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Report of the Medical Officer (Education).
153
the school language. The improvement in articulation among the children of the special schools in the
past half dozen years, however, shows what part the school can play in modifying or educating this
function. He found 111 cases presented by the teachers among 6,216 ordinary school children, that is
1.8 per cent. Of these, 60 stammered or stuttered, 12 presented lalling or lisping, 26 backward speech,
and 13 defects due to adenoids, deafness or other physical causes.
Dr. Bellingham Smith, working in the East End, where there are many alien children, has analysed
the nature of the defect present among 96 children (1.98 per cent.) chosen by the teachers from among
4,631 ordinary school children, of whom 1,843 were boys, 1,881 girls, and 907 infants. Of these children
3,816 were English and 815 were Jewish by parentage.
He arranges his cases as follows :—
(i.) Organic defects of the articulatory mechanism—
Adenoids 10
Enlarged tonsils 4
Cleft palate 2
Hoarseness (from intra-laryngeal causes) 2
Enlargement of turbinals 1
(ii.) Functional defects of articulatory mechanism—
Stammering and stuttering 44
Substituted speech (lisping, lalling, etc.) 24
Unclassified (lack of will 2, feeble voice 2, nasal tone 1) 5
(iii.) Central nervous defect—
Congenital word blindness 1
Nerve deafness, post meningitic 1
Temporary aphasia 1
Not classified 1
Increased adenoid or turbinal growths, or enlargement of the tonsils rarely gives rise to defect of
speech. This only occurs when the obstruction is almost complete, or the tonsils very large. Where
adenoids have been left till structural changes occur in the articulatory cavities, these themselves may
produce a permanent speech defect, even when the adenoids have been removed. The cause of the
hoarseness noticed in two cases is often intra-laryngeal roughnesses or warts (papillomata), but it could
not be definitely determined by the means at disposal in a school examination.
The functional causes were commonest and stammering was the most frequent. Of these, 20
were Jewish, 2.4 per cent. of the number of Jewish children, and 24 "English," or 0.62 per cent. of
" English "; 30 boys, 1.6 per cent. and 10 girls, 0.53 per cent. with 4 infants (3 boys and a girl).
The large foreign element made enquiry into the history and associated conditions difficult.
Definite causes were only assigned by 13; of these one stammered after recovery from pneumonia, one
after seeing a small brother killed, two after fright from other causes; two learned through sitting next to
stammerers at school, seven had elder members of the family stammer, and the remaining 31 assigned
no cause.
The cases were classified—
(a) The commonest stammer was the simple noisy stutter on the first consonantal sound
—27 cases, 24 of these being only on the first word of a sentence, the others on any words.
(b) The cases with silent struggling over words numbered 5.
(c) A stuttering repetition of the first syllable occurred in 7 cases, 2 of which had much
overflow of nervous effort.
(d) A curious abrupt explosive kind of speech noticed in 3 cases.
(e) Stridulous inspiration with commencing speech noted in 2 cases.
As regards stammering, all these cases could sing perfectly. Although the voices were generally
rather toneless, one was the best singer in the class. In 17 the defect was evident on conversation
alone, in 27 on conversation and reading, and of these 18 read poetry better than prose. Parents or
teachers described 19 as very nervous; 9 were reputed much above the average in intelligence, whilst
4 were in arrear, although not actually mentally defective. One suffered with enuresis and 5 had other
troubles. The stammering varied with, health; 1 nearly cured relapsed after tonsilitis.
The faulty function lies in incoordination of articulation with breath, and in the first variety of
cases the children talk or read in a great hurry, almost with breathlessness. The fear that they may
stammer if they stop leads them to place the breathing periods as far apart as possible and aggravates
the condition. Regular breathing exercises, reading aloud and slowly, if necessary with the teacher,
so that they learn when to fill their chests, cures the majority of these cases. They have to be taught
to speak slowly, deliberately and from a full chest.
In the second variety, silent stutter, no air escapes at all, whilst in the third the fault lies in the
second element, so that the first syllable is repeated. In the fourth variety the chest is not empty,
but voice comes with explosive fores, the over-action of the articulatory mechanism preventing slow
escape. The fifth variety seems to mean approximation of the vocal cords during inspiration, so that a
stridulus is produced on beginning to speak and the sentence is hesitating during the filling of the chest.
It is not sufficient to attempt to remedy these cases in the ordinary school. The teacher must gain
special experience and the children have special training.
12532 U