BY WILLIAN T. OATH ELI,, M. IK, STAMMERING. OF BALTIMORE. REPRINT FROM THE BALTIMORE MEDICAL AND SURGICAL RECORD OF DECEMBER, 1800. b Of all the milder affections to which mankind is heir,perhaps none are so.distressing to the sufferer and at the same time so annoying to.all who come in contact with him, as stam- mering. And in. my opinion a few words upon this import- ant subject will not be amiss. For medical literature has not sufficiently responded to the earnest demand to which this theme is entitled. Therefore, it is my desire in this paper to add my .personal observation to the already existing, on this often inexplicable phenomenon. The heart of the humane physician is ever filled with pitying sympathy when he observes a refined and talented person, born to a good position, relinquish the eminence which he would surely attain, and sees him doomed to tread less favored paths and almost compelled to renounce social intercourse, because the possessor of this mysterious curse which closes to his ambition the law,the stage and the pulpit. The earliest history of defective speech dates from the Scriptures, where we observe Moses as the first patient, and again a natural peculiarity of pronunciation we find ascribed totheEphriamit.es. Later, Demosthenes speaks of vocal cul- ture at the sea shore as being advantageous. Again the mighty Shakespeare with his noble and most precious powers discloses to the world that he himself is.also conscious of this existin''- trouble for ’tis lie who exclaims “I would thou could’st stam- mer that thou might’st pour from thy month as wine comes out a narrow month bottle, either too much at once or none at all.” » Thp human throat we cannot but admit is the most mar- velous of musical instruments, for it indeed is truly great and positively excellent. It is also strange to say,the most difficult to thorough1 v master, as is shown by the fact that those who have reached perfection are few,for the whole of music comprises but seven notes, the different arrangements of which produce the har- mony we admire in the works of Handel and Mozart. Voice even in its simplicity puzzles our imagination, for we cannot conceive how mankind conceived the original idea that certain sounds or combinations thereof could denote ob- jects, and moreover it exceeds the bounds of reason to com- prehend the primary communication of this discovery*. 2 Does the babe in acquiring speech thoughtfully consider the manifold actions of the lips and tongue during vocal and labial plionation, and consequently acquire the dentals and linguals, and thereby transmit certain mpulses to the invis- ible larynx? No. He, incognizant of the existence of a throat, by his trancen dental faculties strives only to imitate. The sounds are to him as the tuning fork to the vocalist, and by his constant imitation he unknowingly causes the currents of expired air to vibrate his inferior laryngeal liga- ments. Therefore it is, that his little brain causes him to acquire a peculiar character of voice,either perfect or imper- fect in its origin or its development. Whether this faculty is carried on by reflection or by ex- perience I am unable to say. But if the child is in want of control over the muscles concerning acritulation, when he has formerly possessed it, then will the properly enunciating powers vanish for months,perhaps for years,and he is doomed to an impediment from which it is extremely difficult to disen- slave him, as both the mental and physical structure of his be- ing will be found in this respect unaiding. A something has vanished of which when present he was not conscious. What first caused these chorea-like actions of the vocal apparatus has not been fully determined, for the solution of this problem like many other powers of humanity lies yet in obscurity. But we do know that the nerves of volition have undergone a strong reaction, and that even concentrated thought and deliberation are unable to regain the perfect vo- cal timbre. Occasionally the cause of stammering is well marked, es- pecially when depending upon an underlapping jaw, a faulty tongue,as where there is too great a breadth of fnenum, a de- ficient aeration of lung power,an ulceration of the bucco-phar- vngeal membrane, an intoxication where tremulous debility is present, or a paresis where there is a crippled condition of the nerve branches which preside over the production of sound. Stammering, or the anomalous choreiform movements of the vocal apparatus which is regarded chiefly as an idiopathic or functional disorder is at times amenable to treatment, some employing the numerous mechanical contrivances that have been devised, others intoning and vocal gymnastics. Many of the cases which the practitioner meets are those of a self-limited duration, the period of vocal recuperation, or the period which is required by the laryngeal apparatus to mature so as to control the muscles of articulation,accord- ing to the statistics I have studied, is from 15 to 20 years. 3 Patients, will, however, consult us with the history of stam- mering to the maximum period of these statistics and most cases, excepting where organic trouble is present, I believe can be reduced to the self limiting variety, and thereby un- dergo resolution, if we remove the pathological condition, which I believe is often visible by the aid of the laryngo- scope. The explanation of this will be found in the following case : (Jhas. H., aged 29, was when a boy daily brought in con- tact with a stammering son of the Emerald Isle. He amused himself by mimicking his contortions and consequently the impediment was irremediably confirmed, for he unknowingly in grim earnest had taught his voice the chorea-habit. He when a youth visited a prominent physician and was informed that his disorder was of a self-limiting variety and that it would reqnire 15 or 18 years to regain his former lar- yngeal control. This period of time having elapsed he con- sulted me desirous of being informed why the impediment remained. Examination of the larynx revealed a small adhesion at the anterior angle of the thyroid cartilage bordering just above the false vocal cords. This was removed by operative measures some six months ago, and when seen some three months ago the patient was progressing favorably. Thus it is that I have convinced my own mind that the majority of stammering cases which we observe in patients above the age of 28 or 30 years, are not alone due to vocal chorea, but also to the addition of an inter-laryngeal lesion and is nothing more or less than the latter trouble which makes the condition non-limited, as in the case I report it was in my opinion the adhesion. Although my patient when last seen had not fully re- covered from his speech impediment, yet the degree of evi- dence thus far shown is conclusive enough in my mind to point to the fact that his case now ranks among the self-lim- ired variety, and if, as I hope, the adhesion has not of itself done any permanent injury then I am sure time will bring about complete resolution.