I- & I net Psychology and Pathology of Speech Development of the Child BY EDWARD CONRADI A THESIS SUBMITTED TO THE FACUI^% had inherited their stuttering. When we consider that Coen at one time found in only 26^% and at another in only 11% inheritance and that Berkhan found inheritance in only 18.7% of 209 cases, Denhardt' s percentage seems rather high. He. how- ever, considers all cases inheritance where the recent ancestors stuttered, without making any allowance for psychic conta- gion. He says (51:93), if children imitated the stuttering of their parents they would stutter in the same way as the parents, just as children copy the peculiar dialects of their parents. He has, however, found no such similarity. His high percentage of inheritance, he says, is in harmony with the facts as they are found in the case of other psychical diseases. Gruenbaum agrees with Denhardt, and says if there is stuttering or if there are other nervous diseases in the family we may speak of an inherited disposition. Of 114 cases in his journal Ssikorski (84:218) found inher- itance in 73% of them. He says predisposing inheritance has four symptoms: i. stuttering in the family; 2. nervous dis- eases in the family; 3. physical signs of degeneration; 4. special peculiarities of character — such as bashfulness, impres- sionability, etc., — characteristics which often manifest them- selves in early childhood. He does not think that these peculiarities are a result of stuttering, since those who stutter as a result of fright exclusiv'ely are entirely free from them. Mygind's investigations (78) show, as he points out, that inheritance plays a role in stuttering, yet he admits that psychic contagion often enters in as a factor, since children very readily imitate peculiarities of speech; 13% of his 200 cases were reported to have acquired their trouble by associat- ing with stutterers, 42% had relatives that stuttered to the number of 124, 62 of which were brothers and sisters and 31 fathers of patients. Of the fathers 1 1 had stuttered only in childhood. Idiocy was not found among the relatives more 30 SPEECH-DEVELOPMENT IN THE CHILD. often than usual. 32 cases, 16% (in two instances there were two from one family), had relatives to the number of 36 who suffered or had suffered with epilepsy or similar convulsions, and 22 cases, 11% (including two of the above 32), had lost a brother or .sister through some form of convulsion, all of which would indicate that there is .some kind of connection between convulsions in childhood and stuttering. 58 cases, 29%, had relatives suffering with nervousness, neurasthenia, hysteria, sick headache, etc., to the number of 73, 46 of whom were mothers of patients. 15 cases, 7%, had relatives suffering with asthma, 7 of which were fathers of patients. In 5% of the cases alcoholism was in the family, in 7 cases it was the father who drank. In 10% intelligence was below normal, though idiots were excluded from the courses. 2.6% of the fathers were mentally deranged, whereas the normal for people of their age (20-40) is 0.2%. Of 162 who were examined on this point 11% wrote mirror script with the left hand. Though he admits that he has known many stutterers who had no neuro- pathic stigma and in whose families there was no nervous trouble, yet from the facts as he found them he classes stutter - tering among the neuropathic degenerations. His reasons he summarizes as follows: i. Neuropathic diseases are frequent among the relatives of stutterers. 2. Stutterers have some neuropathic stigma. 3. Stuttering, like most neuropathic dis- eases, (a) confines itself .somewhat to one sex and to certain age periods; (b) its immediate causes are less important than the more remote ones; (c) it is a functional disturbance of the nervous system though its pathologic — anatomic basis is not known. Oltuszewski al.so uses inheritance in the wider sense, and classes here all cases (i) where father and mother and the nearest relatives stutter; (2) where there were no other causes besides nervous diseases in the family, such as insanity, neuras- thenia, hysteria or any form of nervous degeneration; (3) where, notwithstanding other causes, heredity could be proven. In the nature of predisposing elements he considers inheritance and age as the most important causes (cf. his age table on p. 359). From 1 894- 1 899 he gives a careful record of 535 stutterers who attended his polyclinic. Among them he found 229 cases of inheritance and 30 cases of imitation, and in 169 cases the cause was unknowm. Imitation and fright, he thinks, are mostly important factors in connection with inheritance only, for stuttering he says, is a functional neurosis like hysteria, neu- rasthenia, etc. (80:1894, PP71). The more immediate causes that may produce stuttering are infectious diseases, shock, trauma, fear, etc. A blow on the head may sometimes produce a temporary speechlessness which SPEECH-DEVELOPMENT IN THE CHILD. 3I gives way to stuttering. Agonizing fright is known to cause stuttering. Disturbances in the digestive organs, interference with the blood supply to the brain, adenoid growths, or any- thing that disturbs the rather easily affected nervous equilib- rium of the child are favorable conditions for the disturbance to set in. Prolonged costiveness is a very common complaint among stutterers and generally aggravates the speech dis- turbance. Ssikorski thinks that fright is the most dangerous of the im- mediate causes. Out of a total of 167 cases he found 40 due to immediate causes, and of these 27, 67.5% were caused by fright, and of another 102 cases due to immediate causes reported by the physicians of military schools, 71.57% ^'e^'^ caused by fright. " Trauma, he found the next most important. Oltuszewski's table of immediate causes is as follows: Too rapid speech 18, brain disease 2, Imitation 30, Fright 23, In- fectious disease 10, Constitutional disease 6, Injury 47, out of a total of 535. Of Mygind's 200 cases 29% were brought about by the more immediate causes. His tables of infectious disease is as fol- lows: Measles 6, pneumonia 3, scarlet 4, whooping cough 2, diphtheria 2, mumps i, cerebro-spinal fever i. Only 2% were caused by trauma. 41 of Gutzmann's 300 cases were caused by disease as follows: ' Diphtheria 18, measles 14, scarlet 5, influenza 3, typhus i (11:183). That obstructions in the nasal passages affect respiration and speech is quite well known, but to what extent they rnay bring about speech defects is a question on which opinions differ. It is quite evident that they may produce stammering, but some authorities would say that they are of little importance in the etiology of stuttering. Gutzmann believes that they are pre- disposing conditions. In 33% of the patients he has met in his extensive practice he has found adenoid growths of a high degree (59:226). lyiebmann thinks they may be influential in connection with other causes to bring about stuttering. Dr. Bresgen thinks that at the bottom of most speech- detects there is a diseased condition of the nasal passages, since most of them begin in early childhood. The swellings in the nasal passages produce "speech-laziness" (44:209). They do not only offer resistance to the sound waves which are to pass through but they render less easy the movements of many mus- cles that are called into activity for phonation and articulation (43:99)- These difficulties, he says, lead the child to call other muscles into requisition. By doing this continually the child finally not only calls these muscles into activity but throws them into a spasmodic condition. This muscular activ- ity naturallv means a faulty activity in the nerve centres and 32 SPEECH-DEVELOPMENT IN THE CHILD. nerve tracts, and brings about a morbid condition of the speech centres in the brain. Thus, he holds, the faulty movements of respiration and articulation which lie at the root of stutter- ing are in their turn caused bj^ a morbid condition of the nasal passages. Mygind found adenoid growths in 39% of his 200 cases, whereas another Danish observer found only 18% among the school children he examined. Kafemann and Winckler found among stutterers a higher percentage of adenoid growths than among children in general and think they should be remedied in order to facilitate the cure of speech defects. Gutzmann (57) has in a few cases found temporary relapses in stuttering upon artificial closing of the nasal passages, and Kafemann (67) has demonstrated experimentally that the ability to do mental work is lessened when the nose is clogged and increases when the nasal passage is opened. To what extent these ob- structions have a causal connection with stuttering may be dif- ficult to determine, but it is evident that they are a disturbing factor even in normal speech and should receive careful consid- eration at the hands of a specialist in case of speech disturb- ances. In some instances speech defects, even stuttering, have disappeared by a simple removal of these growths and in other instances the cure was considerably expedited. More- over, these growths are detrimental to the mental and physical growth of the child and should be cured whether they cause stuttering or not. Masturbation is held by a number of writers to be a factor in stuttering. They found that vice with a surprisingly large number of stutterers, and say that it probably contributed to the origin of the trouble, especially since it is well known that this vice, when practiced in childhood, may severely injure the nervous system. Scrofula and rickets are considered by some as important etiological factors; they weaken the system of the child and thus make the conditions favorable for stuttering to set in. ^^e. In most cases this disease takes its beginning in early childhood, very often so far back that no definite data can be obtained as to the first sign. Parents often do not recognize the first symptoms and the patient's memory does not reach back far enough to give reliable information. Denhardt (51:101) gives the age of beginning with 348 patients who attended his institute during several years. Stuttering had begun with 250 cases before school age and during school age (to the 14th year) with 94 cases. From statistics he gathered from some of the large cities of Germany he had data as to the time of beginning in 6,206 cases. 87.14% stuttered when they entered school and 12.86% began during school age. Of SPEECH-DEVEIvOPMENT IN THE CHILD. 33 the latter nearly ^ began during the first school year and ^ during the first three years; after the third year there is a rapid decrease to the 8th school year when he finds only 3 cases. Hart well 'stables (60:8 8ff.), as to the percentage distribution of stutterers of each sex in the several school years, shows a marked increase in the primary school over the kindergarten. He also found that slight stuttering is most frequent at from 7-10 and severe stuttering at from 11 -14. His figures also show that stuttering and specific intensity of life have some relation; that stuttering increases markedly in the year in which the body's tide of exuberant vitality begins to ebb, this is espe- cially true of the increase of stuttering at 13-14 and 15-16. Ssikorski says (84:188) stuttering is a chronic neurosis which generally appears during childhood, remains stubbornly during youth, but gradually wanes in later years; few mature men stutter, old men hardly ever. He took the census of stut- terers in a number of schools with a sum total of over 22,000 pupils. His table shows that stuttering holds tenaciously dur- ing early adolescence, but recedes with increasing years. He also has a second table containing the record of 406 cases ot which he had definite data as to the beginning of the trouble. This table shows that during the second, third, and fourth years of life the tendency to acquire stuttering is greatest. During these years the trouble began with more than half of the 406 cases, but this tendency decreases after five. A ten- dency toward a natural cure, however, sets in much later, as the first table mentioned shows. The danger to acquire stut- tering after 14, according to his table, seems to be very small; almost nine-tenths of the 406 cases acquired stuttering before 10. His highest per cents are at the ages of 13 and 15. Mygind found with his 200 cases the following data as to the age when stuttering begins: 33 cases began at the age of two, 20 at three, 31 at four, 29 at five, 25 at six, 15 at seven, 19 at eight, 17 after eight, and in 11 cases the age could not be as- certained. We see that 42% stuttered at the a_^e of four. He says the great majority of cases that began to stutter dur- ing the third and fourth years were late in learning to talk. About 50% of the 200 cases began to talk after the second year and about 25% after the third year. Mygind does not think that late speech development and stuttering have a causal relation, but rather that they are phenomena of a com- mon cause. As to age when stuttering began Oltuszewski gives the fol- lowing data of his 535 cases: Unknown 16, since early child- hood 138, 7 at two, 50 at three, 67 at four, 64 at five, 47 at six, 32 at seven, 39 at eight, 16 at nine, 24 at ten, 6 at eleven, 34 ' SPEECH-DEVEIvOPMENT IN THE CHILD, 6 at twelve, 7 at thirteen, 2 at fourteen. 4 at fifteen, i at six- teen, I at seventeen, 2 at eighteen, 2 at nineteen, 2 at twenty- one, I at twenty-four, and i at forty -three. Of the 123 stut- terers who attended Gutzmann's polycHnic in 1898 and 1899, 62% had acquired their trouble before the 5th year and 28% acquired it during the three years from 5-7. Chervin says stuttering usually begins between the ages of 3 and 7, and very rarely later than 10 or 12 (48a: 146). All authors agree that stuttering usually begins in early childhood, and that many predisposing elements are found in the speech development of the child. The child has not yet firmh- fixed all the muscular co-ordinations necessarj' to pro- duce speech and hence thej' may easily be influenced by physi- cal indispositions and psychical disturbances such as fear, em- barrassment, etc. Liebmaun (72:6) says this is especially true of children that learn to speak late. Gutzmann says ( 1 1 : 1 76 ff. ) through the awkwardness of the speech musculature the child often halts in its speaking and this halting may, by increasing, develop into an evil. The child's thoughts run ahead of its motor speech ability and it repeats the initial sound or sylla- ble. Thus, little by little, stuttering roots itself in the speech of the child. Liebmann (72:6) would agree to this, but would add that with some children the development of formal language is somewhat retarded; the}^ think slowly and express their thoughts onl}' with difiiculty. They hesitate and correct their speech and thus produce inco-ordinated speech move- ments which, by increasing in inten.sity, eventually develop into stuttering. Ssikorski (84:189) says precipitate speech is more often fol- lowed by stuttering than slow speech. He al.so holds that late speech development is apt to be followed by stuttering. He cites a case, one of his patients, a physician: he had not spoken up to his sixth year when his parents placed him in an institu- tion for the deaf and dumb. Here he soon learned to speak but stuttered. Another patient who had spoken .since his second year, suddenly became dumb at 3; at the end of 6 mos. his speech returned but he stuttered. Some authors consider second dentition and puberty two periods specially favorable to the development of stuttering. Kussmaul (67a:232) says stuttering may appear temporarily during second dentition or at the time of puberty, or it may in- crease during those periods if already present. Gutzmann would agree to this but would not say that stuttering beginning at this period is necessarily temporary. It is well known that puberty is a period of great psychical activity and therefore not surprising that it has a connection with stuttering. It is a matter of common ob.servation that this disease increases at SPEECH-DEVELOPMENT IN THE CHILD. 35 this period. A. Gutzmanti says it sometimes appears at this period like lightning out of a clear sky. Mygind thinks that very early childhood, second dentition, and adolescence are periods when the child is speciall}^ subject to stuttering. Denhardt, on the other hand, thinks that second dentition has not as much influence as some think it has. He thinks that the absence of the upper incisors may cause those cases of stuttering which begin during this period. Baginsky (37:11,351) gives the ages when children are especially subject to stuttering as 7-8 and 12-14. Hartwell's statistics (60:87) indicate that the trouble is particularly frequent during .second dentition and at puberty. The percentage of stutterers for the difierent ages was carefully worked out with 9,312 school children in Wiesbaden and 7,000 in Gorlitz. Gutzmann (59:335) takes the curves thus obtained and compares them with the curves obtained from Hartwell's figures. The three curves show a remarkable similarity; they rise at 7-8, fall after 9 and again rise at the age of 12-14. When one con- siders that the first rise corresponds with the last period of rapid brain growth, and the second with puberty it seems evident that there is a causal connection between the.se phenomena. We also see that these curves are similar to the curves of growth in body w^eight and height. Though stuttering may retard a pupil in his school work, the theory that stutterers are mentally weak has not been proved. Denhardt says that statesmen, poets and artists are found among the stutterers, and in many of his cases a com- parison with individuals of the same rank with normal speech would often have proved favorable to the stutterer. Neither are all stutterers physically deficient even though heredity plays a very great role. A number of writers, for instance, found among their patients men of excellent physique. Kafemanu, however, replies to this that some of these men may not have been so robust in earl)' childhood. Some stutterers pay little attention to the impression their defect makes upon their environment, whereas, many of them are silent rather than expose themselves to ridicule. If they are sensitive they feel their disadvantage and the mockery to which they are subject so keenly that the joys of life have but little meaning to them; they retire into themselves, starve their ambitions, feel suspicious of their environment, and, though living in the midst of society, they starve for the want of it. Sex. All statistics on stuttering show that there is a great sex difference, there being many more male than female stut- terers. Denhardt, Ssikorski and Hartwell give the ratio as about 3:1, Baginsky 2:1. Gutzmann 2:1 for children but 9:1 for adults and says with girls it is more apt to disappear than 36 SPEECH -DEVELOPMENT IN THE CHILD, with boys. Chervin gives the ratio as io:i, but says in lisping the sex ratio is inversed (483:149,277). Berkhan says the dif- ferences are the same as with idiots, half-idiots and deaf mutes. Westergaard found the ratio to be 2.5:1.9, and Lindberg about 3:1 amongst school children in Denmark, von Sarbo about 3:1 in villages and in the country, and about 2:1 in towns and cities among school children in Hungary. My own investigations give the ratio about 3:1 for stuttering and about 2:1 for stam- mering. That this difference exists has been observed by all, at least modern writers, but the cause of this difference, an interesting and important question, has not been solved. Some of the earlj^ writers thought that the girls had their errors corrected by their mothers because they were in the house more, whereas boys played on the streets and were not subject to this correc- tion and they, moreover, had their speech spoiled by Latin and Greek in the school. Others believed, with Rousseau, that since it was woman's sphere to please by dancing and sinj^ing and conversation she had a better developed nervous system and had more fluent speech. Kussmaul, and others after him, think this diflfereuce is connected with the fact that women are in general more graceful in their movements and can move in society and converse fluently earlier than men. Ssikorski (84:208-9) thinks that according to his investigations this dif- ference has an hereditary explanation. He examined several ten thousand manuscripts of pupils and found that atactic handwriting occurred with boys 7-8 times as often as with girls. He furthermore found that among 2,492 boys and 5,640 girls the percentage of left- handedness was twice as great among the boys as among the girls. These facts seem to show that there is a better hereditarily developed motor centre in the left hemisphere, since the oral speech centre and the motor centre for the right hand are located near together in this hem- isphere. Only on such hereditary basis, he says, can we ex- plain the fact that girls are less subject to stuttering at the age of 2-4. The fact that girls usually learn to talk earlier, as has been noted by many observers, seems to support the view that there is an inherited difference. Gutzmann gives the following ex- planations: In its earliest speech development the girl u^es its speech mechanism rather automaticalh- without calling the ideation centre into play, whereas the boy is more apt to attach an idea to what he says, even though it be false. Further- more, in childhood, male and female breathe in almost the same manner; after puberty, however, the abdominal type is more prominent with the male and the costal type with the female^ ' This question is not settled, cf. Havelock Ellis, "Man and Woman," pp. 202-210. SPEECH-DEVELOPMENT IN THE CHII,D. 37 Of the costal type we are more conscious and hence it is more directly under the control of the will, and since disturbances of breathing are an important factor in stuttering the connec- tion can be readily seen (59:324). Waldeyer (88), moreover, points out that though the entire musculature of woman is in- ferior to that of man, the tongue alone is an exception. It is not comparative!)' but absolutely stronger than that of man. Even though this organ is not as essential in the formation of speech as it was formerly supposed to be, the importance of a mobile tongue for fluent speech cannot be denied. Liebmann explains the sex difference simply by the fact that man's muscles are stronger than woman's, but that woman's muscle is more dexterous and graceful (70:4). Chervin says that at the age when stuttering begins girls' language and speech-mechanism is better developed, and that girls lead a calmer life than boys and thus avoid many accidents that lead to stuttering (48a:i49). Hysterical Stuttering. A special form of stuttering which appears in connection with hysteria and hysterical mutism is called hysterical stuttering. Charcot, who was the first to draw attention to hysterical mutism, was also the first to ob- serve that this disturbance is sometimes accompanied by a form of stuttering. He at first believed that hysterical stuttering was a kind of transition-stage from mutism to normal speech; later, however, he found that it may precede hysterical mutism and may pass over into mutism any moment. Ballet and Tissier (38), in 1890, believed that hysterical stuttering may appear as a symptom of hysteria independent of hysterical mutism, though they admit that it may be preceded by a short period of aphasia which may be easily overlooked. They believe that the chief cause lies in a disturbance of respiration. Pitres, in the same year, held that speech defects in many young people who are seemingly not neuropathic may be looked upon as symptoms of a latent hysteria. Chervin (48) objects to this view of Pitres, and also to the term hysterical stuttering, and insists on calling such speech defects simply complications of hysteria. Gutzmann considers Chervin's protest against the term hysterical stuttering useless since it cannot destroy the facts. Ballet and Tissier think the cause is peripheral; Charcot, the great master of the study of hysteria, Greidenberg, and Higier consider it a cortical disturbance. Mendel thinks it is caused by changes in the sub-cortical centres or in the connecting fibres (Leitungswegen), and Remak considers it an inhibition (Intentionshemmung). Periodic Stuttering. It has been observed that stuttering often varies in intensity. Nasal catarrh or any other acute 38 SPEECH-DEVEIvOPMENT IN THE CHII,D. disturbance of the respiratory tract may increase the intensity considerably. Severe stutterers speak often quite normal dur- ing acute diseases, but the disturbance returns as the disease passes away. With some patients the disturbance is most in- tense in the spring and in the fall. Second dentition and puberty are periods when stuttering is more intense. With girls the intensity often increases during the menstrual flow, and some cases are on record where girls stutter during the menstrual period though they speak quite normal at other times. Cases are also on record where early stuttering recedes to such an extent that it occurs only during short periods in the .spring and in the fall — periods when in younger years it probably was most severe. Simulation. The question of simulating stuttering is of im- portance in such countries where all able-bodied men must serve in the army and where the stutterer is released from ser- vice since he cannot repeat his instructions promptly . A number of earlier writers discuss this question and many devices for the detection of simulation have been suggested, such as, starving the individual into telling the truth, narcotising him with alco- hol or chloroform on the supposition that with the stimulant the stuttering would disappear in the stupified condition whereas with the real stutterer it would increase. Other mod- ern and more humane methods are, taking the testimony of witnesses, examining the individual directly, or surprising him so that he forgets himself. This last named method sometimes leads to very ludicrous exposures (59 and 70). Distributioji. Chervin made a careful study of the military statistics of several countries of Europe and found these results: In France 7.5 per thousand were exempt from service on account of stuttering, in Switzerland 3.23. in England 2.87, in Austro-Hungary 2.2, in Belgium 2.1, in Italy .86, in Russia .19 per thousand (48a) . Ssikorski's Russian military statistics give a little over i per thousand, and among 835,389 recruits examined during the civil war in the United States 1.25 per thousand were exempted on account of stuttering. Ssikorski thinks that this difference may be due to linguistic and ethno- graphic differences. Chervin, on the other hand, says that even neighboring departments in France show great differ- ences, and that long and diflScult study have not given him the key to the mystery (48a:95). Gutzmann, taking the French statistics for the provinces which in 1871 became German, and the Russian statistics of the Baltic provinces, both of which had a considerable German population, he estimates that in Germany there would be 2 stutterers per thousand recruits. Official figures, he says, are not accessible. He agrees with the elder Chervin that climatic conditions are di- SPEECH-DEVELOPMEN'T IN THE CHILD. 39 rectly connected with the frequency of stuttering among different races. Von Sarbo found in Hungary that the Hun- garians represent 78. 19% of the school population but furnished only 64% of the children with defective speech. Westergaard (89) took the statistics of 34,000 Danish school children and found 2.2% with speech defects but only .61% stuttered. He found that girls lisped as frequently as boys and nasalized more frequently. He also took the average age of all the children in the different grades and of the children with the different speech defects — each speech defect separatel)', and found that the average age in every case was higher with children that had speech defects. lyindberg (73) found in Denmark, outside of Copenhagen, among 212,000 children in the country .9% stutterers and .74% among 85,000 children in the towns. Von Sarbo found 1.02% stutterers among 231,- 468 children in 53 towns and cities in Hungary. He found that lisping was more frequent among the girls. 37 % of the stutterers, he says, were hindered in their progress in school. Statistics taken in Hamburg in 1896 also indicate that stutter- ing retards intellectual development. I gathered statistics^ of 87,440 school children in this coun- try, 44,754 boys and 42,686 girls, from the following cities: Milwaukee 31,810, Cleveland 19,678, Louisville 14,865, Albany 11,369, Springfield, Mass., 5,902, and Kansas City 3,816. Of these 2.46% had speech defects; .87% stuttered, and 1.59% had other defects of speech. 1.25% of all the boys stut- tered and .47% of the girls, making the ratio nearly 3:1. 2.01% of all the boys stammered and 1.15% of the girls, making the ratio nearly 2:1. Of the four cities which are represented by over 10,000 children each, the percentage is as follows: Cleveland — stutter .5%, stammer .77%; Albany — stutter .66%, stammer 1.35%; Milwaukee — stutter 1%, stam- mer 1.25%; Louisville — stutter 1.08%, stammer 2.41%. The cases were distributed by age and grade as follows: Age 5 6 7 8 9 10 II 12 13 14 15 16 17 18 19 Stutt. 5 45 loi 89 80 84 90 84 82 49 28 13 7 6 4 Stamm. 41 193 221 181 148 144 121 132 86 67 31 9 Grade i 234567891234 Stutt. 142 128 III 119 86 69 53 28 4 12 3 II 3 Stamm. 480 250 156 189 122 71 59 44 4 82 We see that the tendency toward a natural cure is more man- ifest in stammering than in stuttering, a fact also noted by ^For assistance in gathering these data I am indebted to the follow- ing city superintendents : T. M. Balliet, of Springfield, Mass. ; C. W. Cole, of Albany, N. Y. ; E- H. Mark, of Louisville, Ky. ; E. F. Monl- ton, of Cleveland, O. ; H. O. R. Siefert, of Milwaukee, Wis. ; and Asst. Supt. F. D. Tharpe, of Kansas City, Mo. 40 SPEECH-DEVELOPMENT IN THE CHILD. Ssikorski. Whether there is an increase in speech defects from the kindergarten to the grades I had no data to prove; neither had I data to find the percentage of stutterers and stammerers in the different grades and at the different ages. As to the question whether the child with speech defects falls behind in the grades my results were negative, but my data were not full enough to make the results conclusive, since I had data only from Kansas City as to the ages of the children in the dif- ferent grades. The report of the Commissioner of Education for 1902 (Vol. II, pp. 1641) gives the total school enrollment as 17,- 460,000. Applying our percentages to this number we find about 152,000 stuttering and about 278,000 stammering school children. Adding to this 1.25 per thousand of the adult population, as shown by the military statistics, we have in this country about 500,000 people with defective speech, almost half of whom are stutterers. The careful studies of stuttering that have been made in Eu- rope by specialists is certainly in the right direction and their earnestness deserves to be emulated in this country. The same can hardly be said of the theories. A theory may be quite useful as a working hypothesis if it does not fix firmly definite lines of action as seems to be the case with some of these theories of stuttering. They ma}^ be divided into two general classes, nameljs the physiological and the psychical. Gutz- mann, Coen, Ssikorski and others see in stuttering a disturb- ance of the nerve mechanism, which ma)' as a result bring about certain psychic disturbances, such as depression, fear of speech, etc.; they emphasize the physiological side of the ques- tion. And since they hold that the disease has a neurological basis, their method is naturally on the same basis, therefore they give an elaborate series of exercises that build up and drill the nerve mechanism of speech. They place the whole psychology and pathology of stuttering on a physiological basis, in harmony probably with their general philosophical view. On the other hand, men like Denhardt take the oppo- site view. Their views rest on the basis that the nervous mechanism is a means of expressing psychical states and not he cause that produces them. Both views seem to rest on the promotor's general philosophy — on rather a priori concep- tions. If functional nerve disorders could be so easily ex- plained and classified under these conceptions, many now dif- ficult problems of the psychiatrist would be more easy of solu- tion. It would seem to be better to make our theories of stut- tering, and so our methods of curing it. more tentative until we have more light on the nature of functional nerve diseases. The etiology and psychology of stuttering must be carefully SPEECH-DEVELOPMENT IN THE CHILD. 41 studied as has been done by several authors as is shown in this paper, and from these results we must work toward an explanation and a cure, and not make the symptoms and the methods fit certain preconceived ideas. With this spirit we would have fewer standardized methods and less self-satisfac- tion but better conditions of progress. Methods. It is quite probable that stuttering in many cases might be prevented by proper prophylactic measures. Proper precautionary measures should be taken not later than the first appearance of slight disturbances. . If the child's speech is too hurried, if its motor speech activit)'' runs ahead of its mental activity and it hesitates and repeats sounds and syllables it should be cautioned to modify its tempo and to know what it wants to say before speaking. It is a good gen- eral principle always to lead children to talk in a quiet undis- turbed manner. Above all is it necessary for parents and teachers to use patience with children that have defective speech. It is cruel to whip and scold them because, instead of remedying the evil, it makes it worse, and moreover, the child is not to blame for its trouble. The child should be treated sympathetically; should be helped by means of stories and conversations in the most simple and effective language. It should not be made to feel conscious of its speech by insisting on superfine "correctness." The child's attention should be drawn away from its defects; it should unconsciously be led into normal and fluent speech. Nothing should be done that excites fear or anxiety, or that in any way psychically disturbs the child. If there are any physical deficiencies they should be corrected under the direction of a physician. All writers agree that one cannot prescribe a method that ■will apply to all cases. The modes of stuttering are so differ- ent that each case must be treated individually, and, hence, some writers do not give a general method at all, whereas others give a detailed method of breathing, vocal, and articula- tion exercises which is to be adapted to the individual cases. Among the latter we find Ssikorski, Coen, A. and H. Gutz- mann and others. Treitel lays little stress on breathing exercises, but uses the other two, and lyiebmann rejects them all three as not only useless but harmful. Denhardt lays main stress upon the psychical phase of the treatment, a phase also emphasized by L,iebmann; and Gruenbaum would strengthen the will by a change in the speech tempo and by vocal exer- cises. I shall present the methods under the following headings: i. Breathing exercises; 2. vocal and articulatory exercises; 3. medical treatment. I. Ssikorski (84) gives considerable attention to the breath- ing exercises, and divides them into three parts: simple, 42 SPEECH-DEVELOPMENT IN THE CHILD. fractional, aud compound. Simple breathing consists in sim- ple inhalation and exhalation, and is represented thus | — , ! [5-] , etc. The vertical line represents inhalation and the horizontal exhalation; the figures in brackets signify pauses in seconds. The patient should be drilled in extending the expiration. Fractional breathing is represented thus | [5] — — [5] — . etc. In this figure the inhalation consists of two parts, and the exhalation of five parts of various lengths; where no figures occur in the breaks there is to be no pause of any length but only a break in the air current. This exercise can be varied to suit the occasion. The aim is to cultivate abroken exhalation as it occurs during speaking. Com- pound breathing consists in alternating the first two kinds. After a few fractional inhalations and exhalations while speak- ing one usually breathes regularly a few times, either to facilitate the diffusion of gas or to take a rest, or both, and compound breathing exercises are a preparation for this. These breathing exercises are intended to bring breathing under the control of the will and prevent those breathing disturbances which appear in stuttering. It is moreover, possible, Ssikorski thinks, that the sucking action of the thorax regulates the flow of blood from the head, aud that, as Coen says, increased breathing strengthens the chemism of the blood, both of which processes have a beneficent effect on stuttering. During these exercises, he says, the patient should give careful attention to the muscle sensations and should try to produce them mentally. Coen (50) and Gutzmann (59), give extensive breathing exercises which do not vary very widely from those outlined above. Gutzmann, however, follows the breathing exercises given in D. G. M. Schreber's Zimmrergymnastik which he con- siders the best book of its kind published (trans, by C. R. Bardeen). H. Gutzmann, does not use divided, or fractional, inspiration. He would, however, give gymnastic drill in addi- tion to the breathing exercises, since that would not only exer- cise the general musculature of the body but would train the motor centres of the brain as well. All exercises must tend toward enabling the child to use its speech-mechanism nor- mally. Chervin also gives breathing exercises, and says the difficulties of respiration determine the treatment (483:226). 2. After breathing has been mastered, vocal and articula- tory exercises are taken up. Ssikorski first teaches his patients to open and close the glottis. Then by means of the aspirate h one bridges over to whisper the vowels. The h is first given alone, then in connection with a (as in af) in a whisper, and then with sound. The h is a less perfect product than a pure vowel, and hence, is useful as a connecting link. Other vowels are then taken up. To the vocal drill he later adds SPEKCH-DEVKLOPMENT IN THE CHILD. 43 articulatory exercises. Breathing must be carefully observed during these exercises. Then composite speech gymnastic is taken up in the following order: i. repeating after the teacher; 2. reading; 3. reproducing mentally what has been read, as an innervation exercise; 4. reciting what one has com- mitted to memory; 5. talking in a whisper; 6. talking aloud; 7. exercise in modulating the voice while speaking or declaim- ing; 8. the patient tells orally what he has read, or retells what he has told before; 9. conversation. All exercises, he says, should be adapted to the individual and should begin with the least affected part of the speech mechanism, and grad- ually work toward a drill of the affected muscles. Gutzmaun, also begins with h, passes to whispered and then to voiced a (as in arm), all in one breath. Then he drills the vowels, whispered and voiced in continuous and fractional exhalation, passing from the easier to the more difficult. In continuous exhalation the voice should gradually swell to full volume. In passing to words and sentences the same principle is followed. Words with the letter a as initial are taken first; the vowel is begun softly and gradually increases in intensity, thus, | A. tern. Other vowels are drilled in like manner. The first sentences, which are taken up later, should begin with a word whose initial letter is a, and the words they contain should be spoken as if the}- were all sylla- bles of one word. In order that the stutterer may learn to control his articula- tory organs Gutzmaun teaches him the physiology of articula- tion with the aid of a mirror. He is placed before a mirror in which the different muscle actions are shown him. These ac- tions he is led to imitate by focusing his attention on them without thinking of speech, thus: b — bb — bbb — bbbb. The letters w, s, 1, r, m, n, j and sh (Germ, sch) may be drilled by drawing them long in order to accustom the articulatory organs to producing them with voice, thus: | 1 a. Before taking up fluent conversation the stutterer is given the following rules as a guide: i. Speak slowly and calmly. 2. Always be sure that you know what you wish to say and how you want to say it. 3. Do not speak too loud nor in too low a tone. 4. Stand or sit straight and still while you speak. 5. Take a short, deep breath before speaking a sentence. 6. Be sparing with your breath; hold it back rather than urge it forward. 7. Give prominence to the vocal position. 8. Focus the expiring air not on the consonants but on the vowels. 9. Do not use stress in the formation of sound. 10. Begin the vowel with a soft and somewhat deep tone. 11. Extend the first vowel in a sentence and combine all words as though the whole sentence were but one word. 12. Always speak plainly with a pure and melodious voice. 44 SPEECH-DEVEI.OPMENT IN THE CHILD. As a first drill in independent speech the stutterer answers simple questions. Then he reads simple poetry, later prose, and answers questions on these selections. He must also con- stantly practice those expressions which he must use in his intercourse with other people. The psychic phenomena, he says, wull take care of themselves after the stutterer has con- fidence in his ability to speak, unless they are a disease in themselves, then special psychic treatment is required. Coen begins with a vocal drill. The vowel is drawn out as long as possible; then 2, 3, 4 and 5 vowels are sounded suc- cessively in one breath. Umlaute and diphthongs are treated in the same manner. In the word drill the sounds are intro- duced in the following order: i. vowels, umlante, diphthong; 2. consonants: labials, labio-dentals, sibilants, labio-palatals, gutturals. Later, reading and conversation are taken up on similar lines as indicated above. Wyllie first informs the patient that his larynx is at fault; that he must pay no attention to his mouth but to his voice. He should read aloud at least 10 minutes ever}^ morning. He should know the physiology of the alphabet and have test sentences for the different letters of each stop position: First stop position, p, b, m, w, f, v, th, s, z; second, t, d, n, 1, r; third, k, g, ng, h, ch, r. He should note every word that gives him difficulty so that he may refer to the physiologic alphabet (92 : front.) and find the key to its pronunciation. He should not be permitted to speak with empty lungs. Dr. Makuen also would teach the stutterer the physiologic alpha- bet, and constructs one on the basis of Dr. Wyllie's (74:251), Bernard would have the patient repeat the alphabet at least a dozen times a day at the rate of one letter in two seconds. He asks his pupils to study the alphabet before a looking glass. His first exercise is the first 34 lines of "The Deserted Vil- lage," committed to memory'. He has 31 exercises in reading and reciting. Liebmaun uses no preliminar}^ exercises. He immediately begins with conversation; he has the patient speak with ex- tended vowels, and most of them, he says, in this way speak fluently at once, and immediately lose all fear of speaking. He praises his patient freely by way of encouragement, and thus restores his self-confidence. Chervin gives breathing, vocal and articulatory drill, but varies from the other authors in so far as he prescribes absolute silence, outside of the exercise hours, for the first week, to secure repose, and that the patient may forget his trouble (48a:23i). A. M. Bell, though he gives some attention to respiration, saysthe stutterer's "never-to-be-forgotten talisman is: Voice!" The letters which are special stumbling blocks, such as b, d. SPEECH-DEVELOPMENT IN THE CHIL.D. 45 p, g, t, k, f, wh, th, s, sh, h, should be practiced with vowels, with the principle constantly before the mind that "«o mouth action must be allowed to interfere with the flow of throat- sound'' ^ (40:23). The tendency toward an upward pressure of the jaw should be controlled, and the head should be held firmly on the neck, but not with stiffness that would interfere with free mo- tion. The spasmodic actions will invariably pass away when breathing is relieved, he says. When one looks over the detailed methods one immediately sees that they are carefully graded, passing from the funda- mental to the accessory, and from the simple to the more com- plex ; yet one can but conclude that they are conventional. It is true that all these methods lead to more or less successful results; furthermore, no one can deny the value of drill in proper breathing and no doubt many stutterers are benefited thereby, just as many people with normal speech would be; but, since it is proved that stuttering can be cured without such drill, it seems rather dogmatic to prescribe it in a stereotyped manner. Neither need one categorically class all such exer- cises as useless, since some stutterers may be in need of them. Moreover, we always have a tendency to follow tradition and this tendency manifests itself in the schematic breathing, vocal, and articulatory exercises so much in vogue in Europe and which are being introduced into other coutitries. even into Japan (52). Are these exercises an essential part of the thera- peutics of stuttering ? is at least an open question. Though the promoters of these didactic systems all insist more or less on individual treatment, yet their .systems are such that they have a tendency to methodize the treatment to a uniform standard, whereas the nature of the disease urg€;ntly demands individual treatment. A breaking away from these forms as, for instance, lyiebmann has done, is a health}' sign and shows that possibili- ties are being explored. The methods used by Wyllie and Makuen seem better adapted to stammering than to stuttering. It is the prevailing opinion among the authorities referred to in this paper, that the speech specialist should be a physician. One readily sees the reason for this view when one considers that so many physical anomalies are vitally connected with speech disturbances. However, a better plan would be that of Dr. Makuen, who holds that it takes a specialist, assisted by a special teacher. In that way we are more apt to have the clinical and the didactic features at their best. Furthermore, both physician and teacher should have a thorough knowledge of the physiology of speech, and since stuttering is often accompanied by psychic depression they should have, at least, an elementary knowledge of that chapter of morbid psychol- ogy. 46 SPEECH-DEVELOPMENT IN THE CHILD. 3. Medical Treatment. Pharmaceutical treatment for stut- tering has been recommended since the time of Hippokrates. At the present time general prescriptions for stuttering are not used. Ssikorski insists on these points: i. The patient's bowels should be kept open, and he should not eat anything that irritates the intestines. 2. The blood supply in the nerve centres should be regulated by strengthening the vaso-motor system. 3. All psychic excitation must be removed. Bromides may be used to quiet the nerves but depressed patients may be given stimulants. 4. There should be a general building up of the nervous system by means of hydro-therapeutics and electricity. The constant current is used for the vaso-motor system and static electricity to modify nutrition in general. If the speech centre is to be innervated the anode is placed on the head over the speech centre and the cathode in the neck. Gruenbaum galvanizes the lips, tongue, palate and larynx, especially with children. Gutzmann thinks medicines should ordinarily not be u.sed, though in extremely nervous cases, where hydro-therapeutics fail, he uses mono bromide of camphor in doses of o. 3 to o .5, three times a day. He uses the current only for the larynx when it shows spasmodic disturbances — anode on the larynx, cathode in the neck with a current less than one ten thou- sandth of an ampere. The removal of physical abnormalities should be placed in the hands of a physician. Makuen says all irregularities of a structural or pathologic character should be corrected. Free action of the tongue should be made possible by snipping the freuum if it be too short, and, if necessary, by a division of the anterior fibres of the genio-hyoglossus muscle. Aside from this, the treatment must be educational. Bernard always prescribes a compound of arsenic and strychnine — a method not approved by the best writers in this field. Severe costiveness seems to be common among stutterers. Ssikorski sa5'S it is one of the most common complications ot stuttering, even cases of many days' standing are found — a condition which always increases stuttering. Gutzmann, in his clinical experience with stutterers, has found cases of con- stipation lasting as long as two weeks without yielding to the most energetic means. It is quite evident that in such cases proper dieting should be carefully carried out in connection with abundant exercise in the open air. Since eneuresis noc- iurna is very common with stutterers, as some think it is, the amount of fluid taken in the afternoon should in such cases, in addition to the above precautions, be reduced to a minimum. These regulations bring about healthy sleep, an absolute essen- tial to the physical and psychical well-being of the child. SPEECH-DEVElvOPMENT IN THE CHILD. 47 Aud when we consider that onanism is quite common among stutterers, as is observed by a number of writers, the need of proper exercise, proper dietetics, and proper bathing becomes all the more emphatic. Whether hypnotism should be used is an open question. Coen (49:170) would not use it. The temporary relief which it brings is too costly, he says, since oft repeated hypnotism gives permanent injury to the nervous system. Chervin (483:202) says hypnotism has a tendency to increase the patient's already too great excitabilit3% and to weaken the already too weak will and hence he has nothing to gain by it. Gutzmann (59) agrees with the above authors as to the injury it may cause and would use it onh^ as an ultimo ratio. Den- hardt does not believe in it and Berkhan leaves the question open though he has tried it with no satisfactory results. lyaubi agrees with Gutzmann that in most cases one can get along without it, but holds that a physician may use it with a good conscience if he finds it more interesting or if he thinks it ena- bles him to reach his goal quicker (68:129). Heymann (61:206) says hypnotism should in no case be left untried, and Gruenbaum (54:58) uses it to cure the slight paralysis of the speech centre which, he says, is the cause of stuttering, and thinks that hypnotism in the hands of the physician has be- come a blessing for man. The length of the course to obtain a perfect cure varies. Klencke makes the course from 5-6 months; Coen from 4-5 months. Ssikorski says 6 months is probablj' the average. Gutzmsnn says a course of 2-3 months is sufiicient. Lieb- mann's course is 4 weeks with half- hour sessions, daily. Cher- vin's course is 3 weeks, but at the end of his cour.se he considers the patient only convalescent; a good, serious student should continue his exercises one month longer, working 2-3 hours a day. Denhardt's course is only 16 days, but he drills his patients 5 hours each day. It is quite evident, as all writers point out, that the length of the course depends upon many different things, such as the nervous condition of the patient, his general health, the severity of the trouble,' the interest the patient manifests in his cure, etc. It is difficult to give a defi- nite prognosis even after a preliminary examination. It is also quite possible that the length of the course may vary with the method. Stuttering is treated so successfully at the present that where free public courses are offered there is very little excuse for a youth to be afflicted with the trouble. ' Colombat, 1827- 1840, had 428 patients of whom 52% were cured, 21% improved, and 27% were dismissed as failures. Blume, in the early 40's, reported 70% cured of a total number of 40. Coen, in 1886, 48 SPKECH-DEVELOPMENT IN THE CHILD. gives his results as follows: Cured 60%, improved 30%, fail- ures 10%. Berkhan directed public courses in Brunswick, 1883-1885, which were attended by 96 patients — the worst stut- terers in the communitj' were selected. Of the.se 65 were cured, 30 improved, and i failed. There were 25 relapses in all. Gutzmaun gives the result of public courses in 46 Ger- man cities. These courses were attended by 1,390 stutterers of whom 72.7% were cured, 23.6% were improved, and 3.7% were failures. Of about 1,000 patients who attended A. Gutz- mann's polyclinic, 87% were cured, 10% improved, and 3% were failures; 5% of the cases relapsed. Of 600 patients who took private instruction from Dr. H. Gutzmann, 89% were cured, 9% improved, and 2% failed. Of the first 400 5% relapsed, but of the second 200 only ^%. Of 700 patients who attended his polyclinic, 1892-1898, the results were not so good on account of irregularity of attendance. Of 95 patients who took Oltuszewski's complete course, 87 were cured and 8 very much improved, and he thinks they would have been cured had they repeated the course. Dr. R. Coen's report of 1901, of the public cour.ses for stutterers in Vienna for the pre- ceding 10 years is as follows: Number that attended 158, cured 60%, improved 30%, failures 10%. He ascribes the failures entirely to laziness and irregularity of attendance. Chervin (48a:24i) says success is always certain if the subject is docile, attentive, diligent, and persevering, but those quali- ties are indispensable. These data show that stuttering is a disturbance that is quite curable. So much so that in some countries of Europe great efforts are made to relieve the suffering. Denmark has a pub- lic hospital for the cure of speech defects, and also offers public courses of treatment to children of school age. In Germany public courses are offered to school children in probably all communities where there are enough children with defective speech to make a course advisable. There are also several private clinics in charge of thorough specialists. Hungarj' also offers public courses to school children. It also has a cen- tral hospital where normal courses are oflfered to teachers at the expense of the State. A careful census is taken of the children with defective speech in the different communities, and those that have the greatest number of children with speech defects are given the first opportunity to send teachers to these teachers' courses. The number that may attend these courses at any one time is limited. In Russia and France there are clinics for speech defects, but whether there are pub- lic courses for children the writer was not able to ascertain. From private correspondence it seems that no statistics of SPEECH- DEVELOPMENT IN THE CHILD. 49 speech defects exist and no public courses are offered in Eng- land.^ In this country very little is done outside of private institu- tions, the high scientific character of some of which seems to be doubtful. Some directors of private institutions have their methods copyrighted — a cheap method of advertising an assumed originality — and one even courts patronage by dispar- aging the work of other institutions. The only public effort in this country to correct speech defects, as far as the writer knows, is in the Philadelphia Polyclinic where there is a de- partment of speech defects in charge of Dr. Makuen. When we consider that there are probably over 200,000 stutterers and nearly 280,000 stammerers in the United States we can realize that it would be a proper function of the State to fur- nish measures of relief. Furthermore, the classroom teacher in the schools should have a general knowledge of functional speech disturbances. Worry, embarrassment, excitement, etc., are immediate causes of speech defects. If the school is a place of nervous tension; if the child is constantly worried with adult forms and abstrac- tions ill- fitted for its little mind; if it is a.sked to express its confused ideas under the eye of a critical teacher who perhaps considers her day's work to consist of 5 or 6 long, weary hours of wearisome labor — we have conditions for functional speech disturbances to set in, especially so since oral speech is not absolutely fixed till early adolescence. The school should rather use its opportunities to cultivate good oral language by means of stories, conversations and other oral exercises given sympathetically under the influence of a good model. The high percentages of stuttering during the first few years of school life is probably largely due to nerve tension^ and could be reduced considerably if the child in all cases had high minded teachers who understand child-nature, and who find their own life in the happy, exuberant life of the child; teach- ers who know how to subordinate deadening forms and can make the life of the school so free and so unrestrained, that fear, worry and its train of evils are unknown in their presence — teachers who can live with the child and organize its wealth of incoming information from the child's viewpoint, and en- courage it to react with oral expression as simple, as unaf- fected, as natural as the life of the child is itself. We may summarize thus the following points concerning speech defects: ^ For information on this subject I am indebted to the kindness of Dr. R. Langdin Down, of Hampton Wick, Miss Kate Stevens and Mr. Wm. van Praagh, of London, England. ^ Hartwell thinks it is due to bad methods of teaching reading — a thought which deserves serious consideration. LIBRftRY OF CONGRESS 019 821 456 5 50 SPEECH-DEVELOPMENT IN THE CHILD. 1 . Inheritance seems to be a predisposing factor. 2. Anything that disturbs the nervous system of the child may be an immediate cause, especially acute diseases. 3. Suggestion is a factor in the spread of the disease. 4. Stuttering is a children's disease. 5. Second dentition and puberty are periods that favor stut- tering. 6. Boys are more subject to the trouble than girls. 7. It probably retards pupils in their school work. 8. Stutterers are not mentally inferior. 9. Speech defects are often the source of severe psychical depression. 10. The seriousness and the spread of the trouble is such that it deserves more attention from the public and the specialist than is given it in this country at the present time. 1 1 . Stuttering and stammering are, with probably very few exceptions, curable. I wish to acknowledge my great indebtedness to President G. Stanley Hall for suggesting the general topic of this study, and for valuable suggestions and criticisms; to the other mem- bers of the department faculty for suggestions; to Mr. Louis N. Wilson, Librarian of the University, for invaluable aid in securing the literature and in gathering the data; and to Mr. Samuel S. Green, Librarian of the Worcester Public Library, for various courtesies. The bibliography which follows contains onl)'' those works which are referred to in the text. No. 84 contains a good bibliography of the older works on stuttering, and Wilson's bibliography is the standard in child study. The Voice, a magazine published in Albany, N. Y., 1879-85, and later in New York City, has translations of some of the earlier methods practiced in Europe for the cure of stuttering. The student should always consult the standard bibliographies in Child Study, medicine, and psychology. Reference to the bibliogra- phy is by number; (25:37) means No. 25, Shultze, F., Die Sprache des Kindes, page 37. Bibliography — Normal Development. I AmenT, W. Begriff uad Begriffe der Kindersprache. Samml. V. Abh. a. d. Geb. d. Pad. Psy. u. Physiol., 1902, Vol. V, No. 4, pp. 85. 2. Die Entwickelung von Sprechen und Denkeu beim Kinde. lycipzig, 1899, pp. 213. 3. Baldwin, J. M. Mental Development in the child and the Race. London, 1895, pp. 496. 4. CoMPARYE, G. L'Evolution Meutale et Morale De L'Enfant. Paris, 1893, pp. 371. LIBRARY OF CONGRESS 019 821 456 5 Hollinger pH 8.5 Mill Run F3.1719