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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. 





PREFACE . . . . Y 




















I. BREATHING ... 190 



- ci 

i \i.r 

III. I'l I \ ir.ll I I Y ]!l7 




VII. STAKTINO AND ENDING SKMI \< ( , . . . -jo., 


IX. K\ri:i -VSION 

X. l'(>NHI>KX( K 21() 

XI. SniN i \M ..I - M I I < if ^li; 






XVII. Mr-< i I.AK CONTROL j-j: ( 




INDEX .... ,249 


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 

stutterer 28 

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 

stutterer 32 

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 



no. rxoB 

_'_'. 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. 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 


FIG. 1-v.r 

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 


no. PAOE 

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 

marked 158 

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. 





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 


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 


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 


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 
lifelong torture. 


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 


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. 


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 


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. 


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 

rilAl'TKH II 


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- 



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 


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. 


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 


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 


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 


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 


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 


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 


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 
stuttering cramps. 

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 


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 
can give. 

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 


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 


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 
experimental phonetics. 

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. 



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- " lVt<T." 

Instead of a single pressure the stuttcn-r m:iki> ,,,. 

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." 


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 
say "Tommy." 

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 



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 


" 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- 


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 


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 
Fig. 8. 

" 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. 


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 


"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." 


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 






130 . 

-- ^ 


a p 




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- 

The difference 
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. 



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 

















> 9 

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- 


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 
in stuttering. 

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- 


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. 


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 
each other. 

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 
or uncertainty. 


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. 


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; 


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 
true stuttering. 

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. 


and that persons who already have this unconscious 
tendency instinctively seize upon such a means of 
encouraging it. 

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 
other outlet. 

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- 


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 


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 


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- 
cal patient. 

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. 


The over-exertion is continued throughout the sen- 
tence. The syllables are equal in length, and are 
laboriously enunciated. 

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; 


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 
is absent. 

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 
stutterer's fear. 

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 


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- 
ing principles. 

The " principle of a new method of speaking" is 
founded on two facts : first, that the stutterer speaks 


in an abnormal voice, which we may call the " stut- 
ter voice"; and, second, that he does not stutter 





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 


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. 


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 


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 


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- 


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, 


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. 


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 



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 
"laryngeal tone." 

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- 
geal tone. 

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?" 




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 



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. 



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 


called the " octave twist." Fig. 28 indicates the 
method in musical notation. In Fig. 29 the general 
change is shown by u line. 

X^ x<* 


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- 



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 



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 
Fig. 33. 

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 



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 



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 


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. 


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 


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). 

Developing Slowness 

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. 


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 
jerky speech. 

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 


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. 


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 
be used. 

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. 

Correcting Enunciation 

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 


"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 


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. 

Developing Confidence 

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 


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 
to say. 


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 


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 
follows : 

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, 


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. 


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. 


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," 


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 subject. 

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 


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 


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- 


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 


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 


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 


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 
a readjustment. 

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 


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, 


'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. 


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 


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 
common type. 

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' 


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 


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 




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 




ah, father 









8O, > 




zone. <l< 


her, further 

















Pawl, poll 



































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 

11 1 


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 
dental modeling 
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 


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 
tongue. 1 

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 


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 
are surd. 

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- 



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 
be used. 

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 



the child that all his sounds become incorrect (negli- 
gent lisping). 

Lip Defects 

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" 
and "g." 

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 
the teeth. 

FIG. 51. Mouth dia- 
gram for "k" and 


The back of the 
tongue is raised 
against the velum 
at the rear of the 
hard palate. 


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. 


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 


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. 


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' 


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 " 

eluded "" 

the palate a trifle too hard when and "" 

The tongue 

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 

The channel 
of Fig. 56 is 
closed by too 
much pressure. 



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. 
Constant repetition 
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 
breath indicator 
(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." 



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." 


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. 


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. 


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 - 

for "ch" 

farther back than for "t" or "d," and "j." 

The tongue 

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 
(Fig. 50). 

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" 
and "h." 

The typical defects are of two kinds. In one the 



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, ) 

and "j." 

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" 


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." 

Thetongue , 

, ,, 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. 
is lowered. 

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 



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 

breath except 

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 . f eropening "show ) it 
in front than 

for .. 8 .. not. 

.. . 

' 8h< 

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 

touches the 

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" 


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 
spoken normally. 

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 
interdental fricative 
(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. 


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 


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 

tongue are 

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 

1 If. 


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." 

The tongue 

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 


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 


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." 

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 


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 



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. 

Larynx Defects 

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 


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," 


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. 

General Indistinctness 

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. 


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 
Fig. 96. 

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 
marked explosions. 


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 
prolonged "n"s. 

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 


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 


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 

be avoided. 

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"; 


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- 
rect speech. 

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 


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 


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," 


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 


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 


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 
(p. 150). 

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- 


passage through the upper pharynx is also more or 
less obstructed. 

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 


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 



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 


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 


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. 


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 


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 


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 


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 


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 


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 


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. 


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 


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 
the defect. 

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 



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 
also clutterers. 

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. 

PART 111 


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.) 


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.) 



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 

A. Recite: 

"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 : 

moon shining 


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 


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 
it long. 

^ ^ <> <> <> <> 

D. Sing "ma" upward and downward on the 
notes c, e, g, c r . 



12. Singing 

A. Sing the vowel "ah, ' .hrough the notes of 
the octave. 

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). 


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. 

13. Speaking 

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 
person slowly. 

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. 


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 
too fast. 

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 
Exercise 6). 

D. Same without the metronome. 

E. Tell a story about breakfast, etc., keeping time 
to the metronome. 




18. Linking 

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 
on "Linking." 

B. Read likewise. 

C. Repeat sentences and answer questions like- 

D. Conversation likewise. 




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- 
ward tone." 

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 
middle c. 

B. Repeat up the scale for an octave. 

C. Same with "mee" ; same with "moh" ; same 
with "moo." 

D. Repeat on arpeggios of three and four notes. 

Ma ma ma ma ma 





J J 




Ma ma ma ma ma ma ma 


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. 




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- 
ing time. 

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. 


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, 
stories, etc. 

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. 




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. 


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 
expressive way. 

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 




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. 



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, 
speaking slowly. 

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 


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 
United States." 

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 


the instructor is at hand to speak for him in case of 
any difficulty. 

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 




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 
to you. 

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, 



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 
sentence states. 


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. 



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. 


C. Same with complicated pictures. 

D. Same with what you see in the room or out of 
the window. 

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 

48. Relation 

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 



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 


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. 



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 
(impromptu conversation). 


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. 




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 
fifteen minutes. 

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. 

55. Speaking 

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 
mouth shut. 

F. Touch the point of the tongue to the upper 
front teeth. 

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. 


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 
without whispering. 

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. 




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 



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 

with "k" 





















76. Words 

with "k" 

in the middle 





















77. Words beginning with "g" 























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 

again agony 

aggrieve agree 

aghast anger 

aglow angle 

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 " 

age dodge 

bridge dredge 

budge edge 

courage fringe 




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 


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 



94. Wards with "s" in the middle 





















95. Words beginning with "z" 



















96. Words ending 






















97. Words 

with "z" 

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 


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 


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 


118. Words ending with " m " 

aim gleam 

beam gloom 

comb gum 

come home 













119. Words with "m" in the middle 

amaze company limit 
amount dreamer mama 
bemoan former mimic 

murmur summer 
plumber summit 
roomy swimmer 

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 Sounds 

PLATE III. Mouth Diagrams for Typical English Sounds 



PUATB IV. Palatograma fur Typical Engliah Sounds 



Rousselot, Principes de la phon&ique experimentale, Paris, 1897, 

Scripture, Elements of Experimental Phonetics (Yale Bicen- 
tennial Series), New York, 1902 


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 


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 


Gutzmann (A.), Das Stottern, 6 ed., Berlin, 1910 
Gutzmann (H.), Das Stottern, Frankfort-a-M, 1898 
Liebmann, Stotternde Kinder, Berlin, 1903 




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 

(p. 133). 
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" 

(p. 128). 


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" 

(p. 134). 
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). 
Stammering Stuttering. 
Stuttering The disease described hi Part I. 


Abdominal movements recorded, 24. 
Adenoids, 170. 
Akromegaly, 165. 
Anxiety neurosis, 7. 
Aphonia, hysterical, 49. 
Argument, 223. 
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. 
Business, 223. 
Buying, 212. 

Candle flame indicator, 117. 
Censorship, 100. 
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. 
Colds, 171. 

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. 
Conversation, 222. 
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. 
Denasalization, 170. 
Description, 219. 
Diagnosis of stuttering, 42. 
Disease as a cause of stuttering, 8. 
Dreams, 103. 
Drum, 23. 

Embarrassment, 3, 15, 17, 217. 
Emphasis, 208. 
Emphasizing periods, 206. 
Ending, 205. 
Enunciation, 88, 207. 
Equilibration of character, 63. 
Exercises, 69, 190. 
Exhaustion as a cause of stutter- 
ing, 8, 16. 

Experimental phonetics, 22. 
Explosives, 117. 
Expression, 208. 

Fear as a cause of stuttering, 6. 

Feeble lips, 162. 

Fixation of the larynx, 226. 

Flame indicator, 119. 

Flexibility, 74, 197. 

Flurry, 14. 

Forms of stuttering, 15. 

Freud, 7, 67. 

Fricatives, 117. 

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. 
Hereditary :it:i\; 
IliKh palatal an-h, 167. 
Hoarw voice, si. 
Hoarseness, 81. 

He. me, the .stutterer at, 4, 57. 
Husky tune. -'nt. 
H\ perphonia, 12. 
Hypertoiiieity, 1L'. 
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. 
Insanity, 55. 

Institutional treatment, 71. 
Intellectual disturbance in stutter- 
ing. 65, 119. 
Introducing, 213. 

Jaw defects, 165. 
Jaw position, 227. 

Kussmaul, 34, 52. 

Laryngcal tone, 11, 23, 74. 
Larynx, fixation of, 226. 
Larynx defects, 155. 
Lengthened vowels, 199. 
Linking, 201. 

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. 

'lone, 204. 

Melody, 74, 194. 

Melody cure, 77. 

Melody plot. :. 
Mental cramp. '.i7. 
Mental daze, .*,, Intellectual dis- 
Mental flurry. 11. 
Metronome. JIMI. 
Monotony, 11, 33. 
Motor aphasia, 50. 
Mouth recorder. 
Multiple gel 

Muscular action, defects of, 88. 
Muscular control 
Muscular dystrophy. 163. 
Muti.sin, hysterical, Iv 

Nasals, 118. 

Nature of .stuttering. :U. 
Negligent lisping, -i:i, 112. 
Neurotic lisping. M">, 17.'*. 
New method of speaking, 57. 

Occlusives, 117. 

octave twist, 78, 192. 

Office treatment, 67. 

Operation as a cause of stutter- 
ing, 6. 

Organic lisping, 43, 162. 

Organs of enunciation and phona- 
tion. 113. 

Overshot jaw, 165. 

Overtenaion in stuttering, 12. 

Palatal arch, L'_'7. 

Palate defects. 167. 168. 170. 

Palatography, 114. 

IVnmanship .stuttering, 38. 

Periods, 206. 

Phobia, 38. 

Phonetic alphabet, 11-'. 

Phonetics. 22. 

Pncumograph, 22. 

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. 

References, 245. 

Relation, 220. 

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. 

Septum, 170. 

Shock as a cause of stuttering, 
6, 16. 

Singing, 90, 91, 192, 197. 

Slowness, 85, 198. 

Smoothness, 201. 

Social timidity, 39. 

Sonants, 118. 

Spasms in stuttering, 10. 

Spastic speech, 49. 

Speaking, 92, 193, 198, 224. 

Speaking together, 211. 

Speaking with confidence, 211. 

Speech clinic, 72. 

Spelling, 208. 

Spontaneous speech, 94, 216. 

Stages of stuttering, 15. 

Stammering, 44. 

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, 70. 

Subconscious readjustment, 67. 

Talking with people, 222. 

Tambour, 22. 

Tambour indicator, 121. 

Technical terms, 246. 

Telephoning, 96, 221. 

Theory of stuttering, 36. 

Therapy of stuttering, 56. 

Thinking, 86, 217. 

Tic, 37. 

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. 

Trumpet, 204. 

Turbinates, 170. 

Undershot jaw, 165. 

Velar hook, 153. 

Velum defects, 150, 168. 

Vocal quality, 81, 202. 

Voice tone, see Laryngeal tone. 

Vowels, 116. 

Word lists, 228. 
Writer's cramp, 38. 


Los Angeles 
This txx>k is DUE on the last date stamped below. 

SEP 7 i960 

/ttJGS f 

JUN 4 1965 

Form L-30m-7.'60(C8244)444