PATHOLOGICAL DEGENERATIVE CHANGES PRODUCING SPEECH DEFECTS AND WHAT THEY TEACH
As I have before remarked, children utter vowel sounds before consonants, and I used this as an argument that phonation preceded articulation; but there is another reason for supposing that articulate sounds are of later development phylogenetically, as well as ontogenetically. Not only are they more dependent for their proper production on intelligence, but in those disorders of speech which occur as a result of degenerative processes of the central nervous system the difficulty of articulate speech precedes that of phonation. Take, for example, bulbar paralysis, a form of progressive muscular atrophy, a disease due to a progressive decay and destruction of the motor nerve cells presiding over the movements of the tongue, lips, and larynx, hence often called glosso-labial-laryngeal palsy. In this disease the lips, tongue, throat, and often the larynx are paralysed on both sides. "The symptoms are, so to speak, grouped about the tongue as a centre, [!-- pagenumber --]and it is in this organ that the earliest symptoms are usually manifested." (Gowers). Imperfect articulation of those sounds in which the tongue is chiefly concerned, viz. the lingual consonants l, r, n, and t, causing indistinctness of speech, is the first symptom; the lips then become affected and there is difficulty in the pronunciation of sounds in which the lips are concerned, viz. u, o, p, b, and m. Eventually articulate speech becomes impossible, and the only expression remaining to the patient is laryngeal phonation, slightly modulated and broken into the rhythm of formless syllables.
The laryngeal palsy rarely becomes complete. The nervous structures in the physiological mechanism of speech and phonation are affected in this disease; but there are degenerative diseases of the brain in which the psychical mechanism of speech is affected, e.g. General Paralysis of the Insane, in which the affection of speech and hand-writing is quite characteristic. There is at first a hesitancy which may only be perceptible to practised ears, but in which there is no real fault of articulation once it is started; sometimes preparatory to and during the utterance there is a tremulous motion about the muscles of the [!-- pagenumber --]mouth. The hesitation increases, and instead of a steady flow of modulated, articulate sounds, speech is broken up into a succession of irregular, jerky, syllabic fragments, without modulation, and often accompanied by a tremulous vibration of the voice. Syllables are unconsciously dropped out, blurred, or run into one another, or imperfectly uttered; especially is difficulty found with consonants, particularly explosive sounds, b, p, m; again, linguals and dentals are difficult to utter. Similar defects occur in written as in vocal speech; the syllables and even the letters are disjointed; there is a fine tremor in the writing, and inco-ordination in the movements of the pen. Silent thoughts leave out syllables and words in the framing of sentences; consequently they are not expressed by the hand. The ideation of a written or spoken word is based upon the association of the component syllables, and the difficulty arises primarily from the progressive impairment of this function of association upon which spoken and written language so largely depends. Examination of the brain in this disease explains the cause of the speech trouble and the progressive dementia (loss of mind) and paralysis with which it is associated. There is a wasting of [!-- pagenumber --]the cerebral hemispheres, especially of the frontal lobes, a portion of the brain which, later on, we shall see is intimately associated with the function of articulate speech.
THE CEREBRAL MECHANISM OF SPEECH AND SONG
Neither vocalisation nor articulation are essentially human. Many of the lower animals, e.g. parrots, possess the power of articulate speech, and birds can be taught to pipe tunes. The essential difference between the articulate speech of the parrot and the human being is that the parrot merely imitates sounds, it does not employ these articulate sounds to express judgments; likewise there are imbecile human beings who, parrot-like, repeat phrases which are meaningless. Articulate speech, even when employed by a primitive savage, always expresses a judgment. Even in the simple psychic process of recalling the name aroused by the sight of a common object in daily use, and in affixing the verbal sign to that object, a judgment is expressed. But that judgment is based upon innumerable experiences primarily acquired through our special senses, whereby we have obtained a knowledge [!-- pagenumber --]of the properties and uses of the object. This statement implies that the whole brain is consciously and unconsciously in action. There is, however, a concentration of psychic action in those portions of the brain which are essential for articulate speech; consequently the word, as it is mentally heard, mentally seen, and mentally felt (by the movements of the jaw, tongue, lips, and soft palate), occupies the field of clear consciousness; but the concept is also the nucleus of an immense constellation of subconscious psychic processes with which it has been associated by experiences in the past. In language, articulate sounds are generally employed as objective signs attached to objects with which they have no natural tie.
In considering the relation of the Brain to the Voice we have not only a physiological but a psychological problem to deal with. Since language is essentially a human attribute, we can only study the relation of the Brain to Speech by observations on human beings who during life have suffered from various speech defects, and then correlate these defects with the anatomical changes found in the brain after death.
Between the vocal instrument of the primitive savage and that of the most cultured [!-- pagenumber --]singer or orator there is little or no discoverable difference; neither by careful naked-eye inspection of the brain, nor aided by the highest powers of the microscope, should we be able to discover any sufficient structural difference to account for the great difference in the powers of performance of the vocal instrument of the one as compared with that of the other; nor is there any sufficient difference in size or minute structure of the brain to account for the vast store of intellectual experiences and knowledge of the one as compared with the other. The cultured being descended from cultured beings inherits tendencies whereby particular modes of motion or vibration which have been experienced by ancestors are more readily aroused in the central nervous system; when similar stimuli producing similar modes of motion affect the sense organs. But suppose there were an island inhabited only by deaf mutes, upon which a ship was wrecked, and the sole survivors of the wreck were infants who had never used the voice except for crying, would these infants acquire articulate speech and musical vocalisation? I should answer, No. They would only be able to imitate the deaf mutes in their gesture language and possibly the [!-- pagenumber --]musical sounds of birds; for the language a child learns is that which it hears; they might however develop a simple natural language to express their emotions by vocal sounds. The child of English-speaking parents would not be able spontaneously to utter English words if born in a foreign country and left soon after birth amongst people who could not speak a word of English, although it would possess a potential facility to speak the language of its ancestors and race.
It is necessary, however, before proceeding further, to say a few words explanatory of the brain and its structure, and the reader is referred to figs. [15], [16], [17]. The brain consists of (1) the great brain or cerebrum, (2) the small brain or cerebellum, and (3) the stem of the brain, which is continuous with the spinal cord. The cerebro-spinal axis consists of grey matter and white matter. The grey matter covers the surface of the cerebrum and cerebellum, the white matter being internal. The stem of the brain, the medulla oblongata, and the spinal cord, consists externally of white matter, the grey matter being internal. The grey matter consists for the most part of nerve cells (ganglion cells), and the white matter consists of nerve fibres; it is white [!-- pagenumber --]on account of the phosphoretted fatty sheath—myelin—that covers the essential axial conducting portion of the nerve fibres. If, however, the nervous system be examined microscopically by suitable staining methods, it will be found that the grey and white matters are inseparably connected, for the axial fibres of the nerves in the white matter are really prolongations of the ganglion cells of the grey matter; in fact the nervous system consists of countless myriads of nervous units or neurones; and although there are structural differences in the nervous units or neurones, they are all constructed on the same general architectural plan (vide [fig. 15]). They may be divided into groups, systems, and communities; but there are structural differences of the separate systems, groups, and communities which may be correlated with differences of function. The systems may be divided into: (1) afferent sensory, including the special senses and general [!-- pagenumber --]sensibility; (2) motor efferent; (3) association.