STAMMERING.
The first step should be a careful investigation of the nasal passages, pharynx and naso-pharvnx in order to discover a cause for the reflex spasm of the articulatory muscles which produces the difficulties in speaking. Adenoids, enlarged tonsils and every obstruction to the freest passage of air through the nostrils must be effectually remedied.
The individual must be taught to inspire through his nose with the mouth closed and to exercise his diaphragm to the fullest extent possible, expelling the air forcibly through the open mouth. He must learn never to attempt to phonate during inspiration: he should speak in a loud resonant voice, with his chest filled to the fullest extent before speaking. and in order to secure this full repletion, costal as well as diaphragmatic breathing exercises must be steadily practised.
The usual chest-expanding exercises with dumb-bells and the swinging back of the arms in a horizontal plane with the palms held forwards should be performed for half an hour at a time 2 or 3 times a day, the movements being executed in combination or rhythm with deep breathing through the nose, and expiration through the open mouth.
The should always place the stutterer under the training of an experienced voice instructor, taking care to avoid the advertising quack.
Swimming exercises in deep, fresh water are also a very valuable means of increasing the vital capacity and of improving the general muscular tone, and increasing the self-reliance of neurotic subjects, who are more prone to fall into the habit of stammering than robust, healthy individuals.
Educative treatment must be pursued with the greatest patience till the stutterer gradually learns to establish a voluntary control over the centres which regulate the entire speech mechanism. Ile should read aloud slowly with a good teacher, practising over and over again the combina tions of sounds which give the greatest difficulty, with patience and deliberation. In very bad cases a beginning may be made by singing or intoning, after which, by repeated exercises in loud, slow reading, im provement will gradually show itself. The rhythmical cadence of smooth verse is more easily mastered than prose, and hence the exercise of reading poetry is always better at the commencement of educative treatment. By teaching the patient to direct his attention to the position and move ments of his tongue and lips and to the working of his thoracic mechanism much help will be afforded to him, and often by practising before a mirror he may learn much. lie must be warned and taught to abstain from all attempts at phonation or articulation when under the influence of nervous ness, excitement or passion. Some stammerers have been cured by a judicious and skilful application of hypnotic treatment.