Spirit of the Foreign Periodicals. REMARKS ON STAMMERING, BY A SUFFERER. THE following observations on this annoying infirmity are from the pen of a physician, who, till his twentieth year, had been afflicted with stammering, and who then cured himself in the manner which we shall afterwards notice. Most writers on stammering have attributed it to the irregular and convulsive movements, or to the faulty position in relation to the teeth and palate, of the tongue and lips. Thus M. Hervez de Chegoin mentions the absolute or relative smallness of the flesh of the tongue, and the shortness of the frænum as its most frequent causes: and he has reported two cases where a cure was effected by dividing this bridle. But in a large majority of stammerers there is no irregularity whatsoever in the organs of speech and even if there was, the admission of such a cause would not account for the infinite varieties of the infirmity and the influence which moral emotions exert upon its development. MM. Sauvage and Itard regard debility of the muscles of the tongue as one of the most frequent causes. But do not persons that stammer execute with the greatest ease and rapidity all the various movements of the tongue and lips? Is it not rather a state of spasm than of debility? How too, on this hypothesis, are we to explain the spontaneous cure of stammering as life advances, when debility, local as well as general, must necessarily increase? Other writers seek for the cause of the malady in the action of the brain on the muscles of the voice-an explanation which may be quite just, indeed, if it were not so vaguely expressed: a vagueness which seems to have actually bewildered some writers who have adopted the explanation in question. Thus, Rullier, in the Dictionnaire de Medecine, says :-"In stammering, the cerebral irradiation which follows an act of thought, and becomes the moving principle to set in action the muscles necessary to the oral expression of the ideas, bursts forth with such impetuosity, and is reproduced with such rapidity, that it exceeds the mobility of the agents of articulation." But this is surely paying too great a compliment to stammerers; for my part I must confess that I never experienced that rapid flow of ideas and impetuous action of brain, which the author talks of. M. Magendie attributes stammering to such a deficient action of the organic intelligence as is capable of disturbing the movements of the vocal organs, which are influenced at the same time by the nervous system of organic life, and by the action of the brain. All that we can reply to this explanation is, to ask what the author means to announce; for to us his language is quite unintelligible. But to form a more accurate idea as to the cause of stammering, let us now briefly notice what we observe in a person afflicted with this infirmity, when he attempts to speak. In some cases-and this is the least severe form of the malady-the person speaks sufficiently fluently for a greater or less length of time; but if the pronunciation of a word which begins with certain consonants, such as b, p, or v, coincides with the close of an expiration, then the breathing becomes embarassed, hurried, and panting, and the efforts of the person to pronounce the word are No. LXVI. К к accompanied with convulsive movements of the lips; at other times the lips are in a state of tonic spasm. At length the person succeeds in overcoming this difficulty, by taking his breath or making an inspiration. In other cases, where the stammering is more decided, the person often cannot utter without difficulty almost any sound, even when the word which he wishes to pronounce begins with a vowel, (as was the case with myself in respect to the word oui); the features and neck swell up; the jugular veins become distended; and the person tosses his arms about to find relief. These two degrees of the infirmity are often observed to co-exist in the same person if he becomes embarassed by a word which begins with a consonant which is not easily pronounced, the fear of not being able to proceed renders the respiration panting; and then any efforts at speech are quite impracticable. In both degrees or stages of the malady, the stammering ceases after a strong inspiration; but it returns at once if the person does not continue to respire regularly, and the more frequently and badly if his breathing becomes agitated, and he strives much against it. The great object, therefore, is to bring and keep the respiration in a quiet tranquil condition, and cause it to follow a certain degree of cadence, such as we use in singing or in declamation. If the person can but once effect this, he will no longer stammer. From what we have now said, it is evident that in all the various sorts or degrees of stammering, its essential cause consists in a convulsive condition, either of a tetanic or a choreic character, of the respiratory function-the effect of which is, either to disturb more or less, or altogether prevent, the articulation of sounds. What occurs in the lips, tongue, and throat, is not the essential and primary cause, but is altogether accessory; and it is according to which of these parts is chiefly affected, that the different varieties of the infirmity are produced. The immediate cessation of the irregular convulsive movements by taking in a deep inspiration, clearly shews how intimately they are connected with the cause now mentioned. It was by attending to this simple means, suggested to me by Dr. Lindt of Berne, that I cured myself at the age of twenty years. The cure, indeed, was aided a good deal, I believe, by the employment at the same time of gymnastic exercises-the effect of which is powerfully to increase the influence of the will over the muscular system in general. Indeed it has been by their influence in regulating the act of breathing, that the efficacy of various means, which have been recommended and found useful, at various times, in the treatment of stammering, is to be accounted for. In this way the practice of declaiming on the sea-shore with a pebble in his mouth cured, it is well known, Demosthenes of old. M. Itard has advised the use of some mechanical means to keep the tongue raised, and he makes his patients at the same time speak in a foreign language. This plan of keeping the tongue raised towards the palate has been recommended by other writers. By this simple means, Madame Leigh assures us that she effected a cure in upwards of 150 cases. But however useful it may be to a person who stammers to acquire a certain control over the movements of the tongue, let it be ever kept in mind, that no permanent benefit will be derived unless the patient acquires, at the same time, the power of regulating his breathing-so that whenever he begins to hesitate or falter, he at once draws in a full breath. Madame Leigh imposed upon her pupils absolute silence, except during the hours of practising: and she always observed that those who had the greatest mental energy and power over their will were the most easily and quickly cured. M. Colombat, although his theory of stammering is far from being correct in our opinion, has recommended a most judicious method of treatment, which if rightly pursued is always sure to effect a cure. It consists in the adoption of the following three means: 1, giving the tongue such a position that its apex is directed upwards and backwards; 2, taking in a deep breath at the commencement of each phrase, and repeating this more or less frequently; and 3, marking the time in speaking by the movements of the thumb upon the fore finger. By following out these simple rules, it is almost impossible for any one to stammer; and when we consider that this method of treatment consists essentially in causing the person to inspire at the commencement of each phrase, and marking the regular return of the inspirations by the movements of the thumb upon the finger, we at once understand its physiological explanation. M. Serres' plan consists in making the person accompany the utterance of each sound with a powerful movement of the arms; he does not trouble himself about the situation of the tongue. Now this plan will often succeed as well as that which we have just recommended. But neither M. Serres nor M. Itard his reporter, who is surprised at the singularity of this method, seem to have perceived that every muscular effort is in fact made during the act of expiration, and therefore that the pupil, to enable him to accompany the emission of any sound with a movement of his arms, must have always a provision of air in his lungs, and that thus he acquires the custom of speaking only during expiration. There cannot be a question as to the utility of gymnastic exercises in increasing the energy of the will and the action of the brain upon the whole muscular system. It is a novel and a most practically useful idea of M. Serres, that the treatment of stammering should consist in a gymnastique of the respiratory and the vocal organs.-Gazette Medicale. STATISTICAL RESEARCHES ON PNEUMONIA. The following conclusions are deduced from a careful comparison of 75 cases of active pneumonia observed in the wards of La Charité hospital, and under the care of M. Bouillaud. They have been collected by M. Pelletan; and his memoir, founded upon them, was recently reported upon to the Royal Academy by M. Rayer to whom it had been referred. 1. Pneumonia affecting one lung is more frequent than pneumonia of both lungs simultaneously;-in the ratio of 7 to 2. 2. The right lung is more frequently the seat of pneumonia than the left one -in the ratio of 2 to 1. The greater frequency of the disease in the right side had already been noticed by previous writers, although they differ from M. Pelletan, and from each other as to the exact ratio of frequency. 3. The base of the lung is more frequently affected than the summit-in the ratio of 1 to 1. 4. The age or duration of the pneumonia being the same, the degree or severity of the disease has been found to vary much in different cases; and it is only in the extreme limits that it has been possible to establish a relation between the duration of the inflammation and its development. (The meaning of this sentence is anything but clear: we scarcely know what the author wishes to announce.) 5. The disease is twice as frequent between 17 and 37 years of age, as at every other period of life. 6. It is more frequent in men than in women ;-in the ratio of 10 to 1. 7. The influence of cold as the exciting cause has been remarkable in sevenninths of all the cases. 8. The frequency of the pulse has not afforded any exact measure or indication of the intensity of the disease nor of the point which it has reached. It is not, however, to be denied, that the acceleration of the pulse is a sign of con- 10. Prostration and delirium have in general existed when the inflammation occupied the summit of the lung; this coincidence was of much more frequent occurrence than in pneumonia of the base. 11. As to the treatment of pneumonia, when it is franchement inflammatoire, repeated blood-letting, according to the formula of M. Bouillaud, formed its basis. There were only two deaths in 55 cases; and the duration of the disease was incontestably shortened. 12. Blisters were rarely useful in adults; occasionally in children; always in old persons. M. Rayer, in reporting upon the memoir of M. Pelletan, very properly shewed that the question of the statistical or arithmetical history of pneumonia, or of any other disease, although apparently very simple if deduced from an ample number of cases, contains various elements which require to be attended to with the greatest care. For in truth pneumonia is not the same malady in children as it is in adults and in old persons: and again, when it prevails epidemically, it is in many respects very different from that form which occurs in a plethoric person after exposure to cold. It is necessary also to take account of secondary pneumonias, of bilious complications, and of a multitude of other circumstances, before one can fairly draw any conclusions of general application.-Gazette Medicale. Remark. It will be observed by these very brief remarks of M. Rayer that he is a much less hasty reasoner, and less heroic practitioner than his confrere, M. Bouillaud.-Rev. SUGGESTION IN PARACENTESIS THORACIS. Case.-A youth, after suffering for a month from a mucous fever, became affected with all the usual symptoms denoting a pleuritic effusion on the right side, which was fuller and more prominent than the other. Dr. Petit determined to perform paracentesis of the chest; but some hours before making the incision he cauterised the intercostal space with the potassa fusa. In the evening the cauterised part had become quite white, and its circumference was œdematous. After cautiously dividing the integuments and intercostal muscles with the scalpel, he reached the pleura, which he then opened. Immediately a stream of sero-purulent matter, very offensive, was discharged from the wound: altogether there must have been a pound. This patient gradually recovered, and ultimately he was restored to perfect health. Remarks. Dr. Petit considers that it is very useful in the operation for empyema to cauterise the spot where we intend to make an opening into the pleura. This has a double advantage :-1, the pain of the subsequent incision is very trifling; and, 2, the appearance of the integuments affords a very valuable diagnostic sign. For the facility with which the eschar becomes white, and with which the surrounding integuments are affected with oedema, will be found to indicate the presence of a subjacent fluid. This remark is applicable to the diagnosis of collections of fluid, simple or purulent, in all parts of the body. Dr. Petit prefers the bistoury to the trochar in performing paracentesis thoracis. He very properly recommends that the condition of the liver and spleen be ascertained before we determine between what ribs the perforation should be made. He has known the application of the caustic on the intercostal space 1 between the fifth and the sixth ribs fail of making an opening into the cavity of the pleura, and induce a peritonitis which proved fatal.-Gazette Medicale. If M. Petit's observations are confirmed, they suggest a most useful hint in not a few cases, where a certain degree of uncertainty must always exist. -(Rev.) M. PIGEAUX ON THE DISEASES OF THE HEART. It is almost unnecessary to allude to the interminable and ever-changing discordance of opinion of auscultatory writers on the seat and cause of the sounds of the heart. M. Pigeaux dissents, as a matter of course, from the views of other writers, and has an opinion of his own, which by the bye he has materially modified from what it was a few years ago. He describes the rhythm of the movements of the heart as embracing three periods in the first the auricles contract, in the second there is a repose and silence; and in the last the ventricles contract. Here are his own words : " "Let us suppose for an instant the heart entirely empty :-the blood then flows in upon it from all sides and in a continued stream, by the incessant emptying of the large veins, which terminate in it. The blood flows directly into the auricles, and as the auriculo-ventricular valves are down, it falls by its own weight into the ventricles until it fills them. When the heart is once full, let us see what takes place. The auricles will not contract first; for such a movement could effect nothing, seeing that the ventricles are full at the time. The ventricles themselves therefore contract first: the blood pressed on all sides pushes back the auriculo-ventricular and the sigmoid valves; these last give way and permit the blood to be propelled into the arteries. . . . . Immediately after the contraction of the ventricles, the auricles contract in their turn, and project their contents into the ventricles, which at the time are partially empty and approximated to the ribs. After these two successive contractions follows the repose of the whole organ; the heart falls into an entire in-action (resolution), which, it has generally been supposed, is simultaneous with the ventricular dilatation already completed. This repose lasts for a rather shorter period of time than that of the contraction. The ventricles finish by becoming filled during this interval, and the auricles continue their dilatation. Then, again, the rhythm of the movements recommences with the contraction of the ventricles; the cardiac circulation is completed." From this extract it appears that M. Pigeaux, has reproduced the opinion of M. Laennec himself as to the ryhthm of the heart's movements. It may indeed be justly asked of him, what are the grounds for his resuscitating a theory which has been completely disproved and rejected by all recent writers? What facts or experiments does he adduce to disprove the assertions of Haller and of many modern physiologists, among whom Dr. Hope deserves to be particularly distinguished, that the auricles contract before the ventricles, and that the contraction of these cavities follows immediately afterwards, without any intervening period of repose between these two movements? M. Pigeaux has certainly not adduced any such facts in his work; and he cannot therefore reasonably expect any one to believe it merely because such may now be his opinion; and this opinion too differing very materially from that which he held a few years ago. Then he maintained that it was the shock of the blood propelled by the contraction of the auricles against the walls of the ventricles that was the cause of the first sound, and that the second sound was produced by the friction of the stream of blood on the parietes of the aorta when projected into this vessel by the ventricle. |