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he engages in imitation. This practice, notwithstanding the fact that it is unconscious, soon develops into stuttering, without any cause being assignable by the parent until investigation develops that unconscious and even unnoticed imitation is the basic cause of the defective utterance.

It has been definitely determined that stuttering may be communicable through contagious impressions, especially among children of tender age whose minds are subject to the slightest impressions.

For this reason, it is not advisable for parents to allow children to play with others who stutter or stammer, nor is it charitable to allow a child who stutters or stammers to play with other children who are not so afflicted.

So far-reaching are the effects of Imitation or Mimicry that in certain cases, children have been known to contract stuttering from associating with a deaf-mute whose expressions were made chiefly in the form of grunts and inarticulate sounds.

FRIGHT OR SEVERE NERVE SHOCK: Another common cause of stammering is fright or nervous shock, which may have been brought about in countless ways. One boy who came to me some time ago stated that he had swallowed a nail when about six years of age and that this was the cause of his stammering. The logical conclusion in a case like this would be that the nail had injured the vocal organs, but an examination proved that there was no organic defect and that the stammering was caused, not by injury directly to the vocal organs but by the nervous shock occasioned by swallowing the nail.

Another case was that of a stammerer who reported that he had been given carbolic acid, by mistake, when a child and that he had stammered ever since. This, like the case of the boy who swallowed the nail, might be expected to prove a case of absolute physical injury or impairment of the vocal chords, but once again, it was clear that such was not the case and that the stammering was brought about solely from the nervous shock which came as a result of taking carbolic acid.

There is still another case of a boy who felt that he was continually being followed. This was of course merely a hallucination, but the fright that this boy’s state of mind brought on soon caused him to stutter and stammer in a very pronounced manner.

Fright is a prolific cause of stuttering in small children and may be traced in a great many cases to parents or nurses who persist in telling children stories of a frightful nature, or who, as a means of discipline, scare them by locking them up in the cellar, the closet or the garret. To these scare-tales told to children should be added the misguided practice of telling children that “the bogey-man will get you” or “the policeman is after you” or some such tale to enforce parental commands. An instance is recalled of a woman who created out of a morbid imagination a phantom of terrible mien, who abode in the garret and was constantly lying in wait for the small children of the household with the professed intention of “eating them alive.”

Such disciplinary methods of parents savor much of the Inquisition and the Dark Ages and should, for the good of the children and the future generation they represent, be totally abolished. While these methods do not, in every case, result in stuttering or stammering, they make the child of a nervous disposition and lay him liable in later years to the afflictions which accompany nervous disorders. In some cases “tickling” a child has caused stammering or stuttering. Care should be exercised here as well, for prolonged tickling brings about intense muscular contraction especially of the diaphragmatic muscles, which contraction is accompanied by an agitated mental condition as well as extreme nervousness, all of which approaches very closely to the combination of abnormal conditions which are found to be present in stammering or stuttering.

FALL OR INJURY AS A CAUSE: Step into any gathering of average American parents for a half-hour and if the subject of the children should come up, you are sure to hear one or more dramatic recitals of the falls and injuries suffered by the junior members of the household, from the first time that Johnny fell out of bed and frightened his mother nearly to death, to the day that he was in an automobile crash at the age of 23. And these tales are always closed with the profound bit of confided information that these falls are of no consequence—“nothing ever comes of them.”

While in a great measure this is true, there are many falls and injuries suffered in childhood which are responsible for the ills of later life, although it is seldom indeed that they are blamed for the results which they bring about.

Injuries and falls are a frequent cause of stuttering and stammering. Usually, however, an injury results in stuttering or stammering, not because of any change in the physical structure brought about by the injury but rather by the nervous shock attending it. In other words, cases of stammering and stuttering caused apparently by injury might, if desired, be traced still further back, showing as the initial cause an injury but as a direct cause the fright or nervous shock resulting from that injury.

A good example of this is found in a case of a young man who came to me some years ago. He said: “When I was about five years old, my brother and I were playing in the cellar and I wanted to jump off the top step. When I jumped, I hit my head on the cross-piece and it knocked me back on the steps and I slid down on my back, and ever since, for ten years, I have stammered.”

Here is a case where the blow on the head, or the succession of blows on the spinal column as the boy slid down the stairs, might have been the cause of the trouble. More probably, it was the combined injury, undoubtedly resulting in a severe nervous shock from which the boy probably did not recover for many days.

Another man said, in describing his case during an examination: “At the age of 16, I was hit on the head with a ball. I lost my memory for one week and when I regained it, I was a stammerer.” This is a plain case of injury resulting in immediate stammering.

Still another case is that of a boy who, at the age of three, was shot in the neck by a rifle, the bullet coming out of his chin, which resulted in his becoming an immediate stammerer. Here, as in the case of the boy who swallowed the nail, it might be expected that the cause was a defect in the organs of speech, but I found stammering was brought on by the nervous shock.

From these few cases of actual occurrences, it will be seen that practically all cases of stammering caused by injury can be traced to the NERVOUS SHOCK brought about by the injury.

HEREDITY AS A CAUSE: There is little that need be said on the subject of heredity as a cause of stuttering and stammering, save that heredity is a common cause and that children of stuttering or stammering parents usually stammer. In this, as in the case of any malady hereditarily transmitted, it is difficult to say whether the trouble is caused by inheritance or by constant and intimate association of the child with his parents during the period of early speech development.

THE RESULT OF DISEASE: Many cases of both stammering and stuttering may be traced back to disease as the basic or predisposing cause. Acute Chorea (St. Vitus Dance) is frequently the cause of stuttering of a type known as Choreatic Stuttering or “Tic Speech.” Infantile Cerebral Palsy sometimes brings about a condition known as “Spastic Speech,” while whooping cough, scarlet fever, measles, meningitis, infantile paralysis, scrofula and rickets are sometimes responsible for the disorder.

Disease may cause stuttering or stammering as an immediate after effect or the speech trouble may not show up for considerable time, depending altogether upon the individual. But regardless of the length of time elasping between the disease which predisposes the individual to the speech disorder and the time of the first evidence of its presence, diagnosis reveals but an insignificant percentage of organic defects in these cases resulting from disease, indicating that even here the predominant causative factor is a mental one.

CHAPTER III THE PECULIARITIES OF STUTTERING AND STAMMERING

Each individual case of stuttering or stammering has its own peculiarities, already more or less developed—arising from structural differences (but not necessarily defects) in the organs of speech, as well as differences in temperament, health and nervousness; or peculiarities arising from habit—which is the result of previous training or neglect, as the case may be.

SING WITHOUT DIFFICULTY: Almost without exception, the stutterer or stammerer can sing without any difficulty, can talk to animals without stuttering or stammering, can talk when alone and in some cases can talk perfectly in a whisper. Some stammerers have less difficulty in talking to strangers than in talking to friends or relatives while in other cases, the condition is exactly reversed. A stutterer or stammerer almost always experiences difficulty in speaking over the telephone. One experimenter has shown, however, that a stammerer can talk perfectly over the telephone so long as the receiver hook is depressed and there is no connection with another person at the other end of the line. This experimenter shows that immediately the receiver hook is released and a connection is established, the halting, stumbling utterance begins.

These peculiarities of stuttering and stammering for many years puzzled investigators and were, in fact, finally responsible for arriving at the true cause of stammering.

Almost every stammerer seeks for an explanation of these peculiar manifestations. Why is it, for instance, that a stammerer can sing without difficulty, although he cannot talk? This is one of the best evidences that could be produced to show that stammering is the result of a lack of mental control. The stammerer who can sing without difficulty has no organic or inherent defect in the vocal organs, that is sure. If the stammerer can sing, and if this proves that he has no organic defect, then it follows logically that the cause of his trouble is mental and not physical.

TALK WHEN ALONE: The fact that a stammerer can talk without hesitation when alone and that he can talk to animals may be explained by a very simple illustration—any stammerer can try this experiment on one of his friends who does not stammer. He can prove that the reflex, or what might be termed subconscious movements of the bodily organs are more nearly normal than the same movements consciously controlled. Take, for instance, the regular beating of the pulse. Let anyone who does not stammer (it makes no difference in trying this experiment whether the person stammers or not, save that we are trying to prove that the condition may be brought about in one who is not a stammerer) feel his own pulse for sixty seconds. Let him be thoroughly conscious of this effort to learn the rapidity of its beating. If a disinterested observer could record the pulse as normally beating and the pulse under the conscious influence of the mind, it would be found that the pulse under the conscious effort is beating either more rapidly or more slowly or that it is not beating as regularly as in the case of unconscious or reflex action.

This same condition may be noticed in another unconscious or reflex action—breathing. The moment you become conscious of an attempt to breathe regularly, breathing becomes difficult, restricted, irregular, whereas this same action, when unconscious, is thoroughly regular and even.

In the average or normal person who has learned to talk

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