Here is an universal and very strange infirmity, impeding speech, the
origin of which must be anterior to the formation of languages.
Hippocrates, the “Père de la Médecine,” Galen and Aristotle attributed
it to an abnormal moisture of the brain and tongue and to a defective
construction of the tongue, and their theories have been revived by
modern writers. We find in Aristotle a double definition that stammering
is an inability of articulating a certain letter, and stuttering an
inability of joining one syllable to another. Notwithstanding the
difference between the causes, the characteristics and the effects of
both defects, several languages have but one word to express it; in
French, for instance, “Bégaiement” means either stammering or
stuttering. American dictionaries give the same definition for both; and
in common talk no distinction is made, all stoppages in speech being
called indiscriminately stammering or stuttering.
Speech being a combination of separate sounds produced by the expired
air, it is certain that the first condition required for natural and
correct speech is an undisturbed and normal action of the breathing
apparatus.
The movements performed by the respiratory organs for the modification
of the currents of air being produced by muscles owing their activity to
nerves—motor and sensory—and the vocal organs being, like all parts of
the organism, provided with nerves, it becomes evident that a general
excitation of the nervous system, or any unusual excitement of the
motor-nerves in action, will affect the muscles, cause irritation and
create disturbances in inspiration, expiration and speech.
Normal inspiration is produced by a regular contraction of the
diaphragm, and expiration is due to the elasticity of the tissue of the
lungs. A spasmodic inspiration, during which a prolonged contracted
spasm of the diaphragm takes place, produces stammering; such a
convulsive contraction of the diaphragm can take place without
attempting to speak, but any attempt to utter sounds during the spasm
will result in stammering. At the end of the spasm, the air is then
quickly expelled from the lungs. I have noticed stammering children that
I have treated subject to frequent attacks of hiccough; in hiccough the
expiration is quiet: an irritation of the nerves of the diaphragm brings
about, with a violent inspiration, an attenuated convulsive contraction
of the diaphragm, as in stammering.
In stuttering which is characterized by the presence of some spasm, in
all articulations, labial, lingual, dental and guttural, although
respiration is irregular and the respiratory organs do not work well,
the inability to form and join the sounds comes from other sources than
a spasmodic contraction of the diaphragm.
Stammering proper, when organic, might be called stammering of the
diaphragm, and that distinction would be quite logical, as other organs
wholly unconnected with speech show that peculiarity of being affected
with stammering.
The influence exercised on the voice and speech by the respiratory
mechanism is so considerable that a variety of theories on respiration
have been advanced and discussed by physicians and specialists, not only
with reference to speech impediments but specially for singing,
elocution, acting and public speaking, and also in reference to general
health. Writers and professors advocating exclusively so-called
diaphragmatic, or costal, or abdominal respiration, are incorrect and
perfectly deceived. The diaphragm, the ribs, and the muscles of the
abdomen must all do more or less their special work, in order to carry
on a normal and healthy respiratory act. An eminent physician, Dr. Ed.
Fournié of Paris, says: “He who respires exclusively by one or the other
of these alone (diaphragm, ribs or abdomen) must be indeed a sick man.”
Costal or side-breathing is due to the elevation and depression of the
ribs simultaneously with the contraction of the diaphragm. Abdominal
breathing, the method taught to singers, is performed by the pressure of
the abdominal muscles upon the anterior and lateral walls of the
abdomen, forcing up the diaphragm, and thus expiring almost completely
the air in the lungs.
Medical and scientific investigations concerning speech defects have
been as considerable as it is contradictory. The observations of
prominent doctors and specialists, some of them being afflicted
themselves, have in the most argumentative thesis attributed
stammering-stuttering to numerous and varied causes, the enumeration of
which has a real historical and pathological interest:
Faulty action of the tongue, disorders of tongue-muscles, spasms of the
glottis and epiglottis, troubles located in the larynx and in the
hyoid-bone, abnormal depth of the palate, affections of the muscles of
the lower jaw, spasm of the lips, abnormal dryness or moisture, or
lesion of brain, nerves, muscles or tongue, nervous affection,
intermittent necrosis, general debility or weakness, chorea, incomplete
cerebral action, imperfect will-power, want of harmony between thought
and speech, imitation and habit.—Such is the nomenclature of the
principal ingenious theories exposed and upheld by those who have made a
study or a business of the cure of speech defects. But some mistaken
innovators, not satisfied with theories and investigations, gave to
their ideas an experimental form. Forty and forty-five years ago a
surgical craze, originating in Germany as a pretended cure of speech
defects, was raging all over Europe. Stammerers and stutterers suffered
a variety of operations, the horizontal section of the tongue, the
division of the lingual muscles, the division of the genio-hyo-glossi
muscles, the cutting of the tonsils and uvula, etc. Such suppression and
mutilation of the vocal organs could not bring any cure, as it was
proved, and some patients having died, the operating craze was put to an
end forever. Since that it is by more gentle means that all attempts
have been made to cure impediments of speech. The unfortunate stutterer
has no longer to dread the misemployed zeal of surgical operators, and
now it is even his own fault when he allows himself to fall into the
hands of ignorant charlatans.
Without lessening the value of former discoveries, I will say that the
specialist of to-day must disagree with the most eminent authors and the
most prominent works on that question, including Velpeau, Amussat,
Becquerel, Lenbuscher, Bèclard, Bristowe, etc., and arrive at the
conclusion that their testimony was one-sided, being confined to their
own or few cases, and limited to mere theory and speculation. For the
treatment of vices of speech, with the indispensable knowledge, long and
practical experience alone will instruct what is the right method to
pursue. The various theories on the nature and causes of that infirmity,
and the enumeration of the different responsible organs may be, at the
same time, partly false and partially true; but they have proved
powerless to cure or relieve.
In all varieties and forms of stammering-stuttering all the vocal organs
can be blamed, and have, in each case, to be reformed and improved. In
the majority of cases we find some traces of the organic peculiarities
aimed at by authors, even if their influence is doubtful. Respiratory
trouble is at the bottom of every case. The internal organs, and the
tongue, the lips and jaws are to some extent in an abnormal condition,
and suffer a convulsive spasm; they have to be treated, strengthened and
made flexible. The nerve-function of the organs of speech is also
disturbed. We notice in the majority of cases, to a certain degree,
organic weakness, nervousness, lack of will-power, and above all,
disregard of all natural rules and ignorance of the use and natural
functions of the organs of speech.
As to prognosis, I will say that all stoppages in speech, accompanied by
spasms, sometimes hardly perceptible, and which are not the result of
paralysis or lesion, may be classified as stammering-stuttering, and can
always be cured, whatever may be their origin or cause, or their
intensity, and that it is only a question of time and perseverance even
for the most stubborn cases.
The treatment of stammering-stuttering, which does not comport any
operation nor drugs, is purely educational. It consists in remedying the
defect and teaching properly the science of speech. Still, I think, that
in many cases a strict attention ought to be paid to hygienic measures;
some medical care and prescription would help the patient and the
instructor. In the actual condition of things no regular practicing
physician can afford to devote his ability and time to the treatment of
speech defects. But doctors have to study the infirmity, to know that it
can be cured, that it is an interesting and complex disease, in the
treatment of which the progress of medical science can bring a
revolution. Physicians the world over having wholly neglected to
consider that question, the result has been to leave it in the hands of
incompetent persons. In principle the question of speech impediments
cannot be separated from medicine. Physicians cannot ignore an infirmity
in which the organism itself is undoubtedly involved, at times in a very
intricate manner and to a considerable extent. Every true physician
feels that he has a sacred mission—to alleviate suffering; the tortures
of a large class of people partially deprived of the faculty of speech
are well worth his care and attention. Medical students ought to be
provided with the means of becoming versed in an affection offering such
a large field for study and work, where so much light is needed, and
where the prospects of discovery and improvement from a scientific and
medical standpoint are so legitimate. The family physician, often
consulted, will do good work in advising his clients to try and get rid
of such a terrible affliction, to be cured without delay, and in
preventing them from falling into the hands of quacks.