinced that he can sing anything he wants
92 STUTTKRINd AM) LISPING
Having gained so much confidence the patient is
now to learn that he can always speak properly
in a singsong tone. With most older patients the
preceding practice in singing may be omitted and the
singsong may be started at once. The best form of
singsong is a frequently repeated "octave twist"
(p. 57). The patient reads or repeats with the in-
structor a sentence or a poem whereby the voice is
made to go over the octave several times; for
example, in the lines "A wee little boy has opened a
store" the octave twist would be used in "wee,"
"boy," "o" of "opened," and "store." Then he
repeats such material after the instructor, and finally
says it alone. He practices till he is quite confident
that he can do this perfectly.
The instructor reads a series of sentences and
questions (as in a traveler's manual) in a like way.
Whenever a statement occurs, the patient repeats it.
When a question occurs, he answers it spontaneously,
striving to keep the flexible intonation. The nm-t
careful watch is kept on the octave twist. Some
patients persist in raising the voice only a fifth (c to
g) instead of an octave (c to c') when repeating a
sentence. In answering questions all patients at
METHODS OF TREATMENT 93
once drop back to the stiff stutterer's tone, and fail
at first to get the octave twist. The patient's answer
should be used as a sentence for repetition whenever
it does not have the proper intonation. By gradually
developing the melodious speaking during answers
to questions, the patient ultimately finds that he
can always speak independently with the octave
twist. It is pointed out to him that it is impossible
to stutter and to use the octave twist at the same
time ; the instructor tells him, and he will agree, that
he need never stutter again if he can only remember
to use the octave twist always. Of course, it is im-
possible for any one to always think of this before
he speaks; therefore this way of speaking must be
persistently drilled till it becomes automatic. It is
also true that, even though he forms the habit while
at work in the office, he will at once drop it as soon as
he becomes worried by the presence of another
person ; further development is thus necessary, as
When the patient has gained confidence in this
work with the instructor, another person is brought in
to listen to him. This should be done in such a way
as not to embarrass him. If the patient is a child,
t>4 8TI TTKKING AND LISPING
he should first be praised for his progress, and then
asked if he would not like to let his mother or sister
see how well he is doing ; the other person should be
instructed beforehand to praise the patient's success.
With older people it is well to begin with the presence
of the doctor's assistant or with some one whom he
feels not to be a critic. It may be necessary to go
over the whole routine again in order to develop
confidence before a third person. When this is
accomplished, still more people are brought in.
It is often very inspiring for the patient to go
through these exercises in company with other
stutterers. Strangers are gradually added to the
If the patient stutters when reading, a similar
method is pursued. He first reads in unison with
the instructor. The latter stops for a few words
at a time, leaving the patient to read independ-
ently. Gradually the stops are longer, until the
patient can read alone perfectly. He is to learn in
a similar way in the presence of a third person, etc.
Further steps in developing confidence in spon-
taneous speech are taken by assigning topics con-
cerning which the patient must say a few words.
METHODS OP TREATMENT 95
For example, he is to make a few remarks about
the furniture in the room, the weather this morning,
the fine time he had last summer, the best way to
reach his home, etc. For a somewhat more difficult
exercise the instructor relates or reads an anecdote,
a short story, a newspaper item, etc., and the patient
is then required to give the gist in his own words. As
a variation he may first read the material, and then
tell about it. He may be required to give short
accounts of what he has learned in school.
Still further confidence is developed by requiring
the patient to stand up and deliver speeches, either
those that have been memorized, or spontaneous
ones on topics that are suggested. This is best
accomplished with a group of stutterers. The
group is said to represent, for example, a dinner at
which each guest has to respond to a toast. Again,
the group is a party of tourists on an automobile;
one of the patients is the chauffeur; they all
make remarks on the events of the journey. Again,
the group is in a restaurant; one of the patients
is the waiter, the others are guests, etc. Entire
scenes are acted out, whereby spontaneous speech
is constantly required. The inspiration of such a
class is a potent factor in developing confidence.
ST1 TTKKIXC AND I.ISIMNC
More difficult situations arc approached by imi-
tating them first in the office. A table with objects
represents a store. The patient buys and sells in the
presence of people. When he can do this perfectly,
the instructor goes with him to stores and helps in
the buying. In like manner a ticket booth is ar-
ranged. For classroom work a class is organized
and lessons in arithmetic, geometry, Latin, etc., are
assigned, as may be appropriate. The patients are
called up to recite, to demonstrate at the board, etc.
Later the class is transferred to an actual da mom ;
still later outside instructors are brought in, older
patients are appointed instructors, etc.
The special difficulty hi telephoning is met by
practicing at first on a private line between two
rooms. The person at the other end represents
" central" and the people called up. The stutterer
should also practice the part of "central " in order that
the real central may not appear so strange. When
the patient no longer gets excited, the main line
telephone is given to him, but the switch is held down
so that there is no connection. Some one near by
speaks as if he were "central." When the patient
feels quite confident at such "dry telephoning,"
METHODS OF TREATMENT 97
the switch is released and an actual call is sent.
The instructor keeps close to the transmitter, so that
at the slightest hesitation he finishes what the pa-
tient wants to say.
The outside situations are in general to be met by
an attempt to get the patient's mind directed to the
interest of the thing and not the manner of presenting
it. For school it is desirable to go over the exercises
with him beforehand, explaining and illustrating
them in such a way that he becomes fascinated with
The appointment of stutterers as teachers of other
stutterers in the office or in the clinic is very effica-
sious in developing confidence.
A very difficult abnormality of feeling that occurs
in many stutterers is the mental cramp that occurs
when they are suddenly called upon. The cramp of
expectation in a mild degree is perfectly normal ;
for example, while waiting for cards or for dice
to be shown, a normal person usually feels a slight
flurry and holds his breath for a moment. With
the stutterer this goes so far that at a knock on the
door he will be struck absolutely speechless and be
unable to call out. To meet with such a condition
98 STITTKKINC AND LISPING
games with dice, counters, etc., may be practiced ;
thereafter exercises arc instituted in suddenly answer-
ing knocks, and in other situations that the patient
describes as troublesome.
Confidence is also developed by increasing the
loudness and carrying power of the patient's voice.
He learns to speak in a full, resonant tone. Then he
is removed to a distant room and forced to speak
more loudly. The loud, resonant voice cannot be
produced unless the speaker has a feeling of self-
confidence; the cultivation of the voice thus de-
velops the feeling directly. Moreover, a decisive,
commanding voice causes those who hear it to attend
in a more respectful way than they do to a hesitating,
timid voice; this in turn produces more self-confi-
dence in the speaker.
Readjustment to Environment
A. very obstinate abnormality of feeling is the
stutterer's altered appreciation of the relation of
himself to his environment. It arises not only be-
cause he knows that he is abnormal in his speech,
but also because the abnormality makes other
people treat him differently. His feelings toward
METHODS OF TREATMENT 99
other people are therefore very different from those
of normal persons. This leads to an abnormal
kind of life.
With some patients this condition has to be
attended to from the start, because they make no
progress and cannnot be cured except as the abnor-
mality is mitigated. My method is as follows :
I first attempt to establish intimate personal rela-
tions in the ordinary ways of acquaintanceship, so
that the patient feels me to be his personal friend. As
various incidents occur or as topics arise in conversa-
tion, we discuss the rules of conduct of the average
man, and we condemn extremes. For example, a
patient fears to go to a post office window because
he stuttered when he was there before and he feels
that the clerk expects him to stutter and will be im-
patient. It is pointed out that many hundreds of
people have been to that window since he was last
there, and that it is most improbable that the clerk
would remember him. Again, the business of the
clerk is to wait on all customers politely and pa-
tiently; he is trained to allow for the peculiarities
of customers, some of which are more trying than
stuttering. Again, he is not allowed by his em-
100 STriTKRlNC AM) I.ISIMVJ
plovers to show the slight ot impatience or discour-
tesy. Again, the postal clerk is in the sen-ice of the
government of which the stutterer is a member; he
i- therefore the stutterer's employee. In this way
the stutterer is brought to a correct understanding
of the relations between himself and the clerk. The
other situations in life are met similarly.
Readjusting the Subconscious
Recent psychological work has shown that the
instincts and desires with which we are born are
gradually modified and suppressed until they have
become to a considerable extent unconscious.
Moreover, our minds are trained to think along
certain grooves and not to permit thoughts along
other ones. Such a " censorship " makes it quite
impossible, for example, fcr certain thoughts of love
to arise in a European or an American girl that
wculd be only the most natural thoughts for the
negress in Africa. The person knows nothing about
this " censorship " ; it has been drilled into the
mind until it governs without being realized. The
difference in censorship permits certain thought^
to be perfectly natural in the one case and keeps
METHODS OF TREATMENT 101
them entirely absent in the other. Yet, although
absent from consciousness, the original natural forces
persist with undiminished energy. When properly
directed they produce the normal successful indi-
viduals; when improperly, they produce the group
of diseases known as neurasthenia, psychasthenia,
hysteria, some forms of insanity, etc. Our thoughts
and emotions are controlled largely by the sup-
pressed natural instincts. In a stutterer some of
these instincts have gone wrong, and it is necessary
to readjust them.
A minute analysis of the patient's mind, including
the subconscious, is often necessary to a cure. The
methods of psychanalysis furnish an outline of the
patient's subconscious life. These methods may be
applied to the stutterer in somewhat the following
The patient is alone with the physician. The latter
explains that the mind is an extremely complicated
organ whose ways of action have to be learned by
the most careful study. Since stuttering is ac-
companied by a somewhat incorrect action of the
mind, it is necessary for the stutterer to carefully
analyze his mental condition. The physician will
102 STITTKKI\<; AND LISPING
train him to do this. The training may take a long
We judge other persons and interpret their actions
on the basis of our own ideas ; our notions of other
people are "egomorphic." The physician there-
fore asks the patient to note down from time to time
any thoughts or criticisms that may occur to him
concerning the physician personally. The patient
may reply, for example, that just a moment ago he
had said to himself that in spite of his age and calm-
ness he couldn't help thinking that the doctor was
really shy and bashful. It is pointed out to him
that, utterly regardless of whether his judgment
was correct or not, such a thought would probably
not have occurred to a man of fearless disposition ;
the patient had sought out in the physician some
signs of his own trouble. Of course this was not
done consciously; the thought was merely the re-
sult of many past experiences and habits which he
had forgotten, but whose traces remained to make up
his character. The patient is warned not to try to
produce the thoughts concerning the physician, but
to note only what comes unpremeditatedly. The
next day perhaps he says, with many apologies, that
METHODS OF TREATMENT 103
the thought had occurred to him that the doctor
was not always perfectly frank and honest with
him; the reply is, "It is you who are not perfectly
open and honest in your dealings ; you have a tend-
ency to get out of embarrassing situations even at
the cost of some truth. Let your thoughts wander
as they will, and see if you do not recollect a number
of cases where you have acted in this way." These
spontaneous revelations of traits of character strike
the patient with great force and automatically start
During the day the restraints of life do not let
our personalities come freely into play ; we automati-
cally suppress most of our thoughts and emotions
and permit only a certain narrowly limited group to
develop. Moreover, the " censorship " of the un-
conscious does not permit the suppressed instincts
and desires to become known to us. In sleep, how-
ever, the censorship is somewhat relaxed, and our
innermost ideas and feelings come forward in
dreams. A study of the patient's dreams is, there-
fore, a most important source of information. The
patient receives instructions to have paper and
pencil beside the bed and to wake up and write
BT1 TTKIxIXC AND USIMNCJ
down immediately one dream each ni^lit. The ac-
count is read off by him to the physician. The
interpretation of some parts is immediately clear.
When more information on any point is desired,
the patient allows his mind to wander through a
series of associations starting from the part of the
dream involved ; usually the explanation is forth-
coming during such "running associations."
The following analysis of a patient's dream will
illustrate the method. The record of the dream
"I buy a ticket to some place, a single ticket
because I am not coming back. At a certain sta-
tion on the way I get off. I go to the manager's
office, where I find two men at work over papers. I
stand at attention, heels together in the German
fashion. The man has an American military cap
of dark blue. I say to myself, 'Shall I give a mili-
tary salute or take off my hat ? ' When the manager
turns around, I ask for the return of my money
because I have found a patient on the train. The
manager, who has now become a younger man,
says 'Yes, but it will be dear; it will cost one
fare plus a hemorrhage, plus an infarct.' I reply,
METHODS OF TREATMENT 105
'Never mind, the expense is nothing to me.' The
assistant reckons out what I am to get, and says it
will be about fifty per cent."
The patient had originally been in doubt whether
he should stop for treatment in this town or go
to a physician farther off. Stopping at the nearer
place, he had a few days before seen the doctor
and his assistant (manager and clerk) at a scientific
meeting. The doctor had told him he could not be-
gin treatment till next week (he stands at attention
waiting). The patient holds the doctor in great re-
spect (the. dream clothes him in a military costume,
and makes him manager of the station). The doc-
tor is, however, a personal friend ; the two feelings
are present at the same time and the patient doesn't
quite know how to act (shall I give a formal mili-
tary salute or take off my hat in a friendly manner ?) .
The patient naturally expects the doctor to do him
enough good to compensate him for what he loses by
not going to the other place (I ask for return of my
money for the part of the journey not taken). It is
characteristic of dreams that the personalities are
often changed. The patient now represents himself
as a doctor who has found a patient on the train.
106 STfTTKUIXG AND LISPINd
Instead of remaining the inferior (the patient), he
for a moment gratifies himself by feeling that he is
the superior (the doctor), who is about to treat a
patient. The dream now notes that the doctor is
younger than the patient (manager is now younger).
The patient had been somewhat worried over the
probable expense, and feared what the dream de-
clares (it will cost you dear). On the previous
evening the patient had discussed the matter with a
friend, and had remarked that the journey was not
entirely for the sake of the treatment (one fare), but
also to learn the method ; he had also complained
that the treatment cost him part of the time he wished
to give to some anatomical work (hemorrhage plus
infarct). He had finally concluded that he was ready
to pay any price if he could be cured (never mi ml.
the expense is nothing to me). The fifty per cent
seems to refer to the fact that the treatment was
taking about half the time from some other work.
The further interpretation was made in connec-
tion with the rest of the treatment. A vitally
important defect of the patient's character was an
inability to properly and promptly understand his
relations to other persons; the uncertainty as to
METHODS OF TREATMENT 107
how he should approach another person expressed
itself in the dream as the doubt concerning how he
should greet the doctor. Another defect was a con-
stant conflict between a naturally spendthrift nature
and an acquired but annoying and ill-judged penuri-
ousness ; the whole dream consisted of questions of
expense. This dream, as well as many others, ex-
pressed the patient's thoroughly egocentric view of
the events of life. These defects of character were
the sources of the patient's trouble, yet he had
never suspected the existence of any one of them.
As they were revealed by psychanalysis, a correc-
tion took place automatically.
The fundamental principles in interpreting dreams
are (1) that the material of the dream is taken mainly
from recent events, (2) that every dream expresses
the fulfillment of a wish that has remained unful-
filled, and (3) that the language of the dream in adults
is usually symbolical and not direct.
In children the language is not symbolical, and the
dream shows itself at once as the expression of a
wish . My niece, twelve years of age, had received some
chickens which rather disappointed her on account
of their smallness ; the next morning she related a
IDS >TI TTKIM\(i AND l.lsl'l\(;
dream of having a lot of fine, large Cochin-Chinas.
Her dream had fulfilled her unsatisfied wish of the
day before. In adults the language of the dream is
sometimes also direct. It is not unusual for my
patients to report that they dream of losing the paper
given them to record dreams on, of seeing me tell
them not to record dreams, etc. Upon being told
that these are really wishes, they confess that the
task of recording dreams is irksome to them.
Nearly always, however, the language of the dream
is symbolic, and the patient sees no meaning in it.
Many of the dreams of stutterers, however, have a
One stutterer dreamed repeatedly that he was ft
great social success at parties, that he was a friend of
the King of England, etc. Another one thought that
he and a friend, playing with great exhilaration, had
won a football game against an entire college eleven,
whereby he had made brilliant runs and kicks that
had brought applause from the grand stand. In all
such dreams the stutterer represents himself as pos-
sessing an excess of coolness and self-confidence ;
that is, he puts himself into possession of just the
qualities he lacks. It is also typical of stutterers'
METHODS OF TREATMKXT 1C9
dreams that they refer to their relations to other
The method of "running associations" referred to
above is intended to give the subconscious an oppor-
tunity to present its material. Why should my niece,
in the dream related above, have thought of Cochin-
Chinas ? She was induced to talk about chickens ;
before long she came out with the memory of a
former home where she had seen such chickens. The
stutterer who won the football game was asked to
let his thoughts wander freely. He gave the asso-
ciations : " football game crowd class Medi-
cal School -- professor Roosevelt campaign,"
all of which referred to incidents where he had had
difficulty in speaking. The friend who played with
him was indistinctly seen ; when asked what he
thought of when the word "friend" was spoken,
he replied, "doctor." The meaning of the dream
was at once clear. With his friend the doctor
to help his speech he was able to face a formidable
crowd or a difficult situation and achieve success
and applause. The wish that realized itself in the
dream was that with the doctor's help he might get
over his stuttering and be able to conduct himself
110 STUTTKKIM; AND LISIMV;
in his speech so brilliantly that he could success-
fully face his class and all other situations that
might present themselves.
As the peculiarities and deformities of character
of the stutterer present themselves spontaneously
in the dreams and in the discussions, he learns to see
them himself and gradually to correct them. This
is usually more efficacious than any attempt of the
physician to directly point out the defects. The
psychanalysis need not go so far as in the treat-
ment of hysteria ; it has, moreover, the distinct ad-
vantage that every such revelation of his own charac-
ter to himself produces greater ease in the stutterer's
speech. The results of the treatment show them-
selves gradually and steadily.
OWING to the fact that the symptoms are so often
the same or similar, it is convenient to include under
" lisping" several different speech disorders whose
characteristics lie essentially in defects of enuncia-
tion. We may distinguish four different lisping
disorders ; namely, negligent lisping, organic lisp-
ing, neurotic lisping, and cluttering.
The use of the word "lisp" in this larger sense
is in accord with the original Anglo-Saxon "wlisp"
and with the use in literature. "To lisp in num-
bers" (Pope) refers to baby talk, of which negligent
lisping is the survival.
In discussing individual sounds it is desirable to
have an alphabet. The following list gives the chief
sounds of English with a phonetic alphabet in paren-
theses ( ) to indicate them, and with examples in
STITTKKIV; AND USIMN<;
ordinary >prHing. In the <lisru>-i<m of lisping I
have as far as possible avoided the phonetic alpha-
bet and have given illustrations in ordinary English
1 \ \MPLE
The variations from the type are manifold, but
finer distinctions are not useful here. We may note,
however, that the first half of the diphthong in
" fly " is not exactly the sound indicated by (a) but a
somewhat different one that we may indicate by (a).
FIG. 39. Median section of the organs of enunciation and phonation.
The various sounds are produced by different ad-
justments of the vocal organs. Fig. 39 gives a median
section through the vocal organs of the head. The
STUTTERING AND LISIMNc
larynx is just in front of the backbone and just be-
low and behind tin- tongue. The roof of the mouth
is formed by the hard palate, at the rear of which
is the velum (soft palate) with the uvula hang-
ing down. The nasal cavity extends from the
nostrils in front to
the pharynx in the
rear. Median sections
for the typical English
sounds are given in
Plates I, II, and III
at the end of the vol-
ume. The heavy line
at the larynx indi-
cates that the larynx
Fio. 40. Artificial palate. . ,
A thin plate of aluminum is made Vibrates during the
for the roof of the mouth. It is , , , , , .
dusted with chalk and placed in SOUnd J the dotted ring
the mouth. When a sound is pro- j- A tU t '+ rl
duced. the tongue wipes off the H"wM
chalk where it touches the palate. x
When the mouth is widely opened and properly
illuminated, the positions of the tongue and velum
can be observed in a mirror.
The contact of the tongue with the hard palate
in producing sounds may be studied by palatography.
The tongue or the roof of the mouth may be
painted with ultramarine water color. The desired
sound is spoken. The contact of the tongue with
the palate is seen where the color is wiped off.
For more exten-
sive recording a cast
of the roof of the
person's mouth is
made, either with
compound or with
plaster. From this
a dentist makes a
thin artificial palate FIG. 41. Palatogram for the vowel -ee.
i fl . The black areas show where the
Or dental plate Of tongue touched the palate.
vulcanite, aluminum, silver or gold (Fig. 40).
An artificial palate may be made of eight or ten
sheets of wet tissue paper. A sheet is pressed over
the mold ; paste is spread over it, and another sheet
is pressed on, etc. It is carefully worked into the
depressions of the mold by the fingers. When
it is perfectly dry, it is coated with black varnish.
For an experiment the inner surface of the artificial
palate is slightly oiled and sprinkled with powdered
116 BTUTTBBINQ AND I.ISI-INC
chalk. It is inserted in the mouth: the sound is
spoken and the artificial palate is removed. The
parts touched by the tongue appear Mark, the chalk
having been removed whore the tongue touched it.
The results may be photographed, painted on a cast,
or sketched on paper. Such a palatogram on a cart
for the vowel "ee" is shown in Fig. 41. Palato-
grams for typical English sounds are given in Plate
IV at the end of the volume.
The sounds (a, ss, e, e, i, i, o, o, u, u) are termed
"vowels." For all of them the lips are more or less
opened. When the vowel "ah" is sung before a
mirror, the velum can be seen to rise upward and
backward ; this clears the passage from the throat
to the mouth, and cuts off the passage from the throat
to the rear of the nasal cavity. The velum rises
likewise for all the vowels. If the finger is placed on
the front of the neck over the larynx while the vowels
are sung, the vibrations of the voice will be felt dur-
ing all of them. Observations in a mirror show that
the vowels differ in the positions of the lips and
1 It has IXTII proven that tin- l:irynir-a] a<lju>t m^nts also differ
for thr various vowels. Scripture, Researches in Kx|x'rimental
Phonetics, 116, Carnegie Institution Publication No. 44.
The "occlusives " (p, b; t, d; k, g) are made by clos-
ing the mouth passage at some place. The closure
occurs at the lips for the " labial occlusives" (p, b).
The closure at the front of the tongue for (t, d) and
at the back of it for (k, g) causes them to be called
" front" and "rear lingual occlusives," respectively.
In English an occlusive usually ends with release of
the contact before the breath ceases, producing a
sharp puff of air. The English occlusives are there-
fore termed "explosives."
For the sounds (f, v; s, z; J, 3; 6, 5) a channel per-
mits a current of air to issue with a rushing or hissing
effect ; they are called ' ' fricatives." The sounds (f , v)
are "labial fricatives"; (s, z; J, 3; 8, S) are "front
lingual fricatives"; there are no rear lingual frica-
tives in English.
For (j) the tongue leaves a moderately large
opening at the front ; for (1) the opening is at the
sides ; for (w) the small opening is at the lips ; the
opening is not so large as in the vowels and not
so small as in the fricatives; no term for grouping
these sounds has yet been introduced. For (h)
there is a narrow opening at the glottis.
For the sounds (5, j) there is occlusion by the front
IIS STITTKKINC AND LISPING
of tin 1 tongue during the lii>t portion and a rush of
air through a narrow channel for the second portion.
It has been proposed to consider them as double
sounds (tj, d3), but experimental records show vital
differences; the two elements of occlusion and fric-
tion are so closely united in (c, j) as to make them
single sounds. Moreover, the positions of the tongue,
jaw, and lips are different from those of (t, d) and
(I, 3), as may be seen in Plate I.
During (m, n, q) the nasal passage is open, hence
the term "nasal."
During (p, f, t, k, s, J, 8) the larynx does not vi-
brate; these consonants are called "surds." Dur-
ing (b, v, d, g, z, 3, 5) the larynx vibrates ; they are
called "sonants." The sounds (m, n, q, J, w) are
nearly always sonants. The sound (h) is usually
surd, but sometimes sonant. All whispered sounds
The vertical diagrams and palatograms for the
consonants are given in Plates I, II, and III at the
end of this volume. The dotted line over the larynx
indicates that it does not vibrate for the surds; the
heavy line indicates that it does for the sonants.
The breath indicator shown in Fig. 42 may be used
FIG. 42. Candle flame indicator used for the mouth.
According as air issues or does not issue from the mouth, the candle
flame bends or stands upright.
to illustrate the properties of many sounds. The
tube from the mouth is directed against a candle
flame. When the vowels are spoken into the mouth-
BT1 TTBRING A\I>
1 ii. (.5. TumlMiur indicator us:-d for the nose.
The indicator is made from a thistle funnel coven d with ruhlxT.
A piece of card hangs in front of the rul>l>er ami is fastened t.i it l>y
glue or wax. Air issuing from the nose moves the card flap. A
mouthpiece may l>e used, its in Fig. 4_'.
piece, the flame is deflected. The same is true of the
fricatives. During the occlusives the flame is up-
right, but it is sharply deflected by the explosions
at the ends of the occlusions.
The breath indicator shown in Fig. 43 consists of
a thistle funnel over the top of which thin rubber
is stretched and tied. A strip of visiting card is cut
across and joined with tissue paper to make a hinge.
A piece of wax holds one piece of the card to the fun-
nel, while the other one hangs in front of the rubber
membrane. A drop of paste connects the hanging
flap to the membrane. The funnel is connected by
a rubber tube to a nasal tip. When any air issues
from the nose, it goes into the funnel and moves the
rubber membrane ; the movement is indicated by the
flap. This indicator can be used with a mouth-
piece like the one in Fig. 42.
The examination cf a person with incorrect enun-
ciation should cover the typical sounds. Each con-
sonant may be spoken with the vowel " ah " after
it or in some typical word; the list on p. 112 may
Although the patient may be able to speak the
separate sounds correctly, he may mumble and con-
fuse them in ordinary talking.
IN order to produce speech sounds like those of
other people an individual must hear correctly what
other persons say; in
. order to move his
speech organs correctly
he must feel their
__ movements and hear
the sounds he himself
produce-. By long ex-
perimentation the in-
fant acquires the art
of talking like other
people. If, however,
the child is careless or
Fio. 44. Lip position for "f" and
negligent in his obser-
The lower lip is brought against
the upper teeth. vation of the speech of
other people or himself, he fails to produce the sounds
properly and he does not even notice his errors.
These are the characteristics of "negligent lisping,"
or "functional lisping." The essential pathological
fact is mental carelessness. The cure consists in
teaching the patient to carefully correct his
If the cure is neg-
lected, some children
may become nervous
about their speech and
turn into neurotic lisp-
ers (see Chapter IV) ;
as this trouble is a
much more serious one,
it is not safe to neglect
negligent lisping. In
other children the ridi-
cule of their comrades
, , . FIG. 45. Lip position for "w."
and the reprOOI at The lips are projected slightly
i i forward with a small opening.
home may produce a
true hysteria with symptoms of disturbance of mind
(emotional complexes) and body (loss of pharyn-
geal and corneal reflexes, etc.).
Occasionally a defective speech organ produces a
defective sound (organic lisping), which so confuses
STUTTERING AND USIMNC
the child that all his sounds become incorrect (negli-
Some persons use "v" for "w," as in "Samivel
Veller" for "Samuel Weller." For "v" the lower
lip should be against
the upper teeth (Fig.
44) ; for "w" the two
lips are brought near
each other (Fig. 45).
To correct the fault,
the patient is told to
say "well, word,
wind," etc. Just as
he starts to say "veil,
vord, vind," etc., his
lower lip is pressed
down with a finger
or a stick ; he is thus
FIG. 46. Lip position for correcting
"w" into "v."
The lower lip is caught between
the teeth when a "w" is to be forced to Say "w" in-
stead of "v."
The opposite defect may occur. The patient says
werry" for "very," "wote" for "vote," etc. He
is told to bite his lower lip when trying to say words
beginning with "v" (Fig. 46).
The use of "p" for "f
and "b" for "v" arises
from pressing the lips too tightly together. A thick
. 47. Palato-
gram for for-
ward "t" and
. 48. Palato-
gram for back-
ward "t" and
FIG. 49. Palato-
gram for "k"
stick or a finger is stuck between the lips so that they
cannot close tightly. This produces the fricative
FIG. 50. Mouth dia-
gram for "t" and
The front of the
tongue is raised
against the hard
palate just behind
FIG. 51. Mouth dia-
gram for "k" and
The back of the
tongue is raised
against the velum
at the rear of the
126 STUTTERING AND LISPING
sound. The differences are also learned by observa-
tion of the instructor and looking at one's self in
Fiu. 52. Mouth record of "water" spoken normally.
The sudden and complete cutting off of the breath during the "t"
and the strong explosion at its end arc evident.
a mirror. The differences may be made apparent b /
a breath indicator (p. 119).
The substitution of "s" and^z" for "f" and "v"
upon the likeness in the fricative sound. Atten
Fiu. 63. Mouth record of "water" spoken by a lispcr.
Iii-t-ad of the breath being cut off for the "t," there is only a faint
diminution ; the sound is like " th " instead of " t." The laryngcal
vibrations are continued from "a" without stopping through the
"th" into the vowel "er." A correct "t" has no laryngeal vibra-
tion is called to the fact that in words with "f" and
"v" the lips are closed, while in the words with "s"
and "z" they are open.
NEGLIGENT LISPING 127
Defects o/'%" "d," "k," and "g" (t, d, k, g)
For "t" and "d" the front of the tongue is raised
against the palate just behind the teeth (Figs.
47, 48, 50); for "k" and "g" the rear part is
raised (Figs. 49-51). For "t" and "d" it is usual
to turn the tip of the tongue upward as in Fig 47.
Many persons form the "t" and "d" by putting
the tip farther back against the palate (Fig. 48).
One defect in "t" and "d" is failure to completely
close the air passage by the tongue. An additional
defect for "t" is failure to stop the laryngeal vibra-
tions when the sound occurs between vowels. The
two defects are illustrated by graphic records taken
with the mouth recorder (Fig. 7).
A normal curve of "water" as recorded by the
graphic method is given in Fig. 52. A slight rush of
the breath is followed by a nearly straight line indi-
cating the faint sound of "w." The mouth opens
rather suddenly and the line rises as the vibrations
of "a" rush out. The breath is cut off completely
during the "t." As the tongue releases the "t," a
strong puff of air occurs and the line goes sharply
upward. The record ends with the final vowel. The
record for a lisper is shown in Fig. 53. Where there
128 WTTTKKINC AND LISIMNC
should Ix? a straight line with an explosion |Or the "t,"
there are strong vibrations with only a slight sinking
of the line. This shows that the larynx did not stop
during "t" and that the tongue did not close the
air passage. The patient says "wather" (woSa)
instead of "water" (wota).
The chief fault b the failure to close the tongue
tightly at the front. Ordinarily it is sufficient to
explain to the patient that there are t\vo classes
of sounds calle 1 "occlusivcs" and "fricatives." For
the occlusives the current of air passing throuf h
the mouth must be cut off at some point ; for the
occlusives "t" and "d" the tip of the tongue must
close firmly against the palate. When it does not
do so, it produces the fricative sound " th." The
other defect, namely, keeping the larynx vibrating,
disappears when the "t" is carefully made.
A frequent defect among children is the use of "t 1 '
for "k," as in "tandy" for "candy." Sometimes
this substitution occurs regularly; usually it is
only in some words. The patient who says "tandy"
will usually say "car" correctly. That is, although
he is able to make the sound of "k," he replaces it
by "t" in some words through pure negligence.
NEGLIGENT LISPING 129
Both "t" and "k" are occlusives, that is, the cur-
rent of air is shut off entirely during the sound ; the
patient does not take the trouble to distinguish be-
tween them. A similar substitution is made of "d"
for "g" (hard "g" as in "go"). The child says"Div
me sum tandy." The cure ma} r begin by having
him open his mouth wide and say "ca-ca-ca-candy."
He looks into the mouth of the instructor and sees
that the tongue rises in the back ; looking into a
mirror, he learns how his own tongue is to move.
It is sometimes useful to push the point of the
tongue back and down by a stick (tongue depressor)
when a word beginning with "k" or "g" is used.
The child cannot say "t" or "d," and he is forced
to raise the tongue at the back.
Similar procedures are used if "k" and u g" are
replaced by other sounds.
Defects of "s" and "z" (s, z)
To produce "s" or "z" the front of the tongue
is raised against the hard palate behind the teeth,
while a small channel is left in the middle so that a jet
of air is blown through. A palatogram is shown in
Fig. 54, a mouth diagram in Fig. 56. Every modi'
130 STI TTKKINO AND LISPING
fication in the shape of this channel changes the
character of the hissing sound. For "z" the vocal
cords vibrate ; for "s" they do not.
The hiss for the "s" is frequently
too weak, the channel being too wide.
The defect is corrected by using greater
FIQ. 54. Paiato- pressure of the tongue. When the hiss
gram for "9"
and "." is too sharp, relaxation is taught.
The most frequent defect is that whereby the
patient says "toap," "toup," "tun," etc., for "soap,"
"soup," "sun," etc., or "dink" for
"zinc." Instead of a rush of air dur-
ing "s" there is complete stoppage;
the "fricative" sound is turned into
an "occluslve." Through negligence r
FIG. 55. Palato-
the person presses his tongue against gram for oc "
the palate a trifle too hard when and ""
saying "s" or "z." This closes the touches the
palate over a
opening that is necessary for "s" larger area
,_,. N . than in Fig.
(Figs. 54, 56), and makes an occlusive 54. Theeban-
/T rr fr\ J.L j i-i A > nelifldoaedby
(Figs. 55, 57) that sounds like "t. too much
This may be shown by graphic records
(p. 22) by means of the mouth recorder (Fig. 7). A
normal record for "sun" is shown in Fig. 58; a
record with the occlusive instead of the "s" is given
in Fig. 59.
With a small rubber bulb placed bctv/cen the front
of the tongue and
the palate (Fie;. 5),
and connected to
a registering appa-
ratus (Fig. 3), the
force of the pressure
of the tongue can be
recorded. For an FIG. 57. Mouth
FIG. 56. Mouth dia-
gram for "s" and occ i u ded "s" it is
The front of the greater than for the
tongue rises so as
to form a narrow ordinary "s" or for
channel at the
front of the palate, "t" (Fig. 60). The
occluded "s" is thus not the same as a "t"; it
may be defined as an " s " made with excessive
tongue pressure resulting in a sound like "t."
Treatment by having the patient imitate the "s"
of a normal person usually aggravates the defect;
he is already making too much effort with his tongue,
and the more he tries, the greater the effort he makes.
Sometimes he can be taught directly to relax the
tongue, but this rarely succeeds.
diagram for oc-
cluded "s'' and
of Fig. 56 is
closed by too
STITTKRINT, AND LISPING
Fio. 58. Mouth record of "sun" spoken normally.
The record was made as shown in Fig. 7. The rising line register*
the air issuing during "a"; this is followed by the vibrations for
"u" and "11."
Fio. 59. Mouth record of " sun" spoken by a lisper.
The record was made as shown in Fig. 7. The straight portion of
the line shows that no air issued during the attempt at "s."
Fio. 60. Tongue record for occluded "s."
A record by the method of Fig. 5 shows that the pressure of the
front of the tongue against the palate is small for " s," larger for " t,"
and largest for occluded " s."
One cure consists in inserting a probe, an appli-
cator, a toothpick, or a pencil just over the middle
of the tongue and pressing it down as the person
begins to speak a word beginning with "s" (Fig.
61). He cannot close the passage completely,
and instead of saying "t" he is forced to say
"'s." This catches his ear, and he notices the
difference in sound.
enables him to train
his tongue in the new
Another cure con-
sists in practicing the
patient in making a
sound with a sharp
For other cases a
(Figs. 42, 43) is ef-
Frequently the "s"
and "z" are made with channels at the sides instead
of the front. The hiss sounds like an "1" ; instead
of "soap," "soup," the patient seems to say "sloap"
and "sloup." The defect is corrected by teaching a
correct "s," either by imitation of the sound as
FIG. 61. Correcting occluded "s" and
The small stick over the front of
the tongue produces the channel
necessary for " s " and " z."
STUTTERING AND LISPING
heard by the ear or by using a stick ovor thr middle
of the tongue, as in the case of occlusive "s" and
"z"; the patient will close up the side channel as
soon as one is made in the middle.
Sometimes the "s"
and "z" are made in
a way that produces
sounds like "sh." For
"sh" the channel in
the middle of the
tongue is seen to be
broader and differ-
ently formed when
compared to that for
"s." The cure is
often brought about
Fio. 62. -Making the interdental fricar by usmR a pro b e or
The tongue is pushed out be- a 8 tj c k ag j n the pre-
tween the teeth. The sound re-
sembles that of "th." vious case ; the irrita-
tion makes the patient narrow the channel. Some-
times it is necessary to train the patient to use
"t" instead of "s," and then to correct this fault
as previously described.
Sometimes a "th" sound is used for "s" and "z."
NEGLIGENT LISPING 135
The patient who has this fault usually sticks his
tongue between the teeth for "s" (Fig. 62), mak-
ing an interdental fricative not used in English.
Sometimes it is sufficient to show him that people
do not stick their tongues out that way. He then
watches his own tongue in a mirror. He also learns
to make "s" with the teeth tightly closed. A
small stick can also be used, as in "t" for "s."
The patient who uses "f " for "s" is satisfied with
the fact that he is producing a fricative sound; he
notices no difference. He must be taught to dis-
tinguish between the two kinds. He is to watch his
lips in a mirror ; he sees that the lower lip does not
close against the teeth for "s." His lips may be
held open while he is obliged to say "s."
A similar case is that where a guttural fricative
(like the German "ch" in "ich") is used for "s."
The formation of "s" is to be explained and taught.
Occasionally an utterly different sound, such as
"k," is used. If the correct "s" cannot be taught
directly, the "t" is taught and then this corrected
to "s" as described above.
136 STl TTKKIXr, AM) USIMXG
Defects of "ch" and "j" (c,j)
The sounds "ch" and "j," as in "church" and
"judge," have been considered as consonantal diph-
thongs, each made up of two sounds, "t" with "sh"
!. Mouth record of the word " Mitchell.'
The faint vibrations for "m" are followed by stronger ones for the
vowel "i." The air current is cut off entirely for a abort time then-
after; this is the occlusion for the sound "ch" ("tch"). Then-after
the rather quick and strong rise of the line indicates an explosion of
special form. The record ends with the vibrations for "e" and "11."
and "d" with "sh." Graphic records of the sounds
"ch" and "j" have proven that they are two indc-
Fio. 64. Mouth record of the word "nutshell."
The faint vibrations for "n" are followed by stronger ones for the
vowel "u." The air current is cut off for "t," which has no explo-
sion here. This is followed by gradual rise of the line for the- frica-
tive sound "sh." The word ends with the vibrations for "e" and
pendent sounds. 1 A record of the word "Mitchell"
(Fig. 63) shows the sound "ch" spelled "tch" here
- to be an occlusion followed by an explosion of a
'Winifred Scripture, "The sounds of 'ch' and *j,'" Popular
Science Monthly, October, 1911.
NEGLIGENT LISPING 137
special form that is never seen in any other typical
sound. A record of the word "nutshell" (Fig. 64)
shows an occlusion for the "t" without any explo-
sion, followed by a long rush of air for the "sh."
The sound "ch" (6) is thus quite different from the
combination of the sounds "tsh" (tj).
The difference between the two
sounds can be shown in another way.
A palatogram for "ch" or "j" shows
that the tongue touches the palate FlG - 65 -
farther back than for "t" or "d," and "j."
and that it covers a bigger space touchesthe
palate over a
(Fig. 65). larger area
than for "t"
The mouth diagram is given in and "d."
Fig. 66. The front of the tongue touches the
palate rather far back ; the lips are somewhat pro-
truded. The differences from "t," "d" are marked
The establishment of the fact that "ch" and "j"
are individual sounds is analogous to the proof fur-
nished long ago that the two forms of "sh" (J, 3)
are individual sounds, and not compounds of "s"
The typical defects are of two kinds. In one the
STUTTKUIN'i AND LISPING
tongue presses too tightly against the palate, in a way
similar to that for an occluded " s " (p. 130). The
sound is likea"t" for "ch"anda"d" for "j." In the
other the tongue is not pressed tightly enough. This
produces a sound resembling " sh."
The treatment for the former is
similar to that for the occluded "s"
(p. 132), the purpose being to obtain
relaxation of the tongue. For the
latter the patient is told to press
the tongue more strongly.
W*> of "n " and "ng" (n, )
The tongue For "n" the tongue takes the
touches the palate
over a larger area same position as for "t" and "d"
than for "t" and
"d"; the lips arc (Fig. 50), but the velum is not
projected forward, .
and the teeth are raised (Fig. 67). For "ng," as in
rather close. . . ,, , . . . ...
sing, the tongue position is like
that for "k" (Figs. 49, 51) with the velum not
raised (Fig. 68).
The use of "m" for "n" (the lip nasal for the
front tongue nasal) is corrected by observation in a
mirror, by making the patient open his lips while
saying "n," etc. Tne use of "t" or "d" for "n"
NEGLIGENT LISPING 139
is a velar defect; it is corrected by exercises in
raising the velum as described under Velum Defects
below. The sound "n," namely, the nasal with
forward contact of the tongue, is sometimes used
for "ng," the nasal with rear contact, as in "good
FIG. 67. - Mouth dia- FlQ 6g _ Mouth di& .
8 r mfor n - gram for "ng."
, ,, The velum is
touches the palate
. ,. lowered and the
at the same place
as for "t" and back of the tongue
"d." The velum is raised slightly to
. , meet it.
mornin" instead of "good morning." The confu-
sion is aided by the lack of any English letter for the
sound "ng." The correction is made by calling the
patient's attention to the difference and by making
him open his mouth widely while making the "ng"
in such words as "sing," "ring," "bring," "calling,"
etc. The "ng" hi words like "finger" consists
8TUTTKKINC! AND L IS! 'INC
of the two sounds "n" and "g" and not of the
single sound "ng" (q).
Defects of the Two Forms of "sh" (f, 3)
The two sounds indicated by "sh" are made by
raising the front of the tongue so as to cut off all
through a small
channel (Figs. 69,
70). For (J) ("sh"
FIG. 69.-Paiato- as in "azure") the
gram for "sh."
The tongue larynx vibrates ; for
touches the pal-
ate along the (3) ("sh" a s in
idea and leaves .
a.ar f eropening "show ) it
in front than
for .. 8 .. not.
The tongue is
****** t the
palate over a broad
area further back
than for "s." The
channel is longer.
Sometimes the pressure of the
tongue is too weak ; the channel is
tOO large, and the "sh" SOUnds
faint and hollow. The defect can be corrected by
emphasizing the tongue pressure.
Sometimes the contact is so weak and incorrect
that the resulting sound is more like "th." The
tongue is to be pressed with more force.
When the sound "s" is made instead of "sh," it
indicates that the child does not properly distin-
r^^i^i guish between them.
^f ^^L He is to be drilled
in careful pronunci-
^p. ^^^ ation of words with
FIG. 71. Palato- such SOUnds.
gram for "th."
The tongue It occasionally
palate in front happens that "f" is
over a broad
space so lightly USed f or " sh . " Just
that air cs-
capes. as with f for s
(p. 135), he is taught to distinguish
them, and his lips may be held
apart. For the rare " t " f or " sh "
a procedure like that of "t" for "s" may be tried.
FIG. 72. Mouth dia-
gram for "th."
The front of the
tongue is raised
against the palate,
but a very wide
channel is left.
Defects of the Two Forms of'tk" (6, S)
In producing the two sounds indicated by "th"
the front of the tongue is raised against the palate
(Figs. 71, 72), the tip touching so lightly that the
air escapes over it. For "th" as in "thin" the
larynx is silent; for "th" as in "thine" it pro-
duces a tone.
It is very common for children to use "t" and "d"
for "th"; thus, they say "tin," "tree," "tumb"
STUTTERING AND LLSI'INC
for "thin," "three," "thumb," and "dfc," "dough,"
"dee" for "this," "though," "the." It is like
the language of the
!<; i r or the tough:
Ar<> you \vi<l me? Yes,
trou' tick and tin."
Fiu. 73. Mouth record of "thin" The defect arises from
The rising line shows that dur- pressing the tongUC tOO
ing "th" the air issues from the . .
mouth in a steady stream. The tightly, With the TCSUlt
small vibrations arc from the . .
i and . that no air can issue
from the mouth ; this makes an occluded "th" that
sounds like a "t" or a "d."
A mouth record (Fig. 7) of the word " thin " spoken
normally is given in Fig.
73; it is very clear that
air issues from the mouth
during the " th." A record
of the same word spoken FIG. 74. -Mouth record of ti.,-
11. ... -i-,. spoken inirmallv.
by a bsper is given in Fig. Th( . rini ^ t Hnc indicatca
7^- tho first sound was the o^ 1 " 8 ' " of the " i ">
/5, tne nrs the sharp upward movement
evidently an occlusion i- lh " r,-,it f it. pioon.
The small vibrations are from
with an explosion similar th, vuw.iand-n."
to the first sound in "tin" (Fig. 74).
The cure consists in inserting a probe or a stick at
FIG. 75. Mouth record of "thin" with occluded "th," by a lisper.
The sudden depression of the line at the start indicates a strong
jerk of the tongue whereby air is drawn in for an instant. The
straight line indicates that the tongue is held tightly against the
palate. The sudden upward jerk is the explosion of the occluded
"th." The occluded "th" is longer than the normal "th" or "t";
this is a result of the excessive effort. Its explosion is stronger than
that of "t."
the side of the mouth
above the tongue (Fig.
76) . When the patient
tries to say "t," his
tongue is pressed down
across the tip and he
is forced to say "th."
It is also useful to
teach the use of the
(p. 134) as a substitute
for the defective "th."
FIG. 76. Correcting occluded "th."
The breath indicator is A stick is held across the front of
f fe /TT \ *^e t n 6u e ' 8 t na t it cannot be
Ot ten effective (b Ig. 42) . presscd tightly against the palate.
144 STTTTKUINC AND LISPING
Children often use "f" and "v" f.,r "th," sub-
stituting one fricative for another. The defect
is explained to the patient. He is to observe in a
mirror that for words like "thin," "thimble," "this,"
"though," etc., the lips remain apart. If necessary,
Fi 77. Mouth record of front rolled "r" by an American.
'I'd'- larger vibrations result from the flapping of the tip of the
tongue ; the very fine vibrations are the record of the luryngcal
vibrations, that is, of the tone of the voice.
the lower lip may be held down by a stick or the
Defects of "r" and "I" (i, 1)
The original sound from which English derives
ttfl r," as in "run," was the rolled or trilled "r,"
which is indicated phonetically by (r). The rolled
"r," which is no longer used in English, is the only one
in German, French, Italian, and most other languages.
To produce the rolled "r" with the point of the
tongue, its front portion is pressed against the
palate tightly except at the point. The pressure of
NEGLIGENT LISPING 145
the breath causes the point to flap. A mouth record
by the apparatus shown in Fig. 7 is given in Fig. 77.
a In English "r"
the tongue position
is the same, but the
point is held away
FIG. 78. Palato-
gram for Eng-
from the palate
front of the
fl ap pi n g or
raised; the rolling. A HlOllth ric - 79. Mouth dia-
channel in the gram for "r."
middle is wider record of " SO1TOW " The front of the
than for "sh," tongue is raised
but not so wide (Fig. 80) shoWS Small against the palate,
as for the DUt the tip does
vowels. vibrations for the not quite touch it.
r" like those of a vowel. The phonetic letter is (j).
In large cities like Berlin and Paris, and regularly
FIG. 80. Mouth record of English "r."
The record is of the word "sorrow." The rising line at the start
indicates the air issuing during the "s." The small vibrations are
those of two vowels with "r" between them. The vibrations for
"r" do not differ from those for the vowels except in minor details.
in Yiddish, the rolled "r" is produced by forming
a groove in the rear of the tongue in which the
STITTKUIM; AND USIMM;
uvula is allowed to rest. The breath causes the
uvula to vibrate. A mouth record is shown in Fig. 81.
The phonetic letter is (R).
Fio. 81. Mouth record of uvula "r" by a Parisian.
The larger vibrations result from the flapping of the uvula ; the
finer ones are the record of the laryngeal vibrations, that is, of the
tone of the voice.
For "1" the tongue is tight in front and open along
the sides (Figs. 82, 83).
The most com-
mon defect in Eng-
lish is the use of the
easy sound "w" for
FIO. 82. Paiato- the difficult sound
gram for "1."
touches the . , . ...
palate at the S1S * S m getting the Fio. 83. Mouth dia-
in the ri S ht The front'. .f th-
tongue touches the
method is to teach the rolled "r"
place for "u." One
the rolling is
to be done with the tip of the tongue. When the
patient can talk with the rolled "r," he simply
drops the roll while using the same tongue position.
When the person cannot get the tongue right for
the rolled "r," it
is useful to use an-
other sound that
requires the point FIG. 84. Rod fo* pushing the tongue. The
rod is made of an aluminum applicator
OI the tongue (twice the size of the figure).
against the palate. For example, he is told to repeat
FIG. 85. Pushing the tongue into
position for "r."
The rod pushes the front of the
tongue up and back.
sun, run, sun, run,
etc., or "tun, run,
tun, run," etc.
In more difficult
cases the patient ob-
serves the tongue of
another person say-
ing "r." He finds
that it touches the
teeth along the sides,
but is free in front ;
this is particularly
clear when the "r"
is rolled. With a mirror he tries to get the same
The instrument shown in Fig. 84 is made by
148 STUTTKKIV; AM) LISI'INC
bending a light wire (aluminum applicator). With
it the front of the tongue can be pushed upward and
backward into the position for "r" (Fig. 85).
Sometimes "1" is used for "r." It is like the
Mongolian lisp used by the Chinaman, who says
"Melican man here light away." The patient is
shown that for "1" the tongue is open along the
sides while tight at the tip. The action is thus
the reverse of that for "r." For the correction of
this obstinate defect the tongue is drawn back into the
mouth so that it cannot be released at the sides ;
the point is turned up. A flat stick or a small rod
(aluminum applicator) bent to the form shown in
Fig. 84 may be put under the tongue to push it
back and up.
Children of foreign-born parents sometimes use
the lingual or u\ ? ular rolled "r" instead of thesmooth
English "r." Their peculiarity may be illustrated
as follows: "Rrrobert makes a rrring arrround it"
or "RRRobert makes a RRRing aRRRound it" instead
of "Robert," etc. It is usually sufficient to teach
the difference by ear between the English "r" and
the rolled "r." For more difficult cases a breath
recorder (Fig. 7) may be used ; the indicator makes
NEGLIGENT LISPING 149
a steady movement for the English "r," while it
vibrates heavily for the rolled "r."
The "r" may be omitted or replaced by other
sounds, as "n," "t," "w," etc. The use of "w" for
11 r" is very frequent; the child is sometimes en-
couraged to say "vewy," "pwetty," etc., because it
sounds "cute." Both tongue and lips take the posi-
tions for "w" instead of those for "r" (Plate II).
Even when the tongue is in the position proper for
"r," the lips may have the position for "w." This
makes a peculiar "r" with a " w " tinge. These defects
are to be corrected by teaching the patient to make
exaggerated or rolled "r"s. Words are recited with
exaggerated "r"s, rolled and not rolled. The lower
lip may be held down to hinder the "w" move-
The usual defect for "1" consists in the use of an
"r" or in dropping the "1." In both cases the cure
consists in imitation or in explanation with observa-
tion of the tongue. In order to enforce the fact
that the tongue must touch at the tip for "1," it
is useful to draw the tongue back and then throw
the tip sharply into place against the palate as an
initial "1" is to be pronounced.
150 8Trm-:m\<; AND LISPING
If a nasal xmud is used for " 1. " the correction is to
be made by pinching the nose, by the n;t>al indicator,
etc., as described under "Velum Defects."
For all English sounds except the nasals "m, n, ng,"
the velum, or soft palate, must rise so as to close
more or less completely the passage from throat to
nose. When this is not done, the speech has a dull,
nasal snorting character.
The vowels may be tested by the following li-t :
for "ah" (a), "ah, arm, art"; for (SB), "at, after,
am"; for "aye" (e), "aid, ate, ale"; for "eh"
(c), "ebb, effort, egg" ; for "ee" (i), "eel, eat, easy" ;
for (i) "it, in, ill"; for "oh" (o), "old, owe, oak";
for "awe" (o), "awe, awful, ought"; for "oo" (u),
"fool, boor, tool" ; for (u), "full, pull, bull."
The occlusives may be tested by the words "ape,
pa, upper ; able, bee, obey ; at, tar, utter ; add, do,
odor ; oak, caw, ochre ; egg, go, ago."
The fricatives may be tested by the words "eff,
fare, offer; eave, veal, ever ; ess, see, essay ; ease, zee,
easy; shoe, ash, usher; azure, pleasure; thin,
oath, ether; though, bathe, either."
The sounds of "r" and "1" may be tested by the
words "run, arrow, law, ell, fellow."
If the velum does not rise during the vowels,
they have a nasal character reminding one of the
FIG. 86. Recording the nasal current and vibrations.
A small glass tip is inserted into one of the nostrils. Currents of
air and vibrations from the nose pass down the rubber tube to the
small recording tambour, whose lever traces a line on the recording
French nasal vowels. If it does not rise during "s,"
that sound appears like a nasal snort. For the oc-
clusives (p, b, t, d, k, g) the lips or the tongue close the
air passage in front and the velum closes the nasal
passage; the air, which accumulates under some
152 STITTKKINC AM) LISIMNC
pressure, is released by the lips or the tongue; this
causes a slight puff or explosion from the mouth. If
the velum is dropped before the release, the explosion
Fio. 87. Nasal record of "sun" gpokrn normally.
occurs through the nose, producing peculiar snorting
sounds for "p," "b," "t," "d," "k," and "g."
Graphic records may be obtained by the arrange-
ment shown in Fig. 86. For example, the nasal rec-
I'nj. 88. Nasal record of "sun" with n-l:ix-<l velum.
ord of "sun" with correct "s" (Fig. 87) show- no
emission of air during "s," that with nasalized "s"
(Fig. 88) shows a strong snort. The snorting " s "
is what has been described as ' ' nasal sigmat ism " ; the
other snorting sounds have not been specially named.
Sometimes it is sufficient to explain thex- principles
to the patient and let him feel the improper nasal
breathing on the back of his hand. A tissue paper
flag (Fig. 89) or a light piece of cotton is also
It is often very effective to use a breath indicator
which shows when air issues from the nose (Fig. 43).
The patient must learn to make all the vowels and
the proper consonants without letting air escape
FIG. 89. Tissue paper indicator.
The passage of breath through the nose or the mouth moves the
piece of paper.
from the nose. This he must do in continuous speech
The muscles that press the velum against the rear
of the pharynx can be strengthened by a velar hook
(Fig. 90) made of a rubber penholder whose end is
softened in hot water and bent, or of a bent laryngeal
electrode. The hook is inserted behind the velum
STUTTERING AND L1SIMNC
and the vowels are spoken or sung while the hand
pulls on the handle of the hook (Fig. 91).
Very effective is the application of a laryngeal
electrode with a very mild faradic current to the
Fio. 90. Velar hook.
velum. The slight shock induces the person to
draw the velum up.
An appeal to the ear may be made by using the
nasal tip and rubber tube shown in Fig. 86 with the free
end placed to the ear. When the velum is properly
raised during " a," " s," " papa," etc., very little is
heard in the ear. When the velum is not raised,
the sound through the tube is very loud. The tube
is placed to the patient's ear and the instructor puts
the tip to his nose, while he pronounces the words.
FIG. 91. Velar hook in position.
The hook has been placed behind the velum, which is raised against
a slight resistance from the hand.
Then the tip is transferred to the patient's hose so
that he can listen to himself.
The use of surd "s" (as in "sun") for the sonant
"s" (as in "does" or "zone") sometimes occurs.
Such a patient pronounces "lies" and "doze" as
if they were "lice" and "dose." He is taught the
STI TTI-:i;l\<; AM) LISPING
difference between surd and sonant ; he puts his
finger over the larynx (Adam's apple) and feels it
Fio. 92. Mouth record of "dog."
The record was taken with the apparatus shown in Fig. 7. The
straight line at the beginning represents the stoppage of breath
during "d." The following vibrations are those of the vowel. The
faint vibrations where the line begins to sink are those during the
occlusion of "g." Strong vibrations appear at the end, that is, during
the explosion of "g."
vibrate while he sings or speaks a prolonged vowel
with a "z" (as in "does" or "zone").
Fio. 93. Mouth record of "dok."
The record differs from that in Fig. 92 in having no vibrations
during the sound after the vowel, namely, during "k."
Similar confusion may occur with the other sounds ;
"t" may be used for "d," "k" for "g," etc., and like-
wise the reverse.
The most common trouble is that the larynx stops
vibrating before the sonant is really finished. Thus,
the person appears to say "dok" instead of "dog";
in reality the last sound was half "g >J and half "k,"
NEGLIGENT LISPING 157
and he said "dogk." Mouth records of the three
cases are given in Figs. 92, 93, 94. The trouble can
usually be corrected by training the ear.
The negligence may go so far that the patient
speaks in a generally slurred manner. Ordinarily
FIG. 94. Mouth record of "dogk."
There are faint vibrations after the vowel, showing that the sound
began as "g" and not as "k" ; these die away and none are found
at the time of the explosion, showing that the sound ended in "k."
this is corrected by having him repeat sounds, words,
and sentences after a careful speaker. The following
points are to be especially noticed.
The sounds "p, b, t, d, k, g" are produced with the
lips or tongue stopping the air passage. When the
stoppage is released, the air comes out with a slight
puff or explosion. When the air pressure is allowed
to fall before release of the lips or the tongue no
explosion occurs. This is the normal pronunciation
in French ; in English it indicates negligence.
i:>X STUTTERING AND LlSlMNd
A graphic record(Fig. 7)of the normal " p " (Fig. 95)
shows the sharp explosion at the end of the occlusion.
Fio. 95. Mouth record of "apa" with the explosion of "p" well
The record was taken with the apparatus shown in I in. 7. The
waves at the beginning are those of the first vowel. Then follows
the straight line for the occlusion of "p." The sharp upward move-
ment of the line is the result of the explosion of "p." Thereafter
follow the vowel waves.
A record where the explosion is omitted is shown in
The cure consists in training the patient to ex-
plode his "p"s, "t"s, etc., so that the explosion is
Fio. 96. Mouth record of "apa" with no explosion of "p."
The record is the same as in Fig. 95 without the sharp upward
movement of the line. The "p" had no explosion.
quite audible. The breath indicators shown in Figs.
42, 43 with a mouthpiece are most effective. The
patient must learn to make all his occlusivcs with
NEGLIGENT LISPING 159
The "s" and other sounds are often made too
weakly. The patient must learn to hiss the "s"
strongly and to make each sound with sufficient
energy to cause it to be heard distinctly. Some-
times the nasal sound "n" is systematically too
weak. It is corrected by speaking and reading with
Vowels or consonants are often slurred over too
briefly. The training consists in reading and speak-
ing with the vowels exaggerated in length.
For general indistinctness it is useful to speak and
spell Words backward over a private telephone
wire or to a person so far away that there is diffi-
culty in understanding. The patient may prac-
tice repeating words from a dictionary, making, for
example, at one time all the "s"s prominent, at
another all the "t"s, etc.; such combinations as
"tw," "tr," "str," etc., require special attention.
Such sentences as "Peter Piper picked a peck of
pickled peppers," "Round the rough and rugged
rock the ragged rascal ran," "Shall she sell sea shells
by the seashore," "Tired Tommy tripped his toes,"
etc., are useful.
The higher degrees of indistinctness found where
160 STfTTF.mNC AND LISP1NC
the intellectual development begins to ho slightly de-
fective are to bo treated 1>\ the following system:
Tongue gymnastics are introduced. They include,
(1) putting out and pulling in tongue ; (2) moving
it from side to side ; (3) holding it out while 2, 3, etc.,
are counted ; (4) turning up the tip of the tongue
to the palate (with fingers if necessary). Similar
exercises are performed in advancing the lips, bit-
ing them, pouting, grinning, and moving the lower
Respiration exercises may include blowing up
bags, blowing out candles, blowing bubbles, etc.
The articulation exercises are to be based on the
principle that the child is to see how the teacher
makes each sound ; he hears the sound and is then
to feel his own movements and see them in a mirror
while he hears himself make the same sound. Thus,
after seeing the action of the teacher's lips for "f"
and "v" he watches his own lips in a mirror. To
distinguish between "f" and "v" he puts his hand
over the teacher's larynx and feels that the vibrations
are lacking in "f" and present in "v"; then he
feels his own larynx. The lip and tongue positions
for the other consonants are taught similarly. The
NEGLIGENT LISPING 161
emission of the breath during "h" and the fricatives
may be felt by the hand held in front of the mouth.
Careful drill in pronouncing words and sentences
can be carried out in connection with reading exer-
The training of the intellect should be carried on
at the same time. As speech is most closely con-
nected with thinking, the most efficacious method is
to make the speech training the center of the entire
''ORGANIC lisping" is the term that may be ap-
plied to such speech defects as arise from anatomi-
cal defects of the vocal organs.
The defective speech is usually a great drawback
to the patient's career. It sometimes leads to fur-
ther troubles. One boy whose enunciation of "s"
and "z" was defective on account of overshot
jaw had his ideas of speech so confused that he had
failed to correct the infantile " t " for " k " (" tandy "
for "candy"), although he could make such sounds
perfectly. Moreover, the defect had caused him so
much mental distress and strain that he enunciated
his sounds with strongly contracted muscles,
whereby they were indistinct. He thus had all
three kinds of lisping : organic, negligent, and neu-
rotic (Chapter IV).
Lisping from Hare Lip or from Feeble Lips
The former requires the surgeon. The latter may,
in some cases, be aided by massage, electricity, and lip
gymnastics. The lip gymnastics include specially
pressing them tightly together, holding them tightly
while the breath is pressed
against them, pouting,
puckering, etc. If the
lips are weak on account
of muscular dystrophy,
all such treatment must
Lisping from Tongue Defects
When the tongue is too
thick, too small, too
clumsy, or injured, the
resulting inaccuracies may
be mitigated by careful
gymnastics (p. 160) and
training by means of mir-
ror, palatograms (p. 114),
FIG. 97. Hemiatrophy of the
Degeneration of the nerve
centers had caused one side
of the tongue to become much
smaller and weaker. This
caused the patient to lisp.
The lisping had produced
such a condition of embar-
rassment and fear that she
was considered back-
ward, although really per-
fectly normal mentally.
Hemiatrophy of the tongue (Fig. 97) shows itself
in smallness of one side of the tongue, in grooves in
the surface and in fibrillary twitchings. The speech
is usually correct, but not always so. The speech of
164 STUTTKKINC AND Us|'|\r,
one girl of fifteen was so indistinct that she could
not get along in school and was considered mentally
dull. The correction and scolding at school and by
the mother had produced intense depression. The
cause was a hitherto unobserved hemiatrophy of
the tongue which made it difficult to use the tongue
properly (organic lisping) ; this had so confused her
that she made all sounds indistinctly (negligent
A stuttering boy of eight years was found to have
imperfect enunciation, due to confused habits of
enunciation arising from weakness of one side of
the tongue. The physical defect had thus produced
organic lisping, which had in turn produced negli-
gent lisping. The embarrassment and shame had
produced not only severe stuttering, but also a serious
deformity of character.
Lisping from Tongue-Tie
When the frenum of the tongue is too short, it
prevents the tongue from rising sufficiently in front
to cut off all the air except what passes through a
small channel to make the "s" sound (Fig. 56).
The sound actually produced is more like "th";
ORGANIC LISPING 165
e.g. "people thay I lithp, but I don't pertheive
it." If the person can project the tip of the tongue
beyond the teeth, the tongue is free enough for cor-
To cut the frenum the region is thoroughly co-
cainized ; an incision is made with aseptic scis-
sors ; the membranes are then torn slightly further
by the fingers wrapped in gauze. A too deep in-
cision risks cutting large blood vessels.
In older people the lisp may still remain as a habit.
It should then be treated as in the case of "t" for
"a" (p. 130).
There is an antiquated belief that tongue-tie
causes stuttering. It cannot do so directly, but I
have had cases where the lisping due to tongue-tie
had made the person so nervous that he had become
a stutterer (p. 43).
Lisping from Jaw and Tooth Defects
Overshot and undershot jaws are due mainly to
irregular development of the teeth. The undershot
jaw occurs also with the disease akromegaly. In ex-
cessive cases of overshot or undershot jaw the pro-
jection may be so great that the lips do not close
166 STUTTERING AND LISIMM!
properly for "f," "v,""p," "b," "m," and several of
the vowels. In these and similar cases it is frequently
difficult to adjust the tongue quite correctly, especially
for "s." With strongly undershot jaw the "s" sound
may be produced as the tongue moves to its posi-
tion to make a "t"; "tool" sounds like "stool."
When the upper front teeth project much beyond the
lower ones it is frequently difficult to adjust the
tongue so that the jet of air strikes the lower teeth
correctly for "s" (Fig. 56) ; the sound is rather like
"sh." The procedure is like that for the similar
cases in negligent speech.
The gaps left by extracted teeth often affect the
"s" in ways difficult to remedy except by insert-
ing artificial teeth.
Sometimes a canine tooth is bent inward in such
a way as to hinder the tongue in making "t"; a
slight "s" sound precedes the "t."
For many jaw and tooth defects the most impor-
tant therapeutic procedure is orthodontism. If the
child is under sixteen years old, he should be put in
the care of an orthodontist. Older cases are usually
ORGANIC LISPING 167
Lisping from High. Palatal Arch
The defect mainly affects the "s" ; the person has
difficulty in getting the tongue properly again t the
palate to produce the small channel. Sometimes he
lets the air escape at the sides. Sometimes the at-
tempt to press the tongue up tightly leads to a strong
spasmodic pressure at every "s." One such pa-
tient with the "s" spasm was often supposed to be a
person who stuttered only on "s." In one case the
patient, eleven years old, had given up all effort at us-
ing the tongue for "s," replacing it by a pause filled
by a cramp in the larynx. He pronounced "sink"
apparently like "ink" ; in reality the pronunciation
was ('ink), where (') indicates the glottal catch.
The distortion of speech caused by the omission of
the "s" had produced so much trouble that the boy
had acquired the strained, hoarse voice and the sad
face of a stutterer. The defect can be cured or
alleviated by careful attempts to get the proper
position. The spasmodic cases are helped by train-
ing in soft and relaxed speaking. With the patient
just mentioned who always omitted the "s," the cure
consisted in teaching him to use "ts" for "s,"
His STUTTERING AND l.lsi'INC
whereby he would say "tsoup" for"up." As soon
as the habit was formed, he dropped the "t" and
retained the "s."
Lisping from Cleft Palate
When the velum cannot close the rear passage
through the nose, all the sounds except nasals are
modified. All the explosives become nasal sounds,
thus "p" and "b" become "m," "d" becomes
"n," "g" becomes "ng," "t" and "k" become surd
"n" and "ng," "s" becomes a snort, etc. The
vowels are all nasal.
After the velum has been closed by operation,
there may be little or no ability to raise it into place
across the pharynx. Its muscles can be strengthened
by the velar hook (p. 154). Exercises can be devised
for teaching the use of the velum, such as blowing out
a candle, playing a mouth harmonica, etc. The pa-
tient does them at first while holding his nose closed
with his fingers ; he gradually lessens the finger pres-
sure and tries to substitute velar action.
With a light illuminating the interior of the mouth,
the patient observes his velum in a mirror as he sings
"ah" on a low note and then on a high note. The
ORGANIC LISPING 169
velum should rise for both notes, more for the higher
ones. Exercises with a nasal indicator, tissue paper
flag, etc., as described for negligent speech (p. 153),
aid in giving the proper control. Electrical stimula-
tion (p. 154) is often very effective.
To make the velum rise during the occlusives
"p, b, t, d, k, g" they are pronounced singly and in
words with much prolonged occlusions and sharp
explosions at the end. This cannot be done unless
the velum is properly raised.
Occasionally some of the velar associations are very
firmly fixed ; special devices must be tried to break
them up. Thus, if the velum persists in remaining
down for "s," rods of various sizes may be placed
over the tongue (p. 143, Fig. 76).
The loss of air during speech with a cleft palate
naturally leads the patient to take breath repeatedly
within a sentence. The habit may persist after the
operation ; in such a case systematic breath exer-
cises are to be performed.
The great effort involved in speaking with a cleft
palate may lead the patient to overexertion of all his
speech muscles; this produces a grimacing speech;
that is, the muscles of the face overact. This is
170 STUTTKHINC. AND LISIMNC
liable to persist after operation. Relaxation is
taught by speaking with no lip motion (as in ven-
triloquism), by singing, by exercises in melodious
speech (p. 74), etc. The nervous rapidity of speech
requires exercise in slowness (p. 85).
Lisping from Relaxed Palate after Adenoids
When a person has large bunches of adenoids, the
closure of the velum is made against them. After
they have been removed, the velum sometimes
makes the same amount of movement as before.
This leaves a gap between it and the rear wall of
the pharynx whereby all sounds become nasal.
The treatment is the same as for negligent lisping
Lisping from Obstructed Nasal Passages
The obstruction deprives the nasal sounds more
or less of their peculiar ring. Thus "m" sounds
like "b,""n" like "d," etc.
This condition is found temporarily in severe
colds ; the turbinates in the nostrils become swollen
and the nasal cavities are more or less closed. Per-
manently enlarged turbinates or a deflected septum
may cause a similar result. With large adenoids tin-
ORGANIC LISPING 171
passage through the upper pharynx is also more or
In regard to speech this condition is the opposite
of that with cleft palate. The nasalization from
cleft palate, etc., consists in adding nasal tones to
sounds where they do not belong. The denasaliza-
tion from obstruction consists in eliminating nasal
tones when they should be present.
No special voice treatment can improve this condi-
tion. For colds the treatment comprises a laxative
(Seidlitz powder, citrate of magnesia), cleansing with
antiseptic sprays, menthol, coryza wool, etc. Tur-
binates, adenoids, and tonsils are referred to special-
Lisping from Defective Hearing
When the hearing is diminished, the child may fail
to grasp the finer essentials of the sounds. In mild
cases the words may be spoken loudly into his ear.
Each incorrect sound may also be treated separately
as described in the chapter on Negligent Lisping.
Hearing tubes are often useful.
In more severe cases lip reading should be taught
in a way somewhat similar to that for deaf children.
By feeling the teacher's larynx and his own larynx
172 STUTTERING AND LIsiMMJ
and by listening to loud tones from a musical in-
strument the child gets a definite idea of pitch and
of the adjustment he must make in his larynx in
order to produce musical sounds. Then by watch-
ing the instructor's face and by looking in the
mirror he learns the positions of the lips for the
individual sounds. In a similar way he learns the
positions of the tongue for "t," "d," "k," "g," etc.
The positions are explained by the diagrams in the
plates at the end of this book. The tongue posi-
tions for the vowels and consonants can be taught
in this way.
To show the various amounts of breath that issue
during the vowels, during "h," during the frica-
tives, and for the explosions in the occlusives, the
patient's hand is put before the instructor's mouth
and then before his own. A slate, a cold piece of
metal, or the breath indicators described on pages
119-121 can be used for the same purpose. The
presence or the absence of nasality can be shown
in a simlar way. As much as possible the child
should be made to hear all the sounds. When such
children are spoken to, they should be able to see
the face of the instructor.
PATIENTS with this trouble often enunciate sounds
in ways that resemble negligent speech. The failure
of the methods of treatment for negligent speech
first made it clear to me that this disorder was of
an entirely different nature.
One patient used "t" for "s," "d" for "z," and
"t" and "d" for the two forms of "th," the tongue
action being the same as that described on pp. 130,
141. The patient also said "tsoe" instead of "shoe."
The occlusives (t, d, k, g) were used correctly, but
they had no explosions (p. 157). This was quite in
contrast to the false occlusives "t" and "d" used
for "s," "z," "th," as these had strong explosions.
The patient had learned to talk clearly, but at four
years of age she fell, striking her head ; she remained
unconscious for several hours.
A few days afterwards she had convulsions ; they
were frequently repeated till the age of six. The
174 >'i i TTEBINQ AND USIMM;
defect in speech appeared shortly after the fall.
She now has a tremor of the entire body when she
attempts to speak. There is also a tremor of the
lips during "p" and "b" and a tremor of the laryn-
geal tone when a vowel is sung. It is hard to get her
to produce any loud or long sound ; every sound,
even a simple hiss, is produced in a manner indica-
tive of excessive timidity and almost of fright. These
conditions never occur in cases of negligent lisping;
the patients are always perfectly cool and deliberate ;
they are sluggish and phlegmatic instead of nervous.
The similarity of her mental condition to that of the
stutterer is evident.
Graphic records were made of the air current for
the mouth while she pronounced some sounds.
The arrangement was that shown in Fig. 7. When a
current of air issues from the mouth, the recording
lever rises and the white line bends upward. A de-
scent of the line indicates that the air current is
diminished or cut off. The decrease of the air current
may be due to some adjustment of the tongue or
lips or to a cessation of the pressure from the chest.
The record for "so" in Fig. 98, spoken by a
normal person, shows that the air current steadily
NEUROTIC LISPING 175
increased during the first part of the "s" and then
fell somewhat. The small waves in the record are
due to the laryngeal vibrations; in "so" they indi-
FIG. 98. Mouth record of "so" spoken normally.
The first part of the line registers the emission of the air during
the "s" ; it rises and falls smoothly. The small vibrations indicate
the waves of the vowel.
cate the vowel. A record of "so" spoken by the
patient is given in Fig. 99. Instead of the gradually
increasing and diminishing air current for "s," the
FIG. 99. Mouth record of "so" in neurotic lisping.
There is very little emission of the air for the "s" ; it is suddenly
cut short by complete stoppage. The sudden descent of the line at
the beginning indicates that the tongue was drawn sharply back.
The larger waves after the step show the explosion as the "t"-like
sound is completed by the release of the tongue. The small vibra-
tions are those of the vowel.
patient merely starts the current, and then not only
cuts it off, but actually causes the line to fall below
For the normal "s" the tongue is placed against
the roof of the mouth in such a way as to leave a
176 STI TTKUI.M; AND USI-INC
small channel in the middle, through which a jet of
air is directed against the lower teeth. A palato-
gram for normal "s" is shown in Fig. 54 ; a mouth
diagram of the position of the tongue is shown in
Fig. 56. During the normal "s" a current of air
passes to the recording apparatus and causes tho line
to rise steadily.
The record in Fig. 99 indicates that the patient
pressed the tongue so hard against the top of the
mouth that she closed up the small channel ; more-
over, in doing this she made such a forcible move-
ment of the tongue that air was actually drawn into
the mouth for an instant. The sudden rise of the
line indicates that, as the tongue was released from
its place, the air burst from behind it in the form of
a sharp puff, or explosion, that acted like a blow
on the recording membrane. The sound produced
by such action is like that of "t." Apparently the
patient substituted "t" for "s." In like manner
for "z" she used a sound like "d."
The mechanism for the defective "s" is like that
for occluded "s" (p. 130), as indicated by the palato-
gram in Fig. 55 and the mouth diagram in Fig. 57.
The tongue is pressed against the palate harder
than it should be ; the small channel is thereby
The graphic record of "silk" (Fig. 100) in normal
speech shows a rather long emission of air for "s,"
FIG. 100. Mouth record of "silk" spoken normally.
The "s" and the vowel are indicated as in Fig. 98. The "1"
is represented by some small vibrations at the end of the vowel.
The "k" begins as a fall in the line due to cutting off the breath by
the tongue ; it ends in a strong upward movement due to the ex-
plosion as the tongue is released. '
followed by waves for the vowel and "1." The "k"
begins as the vowel waves cease ; the line falls be-
FIG. 101. Mouth record of "silk" in neurotic lisping.
There is first a brief intake of breath, then an emission of breath
corresponding to a normal "s." This is followed by an occlusion
with an explosion. The sound is thus partly a normal "s," as in
Fig. 98, but mainly an occlusion with an irregular explosion. The
following fine vibrations belong to the vowel and "1." The "k" is
represented by a straight line due to the stoppage of the breath by
the tongue ; the abnorm ality is shown by the lack of an explosion
wave for the "k," the breath being stopped before the tongue is
cause the current of air is cut off by the tongue ;
the explosion of the "k" is marked by the sudden
rise of the line at the close.
17S STlTTKRINd AND LISPIV;
The record of "silk" (Fig. 101) by the patient shows
a sharp inrush of air followed by a sudden rise of
the line with some emission of air thereafter. The
inrush of air indicates presumably an extremely
brief gasp as she starts the tongue movement. The
sudden rise shows that the sound "s" is begun.
This sound is at first a true though faint "s," some
air being emitted. There follows, however, a sudden
FIG. 102. Mouth record of "shoe" in normal speech.
The emission of air during the "sh" is similar to that of "s" in
Fig. 98. The record ends with the vowel vibrations.
drop of the line ; this shows that the breath has been
stopped and that the sound has become an occlusive.
The sudden rise of the line thereafter shows that this
sound, like most occlusives in English, ended with
an explosion. The first part of the sound was thus
a true "s," while the second was an occlusive "s"
with an explosion. The remainder of the record
shows the waves for the vowel and "I" followed
by a straight line for the occlusive "k." The "k"
is abnormal, having no explosion.
The record of "shoe" in Fig. 102 is that for normal
NEUROTIC LISPING 179
speech. It shows an emission of breath during u sh"
similar to that for "s" in Fig. 98. The action of the
tongue for u sh" is like that for "s" in forming a
channel through which the air is directed. A
palatogram for normal "sh" is given in Fig. 69;
a mouth diagram in Fig. 70.
A record of neurotically lisped "shoe" is given
FIG. 103. Mouth record of "shoe" in neurotic lisping.
The straight line, the sudden fall, and the strong waves show that
the tongue closed the mouth, was sharply drawn back, and was then
released with a strong explosion. Then followed a faint breathy
sound like a weak "s." The record ends with the vowel vibrations.
To the ear the word sounded somewhat like "tsoe."
in Fig. 103. There is a sudden intake of breath ; this
is abruptly released. This indicates that at the
start the tongue was placed tightly against the palate.
As it was released to form u sh," it permitted a slight
puff of air to pass. This would produce a short
"t." The "t" was followed by a rather faint emis-
sion throughout the "sh." There was no occlusion
during or after the emission ; otherwise the line would
have descended at some point as in the "s" of Fig.
99. That the passage was not wide open, however, is
ISO STITTKK1N<; AND USl'INC
shown by the slight elevation of the HIM- during the
emission of the breath and by the sudden rise (slight
explosion) in the line at the end of the "sh" just
before the vowel begins. The sound is not so open
as in the normal "sh." The impression on the ear
was that of "tsoe" rather than "shoe."
For the two forms of "th" as in "thick" and
"this," she used sounds resembling "t" and "d."
For "th" the tongue is pressed against the palate
at the sides, but the contact in front is so light that
the air escapes (Fig. 71). The patient pressed the
tongue too tightly and cut off the air entirely.
The condition for "k" noted in Fig. 101 is typical
for all her occlusives, i.e. sounds involving a complete
closure of the mouth passage; namely, "p," "b,"
"t," "d," "k," hard "g." In these she regularly
weakens the breath pressure before they end, so that
they have no explosions when the tongue or the lips
release the tension. This is quite in contrast to the
incorrect occlusives that she makes out of the frica-
tives "s" and "sh," etc., to which she gives strong
The case seems at the first view to be one of what
has been termed "negligent lisping" (p. 122) . Children
NEUROTIC LISPING 181
with this trouble regularly substitute "t" for "s,"
"d" for "z," and "t" and "d" for the two forms
of "th," just as this person does. The defect arises
from the same cause, namely, pressing the tongue too
tightly against the palate.
The excessive tongue action in negligent lispers
arises from negligent observation and careless action.
The children with negligent speech are usually those
that have grown up in surroundings unfavorable to
careful enunciation, as among the poorer classes or
where baby talk has been encouraged. This patient,
however, had learned to talk clearly. Moreover, she is
not careless about her speech, but overanxious. Her
tongue touches her palate not simply because she is
too negligent to take the pains to leave a small open-
ing, but because it is seized by an uncontrollable
It is evident that we have here a form of speech
characterized by quick nervous muscular action in-
stead of the deliberate smooth action required for nor-
mal sounds. In trying to make the "s," for example,
the patient is too nervous to carry out the fine
adjustment requisite; she presses the tongue too
tightly and thus makes a "t." The result for the
182 STl TTKKINC AND
hearer is the same as in negligent li-pinp;. but the
nervous processes in the two diseases are quite dif-
Can this be a form of stuttering where the exces-
sive contractions are quite limited ? A never-failing
symptom in stuttering is the excessive contraction
of the laryngeal muscles whereby the laryngeal tone
becomes hard and monotonous; here the laryngeal
tone is rather soft and timid. Moreover, the stut-
tering cramps are never confined exclusively and
constantly to just a few sounds. They frequently
vary from time to time, the trouble being on "p,"
for example, during one month and on "s" during
another month. Again, the stutterer will have
trouble not on a single consonant wherever it occurs,
but on consonants in a certain position, generally
initial ones. Facial and bodily contortions often oc-
cur with stuttering, but I have never found tremor
present. We must conclude, I think, that this is not
a case in any way resembling stuttering, although
the cause may be the same.
Another case was that of a girl of thirteen who lisped
over all the consonants. Her speech was at times
almost unintelligible. Treatment along the lines
NEUROTIC LISPING 183
of muscular and mental education indicated for
negligent lisping produced no result. She was an
excessively nervous child, and she spoke with in-
credible rapidity. As she was gradually quieted down,
the lisping decreased. It became evident that the
excessive nervous tension, combined with self-con-
sciousness, produced a tense condition of the vocal
organs allied to that of stuttering. She could not
produce the smooth and delicately adjusted move-
ments of normal speech because her muscles were
Another case of nervous lisping was that of a girl
of twelve whose speech was mumbled. Her
mother thought her tongue was too long; her
father thought there was something the matter
with her intelligence. The methods for curing
negligent lisping were fruitless. It became evident
that partial deafness had made it ; hard for her
to learn to speak. Being a sensitive child, the con-
stant correction by the parents and the embarrass-
ment and fear before them had produced a condition
of nervousness much as in the previous case.
She spoke improperly because she overinnervated
the speech muscles. She began to improve under
1X1 STUTTERING AND LISIMNC
quieting treatment. Unfortunately the parents did
not trust the diagnosis, and preferred to regard the
defect as one of intellect.
Neurotic lisping is rather frequently found combined
with stuttering. A patient twenty-eight years old was
a typical stutterer. At the same time his speech was,
aside from his stuttering, so indistinct that he was
frequently asked to repeat a word. For example,
he would say that he had been to Hartford in such a
way as to leave it in doubt if he had said " Harwood,"
"Harvard," " Havre," or something similar. The
"s"s and "n"s were weak and often inaudible.
The explosions of the occlusives "p," "b," ' V "<V
"k," "g" were generally omitted. The "r" sounded
sometimes like "u" and sometimes like "1." The
words were often contracted to unintelligible
mumblings. Treatment by the methods used for
negligent lisping made the trouble worse. The
treatment for his stuttering included methods that
caused the patient to relax his vocal muscles. It
was noticed that during such relaxation the con-
sonants were often spoken correctly. It was thus
evident that the lisping was due to excessive general
innervation, that is, that it was neurotic lisping.
NEUROTIC LISPING 185
For differential diagnosis we may sum up as fol-
lows : Neurotic lisping is allied to stuttering in its
causation (fright, nervous strain) and in the pres-
ence of an emotional disturbance. It differs in hav-
ing excessive muscular tension of a constant rather
than a spasmodic kind ; this results in speech some-
what like lisping and not in the peculiar sounds of
the stutterer. It differs from negligent lisping in
the fact that it appears in nervous persons and not
in phlegmatic or dull ones, and that the muscular
movements are cramplike instead of careless.
The general treatment is mainly that for neuras-
thenia. General hygiene, mode of life (school,
profession), moral habits, eyestrain, nose and throat
conditions, etc., must be considered. Arsenic,
quinine, strychnine, and other tonics, cold rubs,
lukewarm or cold half baths, sprays, moist packs,
electrotherapy, massage, change of climate, and sea
baths may be tried. Open-air exercise is always
admirable. Hypnotism and other forms of psy-
chotherapy are often most efficient.
The special speech treatment consists in ex-
plaining the trouble to the patient and then having
him repeat sentences, answer questions, and talk
ISO STUTTERING AND LISPING
in a relaxed way. The relaxation may be brought
about voluntarily or by suggestion. An efficacious
method of suggesting relaxation is to have the patient
recline on a couch and gradually fall into a semi-doze
while repeating sentences or conversing.
CLUTTERING is characterized by great nervousness
that shows itself in excessive rapidity of speech with
indistinct enunciation. When the patient starts
to speak, he hastens recklessly through what he
has to say. The nervous hurry of his mind makes
him form and combine the sounds imperfectly.
Sounds, syllables, and words are mumbled together.
The breathing may become spasmodic and irregular.
A normal person can speak as rapidly as a clutterer
without necessarily losing the distinctness in enun-
ciation ; it is the clutterer's nervousness that produces
Cluttering is usually combined with stuttering, but
it can be distinguished from it. In the one there is
nervous haste ; in the other there is nervous fear.
The clutterer speaks better the more he thinks about
his speech, the stutterer often speaks better the less he
thinks about it. The clutterer shows negligence and
188 STUTTERING AND LISPING
lack of self-control ; the stutterer cannot release him-
self from anxiously watching over his speech. My
experience has included only a Jew cases of clutter-
ing without stuttering. Quite a few stutterers are
Cluttering sometimes produces stuttering. The
cluttering child is ridiculed or made anxious in
other ways until the "stutterer's fear" is produced.
One unusually bright but excessively nervous and self-
willed boy of six had developed a language of his own,
which he spoke at excessive speed. This speech was
intelligible only to his younger brother, who had
learned to speak in the same way. His notions of
spelling were likewise completely confused. The
troublesome situations that had resulted from the
cluttering had embarrassed the boy and made him
anxiously nervous, with the result that he both
cluttered and stuttered.
Negligent lisping, when it includes many sounds,
resembles cluttering in the general indistinctness
of speech, but the two disorders can be distinguished
by the fact that in cluttering the speech is quick and
hasty, whereas in negligent lisping it is of normal or
slow speed. With very slow speech the cluttering
sometimes disappears, the negligent lisping remains.
All sorts of sounds are affected in many cases of
cluttering; in negligent lisping a definite set is
affected. It is my experience that some clutterers
make a set of defective sounds, such as "s" or
"sh," incorrectly even when they speak slowly. It
is not correct to say such cases have negligent lisp-
ing also, because the cause namely, the mental
attitude is utterly different in the two cases.
The therapy consists of tongue gymnastics, of
exercises in enunciating words singly and in com-
bination, and in speaking slowly and distinctly.
If the clutterer is forced to enunciate certain sounds,
such as the explosives (p. 117) or "s" very distinctly,
he is obliged to speak slowly, and can thus learn to
enunciate all sounds better. The breath indicator
(p. 119) can be used. In severe cases the treatment
may begin with singing. The nervousness may be
combated by proper hygiene, tonics, rest cures,
hypnotics, or psychanalysis.
BREATHING (p. 84)
1. Active Calisthenics
A. Standing, breathing while raising arms fore
upward and side downward.
B. Same, raising arms side upward and down-
C. Broad standing (that is, with feet separated),
neck firm (that is, finger tips touching back of neck,
elbows out), sideward bending alternately right and
left (breathe in on upward movement).
D. Broad standing, neck firm, turn trunk to right
and then to left as far as possible, inspire on return-
ing to position.
E. Broad standing, hands on hips, turn to right as
far as possible, then forward and backward, inspire
on returning to position ; continue turning to left.
F. Broad standing, arms raised upward, bend
forward, rise up.
(In all these exercises inspiration through the nose
should occur as the ribs are expanded, expiration
through the nose as they are moved inwards. Each
movement is to be performed five times or more.)
2. Regulation of Breathing
A. Standing, place one hand on the chest and the
other on the abdomen ; take a long breath, enlarging
the chest in all directions, and drawing the abdomen
in. Expire by letting the chest fall and the abdomen
spring out. Repeat this, always trying to enlarge
the chest still more, and trying to blow out a
stronger breath on expiration.
B. Same on inspiration, but not using the hands.
On expiration, let the breath pass out slowly. Re-
peat this, trying to make the breath last longer and
C. Same, except that a powerful "ah" is sung.
D. Same inspiration, sing "ah" as long as possible,
(Breathing is to be done with open mouth. Each
movement is to be performed five times or more.)
192 STfTTKKINd AM) I.ISIMNC
3. limit h ing and Use of Twist (p, 7^
A. Raise the arms side upward, inhaling, lower
side downward, singing "ah" on middle c.
B. Raise the arms side upward, inhaling ; lower
side downward, singing "ah" sliding from middle c
to high c (octave twist).
C. Likewise, speaking words of one syllable with
the octave twist.
D. Likewise speaking words of two syllables with
the octave twist on the first vowel.
(Each step is to be done a number of times.)
4. Regulation of Breath in Singing
A. Sing a short song with inspiration before each
B. Sing two lines with one breath.
C. Sing three lines with one breath.
D. Sing four lines with one breath.
5. Regulation of Breath in Reading
Take a full breath before each sentence or phrase ;
wait one second, not letting any breath out. Then
speak the sentence or phrase slowly in one breath ;
do not breathe hi the middle. Use a text with short
sentences, poems, and longer prose pieces.
6. Regulation of Breath in Speaking
Holding a stick in the hand, raise it each time before
speaking, while breath is inspired vigorously. After
waiting one second with bated breath, speak as in-
A. Read a short sentence after the instructor.
B. Answer the question of the instructor.
C. Make a sentence concerning some topic assigned
by the instructor.
D. Give a description of some object pointed out
by the instructor, breathing vigorously before each
(The first two parts of this exercise can be con-
veniently combined into the "statement and question
exercise." The instructor gives a series of state-
ments and questions. Each statement is to be
repeated, and each question is to be answered. The
confidence gained by the pupil in repeating the
statement helps him in answering the questions. A
book on "travel talk" supplies convenient material.
See also p. 92.)
I'M STUTTERING AND Llsi'INC
MELODY (p. 74)
7. Giving the Idea of Melody
A. Sing a short song in the key appropriate for the
pupil's voice with inspiration before each line.
B. Speak the words of this song on the same notes,
the piano being played at the same time.
C. Same as B without the piano.
D. Speak the words melodiously, that is, with a
rise and a fall of the voice, but not necessarily on
the same notes as the song.
E. Speak the words of the song melodiously, but
with perfect freedom.
8. Introducing Melody into Speech (p. 91)
A. Sing a short song, speaking the last word of each
line instead of singing it.
B. Repeat, speaking the last two words.
C. Repeat, speaking the last three words.
D. Continue in the same way, adding word by
word until the whole song can be spoken perfectly.
E. Sing some statement, for example, "New York
is a very large city." Repeat it, speaking the last
word. Then repeat it, speaking the last two words.
Continue as before.
F. Question and answer. The instructor gives the
question, the patient gives the answer. First sing
them, then speak the last word, then last two words,
9. Introducing Melody into Recitation
"Oh, look at the moon! She is shining up there.
Oh, mother, she looks like a lamp in the air.
Last week she was smaller, just like a bow ;
This week she is larger and round as an 0."
The voice is to rise and fall somewhat in the follow-
ing way :
the is there.
Oh, at she up
B. Recite other pieces of verse and prose likewise.
10. Introducing Melody into Conversation
A . A question is sung on some simple melody or on
the notes c, e, g, c ', or as a chant on one or two notes.
The answer is sung likewise. It is of no account
19G STUTTERING AND LISIMNCl
whether the syllables exactly lit the notes or not.
This is repeated until there is no difficulty; each
of the following steps is also to be repeated until at
least fair success is obtained.
B. Statements are alternated between two per-
sons in the same musical way. At first the state-
ments may be disconnected; "Rice grows in
the Southern states"; "New York is the largest
city in America." Gradually they are to be turned
into a connected conversation.
C. Same as A, but speak the words with piano
D. Same as B, but with words spoken to accom-
E. Question and answer without the piano, but
with attempt at the melody used before.
F. Statements like wise.
G. Question and answer melodiously, but freely.
H. Statements likewise.
11. Training the Ear to Control the Voice
A. Sing "ma" on each of the notes as indicated.
B. Sing "ma" on each of the notes of the scale
going upward and downward.
C. Sing "ma" on each of the notes of the scale,
beginning and ending it very faintly, and making
^ ^ <> <> <> <>
D. Sing "ma" upward and downward on the
notes c, e, g, c r .
FLEXIBILITY (p. 74)
A. Sing the vowel "ah, ' .hrough the notes of
B. Strike the lowest note of the octave, then the
highest; sing the vowel "ah," half on the lowest
note, half on the highest.
C. Sing the vowel continuously (portamento)
over the octave (octave twist).
I'.IS STCTTKKINC AND LIM'INC
D. Practice singing the different vowels over the
octave in this way.
E. Sing a series of one-syllable words with long
vowels, running the vowels up in the same way.
A. The instructor speaks a word with the octave
twist. The pupil repeats it.
B. Same with sentences, putting the octave twist
on the first important vowel (the first important
vowel is not necessarily the first vowel).
C. Same with poems, putting the octave twist
on the first important vowel in each line.
D. Same with prose, putting the octave twist on
the first important vowel in each phrase.
E. Statement and question exercise (see note to
Exercise 6) with the octave twist.
SLOWNESS (p. 85)
(It is advisable to give the "octave twist" to the
first important vowel in each sentence, as under
Flexibility, Exercise 13, B.)
14. Speaking wiih Lengthened Vowels
A. Repeat, after the instructor, single monosyl-
lables, making the vowel three times as long as nor-
B. Repeat words of more than one syllable,
lengthening the chief vowel likewise.
C. Repeat short sentences likewise.
D. Read words from a book likewise.
E. Read poems likewise.
F. Read prose likewise.
G. Answer questions likewise.
H. Tell a short story likewise.
15. Speaking Together (pp. 62, 94)
A. Repeat or read a poem in unison with another
person speaking slowly.
B. Repeat or read it alone slowly.
C. Repeat or read a prose piece with another
D. Repeat or read it alone slowly.
E. Alternate C and D, a few sentences of each.
F. Read conversation (dramas, traveler's manual,
etc.) slowly with another person.
G. Free conversation, question and answer.
200 STITTKKING AND I.lsl'INC
16. Metronome Exercise (p. 85)
A. Speak sentences to a metronome beating 54
to a minute, with one syllable to each beat.
B. Statement and question exercise likewise
(see note to Exercise 6).
C. Tell a connected story likewise, such as what
you had for breakfast, how you spent last summer, etc.
D. Repeat A, B, C while some one holds the finger
on the metronome ready to act whenever you speak
E. Repeat A, B, C, D without the metronome.
F. Repeat A, B, C, D without the metronome,
taking care to eliminate all jerkiness of speech.
17. Speaking with, Sticks
A. Repeat sentences, striking the stick to each em-
phatic vowel and keeping time with the metronome
at 54 a minute.
B. Same without the metronome.
C. Question and answer likewise (see note to
D. Same without the metronome.
E. Tell a story about breakfast, etc., keeping time
to the metronome.
A. Repeat and read sentences, linking all the words
together, that is, making no pause or interruption
between the different words. The whole sentence
should be spoken as if it were one word, or just as in
French. "Thecoverofthebookisred." "Thecarpet-
onthefloorisgreen." " Theelectriclightisveryconven-
ient." " TheturkeycomesonThanksgivingDay."
B. Repeat and read short stories likewise.
C. Repeat sentences and answer questions likewise.
19. Vowel Start
A. Read sentences, making the first important
vowel in each sentence at least three times as long
as usual. Speak it with the octave twist. Speak
the rest of the sentence as described in the exercise
B. Read likewise.
C. Repeat sentences and answer questions like-
D. Conversation likewise.
202 >T UTTERING AND LISPING
VOICE QUALITY (p. 81)
20. Tone Placing by Chanting
A. Chant one line of a poem or a prose statement
on one note.
B. Repeat this on other notes.
C. Same, dropping to a lower note on the last word.
D. Same, short story.
E. Same, statements, question and answer.
21. Tone Placing vnth "Bee-bee-bee"
A. Strike middle c and sing "bee-bee-bee," mak-
ing the vowel sharp as in the French word "pique" ;
this is far more sharp than the English word "peek."
Go up the scale for an octave in the same way.
B. Same with "bee-ah."
C. Same with "bee-ay."
D. Same with "bee-oh."
E. Same with "bee-you."
F. Same with "bah."
G. Same with "bay."
H. Same with "boh."
7. Same with "bou."
All these vowels should, be sung in a ringing, very
slightly nasal tone, that is, in what is termed a " for-
22. Tone Placing with "Ma"
A . Strike middle c and sing ' ' mmmmmmaaaaaah . ' '
Hold "m" until the vibrations are felt strongly on
the lips; then simply open the mouth to let the
"ah" out, being careful to keep the same quality
of tone as in "m." For a high voice begin above
B. Repeat up the scale for an octave.
C. Same with "mee" ; same with "moh" ; same
D. Repeat on arpeggios of three and four notes.
Ma ma ma ma ma
Ma ma ma ma ma ma ma
204 STl TTI.KIMJ AND
23. Husky Tone
A. Strike middle c and sing "ah," beginning and
ending it with the glottal catch (p. 81). Continue
up the scale.
B. Sing arpeggios likewise.
C. Sing "ah" to the notes of a song likewise.
D. Sing a song, cutting all the words sharply
24. Trumpet and Megaphone
A. Hold a small trumpet to your lips. Shout
through it the phrase "Pie-apples, ten cents a water
pail," using the sharp tones that would be used by
a peddler calling out on the street. Use other phrases
in the same way, for example, "Nice fresh straw-
B. Call out railway stations in a similar way.
C. Same with a small megaphone. Note that you
have to make somewhat more of an effort to get the
sharpness with the megaphone.
D. Repeat all the preceding without anything
before the mouth. Make a special effort to get the
sharp ringing tone.
STARTING AND ENDING SENTENCES
25. Strengthening the First Word
A. Sing short sentences, striking a note on the
piano as you sing the first syllable. Instead of
using the piano you may strike a bell or a table or
you may hit your knee or make a gesture as in beat-
B. Repeat the same sentences, with the same
accompaniment in the same way, but singing only
the first word.
C. Speak them with the same accompaniment
on the first syllable.
D. Question and answer are sung with the ac-
companiment on the first syllable.
E. As before, but only the first syllable sung,
the rest being spoken.
F. As before, but all spoken.
G. Tell a story, singing the first word of each
sentence with the accompaniment.
H. Tell a story without singing, but accompany-
ing each first syllable.
JIM, STTTTKKIMi AND LIS1MNC
26. Emphasizing Periods
A. Read short sentence-, striking :i hell or a piano
note at the period.
B. Read a story likewise.
C. Question and answer likewise.
D. Tell a story likewise.
E. Raise a heavy weight in the hand and hold it
till a period is reached. Read and speak sentences,
27. Lowering Tones at the End
A. Chant sentences on one note, but drop by a
fifth sol to do on the last syllable. Use the
piano at first, but gradually omit it.
B. Speak sentences on a rather high tone, and
drop on the last word.
28. Clear Endings
A. Sing sentences, cutting the last word short
with the glottal catch.
B. Speak sentences, singing the last word sharply.
C. Speak sentences, making sure that the last
syllable is sharp.
ENUNCIATION AND SPELLING (p. 88)
29. Typical Sounds (p. 117)
A. Indicate by printed or written letters on
paper, blackboard, or chart the typical explosives
"p, b, d, t, k, g"; show their explosions by paper
flags or the breath indicator (pp. 153, 119).
B. Indicate the typical fricatives " f, v, s, z, sh,
C. Indicate the occlusive-fricatives "ch and j."
D. Indicate the nasals "m, n, ng, " showing that
air issues through the nose.
E. Indicate the liquids "1, r."
F. Indicate the semi- vowels "w, y. "
30. Combination of Sounds into Syllables
A. Combine each of the explosives "p, b, t, d, k, g"
with various vowels; indicate the result on paper,
blackboard, or chart and speak it at the same time ;
thus, "pa, pay, pee, po, pu, ba, bay, bee, bo, boo," etc.
B. Same with fricatives and the other sounds of
the previous exercise; thus "fa, fay, fee, fo, foo,
va, vay, vee, vo, voo," etc.
208 STUTTERIXO AND LISPIXO
C. Form syllables with explosives followed by
"r" and the vowels: thus, "pray, pree, pro, proo,
bray, bree, bro, broo," etc.
D. Same with "1" instead of "r"; thus, "play,
plee, plo, ploo, blay, blee, bio, bloo," etc.
31. Division of Words into Syllables (p. 88)
A. Learn to spell words, dividing them into syl-
lables according to the dictionary. Pronounce each
syllable separately, for example, "a-c, ac, c-e-1,
eel, e-r, er, a-t-e, ate, accelerate."
32. Giving the Idea of Emphasis
A. Sing "ah" with notes on the piano as
This gives an idea of emphasis by change in pitch.
B. Sing "ah" on one note but with different
lengths as indicated.
This gives the idea of emphasis by change of
C. Sing a ah" on the same note and with the same
length, making the first one of each group of three
louder than the others.
This gives the idea of emphasis by change in loud-
33. Developing Expression
In each of the following exercises the instructor
first shows the pupil just what he is to do. He
criticizes the pupil's deficiency, and imitates him
where he fails to get the proper expression.
A. Repeat a poem with expression.
B. State a certain fact in a very melodious and
C. When the instructor gives a question in a very
melodious and expressive voice, answer it by taking
a few words from the question.
D. As before, but answer freely with the same
melody and expression as in the question.
E. Recite poems and prose pieces with proper
210 MTTTKKING AND LISIMNC
F. Read dialogues with the proper change of ex-
pression for each character.
G. Read and speak jokes with an effort to give the
most effective expression.
CONFIDENCE (p. 90)
34. Reading Together (pp. 62, 94)
A. Read a poem together with the instructor.
Read alternate lines together and alone.
B. Same with sentences.
C. Read a prose speech together; the instructor
is to remain silent occasionally.
D. Read a prose piece; the instructor is to join
in at the first intimation of difficulty.
E. Read statements and questions sometimes to-
gether, sometimes alone (see note to Exercise 6).
F. Read parts in a drama; the instructor joins in
whenever the pupil has difficulty.
G. Read a paragraph, and then tell its contents in
your own language ; the instructor joins in wherever
there is any difficulty.
35. Speaking Together (p. 62)
A. Repeat a poem in unison with another person,
B. Repeat it alone slowly.
C. Repeat a prose piece with another person slowly.
D. Repeat it alone slowly.
36. Reading with Decided Voice (p. 98)
A. Call off the railroad stations from a time-table
through the megaphone. The voice must ring out
clearly and decidedly.
B. Same without the megaphone.
C. Read headlines from a newspaper in a similar
D. Read short sentences likewise.
E. Read short poems likewise.
F. Read short prose pieces likewise.
G. Read jokes likewise.
Speaking with Confidence (pp. 94, 95)
A. Call out railroad stations with the megaphone ;
the voice must be clear and decided.
B. Same without the megaphone.
C. Make geographical statements with and without
212 STUTTERING AND LISPINC
the megaphone; for example, "The Atlantic Ocean
is east of the United States."
D. Make historical statements likewise (that is,
with and without the megaphone) ; for example,
"George Washington was the first president of the
E. Question and answer likewise.
F. Relate a story of an incident likewise.
G. Make a speech likewise.
H. Take part in a debate likewise.
/. Take part in a continuous story which is ar-
ranged as follows : One person tells a story which
he makes up as he goes along; he suddenly stops,
and the next person is immediately to continue the
story according to his own ideas ; he, in turn, sud-
denly stops and the following person continues.
This is kept up until the story reaches the first person.
38. Buying (p. 96)
A. You are supposed to be a storekeeper with a
number of objects before you ; other people go to the
store, inquire about articles, discuss the prices and
buy. This must all be done with proper attention
to slowness and melody of speech.
B. Take the part of the buyer.
C. The store is turned into a railroad ticket office
with yourself alternately as ticket agent and as trav-
eler. Various questions concerning trains, accommo-
dations, etc., are to be asked.
D. The ticket office becomes the box office at the
theater ; the questions are to include location and
seats, exchange of tickets, etc.
39. Introducing (p. 63)
A . The instructor introduces himself to you ;
you reply, "I am glad to meet you."
B. Introduce yourself to the instructor.
C. The instructor introduces some other person
to you, you reply "I am glad to meet you" or
"How do you do?"
D. The instructor introduces you to another per-
son ; you say "How do you do ? "
E. Introduce yourself to another person.
F. Introduce the instructor to different persons.
G. Introduce different persons to the instructor.
H. Introduce two familiar persons to each other.
7. Introduce strangers to each other.
As much as possible the stutterer should feel that
214 STUTTERING AND LISPING
the instructor is at hand to speak for him in case of
40. Public Speaking (p. 95)
A . Prepare a short speech to make on an assigned
topic, and deliver it in the presence of the instructor.
B. Same in the presence of several people.
C. Make an impromptu speech on a given topic in
the presence of the instructor.
D. Same in the presence of other people.
The number of the people is to be gradually in-
creased until the stutterer feels ready to get up at any
moment and make a short speech on any topic.
41. Scenes from Life (p. 95)
A. A group of people is supposed to be in some
familiar situation ; for example, eating at a restau-
rant, riding in an automobile, forming a box party at
the theater, etc. The instructor works out the situa-
tion by description, while the persons, including the
pupil, make the appropriate remarks. For example,
if the scene is at the restaurant, the instructor takes
the part of the waiter, while the other persons order
what they wish to eat, discuss the bill of fare, etc.
If the scene is at the theater, the instructor tells a
story of the play while the persons discuss the inci-
dent, the house, their neighbors etc. In the auto-
mobile party, the instructor takes the part of the
chauffeur while the party travels to various places
and discusses what he has seen.
B. Similar scenes are worked out, the patient tak-
ing the leading part.
C. The group of persons is supposed to represent
a club, the instructor occupying the chair. Various
members are to make motions and discuss them,
officers are to be elected, etc.
D. The stutterer is made chairman of the club.
42. School Work (p. 96)
A. The stutterer is to prepare and recite to the
instructor some of his school exercises.
B. He is to do the same before several people.
(7. The group is to be gradually increased till it
forms quite a class. The instructor is to be the
teacher and is to call on the patient or patients to
D. The exercise is transferred to a schoolroom.
E. Outside teachers are called in to conduct the
216 STl TTKKING AND LISPING
43. Collection of Ideas (pp. 14, 19, 62)
A. Say some word referring to an object placed
before you or pointed out ; the word must have some
application to or connection with the object. You
may say "large" referring to its size, or "black"
referring to its color, or "read" referring to its use,
or "table" referring to its position, or "yesterday"
referring to something it reminded you of, etc.
B. Make a statement slowly and melodiously con-
cerning some object placed before you or pointed out
C. Name the objects you see on one side of the
room, proceeding systematically from left to right
and speaking slowly and melodiously.
D. Describe an object placed in front of you, us-
ing single words and proceeding systematically ; for
example, if a telephone is placed before you, you
will first use words referring to its appearance, then
to its use, then to its faults, then to its history, etc.
Always adopt some such system in selecting words.
E. Same as D, but complete sentences are to be
used instead of single words.
F. Short sentences are to be spoken concerning
objects not seen but more or less familiar; for
example, breakfast, a distant city, George Washing-
ton, Atlantic Ocean, etc.
G. A more extended account is required concerning
similar objects, as in F<
44. Increasing the Embarrassment (p. 62)
A. Part or all of the preceding exercise is to be
carried out in the presence of additional people.
B. When this can be done perfectly, you are to be
called on to make short speeches on topics that have
been given you before.
C. You are to make speeches on topics of your own
THINKING (p. 86)
45. Single Associations of Ideas
A. The name of an object is called out. You call
out the name of some other object that suggests
itself to your mind. If you are in doubt what to say,
STUTTERING AND I.ISPINC
choose some object that is often seen together with
the one mentioned. For example, on hearing the word
" horse" you reply "cart." This process is called
"association of ideas." For the present you are to
associate slowly, taking as much time as you wish.
Practice for several times with the following list
of words ; then add other words.
B. Upon hearing each of the words just used, make
a sentence about it. It does not matter what the
C. Upon hearing each of the words make a sen-
tence defining it.
D. Upon hearing each of the words state some fact
about the object implying something in regard to its
location or its use, or something that preceded it,
or caused it, or followed it, or resulted from it, or
had some relation to it.
46. Running Associations
Starting with any given word, let the mind bring
up a long series of thoughts. These thoughts
should not revolve around the original word, but
should pass away into other subjects. If necessary,
the rule may be adopted of obliging the mind to leave
the original word within three associations.
DESCRIPTION AND RELATION
47. Description (p. 19)
A. Describe an object placed before you; if you
have any difficulty, you are to adopt some system,
such as proceeding from top to bottom or according
to cause and effect, etc.
B. Same with simple pictures.
220 STUTTERIXC AXD LISPINd
C. Same with complicated pictures.
D. Same with what you see in the room or out of
E. Same with a simple topic from memory, such as
breakfast this morning, house where you live, school,
well-known buildings, etc.
F. Same with a longer experience, such as a journey,
a visit to a theater, the plot of a story, etc.
G. All the preceding exercises are to be performed
in the presence of one other person, then two, and so
A. Read aloud a short story, for example, one of
jEsop's fables ; then with the book open before you
relate the contents of the story.
B. Same with the book closed.
C. Relate some story that you have previously
read, for example, Robinson Crusoe, Cinderella, etc.
D. Same with some previous experiences, such as
last summer, last Christmas, etc.
E. Read a joke and then tell it.
F. Tell some funny story that you read some time
G. Tell what you would like to do next summer,
next Christmas, etc.
H. All these exercises are to be done in the presence
of one additional person, then two persons, etc.
/. Pretend that you are conducting a scene in
TELEPHONING (p. 96)
49. Private Line
A. Call up some one on the private telephone,
using the system of your town as nearly as possible.
First call " central," and then speak with the person
desired. You are to speak slowly and melodiously.
B. Take the part of "central" and then of the
person called up.
C. Repeat A and B in the presence of other people.
D. Do some of the most difficult exercises over
the telephone with the instructor or some other
person at the other end.
50. Main Line
A. Put your finger on the telephone switch so
that when you take the receiver off the hook, the
._>_>_> STUTTERING AND LISIMNC
telephone is not connected with " central." Some one
sit t ing beside you takes the part of " central " and the
person to whom you wish to speak. Carry out exer-
cises as on the private line.
B. With the instructor close beside you, call up
"central" and then some friends; if you have the
slightest hesitation, the instructor will speak for
C. When you succeed perfectly as in B, try the
telephone independently. The instructor is to criti-
cize your success.
TALKING WITH PEOPLE (p. 90)
51. General Conversation
A. In a group of two people, talk on assigned
topics of conversation, with material prepared be-
B. Then with three people, and so on, gradually
increasing the number in the group.
C. Gradually bring in strangers.
D. Same as A, with topics not prepared beforehand
E. Same with three or more people.
F. Same with strangers.
52. Coolness in Argument
A. Argue a question with the instructor.
B. Argue a question with somebody else.
C. Argue a question in a group of three.
D. Debate a topic with some person before a small
E. Debate a political question with interruptions
from the audience.
53. Transacting Business
A. Sitting at a desk, you ring a bell as a signal for
a person to enter. As he approaches your desk, you
greet him and ask him what he wants. If he is
applying for a position, inquire into his qualifications
and then dismiss him ; if he wants to buy or sell or
transact some other business, you are to promptly
settle the matter, speaking very slowly and melodi-
ously. A series of persons is interviewed in like
B. You are to take the part of the person entering
the office for business.
224 STUTTERING AND LISPING
RELAXATION (p. 61)
54. General Relaxation
A. Lie on a couch, close your eyes, and purposely
try to relax every limb.
B. Some one passes his hands over the various
limbs, feeling that the muscles are all relaxed. This
is repeated four or five times at intervals of about
C. Get your mind fixed on the thought of relaxa-
tion and quietness. Lie perfectly quiet in this way
for five minutes on the first occasion, for ten minutes
on the next, and so on for an increasing length of
time up to a half hour.
A. You are to lie on a couch in a relaxed condition.
Some one speaks a sentence to you very slowly and
melodiously ; you are to repeat it likewise.
B. Repeat sentences and reply to questions in the
usual way (p. 92).
C. Exercises in description and relation (p. 219) are
carried out in this relaxed condition.
56. Tongue Gymnastics (p. 160)
A. Thrust the tongue out and draw it back
quickly ; do the same slowly.
B. Move the tongue from side to side outside of
the mouth, first slowly, then quickly.
C. Same inside of the mouth.
D. Touch the point of the tongue to the upper lip.
E. Touch the point of the tongue to the roof of
mouth, keeping the mouth open; same with the
F. Touch the point of the tongue to the upper
G. Place the thumb and finger on each side of
the tongue ; broaden and narrow the tongue by use
of the muscles within the tongue ; this is felt by the
H. Place the thumb and finger below and above
the tongue; repeatedly thicken the tongue; this is
felt by the fingers.
226 STUTTERING AND Llsi'INC
57. Lip Gymnastics
A. Without projecting the lips, alternately con-
tract them to a round circle while saying "oh,"
and draw the corners back while saying "eh."
B. Same, on different tones.
C. Same, speaking sentences.
58. Relaxing the Jaw (p. 83)
A. Place the hands at the back of the cheeks;
notice the swelling of the masseter muscles during
speech ; relax them by dropping the jaw.
B. Speak the vowels, dropping the jaw at the same
C. Speak sentences, dropping the jaw as much as
D. Leave the mouth open for long periods of
59. Fixation of the Larynx (p. 83)
A. With the fingers, press backward and down-
ward on the hyoid bone ; resist its rising while you
pretend to swallow.
B. Sing "ah," pressing the hyoid bone backward ;
alternate in singing "ah" with and without pressing.
Try to make the " ah " without pressing sound like
the " ah " with pressing.
C. Speak vowels, words, and phrases as in B.
60. Jaw Position
A. Insert two fingers vertically between the teeth ;
speak the vowels in this position; speak sentences
B. While looking in a mirror, speak all the
vowels, keeping the mouth as widely open as before,
or nearly so.
C. With the mirror, speak sentences, opening the
mouth as widely as before on the broad vowels,
such as "ah" and "oh."
61. Rear Palatal Arch (p. 84)
A. Look in the mirror; observe the rear palatal
arch; whisper "ah" softly and loudly alternately;
observe that the arch is narrow for the loud whisper.
B. Try to narrow the arch by a voluntary effort
C. When the ability to narrow the arch is obtained,
sing out a loud "ah" at the moment of narrowing.
D. Same with other vowels.
E. Same, speaking the vowels.
J'JS STUTTERING AM)
62. Words beginning with "p"
pay .pie play
peel piece plum
pear pink point
pen plain pole
63. Words ending with "p"
deep help loop
drape keep map
grape lap mop
hope leap nape
64. Words with "p" in the middle
approach dipper lisping
apron dripping repeat
chapel happen repel
clapper helping repent
65. Words beginning with "6"
band bead bend
bank bear bet
bark bed bill
bat bee bind
66. Words ending with "b"
Arab crab drab sob tub
babe crib garb stab tube
bribe cube grab stub verb
cab daub probe tab web
67. Words with "b" in the middle
68. Words beginning with "t"
table tame tell town trust
tack tape test trade tune
take taste toe train twist
talk tea top trunk twine
69. Words ending with "t"
at boat fat not rate
ate cat fit nut rust
bat coat get ought what
bit eat hit put wet
STUTTERING AND LISPING
70. Words with "t" in the middle
attach attire fatal mutter tattle
attack battle fitting outer utter
attain bitter letter patter vital
attend butter matter rattle water
71. Words beginning with "d"
dance date debt desk dive
dare day deep dew dog
dark dead dell dim doll
dash deaf depth dine draft
72. Words ending with "d"
add fed lid mud road
bad glad load odd rude
bed had mad pad sad
bid lead made raid sled
73. Words with "d" in the middle
address bondage childish endless fiddle
adept boulder conduct fading gladden
binding cadet cradle federal harden
bundle cedar edition feeding widen
74. Words beginning with "k"
75. Words ending
in the middle
77. Words beginning with "g"
STl TTKRING AND LISI'IXC
78. Words ending with "g"
clog egg pig tag
dig fog rag tongue
dog frog rug tug
drag mug sting wig
79. Words with "g" in the middle
argue bungle longer
baggage digging organ
braggart dragging program
bugle laggard rugged
80. Words beginning with "ch"
chain chap cheer chill chisel
chair cheap chicken chimney chocolate
chalk cheat chief chin choke
change check child chip chop
81. Words ending with "ch"
batch crutch much pitch Scotch
beach grouch notch pouch screech
botch latch peach preach smirch
church lurch perch reach such
82. Words with "ch " in the middle
bleaching hitching perching Scotchman twitching
butcher itching pitcher screeching urchin
etcher latching preacher searching watcher
fetching lurching scorching teacher witching
83. Words beginning with "j"
84. Words ending with " j "
85. Words with " j" in the middle
adjoin engaging language regent Roger
arranging enjoy luggage reject stranger
baggage ginger manger rejoice tinged
conjurer injury prodigious religious unjust
STUTTERING AND LISPING
86. Wards beginning with-"/"
face fair fame fast fight
fact faith fan fault fine
fail fall fare feel fire
faint false farm fell fish
87. Wards ending with "f"
bluff elf hoof life rough
chafe grief if muff safe
cliff gruff laugh off snuff
cuff half leaf puff stuff
88. Wards with "/" in the middle
affair buffet effect lofty puffy
affect coffee effort offer roughen
afford differ laughter office stuffy
afraid efface lifting often toughen
89. Words beginning with "v"
vague van vain voice value
vain vast verb void vapor
vale vault vest vote very
valve veil vine valley vigor
90. Words ending with "v"
above dive glove live save
brave drive groove move valve
cave five grove pave wave
crave give have rave weave
91. Words with "v" in the middle
braver event evince having never
diving ever favor level over
evade every fever lever river
even evil flavor movement silver
92. Words beginning with " s "
sack same seed sin slate
sad school sell since slave
safe scrub set sit sleep
sail sea silk skate slice
93. Words ending with "s"
base dress kiss loose race
brass face lace miss rice
case grease lease moss slice
crease hiss loss place us
236 STUTTERING AND LISI'IM;
94. Wards with "s" in the middle
95. Words beginning with "z"
96. Words ending
in the middle
98. Words beginning with "sh" (surd)
shade shame shed ship shore
shaft shape sheet shock short
shake share shelf shoot show
shall sharp shell shop shut
99. Words ending with "sh" (surd)
ash dish lash rash trash
bush fish mash sash thrush
cash flash push slash wash
dash fresh plush smash wish
100. Words with "sh" (surd) in the middle
ashes bushel crashing flashing rashly
bashful bushy crushing flushing rushing
blushing cashier dashing hushing washing
brushes clinching fishy freshness pushing
101. Words with "sh" (sonant)
adhesion delusion evasion Parisian seizure
azure derision invasion pervasion treasure
cohesion division leisure pleasure vision
decision elision measure precision visual
STUTTERING AND LISPING
102. Wards beginning with "th" (surd)
thank thin thirst three throb
thaw thing thorn thrift throw
thick think thought thrill thrust
thief third thread throat thud
103. Wards ending with "th" (surd)
bath broth faith month tooth
blithe death fourth moth width
both depth fifth mouth wrath
breath earth lithe path wroth
104. Wards with "th" (surd) in the middle
athirst bathos ethereal monthly southerly
athlete earthly . lengthen pathway strengthen
athwart Ethel Matthew pathetic youth
author ether method pathos zither
105. Words beginning with "th" (sonant)
than them they this thus
that then these thou they
the there thine though therefore
106. Words ending with "th" (sonant)
bathe clothe lathe soothe
breathe swathe smooth loathe
107. Words with "th" (sonant} in the middle
another brother further lather panther
bathing either gather leather rather
bother father heather neither together
breathing feather mother other weather
108. Words beginning with " w "
wad weak wish willow wafer
wag wealth wit wily wager
waif wear wolf wince wagon
wail wax worn wife waffle
109. Words with "w" in the middle
awake bower jewel rower towel
aware cower lower sewer tower
bewail dowry mowing slower trowel
bewitch fewer power sowing vowel
240 STUTTERING AND LISPING
110. Words beginning with "y"
yacht yawn yeast yes yoke
yard ye yell yesterday you
yarn year yellow yet young
yawl yearn yelp yield youth
111. Words beginning with " r"
race rasp rid rob rule
rack rat ride robe run
raft rate ridge rock rung
rag rave rig rod rush
112. Words with "r" between vowels
arrow errand marry narrow terrace
berry ferry merry parrot terror
current garret mirror pirate turret
direct hurry moral sorry worry
113. Words with "r " after a consonant
braid bread drive dry fruit
branch break droop fraud fry
brass crab drop free grape
brave drip drum frost grease
a 7 >>
114. Words beginning with " I
lad leaf let lion long
lake leak lick lip loose
lame lean lie live lot
lamp left limp loaf low
115. Words ending with " I "
animal avail bell call deal
annual owl bewail camel dial
appal bail bill cereal eel
appeal bawl boil chill fool
116. Words with "I" between vowels
alarm along elegant eleven illegal
alert aloud element elope illumine
allow alum elephant eloquent illusion
alley elect elevate island olive
117. Words beginning with "m"
machine magnet major man milk
mad maiden maker measure monkey
made mail malice meat move
magic mane mama meal must
STUTTERING AM) Lisi'ixr,
118. Words ending with " m "
119. Words with "m" in the middle
amaze company limit
amount dreamer mama
bemoan former mimic
comma hammer moment steamer trimming
120. Words beginning with "n"
name niece no north nudge
neck niche nod not number
nest night noon note nurse
nice nine noose now nutshell
121. Words ending with " n
alone dawn John pine
balloon fine moan pint
bean gone moon prune
122. Words with " n" in the middle
Annie corner honor panel tender
banner counter lining render whining
bonny dinner money running winner
briney fountain only sooner wonder
123. Words with " ng "
ailing covering having nothing ringing
bending caring killing pudding singer
being counting laughing remaining willing
bringer crawling living ring wringer
PLATE I. Mouth Diagrams for Typical English Sounds.
PIRATE II. Mouth DinKrnm for Typir-jil Enjtli.sh Sounds
PLATE III. Mouth Diagrams for Typical English Sounds
PUATB IV. Palatograma fur Typical Engliah Sounds
FOR COMPLETE WORKS ON THE VOICE
Rousselot, Principes de la phon&ique experimentale, Paris, 1897,
Scripture, Elements of Experimental Phonetics (Yale Bicen-
tennial Series), New York, 1902
FOR THE PRINCIPLES OF PHONETICS
Sievers, Grundziige der Phonetik, Leipzig, 1901
Victor, Elemente der Phonetik, Leipzig, 1904
Victor, Kleine Phonetik, Leipzig, 1907
Grandgent, German and English Sounds, Boston, 1892
Sweet, Primer of Phonetics, Oxford, 1890
Jones, The Pronunciation of English, Cambridge, 1911
FOR SPEECH DEFECTS
Gutzmann, Sprachheilkunde, 2 ed., Berlin, 1912
Kussmaul, Die Storungen der Sprache, Leipzig, 1885 ; 4 ed., 1910
Liebmann, Vorlesungen iiber Sprachstorungen, Berlin, 1898-
Rouma, La Parole et les troubles de la parole, Paris, 1907
FOR ACCOUNTS OF STUTTERING
Gutzmann (A.), Das Stottern, 6 ed., Berlin, 1910
Gutzmann (H.), Das Stottern, Frankfort-a-M, 1898
Liebmann, Stotternde Kinder, Berlin, 1903
246 STUTTERING AND LISPING
FOR P8YCH ANALYSIS
Freud, Traumdeutung, Leipzig- Wcin, 1911
Freud, Selected Papers on Hysteria and other Psychoneuroses,
(Brill), New York, 1909
Freud, The Origin and Development of Psychanalysis, Clark
University, Worcester, 1910
Jung, Diagnostischc Associationsstudien, etc.
Stekel, Nervdse Angstzustande, Berlin-Wien, 1908
Stekel, Die Sprache des Traumes, Wiesbaden, 1911
White, Mental Mechanisms, New York, 1912
Cluttering The disease described on p. 187.
Deltacism Defective pronunciation of "t " and "d" (p. 127).
Frontal sigmatism See simple sigmatism.
Gammacism Defective pronunciation of "k," "g" (p. 128).
Lambdacism Defective pronunciation of "1" (p. 149).
Lateral parasigmatism See lateral sigmatism.
Lateral sigmatism Producing "a" and "z" with side opening
Lisping The group of diseases described in Part II ; another use
of the word confines it to simple sigmatism.
Nasal parasigmatism See nasal sigmatism.
Nasal sigmatism Producing "a" and " z " with open passage
through the nose (p. 151).
Negligent lisping The disease described on p. 122.
Neurotic lisping The disease described on p. 173.
Organic lisping The disease described on p. 162.
Paragammacism Substitution of other sounds for "k" and "g"
TECHNICAL TERMS 247
Paralambdacism Substitution of other sounds for "1" (p. 149).
Pararhotacism Substitution of other sounds for "r" (p. 146).
Parasigmatism Substitution of other sounds for "s" and "z"
Rhinolalia Defective action of the nasal cavities in producing
sounds (p. 150).
Rhinolalia aperta Rhinolalia with improperly opened nasal
cavities (pp. 150, 168).
Rhinolalia clausa Rhinolalia with improperly obstructed nasal
cavities (p. 170).
Rhotacism Defective pronunciation of "r" (p. 146).
Sigmatism Defective pronunciation of "s" and "z"; also
sometimes defective pronunciation of " sh " (pp. 130, 140).
Simple sigmatism Defective pronunciation of "s" and "z"
whereby the sound of "th" is produced ; the term lisping is
often limited to this defect alone (p. 134).
Stuttering The disease described hi Part I.
Abdominal movements recorded, 24.
Anxiety neurosis, 7.
Aphonia, hysterical, 49.
Artificial palate, 115.
Association of ideas, 87, 217.
Belief in success, 66.
Breath indicator, 118, 153.
Breathing, 84, 190.
Breathy voice, 81.
Bulbar paralysis, 52.
Candle flame indicator, 117.
Character in stuttering, 20.
Chest movements recorded, 22.
Choreatic stuttering, 47.
Class work, 72.
Clear endings, 28.
Cleft palate, 168.
Clinic treatment, 72.
Cluttering, 46, 187.
Collection of ideas, 216.
Compulsive act, 37.
Confidence, 13, 90, 210.
Contagiousness of stuttering, 7.
Continued story, 212.
Control of the voice by ear, 196.
Coolness in argument, 223.
Correct enunciation, 65.
Correct thinking, 64.
Correction of character, 66.
Coup de glotte, see Glottal catch.
Cramps in stuttering, 10.
Defective enunciation, see Lisping.
Defective hearing, 171.
Deflected septum, 170.
Diagnosis of stuttering, 42.
Disease as a cause of stuttering, 8.
Embarrassment, 3, 15, 17, 217.
Emphasizing periods, 206.
Enunciation, 88, 207.
Equilibration of character, 63.
Exercises, 69, 190.
Exhaustion as a cause of stutter-
ing, 8, 16.
Experimental phonetics, 22.
Fear as a cause of stuttering, 6.
Feeble lips, 162.
Fixation of the larynx, 226.
Flame indicator, 119.
Flexibility, 74, 197.
Forms of stuttering, 15.
Freud, 7, 67.
Fright stage of stuttering, 118.
Functional lisping, 123.
General anxiety neurosis, 7.
General conversation, 222.
General indistinctness, 157.
General paralysis, 54.
Glottal catch, 81.
H.-iliit formation, 61.
Habit stage of stuttering. 15.
Han li|>. 162.
Hemiatrophy of the tongue, 163.
IliKh palatal an-h, 167.
Hoarw voice, si.
He. me, the .stutterer at, 4, 57.
Husky tune. -'nt.
H\ perphonia, 12.
H\ -teria, 48.
Il\ M'-ri'-al aphonia, 49.
:>-nl mutism, 48.
Ideas, collection of, 216.
Imitation as a cause of stuttering, 7.
Increasing embarrassment, 62.
Indifferent stage in stuttering, 10.
Infantile cerebral palsy, 49.
Institutional treatment, 71.
Intellectual disturbance in stutter-
ing. 65, 119.
Jaw defects, 165.
Jaw position, 227.
Kussmaul, 34, 52.
Laryngcal tone, 11, 23, 74.
Larynx, fixation of, 226.
Larynx defects, 155.
Lengthened vowels, 199.
Lip defects, 124.
Lip gymnastics. 163, 226.
Li| iveinents recorded, 25.
Lip reading, 172.
I.ips in connection with lisping, 162.
Lisping, as a cause of stuttering.
17. Hit ; .Mined. Ill ; negligent.
122; organic, 162; neurotic. 17.i.
Loud ness of voice, 98.
Lowering tones at cud, 206.
Melody, 74, 194.
Melody cure, 77.
Melody plot. :.
Mental cramp. '.i7.
Mental daze, .*,, Intellectual dis-
Mental flurry. 11.
Monotony, 11, 33.
Motor aphasia, 50.
Muscular action, defects of, 88.
Muscular dystrophy. 163.
Muti.sin, hysterical, Iv
Nature of .stuttering. :U.
Negligent lisping, -i:i, 112.
Neurotic lisping. M">, 17.'*.
New method of speaking, 57.
octave twist, 78, 192.
Office treatment, 67.
Operation as a cause of stutter-
Organic lisping, 43, 162.
Organs of enunciation and phona-
Overshot jaw, 165.
Overtenaion in stuttering, 12.
Palatal arch, L'_'7.
Palate defects. 167. 168. 170.
IVnmanship .stuttering, 38.
Phonetic alphabet, 11-'.
Principles for treating stuttering,
Progressive bulbar paralysis, 52.
Prophylaxis of stuttering, s.
Pseudobulbar paralysis, 53.
Psy. hanalysis, 67, 69. 101.
Ps\choneurosis, stuttering 94 a
form of, 7.
Public speaking, 214.
Quality of voice, 81.
Reading, 94, 192.
Reading together, 210.
Reading with decided voice, 211.
Readjusting the subconscious, 100.
Readjustment of environment, 98.
Rear palatal arch, 227.
Recording drum, 23.
Recording tambour, 22.
Relaxation, 61, 224.
Relaxed palate, 170.
Relaxing the jaw, 226.
Running associations, 104, 109, 219.
School, the stutterer at, 3.
School work, 215.
Sentences for indistinctness, 159.
Shock as a cause of stuttering,
Singing, 90, 91, 192, 197.
Slowness, 85, 198.
Social timidity, 39.
Spasms in stuttering, 10.
Spastic speech, 49.
Speaking, 92, 193, 198, 224.
Speaking together, 211.
Speaking with confidence, 211.
Speech clinic, 72.
Spontaneous speech, 94, 216.
Stages of stuttering, 15.
Starting, 201, 205.
Statement and question exercise,
Statistics of stuttering, 9.
Strengthening first word, 205.
Stuttering, description, 1 ; det-
riment to welfare, 2 ; at school,
3 ; at home, 4 : a disease, 4 ;
regarded as a habit, 5 ; causes,
5; connected with nervousness,
6 ; contagiousness, 7 ; after
exhaustive diseases, 8; pro-
phylaxis, 8 ; statistics, 9 ; symp-
toms, 10 ; forms or stages of, 15 ;
habit stage, 15 ; fright stage,
18; indifferent stage, 20; con-
nection with character, 20 ; ex-
perimental study of, 22 ; na-
ture of, 34 ; Kussmaul's theory,
34 ; relation to other neuroses,
37; author's theory, 38; dif-
ferential diagnosis, 42 ; therapy,
Subconscious readjustment, 67.
Talking with people, 222.
Tambour indicator, 121.
Technical terms, 246.
Telephoning, 96, 221.
Theory of stuttering, 36.
Therapy of stuttering, 56.
Thinking, 86, 217.
Tic speech, 47.
Tissue paper indicator, 153.
Tone of voice, see Laryngeal tone.
Tone placing, 202.
Tongue defects, 163.
Tongue gymnastics, 160, 225.
Tongue movements recorded, 25.
Tongue-tie, 18, 43, 164.
Tooth defects, 165.
Transacting business, 223.
Undershot jaw, 165.
Velar hook, 153.
Velum defects, 150, 168.
Vocal quality, 81, 202.
Voice tone, see Laryngeal tone.
Word lists, 228.
Writer's cramp, 38.
UNIVERSITY OF CALIFORNIA LIBRARY
This txx>k is DUE on the last date stamped below.
SEP 7 i960
JUN 4 1965