In severe cases the patient is taught how to fill his lungs properly. He is taught to acquire an inferior lateral costal expansion in inspiration. During expiration the abdominal muscles are trained to contract slowly and strongly, pressing the diaphragm upwards and drawing the lower ribs downwards and inwards. This steady breathing produces a sensation of repose in the stammerer. He is not to raise the upper chest and not to tense the throat, tongue or jaws.
The main vowel sounds are now taught. The main vowel sounds are oo, oh, au, ah, a and ee. They combine in six ways, oh and oo in the word wound, ah and ee make the long i, au and ee in boy, oh and oo in road, a and ee in rain and fair, ee and oo in new and you. There are also words in which no main vowel or compound sounds appear, which may be placed either on the open ah position or the closed ee position. Such words as long, abbot, among, which are on the position of ah and such words as it, sister, minister which are in the position of ee. The voice consonants are b, d, g, j, l, m, n, r, v, w, y, z, w being oo sound and y the ee sound. The breathed consonants are c, f, h, k, p, q, s, t.
The treatment of stammering intensified by Shell-shock is more difficult than that of Shell-shock stammering de novo.
Wound of face: Speech disorder. Recovery by reëducation in two months.
Case 583. (MacMahon, August, 1917.)
An officer was wounded under his left eye, October 7, 1916. His speech was affected only five days later in a casualty clearing station. Observed by MacMahon, November 5, he was found to speak with great difficulty and became exhausted after a few words. He was tensing all the muscles in attempting to speak. Breathing advice was given and counsel how to relax in the abnormal efforts.
November 12, the officer, who was at Number One London General Hospital, began to speak with more freedom. “I am getting a bit better. I feel I must keep quiet, and it comes after a bit. I think far quicker than I speak.” He said that the breathing exercises had helped him most.
November 15, he still spoke in a rather staccato way; but the words did not check as they had. In a week further there had been so much improvement that he was discharged with a prognosis of complete recovery.
January, 1917, he had recovered.