Since writing the report of this case the patient has been seen and examined. She seems to be in perfect health, and says she never felt better. There is not a vestige of the tumor remaining, except two or three small indurated spots that can be felt through the vagina.
STAMMERING, STUTTERING.
By Prof. G. Delon, late of Paris, France.
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.