The law of heredity does not in any way contravene this law of the pulse; on the contrary, it' accommodates itself to it.

Different periods of the day have different effects on different people. Thus you will find people who are peculiarly sensitive and susceptible to extraneous influences in the morning. As I once heard a deacon remark: That if he could keep from sinning up to ten o'clock in the morning he was safe from sinning the balance of the day. These are physical laws, and are peculiar to the individual, affecting each according to his nervous and structural organism, being part and parcel of his physical organization, attending him during life, and fixing the hour of his death.

This law of heredity at fixing the hour of death is most observable in organic disease, since these diseases have a law of their own, and override mere peculiarities of disposition which, in ordinary cases, might be controlling in their effect; that is to say, if a patient has hereditary organic heart disease, inherited from the paternal side, this disease will override and control any mere maternal impressions in determining the period of his death. But if this maternal impression is sufficiently strong to work an element of heredity in the organization of the son, it will have its effect in determining the length of the son's life, even though he inherit from his father fatal heart disease. Thus, I knew a man who died at fifty-three with heart disease. His wife was a healthy woman, with no trace of heart disease, whose mother lived to be over one hundred years old, and she herself lived to be between sixty and seventy. Their oldest son inherited from his father fatal valvular heart disease, but he outlived his father twenty years-dying at seventy-two years of age. Here the son inherited from his maternal grandmother much long-lived blood, which, acting on the heart disease, derived from his father, caused the son to outlive the father twenty years, though, like his father, he had fatal heart disease.

The case just cited supra, teaches another truth, and that is that persons may possess in their physical make-up characteristics which never manifest themselves, and even are not operative in their own lives, but manifest themselves and operate in the lives of their children. In the case just cited the son inherited his length of life, his long-life blood from his maternal grandmother, causing him to outlive his own mother two years and his father twenty years. It is a known fact that he inherited this long-life blood from his grandmother. This is positively known because the records are existing, showing when the other grandparent died, and they all, including his paternal grandfather and grandmother and his maternal grandfather, died under the age of fifty-five years; yet his own mother, with this long-life blood in her veins, died at sixty-two.

Why did not the long-life blood which flowed in the mother's veins manifest itself in lengthening out her life?

So, then, we see that parents frequently possess qualities which lie dormant in their own lives, yet spring up and bear their legitimate fruit in the lives of their children.

I might cite further, in corroboration of what has been stated in this behalf, the case of a man whose timidity was well known. This man married into a quiet, timid, peace-loving family, but he had born to him a son who was as remarkable for his courage as his father for his cowardice. But the paternal grandfather of this boy was just such a man as his grandson, bold, courageous and self-reliant. He also resembles his grandfather in his personal appearance.

The elements which enter into the conditions which determine the period within the twenty-four hours within which a patient will die have been to some extent considered, and from this consideration we see that heredity plays no unimportant part, but is the leading factor.

ON THE NATURE, CAUSES AND TREATMENT OF STUTTERING, WITH A SUGGESTION AS TO ITS CONTROL

IN PUBLIC SCHOOLS.

BY A. E. IBERS HOFF, M. D., Cleveland, Ohio.

[Written for the MEDICAL BRIEF.]

Recent statistics, gathered in the Cleveland public schools, go to show that in a total of five thousand school children, three hundred and sixty, or 0.7 per cent, are stutterers. This is but a cursory estimate, for if a more careful examination were to be instituted, it would be found that fully one per cent of all school children are afflicted with impediments of speech, bringing the total up to five hundred pupils. Such, in fact, was the condition disclosed by similar investigation of the schools of Boston, Berlin, and other large communities.

In view of the fact that the majority of these unfortunates are children of wage-earners and laborers, and, therefore, leave school at the age of thirteen or fourteen years, from seventy-five to one hundred pupils afflicted with speech defects enter life annually. Such individuals are handicapped, not only by their defect, but by reason of the fact that their schooling has been very materially embarrassed in consequence, and it can not be denied that many discontinue their education early on account of their affliction. Perhaps these facts will serve to justify a brief resumé of the subject of defective speech, its nature, causes and treatment, with the hope of emphasizing the importance of practical intervention.

In the interest of clearness it will be first necessary for us to distinguish between stuttering and stammering, for the two are, contrary to a prevailing notion, not synonymous. Stuttering is based upon an abnormal mental condition. It may be defined as a temporary inability to vocalize certain consonants or vowels, either singly or when joined into words. This ina

bility is due to either an excess or lack of force and results in hesitation or repetition of letters, syllables or words.

Stammering, on the other hand, is a defect of pronunciation, enunciation or articulation. The stammerer does not hesitate. He speaks fluently, but habitually substitutes an incorrect letter or sound for the correct one, such as the "th" sound for the "s," a defect popularly known as lisping. In a similar manner there may be a substitution of the letter "t" for the letter "k," as in "tind" for "kind;" the letter "p" for "f," in "toppee" for "coffee," or the letter "d" for "st," or "t," as in "duddering" for "stuttering." Stammering, unlike stuttering, is a continuous process, altogether independent of any defective cerebration, and is found most frequently in children while learning to talk. Yet stammerers are occasionally met among adults, a historic example being the Greek orator, Demosthenes, who, we are told, had difficulty in sounding the letter "r," a defect he attempted to overcome by placing pebbles on his tongue, and hurling invectives at the

ocean waves.

With this distinction in mind, we may dismiss the subject of stammering as being of little importance, when compared to the much more frequent, severe and extensive form of speech defect-stuttering. This malady takes rise most frequently in the first period of speech development, and undoubtedly owes its origin, to some degree at least, to faulty methods. In accordance with this fact a leading authority recognizes the following. three stages: The first stage, characterized by mistakes in speaking, and by repetitions which might be readily overcome, if promptly corrected by parents or teachers. In this stage, even under psychic excitement, embarrassment or fear, the patient is able to speak correctly when properly admonished, owing to the fact that he has not yet lost his muscular control. There are, indeed, adults whose condition has never progressed beyond this first stage, and who can, with proper attention, disguise their affliction.

When, however, faulty speech has continued uncorrected for a long period of time, the condition reaches the second stage, wherein the patient is no longer able to correct himself. He becomes fearful of certain sounds, which have previously appeared particularly difficult, and prefers to circumvent these, and to substitute others offering fewer difficulties.

From this stage to the third is but a brief step. The notion of speechfear becomes a fixed, positive conviction. The patient is certain of his inability to vocalize the difficult sounds, or even at times to speak at all. This speech doubt, as may be expected, leads to a long train of emotional disturbances, mental depression, psychic irritations, conflictions and uncertainties, resulting in a weakening of the will power, and in unmistakable. evidence of nervous exhaustion. Disharmony, lack of co-ordinate thought and loss of mental poise, are, therefore, characteristic of the last stage of this malady, and render the patient a helpless, diffident, floundering being.

ETIOLOGY.

Statistical information points to hereditary predisposition as the primal underlying cause in the great majority of cases, while traumatisms, sudden violent emotions, and acute diseases of childhood frequently act as excitants or contributing etiological factors.

That abnormalities of the external organs of speech can not be looked upon as causes of stuttering, is the verdict of the best authorities. For the fact is, that, while malformation of the palate, teeth and cranial bones are found among stutterers, they are quite as prevalent among those unafflicted with speech defects, and in each case are significant only of degeneracy. Neither can we look to embarrassed breathing as a causative factor, for asthmatic patients are not necessarily stutterers, while, on the other hand, individuals of more than normal breathing capacity are frequently found among the ranks of speech defectives. Finally, such symptoms as spasm of the glottis, contractures of the tongue muscles and deficient will power, must be looked upon as sequelæ, rather than as causes of this condition. For lack of will power is by no means a constant quantity among stutterers; while, on the contrary, an excess of effort is frequently put forth by such unfortunates in their attempts to vocalize a difficult sound or word. We must appreciate that the function of speech involves two distinct processes, the one mental, the other physical-the one subjective, if you please, the other objective. The mental process of speaking is quite continuous. for we are in reality constantly holding converse with ourselves, or with others, yet in doing so may not utter a sound. This mental speech is. therefore, independent of the physical use of the organs of speech, while, on the other hand, physical utterance is always dependent upon cerebral activity, conscious or unconscious. If it is true, then, that stuttering is not due to defects of the external organs of speech, it must be a disorder in the mental process. There is no alternative, and a predisposition to such a disorder is, undoubtedly, transmitted by way of procreation.

Evidence bearing out this conclusion lies in the fact that over eightysix per cent of stuttering cases can be traced to the earliest period of speech development, i. e., previous to the beginning of school work, the remaining per cent developing their defect after their entry into the school. This fect would, a priori, have been expected, for mental speech is an active process before physical utterance has begun. The former is an inheritance, the latter purely an accession acquired by the aid of mimicry through the agency of other special functions, notably those of sight and hearing. That a correct mental word picture be created in the mind of the child is, therefore, the first requisite of normal speech-development. This process may be frustrated, or embarrassed in various ways, such as partial or complete deafness, due to absence, malformation, occlusion or disease of the external hearing organs, obstruction of sound conduction or perception, or

weakness of the acoustic center. Any or all of these impediments will alter or prevent the formation of a correct word-picture in the mind of the child.

Yet in the absence of these deterring influences, and with a correct conception of sounds, letters and words, the individual may be prevented from correctly imitating the same by reason of a blocking of nerve impulses in their passage from the acoustic to the co-ordination center. The individual will be unable to distinguish clearly between the separate sounds, resulting in a confusion of sound images which constitute, when reproduced or vocalized, a stuttered speech. This fact should serve to emphasize the importance of guarding against too rapid speech in the early training of the child.

Finally, the most important requisite to normal speech is that of coordination between the two processes of mentality and vocalization. For if, as has been stated, articulate speech comprises an harmonious co-operation of these two, any disproportion in rate must result disastrously. The thinking process is normally the more rapid of the two, and must, therefore, be held in check to keep pace with vocalization in order that harmonious co-ordinate speech be maintained. Evidence of disharmony of these two functions is, occasionally, found among adults who "think faster than they speak," with the result that they begin a new sentence before completing the previous one. Such individuals are, in a sense, stutterers"sentence stutterers," if you please, the reason they are free from word stuttering being due either to the fact that their speech was developed before the habit of inco-ordination was formed, or owing to the fact that they are unconscious of this disharmony. For it is the consciousness of the lack of concord between thought and utterance, with its attendant distrust, uncertainty, diffidence, hesitation, and fear that produces stuttering. All stutterers speak quite fluently so long as they do not think of their affliction.

SYMPTOMS.

As has been stated, stuttering is a temporary condition. Speech difficulties affect all manner of sounds, especially the consonants, either singly or in a combination at any point in a sentence and under all conditions of time, place and environment. The unfortunate makes hard work of what seems to others an easy task, for he assists his speech with an increase of physical force, resulting in wild gesticulations, paroxysms, convulsions. stamping of feet, clapping of the hands, and a general frenzied demeanor.

By nature, the stutterer is capricious and whimsical. He makes every effort to forget his affliction, and to direct his attention to some other channel by doing certain things or carrying certain objects. These efforts may be, to a degree, successful, but the result is only temporary, for, in accordance with the law of association of ideas, his trouble returns in the midst