No. 1410.

SEPTEMBER 7, 1850.

A LectureON THE MENTAL AND MECHANICAL OBSTACLES

PRESENT IN THE DEFECTS OF SPEECH,TERMED

STAMMERING AND STUTTERING.Delivered at the School of Medicine adjoining

St George’s Hospital.BY JAMES WRIGHT, ESQ.,

OF MAGDALEN COLLEGE, OXFORD.

Stammering and stuttering erroneously confounded. Definitionof both. Means for removal of stammering: deliberation, andmental discipline. Instances of Addison, Charles James Fox,and Sir Charles Bell. Stuttering is an effort to speak withoutthe proper use of the vocal organs, furling of the velum pen-dulum palati. Use of explaining to the patient the physiologyof vocal sounds. Names of letters not identical with theirpower: mechanism of the pronunciation of some. Mechanismfor acquiring distinct utterance. Intonation determines theincompleteness or termination of a sentence. Examples. Organsand physiology of articulation. Voice and articulation notsynonymous. Errors of speech remediable by exercise anddetermination. Analogy presented by the machinery of awatchman’s rattle. Production of the mutes and liquids.Division of the frœnum linguœ seldom necessary. Lisping.Most of the defects in utterance originate in the indolence orignorance of persons having the care of children. Relaxationof the velum. Inefficiency of artificial palates, from their havingno effect over closure and opening of the nasal passages. Theinvention of Dr. Stearns. Importance of due action of thevelum in the production of speech. Examples of treatmentwithout surgical interference. Instance of dentition concernedin inability to utter speech. Probable derangement of therespiratory system a cause. Treatment of persons who havebeen deaf and dumb. Stuttering dependent upon abnormalactions of the pharynx and velum pendulum palati. Anxietyof stutterers as to their incapacity, and indifference of indistinctspeakers without organic defect.

Tnis is the second time of my having the honour of ad-dressing you, gentlemen: it is with the united consent of thelecturers of this school, and their entire approbation, that Iam before you at this moment. Upon a former occasion, I re-marked, that, with respect to impediments of speech, there isa discrepancy of expression, that every sort of hesitation andinterrupted utterance is called by one name; so that, accord-ing to the fashion of the day, incontinuity of voice and mentalhindrance-that is, vocal and respiratory stoppages, on theone hand, and the want of intellectual readiness, (but uncon-nected altogether with physical interruption,) on the other,have been confusedly designated and blended together by oneindefinite term-stammering. Now, a tedious reiteration ofwhole words, and a faulty and painful substitution of letters,with difficult breathing, are not identical! The difference isself-evident! One is a pure mental impediment; the otheris not only a mental, but also, and principally, a physical in-terruption.

[The learned lecturer here exemplified stammering andStuttering.]

This latter impediment is not stammering over words, butstuttering at letters, and converting vowels and liquids tomutes.

In reference to the removal of the former of these infirmi-ties, which we justly call stammering, the practical meanswhich may be recommended are these: viz., presence of mind,reflection, mental control and discipline, much caution, and,in most instances, a measured and moderate slowness of ut-terance. For the cure of stammering, the utility of suchmeans as these are apparent.

That many public speakers have this infirmity cannot bedenied. Call to your recollection the circumstance of thegreat Addison! I-Ie conceived three times, and broughtforth nothing!" Hence, in the Spectator, he called himself" the silent gentleman!"

Call to your recollection the very eminent statesman,Charles James Fox. Certainly, it could not be said that the

topics and questions which were brought forward by thatgreat man were heedlessly discussed and carelessly delivered!Still, it must be admitted on all hands, that his deliveryseemed at least to be precipitate, because his repetition ofwords and clauses was constant and frequently excessive;which arose, probably, from an over-heated imagination, anda certain transcendent ebullition of feeling. It might besaid, however, that had such feeling been checked, mischiefwould have been done to the constitutional ardour of thespeaker; and that had Fox in his ripened and advanced lifeattempted to alter his accustomed reiteration of words andclauses, by speaking calmly, and perhaps cautiously, and withdeliberation, though his delivery might have been renderedmore regular, and, in one sense, fluent; still, possibly, it wouldhave been deprived of its unction and ripeness, its spirit, itsforce, and climax.The name of Sir C. Bell is familiar to us all! That highlytalented man confessed to me, that, in early life, he experiencedconsiderable inconvenience and anxiety, whenever he spokein public; but that the infirmity was conquered by putting tohimself the questions—" Am I qualified to teach? ? Let melook around ? Is such an one better able ?" "He speaksreadily, and without mental stammering and embarrassment ;his words are ready, and they express what he means;he speaks with confidence. And so will -T!" "From thatmoment," said be, 11 I took courage! I was a young man, andbegan to speak quietly, and with great caution; the conflictwas great, but I succeeded."Gentlemen, you agree, I am sure, when I say that Sir C.

Bell was acknowledged to be, as a lecturer, one of the bestspeakers of his day.

Persons who tediously repeat words are generally rapidspeakers. The best way to remedy such an inconvenience isnot to speak more or oftener than absolute occasion may re-quire, and when such a person does speak, then lie shouldutter every sentence with caution; he should endeavour, nay,painfully struggle, to correct the rapidity, and give a compa-rative slowness to the delivery; and never, if possible, need-

lessly to utter a word twice.! It may have been observed, that many tediously slowspeakers stammer or repeat words. To such persons I wouldsay, let your delivery be as slow as you please, or as deliberateas your taste may dictate, but never reiterate your words.Conquer the wearisome habit, and, afterwards, speak a littleand a little faster, till at length you reach the time andrhythm of natural speech.

I have defined stuttering to be an effort to speak undercertain unfavourable mental impressions,--under a real orsupposed physical inability,-and I have affirmed that it is aneffort to speak without the proper use of the natural and effi-cient causes of fluent speech; that it is a struggle to accomplishwhat, under particular circumstances, is decidedly impossible;that it is a deranged action of those organs of speech whichare assigned by Nature for the utterance of the consonantscalled mutes, with a faulty effort of the will to prolong theirsounds, like those of the liquids and vowels; that, from suchderanged action, stuttering is stopped or drawn breath, whichchanges the muscles of respiration to those of volition.In neglected utterance, and confirmed stuttering, from an

improper use of the velum pendulum palati, (that is, in itsfurling up, at the nasal liquids, and preventing the breath andvoice from passing through the nares,) the letters n, nasal g,(as in ing,) and m, are consequently changed to the mutes d ort, hard g or k, and b or p. Such a simple but deranged actionas this, with frequent and fruitless struggles to give prolonga-tion to the substituted letters, causes interruption of voice, andpainful stoppages of breath, contortions of countenance, andwry motions of the body.A person labouring under an impediment of this nature,

seems, at times, to be impressed with a notion that he isunable to utter a single word, or even an element of speech.Upon some especial occasions, he has no confidence in hisphysical ability.Now, the question returns, what is likely to remove his em-

barrassment, give him proper confidence, and enable him tospeak, at all times, without interrupted utterance? Theanswer is ready. That advice which explains, upon gram-matical and physiological principles, the mechanical opera-tions of fluent speech; that method which recommends philo-sophical analysis and steady practical application; that sys.tem of instruction and encouragement which is applicableto the feelings as well as the reason; that treatment and do-mestic care which are essential to the establishment of mentaland bodily health.

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In order, therefore, that he may learn to speak with free-dom and fluency, and acquire a proper degree of self-posses-sion, it is evident, I think, that the adult stutterer shouldendeavour to comprehend the mechanism of fluent speech.He should make himself acquainted with the nature and useof all the organs, breath, voice, and enunciation, as connectedwith the elementary principles of mute, sibilant, and vocalletters: by which means, with sound physiological and elocu-tionary training, and with mental discipline and practice,-mental energy and continued perseverance, seconded by thekind, but, at the same time, judicious encouragement of hisfriends, he may acquire perfect freedom from all doubt ofbeing able to speak; and, by degrees, obtain a safe andwell-grounded confidence.But there are other physical impediments of speech, which

are totally different in character, perfectly free from vocaland respiratory stoppages, such as confused and indistinct ar-ticulations, contrary substitution of vowels and consonants.These, also, demand our attention.The cause of such impediments is different from that of

stuttering. The cure, nevertheless, is, in some sort, connectedwith what has been already advanced. The circumstances ofcure, I say, are applicable to lingual, guttural, and palatineimperfections, whether fluent or interrupted; and the systemis connected, in a modified sense, with cases also of the dumb,- with such cases, I mean, where deafness has been amelio-rated, or entirely removed. Presently I shall bring to yournotice particulars of the case of a young lady, who was intro- duced to me four months ago, by Mr. Pilcher, your lectureron aural surgery.In discoursing upon infirmities of speech, from simple de-

fective articulations to complicated instances of stutteringand painful stoppages of breath and voice, the propriety ofanalyzing speaking sounds is quite apparent. I repeat, thatthere are modifications of voice which are not synonymous oridentical with articulation. The many positions, and promptmovements of various parts of the tongue, the progressiveactions of the jaw, and the correspondent lateral and longi-tudinal motions of the mouth, for the production of the vowels,have been explained in elucidation of a doctrine which is atvariance with popular theories.

It has been felt and acknowledged that the name of a letteris not identical with its power. This was clearly seen in thedesignation of the very first letter of the alphabet, which ismanifestly a diphthong, commencing with the long sound ofthe vowel, as in face, but ending with e, the sides of the tonguetouching the lower anterior molar teeth. Now, this namehas no more to do with the power ii, face; a, at; o(r), all; a(r),art; u(t), scholar-than the Greek alpha ! And thoughorthoepists and physiologists may go hand-in-hand with re-spect to wand y, it is certain that to preceding a vowel, as inwoop, is not oo; neither is y the vowel e, as a prefix to e in thepronoun ye. In pronouncing or repeating oo, the lips areinactive, but in articulating woop, the lips are partially con-stricted for w, and tb e jaw falls xor oo, whereas for 00.00 the lipsare quiescent, and the jaw is stationary. With respect to ye,the jaw is raised for y, but falls for e. Both in w and y initial, abreath murmur or sound may be distinctly heard, but in oo ore there is none whatever-oo-oo, ee-ee.Now whether the object be to assist the patient, whose

utterance is an instance of lingual, guttural, and palatine im-perfections, or to aid the sufferer who was born deaf and dumb,but who has since, by judicious medical treatment, obtainedthe power of distinguishing the differences of sound, it is self-

’ evident that the elocutionary examples, for the comprehen-sion and imitation of either patient, should be correspondent- that is to say, they should be philosophically correct, andnormally concise, and that every element, in such examples,should be quite distinct, and perfectly true to nature.The exercising the organs of speech properly constitutes

what is termed distinctness of pronunciation: the mouth mustbe fitly and suitably opened for the utterance of each vowel;and without any hazard of being confuted, it may be said thatthe vocality of language is altogether dependent upon a clearand distinct utterance of the vowels. Each or every modifica-tion of a vowel demands an appropriate aperture or openingof the mouth, and a free use of the jaw. One aperture cannotbe substituted for another. And with respect to consonantsand their normal articulation, every appropriate organ mustpromptly perform its office, and the lungs and larynx mustcorrespondently supply each consonant with either a whisper-ing, or an audible voice.To attain an easy utterance of these elements, the student

and patient should be made familiar with the nature andpower of the organ or organs which are requisite for their

production, and this cannot be more easily and more satisfac-torily ascertained than by adopting the plan of practisingthem with a vowel preceding each, as ab, ac, &c., by whichmeans it will not be difficult to judge of the respective powerof every one of them.The ready way to prevent indistinctness of speech in young

people is never to urge them to speak a word containingany letter which they cannot first properly sound by itself ; onthe contrary, as far as possible, they should be discouragedfrom making the attempt. In this way children will acquirea distinct articulation, which is the foundation of fluentspeech; and if it be not laid in the first simple elements withthe utmost care and exactness, Quintilian, one of the bestjudges of antiquity, did not scruple to affirm, that whateversuperstructure we may labour to raise on it, must fall.Audible voice is produced by a set of muscles acting on that

cartilaginous cavity at the top of the trachea, called thelarynx, while the air is passing through the glottis and thepharynx. Voice so produced is capable of certain modifica-tions. On of the principal circumstances to be regarded in

first attending to the speaking voice, it will be remembered,is its power of conveying, by one single percussion, inde-pendently of articulation, an idea of continuation or comple-tion. In further explaining to you this principle, it willreadily occur to you that every conversation marks this dis-tinction ; that in every part of a discourse the accentualvoice suggests either that the speaker has or has not finisheda sentence. The modifications of the voice signifying con-tinuation and completion, in their fullest meaning, are dis-cernible even in a monosyllable ; but, perhaps, to the un-tutored ear, these characters of sound might be more easilydetected in words of more than one syllable, the accent ofwhich is at their beginning-viz., preferenee, popular, chastity,exercise, temperance, &c.

" Exercise and temperance strengthen the constitution.’"The constitution is strengthened by exercise and temperance." The positive utility of these modifications of thevoice is clearly demonstrated by the following examples,showing how the meaning of a sentence is altered by stops orintonation :-" Nothing will ever be attempted. If all possible objee--

tions must first be overcome, if so, then, let it be asked,’Upon what can we speculate? Matters of fact ?"I Now,what have I said? The reply is-" You said that nothingwill ever be attempted."’ " But that was not my meaning.""No! How am I to know that ? ? " By explaining the error ofmodulation." The fault arose, and you were misled, by myfalling the voice, and stopping, at the word attempted. Pro-perly delivered thus:[The sentence is then read correctly by avoiding a full stop

at "attempted," and making a colon at " overcome."]But further, and to show that there are modifications of

voice which are not identical with articulation. RichardBrinsley Sheridan todk an opportunity of exercising his readywit upon an adversary in the House of Commons. Sheridancontended that the right hon. gentleman had misquoted oneof his assertions, and not only marred, but overturned, themeaning, by his delivery and twist discordancy of voice, whichput him in mind of a facetious placard that a barber displayedat his shop window. It read thus: " What do you think ! I’llshave you for nothing, and ask you to drink !" A sailor witha long beard, passing by, espied the placard. Having littlemoney, and being rather thirsty, he took the charitable hintof the barber, entered the shop, and requested to be shaved.However, he soon found that he had made a blunder. Inreading the paper the sailor twisted to an opposite directionthe barber’s equivoque, which was, " What! do you think I’llshave you for nothing, and ask you to drink ?" The anagramriddle-

" I saw a peacock (;) with a fiery tailI saw a comet (;) shower down hail" &c.-

will serve as an example of the necessity for properly regard-ing stops.To enter into the theory of inflexion, and fully to explain

its entire use, would take me from my present purpose.Articulate speech, therefore, may be accompanied with

certain intonations and inflexions of voice, as symbols ofgrammatical construction and of emotion, yet it is to be com-prehended that those intonations are not in the least analogousto articulate speech.

Articulation, you know, is occasioned by certain interrup-tions of the voice or breath, affected, more or less, by theactions of the glottis, tongue, hard and soft palate, uvula, nostrilsand cavities of them, and the teeth, lips, and jaw. When theommon current of breath is urged more forcibly through thes

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various apertures of articulation, without much affecting the d d d, t t t, he, not comprehending at once the force of phy-larynx, we have an instance of the indefinite sound, known by siological and grammatical arguments, mimicked me-b b b,the name of the whisper. In audible voice, the air, while p p p, and then said pun. But, however, upon further de-passing from the lungs to the mouth, must, little or much, scriptions and explanations-upon showing that in whisperingaffect the larynx and pharynx, in proportion to the quantity, the soft and middle mutes there is no discernible difference-quality, or character of the voice which is produced. and upon explaining the "why ?" because the vocal chords

If the nasal passage be opened, the whole diversity of sound are in a quiescent state for both-my friend then altered hismay be distinctly heard, though the mouth be shut; and from tone" That is very good." His funny note of disapprobation,this may easily be conceived, that as the sound of the voice, in the first instance, with the upper and lower lip, however,as to high or low, depends upon the diameter of the rima glot- was an apt elucidation of the elastic temperament of the tiptidis, or orifice of the glottis vera, with the tensions of its of the tongue against the gums for the production of r.ligaments, or chordse vocales, and the actions of the pharynx, We sometimes hear of dividing the frænum linguæ for thewith other causes, possibly, but not upon the organs of enun- removal of this faulty habit; but there would be no difficultyelation, the whole diversity of syllables may be accomplished, in maintaining, that if an individual can protrude the tonguein any one note of a diatonic or chromatic scale in music. In half an inch, or a little less, or, at the utmost, three-quarterssinging, the leaps or intervals of voice may be heard, under- of an inch, there is not, nor can there be, any occasion to dostood, and compared with any note of the same measurable mischief by performing this painless operation. During thegamut or scale, after the articulation shall have ceased. The whole course of my observation and practice, I have not metterms, voice and articulation, in singing, therefore, are not with more than one instance where division was requisite,synonymous; neither in speech is articulation the same as the and that was at Ealing School, in the case of a young gentle-inflexion of the voice. An inflexion may be heard and accu- man: Mr. Cooper, surgeon, of Brentford, at my request, snippedrately defined, independently of articulation. Articulate the chord. The youth was enabled instantly to touch thelanguage is audible or whispering voice modified by the various proper part of the hard palate, and after a month or sixorgans of enunciation. Articulation is distinctness of pronun- weeks’ practice, he was enabled to give the vibratory motionciation; it is a method of speaking, or whispering clearly and to the tip of the tongue, and pronounce r.distinctly, so as not to confound or blend one voice or sound Ten or twelve years ago, I remember to have met with anwith another. instance in a young gentleman, where there was an organicFrom indiscreet and irregular training with respect to the deficiency. Though he had no frænum, this young gentleman

organs of speech during early life, are to be traced many was completely tongue-bound. Of course, he could not beinstances of faulty articulation, which sometimes are obstinate made to vibrate r.and require considerable labour, patience, and perseverance; to On the other hand, upon the same principle, if a child beovercome; such, for instance, as a nasal sloth-like enunciation; urged to articulate s before the cutting of the molar teeth,such, sometimes, even as the Northumberland r ; such, again, and subsequently, before an efficient action shall have beenas the articulating t or d for gas in the word diligent, orjin the given to the jaw, and after the loss or shedding of the incisorword just; such as a monotonous drawl instead of a sensible teeth, he being too frequently pressed to speak plain, as it isinflexion and variety, an intellectual and natural, a lively and called, would very likely lisp. The defect of lisping-thata pleasing modulation. In a youth, or even an adult, having is, the pronouncing of th instead of s, may be removed bythe organs of hearing, and those of utterance, it would be idle closing the teeth, keeping the tongue from them, and by re-to say that any one of those impediments, or all of them, are peatedly uttering such monosyllables as have the hissingnot to be removed by sound grammatical and physiological sound joined with the vowel a, as in face, base, &c. This,exercise; it would be trifling to say that they are not to be however, does not always succeed, but the summary methodcured by practical energy and constant willingness of mind, of gently tapping the jaw at every faulty articulation of s andon the part of the pupil, to realize the correctness of rational z, and thereby causing the tip of the tongue to be pinched atheory. little, is rarely known to fail.

’

If a young person be late in beginning to talk, and he be Hence it may be suggested that the greater part of suchurged prematurely to pronounce the letter R, that is, before defects in utterance and impediments originate in the indo-the tip of the tongue have been duly exercised with the mute lence or ignorance of persons concerned in the managementdentals, and th, there is every probability that a faulty action of children.would be given to the dorsum, and that the Northumberland The mischief unfortunately, however, is not suffered to end"burr" would be produced. An attempt to vibrate r by the here; for no sooner does the fond parent discover the thick-dorsum against the palate instead of the tip of the tongue ness of speech of her little boy, than a superannuated grandamagainst the gums, is called the "Northumberland burr." declares, that "Master Edward is tongue-tied." The poorThe normal or vibrated motion of the tongue against the boy is then hurried away to have the fraenum divided. Thisgums may be well described by the clapper of a watchman’s not answering the intended purpose, the tongue is pronouncedrattle; it is only to suppose the end of the clapper, the tip of to be disproportionably large! Upon such an injudicious prac-

the tongue, a tooth of the wheel the front part of the hard tice it is unnecessary to offer another remark.palate or gums, and the circular action of the wheel the It may now be explained that if the velum of a young childvocalized breath which gives the vibratory montion to the be tardy in its action, and more disposed to hang down thantongue. to furl up, unless prevented, he would speak with a continuousThis impediment may be removed, and an efficient action nasal insufflation. However normal and perfectly well formed

given to the tongue against the gums, by practising such words might be the soft palate of the child, this would be an instanceas have d or t connected with r-viz., dread, tread, dray, tray, of impediment closely resembling one of organic defect. It&c., or th, prefixed to r—viz., throng, three, &c.; when the calls to my recollection the case of a young gentleman, wherewithdrawing of the tongue will probably assist. there was deficiency in respect to the uvula and part of theBut it may be said, 11 its the position of the tip of the tongue soft palate. This youth had the power, by means probably of

for d or t, accurate with respect to the free use or vibratory the glands or some action of the defective velum, to utter themotion of the organ for R ?" The reply is "No!" Both d mute consonants, but not without a nasal articulation. Inand t are mutes; that is to say, the organs for their production this case, in order that the deficiency might be supplied, ap1’event the breath and voice (the velum being furled up) surgical operation was recommended. Sir Benjamin Brodiefrom passing through the nares; and the tip and sides of the dissuaded the party from consenting to it; the attempt, intongue being closely and firmly applied to the gums or front consequence, was not made. Admitting, however, that theof the hard palate, exclude the breath and voice in this direc- operation had been successfully performed, and that the parttion. R is a liquid or prolonged articulation; that is to say, of the curtain or soft palate which was wanting could havethe tip of the tongue, the principal organ for its production, been supplied, and the whole of the uvula could have beenby a sort of springiness, permits a partial escape of breath formed, I feel assured that no benefit in regard to articulationand voice, similar, in one sense, as I have already said, would have been derived from it, unless muscular power couldto the clapper of a watchman’s rattle; or the elastic power have been given to the produced organ to act upon the nasalof the tongue in the vibration of r may be exemplified passage, so as to prevent an escape of breath and voice, throughby similar actions or movements of both upper and lower the nostrils, during the utterance of the mute letters.lip. For the amelioration of such a defect, a gold palate hasSome years ago, a German applied to me for elementary been usually recommended. The following description of an

instruction in English pronunciation. Upon endeavouring to impediment will answer a double purpose. It will show themake him comprehend that the difference between the middle utter uselessness of the lifeless agency of an entirely hardand soft mutes is the moveable or quiescent state of the vocal substance, and the efficient power of one, combined with achords, and upon exemplifying them in this way-b b b, p p p, moveable apparatus, to act in the direction of the nasal

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passage,* the ingenious contrivance of an American gentleman,who presented himself to me at this school three years ago.The patient whom I am about to describe was an adult, and

wished to take holy orders. From the peculiarity of his casehe could not be admitted. This was an instance of division ofthe upper lip, a total deficiency in the uvula and all the hardand soft palate. His friends had recommended the use of anartificial or gold palate; but which, when procured, did notanswer the purpose. It failed, of course, in the main point,-in the power of closing and unclosing the nasal passages. Hisdentist introduced this gentleman to me, and recommendedhim to receive elocutionary instruction. But although hewas taught to speak much plainer, and though he learned touse, with adroitness, the organs which he possessed, and tospeak so as to be perfectly intelligible in a private circle;still, from the utter impracticability of his uttering the muteconsonants, and from the excessive expenditure of breath,and consequent exhaustion, which, in his case, would neces-sarily follow the labour of speaking in public, he was com-pelled to abandon the thought of presenting himself as a can-didate.In such instances as this, where there is a total deficiency

in respect to the soft and hard palate, uvula, and lips of themouth, the consent or harmony in the lungs, glottis, pharynx,and tongue, is, doubtless, seldom or never checked: and forthis plain reason,-because the organic deficiency which hasbeen described prevents the possibility of articulation withregard to the mute elements. To compensate for the incon-venience of having no velum, the introduction of an artificialand inflexible hard curtain would be of little or no use, whilethe exceedingly convenient, and, at the same time, pleasantcontrivance of Dr. Stearns, the American physician whom Ihave just alluded to, would nearly perform every essentialpurpose of the velum pendulum palati. It is now upwards oftwo years since the instrument was introduced, but I am fear-ful the inventor did not meet with sufficient encouragementto induce him to carry out his plans; or there might havebeen some objection to the method of fastening the apparatus,so as to render it quite harmless to the teeth.

It may now be comprehended, that if the velum be tardy inits action, and, on the other hand, more disposed to furl upthan to hang down, and the young person be hectored into ahurried manner of speaking, it is more than probable that hewould stutter. To prevent impediments of speech is muchmore easy than to cure them. The qualifications of tutors, asfar as the utterance of the children who are placed undertheir care is concerned, are, patience, kindness, and gentleness,combined with steadiness, firmness, and perseverance; and asthe infant, or rather the little child, is taught to speak, not byrule, but entirely by imitation, the qualifications for nursesand servants are, distinctness of articulation, and slowness anddeliberateness of speech.To return. If contrary and confused actions in the organs

of enunciation, independently of checked and irregular breath-ing, were of a nature to induce interrupted speech and stut-tering, the following instances in two young ladies, whom Ihad the pleasure of instructing some years ago, would be illus-trations. But the reverse is the fact. They were sisters: onewas six, the other ten years of age. The breathing of bothwas prompt and regular; both had command over the softpalate and vocal chords; but it is hardly conceivable to imagineenunciation more indistinct, complicated, or unintelligiblethan theirs, excepting in those young persons who were borndeaf and dumb, but have just obtained hearing, and are begin-ning to talk. Their impediments did not arise from anyorganic defect. By showing, and directing the various andproper positions of the enunciating organs, they were taughtto speak distinctly and intelligibly. Nevertheless, before theimpediments were cured, their pronunciation, with all itsfaults, was perfectly continuous; it was not in the slightestdegree interrupted.The following description of cases will further assist in

showing, that stuttering is really occasioned by an improperuse of the organs requisite for the pronunciation of the muteletters.Upwards of twenty years ago the principal of Stockwell-

park School requested to have my opinion of a little boy,literally dumb. The child was amusing himself in sparringwith another little fellow, at some distance in the playground.I desired to examine him. Upon coming up, I began to playwith the child. We doubled our fists, and had "a regularset-to" ! After one or two rounds, I made a loud noise-Igave a yell. The little fellow by this time being quite at

* The invention has been sahstaetonty described, and ably advocated, inTHE LANCET.

home, and at his ease, began to mock, and to try whether ornot he could make as much noise as his new playmate. Theaffray, by way of experiment, proved some essential particu-lars-that he could hear, observe, and comprehend, and that hehad voice, and the power of imitation. I looked into hismouth, but discovered nothing remarkable, otherwise thanthat the palate was unusually high and hollow. It thenstruck me that the boy must hitherto have been placed in asituation altogether unfavourable to nursery instruction. Thisturned out to be the fact; for I learned afterwards that hehad not been trained or brought up at home under the careof a watchful mother. His speech had been neglected in hisearliest infancy; he had not been shown how two talk." Iventured to give an opinion in opposition to that of twogentlemen, surgeons of the school, that the child mightreadily be taught to speak. The method to be pursued wasplain and easy: it was that of repeating words by imitation,in precisely the same way in which little children, in the firstinstance of infant teaching, are enticed to say " Papa" and" Mama," and persevering in the exercise until the ear beaccustomed to receive and detect the difference in vocalarticulated sounds, in correspondence with the objects forwhich they stand. The plan succeeded. The child was soonable to derive benefit from the instructions of the juniormaster of the school. The respirations of this little boy wereregular, and his speech, in beginning to talk, was perfectlycontinuous.In correspondence with this case, that a child maybe dumb,

and yet not deaf, is the following instance in the work of Dr.Ashburner on Dentition, p. 104 :-"That the mind should be clear and intelligent; that the

expression of countenance, in a child six years of age, shouldindicate the possession of an understanding even beyond hisyears; and yet that he should never have spoken, although he.was not deaf, appears strange. What entanglement of deve-lopment was there that prevented the mind from commandingthe organs concerned in articulation ? The jaws had alwaysbeen too small for his teeth; they took a start in growth; thefirst permanent molares were cut; the spaces between theteeth became wider; the pressure was taken off from thedental nerves; the organs with which they were associated inerror were free; and the boy was taught to speak."

It is perceivable that this quoted case is a little different,perhaps, from that of the boy in Stockwell-park School; andin some essential points the following case differs from both :-A young gentleman, eleven years of age, was introduced to

me some time ago, at Eagle House, Brook-green. The youthhad received good nursery instruction, and spoke, I am told,with fluency at the age of three. At that period he was seizedwith an attack of fever, and was bereft of the power of speechfor three months, during which period, though he could hear,he was completely dumb. At the end of the third month, hemade an effort to ask for water, and then for the first time hestuttered. His health was shortly afterwards restored, but hestill continued to stutter, and to speak with greater and greaterdifficulty. Upon his introduction to me it was exceedinglydistressing to hear him. In every attempt to speak, hisbreathing was painfully checked, as much when he attemptedto pronounce the vowels as the mute consonants. Every effortto articulate was accompanied with wry motions of the body,sudden starts, and violent contortions of countenance. Thecause of this impediment was doubtless a derangement in therespiratory system. Upon quitting Eagle House, to go toWinchester, the boy spoke with comparative ease.

I now call your attention to an exceedingly interestingcase, in a young lady who was quite deaf and dumb duringthe first six years of her life. She has now attained the ageof fourteen, and was introduced to me, four months ago, byyour lecturer on surgery. By the able advice and judi-

, cious treatment of Mr. Pilcher, the faculty of hearing isgradually developing, which renders this young person capable

. of distinguishing and imitating sound in a moderate degree,’ and of attempting to utter the first principles of speech.

Previously to our acquaintance she expressed herself by asort of heterogeneous jargon, intelligible only to her relatives,

- and those persons around her. The time, however, for efficient, teaching arrived, and the system which I have adopted is, suitable, and corresponds with the leading principles of. mental and physical training.

The means of cure are now in full operation; they arepractically drawn from the theory of the voice and its into-[ nations, from my theory of the vowels and their progression-: as already explained and elucidated to you in the lateral and

longitudinal openings of the buccal and oral cavities; from thetheory of vocals and sibilants-the labial, dental, and palatine

291

mutes; from the oral and nasal liquids, and all the elementaryprinciples of normal articulation; together with their physicalcauses, the various inflexions of the tongue, the lips, the jaw,and the soft palate.My patient has now taken a start, and is beginning to speak

out the vowels and some of the leading elements intelligibly;and she will, no doubt, with patience and perseverance, as herhearing advances, speak fluently, easily, and well.The speech of this young lady, with all its past and present

imperfections, is quite continuous; and thus have we anotherinstance, gentlemen, of normal applications of the velum, withconfused actions in the other organs of enunciation, which donot engender stuttering.

It has been proved that substituted articulations will notengender stuttering, so long as the velum and the pharynxare normally prompt in their actions. It has been also shown,that if the velum be quick in its action, and more disposed tohang down than to furl up, the murmur from the glottis willeasily combine with the actions of the pharynx; but the voicewill be nasal and continuous. On the other hand it has beendemonstrated, that if the velum be tardy in its action, andmore disposed to furl up than to hang down, the muscles ofrespiration will be in danger of receiving a check, and thebreath and voice of being stopped at the oral or buccal andnasal passages.In support of these doctrines, you have, doubtless, seen

many a case where there was a deficiency in respect to thesoft palate or velum, and you may have observed, that, inevery one of them, the utterance of the patient was uninter-rupted, or, in other words, not in the slightest degree a stutter.We therefore conclude, that where persons merely substi-tute letters, their enunciation being continuous, with anutterance, nevertheless, defective and thick, confused and

complicated, such persons do not stutter, so long as theycontinue to have power and command over the organwhich closes the nasal passage, and over those whichare essential to the fluent utterance of the mute consonants;and we may also safely conclude that those individuals whosestructure is imperfect, in respect to the organ which closesthe nasal passage, and to the hard palate and lips, neverstutter; which is a powerful argument in favour of myviews respecting the mute letters, and the velum pendulumpalati.One or two words before I conclude. With respect to these

two classes of persons with defective speech-the individualswho stutter and those who do not, there is a material differ-ence in point of moral temperament. Those who merely sub-stitute letters, or, in another sense, speak with an unintelli-gible indistinctness, seem, with very few exceptions, not tocare for the infirmity, nor to be over-anxious about correct-ness ; while those who stutter appear to be scrupulously exactabout vowels, liquids, and mutes. In attempting to say sucha word as mad, and not having command over the actions ofthe velum, the stutterer would boggle at b, and struggle toprolong its sound; that is, convert b into the nasal liquid m,or in other words, he would try to articulate m with the nasalpassage closed. He would not be content to say bad! whereasthe other, whose articulation is complicated, indistinct, andfull of error, but nevertheless continuous, would be under noalarm, and would readily say bad! " He ith(s) th(s)tark bad!"The stutterer being asked if he were glad that he could notsay " mad," he would answer, " D-d t-t no;" if the other wereasked if he were sorry that lie could not say mad, he wouldimmediately and unhesitatingly reply, "Do, I ab dot!"

SYPHILIS AS A CAUSE OF THE DEATH OF THE FcETUS.- Syphilis often causes the death of the foetus, and it is ofimportance to obtain a diagnostic sign by which it can bemade out that syphilis has really destroyed the child, so thatin doubtful cases the parents might be appropriately treated,and the next offspring saved. Such diagnostic signs as whiteand hard nuclei in the placenta, peritonitis, a peculiar altera-tion of the liver, have been mentioned, but they are commonto other diseases. M. Paul Dubois has looked for more cer-tain symptoms, and conceives that suppuration of the thymusgland may be reckoned among them, as he has found thispathological change in all children who have died of syphilis,and not in other fatal cases. The pus is mostly to be found inthe secreting portion of the gland, and is yellow, opaque, andCreamy; it should not be confounded with the normal secre-tion, which is white, opaline, transparent, and viscous. M.Dubois does not, however, put implicit confidence in thesesigns, and thinks that further investigations are necessarybefore the question is settled, -

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PRACTICAL OBSERVATIONS ON

THE HISTORY, CAUSES, AND TREATMENTOF SOME OF THE

MORE IMPORTANT DISORDERS AND DISEASESOF EUROPEAN INVALIDS ON THEIR RETURNFROM TROPICAL CLIMATES.

BY JAMES RANALD MARTIN, F.R.S.,SURGEON, BENGAL ARMY, RETIRED ; LATE PRESIDENCY-SURGEON, AND

SURGEON TO THE NATIVE HOSPITAL, CALCUTTA.

(Continued from p. 147.)

GEORGE D. POLLOCK.

CHRONIC ENLARGEMENT OF THE LIVER—(continued.)FOR the following interesting case I am indebted to Mr.Pollock, of St. George’s Hospital:-

" 27, Grosvenor-street, Jan. 5, 1850.

MY DEAR SIR,—I send you the particulars of the case Imentioned to you of scrofulous disease of the hip-joint andenlarged liver, the recovery from which I solely attribute tothe use of the nitro-muriatic-acid bath, used as recommendedby yourself.In July, 1848, I was requested to see a boy, (Walter M-,)

fifteen years of age, with extensive scrofulous disease of thehip. The region of the joint was externally marked bynumerous deep cicatrices,,and several sinuses still dischargedtheir pus from the interior. The thigh was contracted on thebody, and the pelvis much distorted. His aspect was veryunhealthy; countenance delicately pallid. It was impossibleto ascertain the exact condition of the joint, or position of thehead of the femur, from the consolidation of the surroundingsoft parts, and also from the suffering any movement of theparts produced in the child, but there was no doubt that con.siderable mischief had occurred in the joint, and had beengoing on for some time.The abdomen was also found to be very large; there was a

small quantity of fluid in the cavity of the peritonseum, butthe enlargement was chiefly dependent on the great size ofthe liver, which was very prominent, reached down below thecrest of the ilium, and filled up the greater part of the abdomen.He was unable to sit up, and moved with difficulty. Pulseweak and quick; appetite good; tongue clean; but everystructure marked his exsanguine condition.When six years of age, and nine years before I was consulted,

he had a fall down stairs. Some months subsequently, hisparents observed him walking lame, and, as they describe it," he was attended by a doctor for a disease of the hip." Hebecame worse by degrees, and for the symptoms referred tothe hip; he had an issue made in the back part of the thigh,which was kept open for some eighteen months. He appearedto improve under this treatment, but soon after an abscessformed in the side of the thigh, which was opened, allowingthe escape of much pus. From this time until I saw himmany abscesses opened and healed, but a constant dischargecontinued from the hip, and occasionally pieces of carious bonecame away through the openings. Within twelve months ofmy seeing him his parents observed the increased size of theabdomen. About a week after I saw him, he commencedusing the nitro-muriatic-acid foot-bath, and spunging the bodywith the nitro-muriatic acid, as recommended by you. Inthe first week of its application, the size of the abdomen, bymeasure, di7ainished one inch and a half, and during the foursubsequent weeks, one inch every uieek. After this the parentsceased to keep the measure accurately; but during the wholeof the time, from the commencement of the use of the bath,he rapidly improved in every respect; he gained strength,and health, and colour, and all the sinuses healed up rapidly;and he was shortly afterwards able to move about uponcrutches. I saw him again in April, 1849, so much improvedthat I did not know him again. Every sinus was closedround the joint, and quite sound; he could place his foot tothe ground, and even bear some weight upon it. He hadgained flesh, and could walk about with the help of one crutchonly, and wished much to have a high-heeled shoe, which,however, I recommended not to be tried too soon. The livercould not be detected larger than natural. The bath was usedfor some three or four months, being omitted for the intervalof a week or a fortnight occasionally; and in the interval hetook internally small doses of the nitro-muriatic acid. Theentire treatment consisted in this; and to the use of the bathI cannot but attribute the favourable result of the case.

I enclose you a letter from the parents, of which you canmake any use you may think proper.

-

Yours very sincerely,J. R. Martin, Esq." GEORGE D. POLLOCK