From this behavior of infants born deaf it manifestly follows that even without the possibility of natural imitation of sounds, and without the knowledge of a single word, qualities may be blended with qualities into concepts. Thus,primitive thinking is not bound up with verbal language. It demands, however, a certain development of the cerebrum, probably a certain very considerable number of ganglionic cells in the cerebral cortex, that stand in firm organic connection with one another. The difference between an uninstructed young deaf-mute and a cretin is immense. The former can learn a great deal through instruction in speaking, the latter can not. This very ability to learn, in the child born deaf, is greater than in the normal child, in respect to pantomime and gesture. If a child with his hearing had to grow up among deaf-mutes, he would undoubtedly learn their language, and would in addition enjoy his own voice without being able to make use of it; but he would probably be discovered, further on, without testing his hearing, by the fact that he was not quite so complete a master of this gesture-language as the deaf-mutes, on account of the diversion of his attention by sound.
The total result of the foregoing observations concerning the capacity of accomplishment on the part of uneducated deaf-mutes in regard to the natural language of gesture and feature, demonstrates more plainly than any other fact whatever that, without words and without signs for words, thought-activity exists—that thinking takes place when both words and signs for wordsare wanting. Wherefore, then, should the logical combination of ideas in the human being born perfect begin only with the speaking of words or the learning to speak? Because the adult supposes that he no longer thinks without words, he easily draws the erroneous conclusion that no one, that not even he himself, could think before the knowledge of verbal language. In truth, however, it wasnot language that generated the intellect; it is the intellect that formerly invented language: and even now the new-born human being brings with him into the world far more intellect than talent for language.
FOOTNOTES:[C]Empfindungsvorstellungen.
[C]Empfindungsvorstellungen.
No human being remembers how he learned his mother-tongue in early youth, and the whole human race has forgotten the origin of its articulate speech as well as of its gestures; but every individual passes perceptibly through the stage of learning to speak, so that a patient observer recognizes much as conformable to law.
The acquisition of speech belongs to those physiological problems which can not be solved by the most important means possessed by physiology, vivisection. And the speechless condition in which every human being is born can not be regarded as a disease that may be healed by instruction, as is the case with certain forms of acquired aphasia. A set of other accomplishments, such as swimming, riding, fencing, piano-playing, the acquirement of which is physiological, are learned like articulate speech, and nobody calls the person that can not swim an anomaly on that account. Theinability to appropriateto one's self these and other co-ordinated muscular movements, this alone is abnormal. But we can not tell in advance in the case of any new-born child whether he will learn to speak or not, just as in the case of one who has suffered an obstruction of speech or has entirely lost speech, it is not certain whether he will ever recover it.
In this the normal child that doesnot yetspeak perfectly, resembles the diseased adult who, for any cause,no longerhas command of language. And to compare these two with each other is the more important, as at present no other empirical way is open to us for investigating the nature of the process of learning to speak; but this way conducts us, fortunately, through pathology, to solid, important physiological conclusions.
The command of language comprises, on the one hand, the understanding of what is spoken; on the other hand, the utterance of what is thought. It is at the height of its performance in free, intelligible, connected speech. Everything that disturbs theunderstanding of words heardmust be designated disturbance of speech equally with everything that disturbsthe production of wordsand sentences.
By means of excellent investigations made by many persons, especially by Broca, Wernicke, Kussmaul, it has become possible to make a topical division of most of the observed disturbances of speech of both kinds.In the first class, which comprises theimpressiveprocesses, we have to consider every functional disturbance of the peripheral ear, of the auditory nerve and of the central ends of the auditory nerve; in the second class, viz., theexpressiveprocesses, we consider every functional disturbance of the apparatus required for articulation, including the nerves belonging to this in their whole extent, in particular the hypoglossus, as motor nerve of the tongue, and certain parts of the cerebral hemispheres from which the nerves of speech are excited and to which the sense-impressions from without are so conducted by connecting fibers that they themselves or their memory-images can call forth expressive, i. e., motor processes. The diagram, Fig. 1, illustrates the matter.
fig_1Fig. 1.
The peripheral earo, with the terminations of the auditory nerve, is by means of sensory fibersa, that are connected with the auditory nerve, in connection with the storehouse of sound-impressions, K. This is connected by means of the intercentral pathsvwith the motor speech-center M. From it go out special fibers of communication,h, to the motor nerves of speech which terminate in the external instruments of articulation,z.
The impressive nerve-path,oaK, is centripetal; the expressive, Mhz, centrifugal;v, intercentral.
When the normal child learns to speak,oreceives the sound-impressions; byathe acoustic-nerve excitations are passed along to K, and are here stored up, every distinctly heard sound (a tone, a syllable, a word) leaving an impression behind in K. It is very remarkable here that, among the many sounds and noises that impress themselves upon the portions of the brain directly connected with the auditory nerve, a selection is made in the sound-field of speech, K, since all those impressions that can be reproduced, among them all the acoustic images necessary for speech, are preserved, but many others are not, e. g., thunder, crackling. Memory is indistinct with regard to these. From K, when the sound-images or sound-impressions have become sufficiently strong and numerous, the nerve-excitement goes farther through the connecting pathsvto M, where it liberates motor impulses, and throughhsets in activity the peripheral apparatus of speech,z.
Now, speech is disturbed when at any point the pathozis interrupted, or the excitation conducted along the nerve-fibers and ganglionic cells upon the hearing of something spoken or upon the speaking of something represented in idea (heard inwardly) is arrested, a thing which may be effected without a total interruption of the conduction, e. g., by means of poison and through anatomical lesions.
On the basis of these physiological relations, about which there is no doubt, I divide, then, all pure disturbances of speech, orlalopathies, into three classes:
The organ of hearing is injuredat its peripheral extremity, or else the acusticus in its course; then occursdifficulty of hearingordeafness. What is spoken is not correctly heard or not heard at all: the utterance is correct only in case the lesion happened late. If it isinborn, then this lack of speech, alalia, is calleddeaf-mutism, although the so-called deaf and dumb are not in reality dumb, but only deaf. If words spoken are incorrectly heard on account of acquired defects of the peripheral ear, the patient mis-hears, and the abnormal condition is called paracusis.
a.The higher impressive central paths are disturbed:centro-sensory dysphasia and aphasia, orword-deafness. Words are heard but not understood. The hearing is acute. "Patients may have perfectly correct ideas, but they lack the correct expression for them; not the thoughts but the words are confused. They would understand the ideas of others also if they only understood the words. They are in the position of persons suddenly transported into the midst of a people using the same sounds but different words, which strike upon their ear like an unintelligible noise." (Kussmaul.) Their articulation is without defect, but what they say is unintelligible because the words are mutilated and used wrongly. C. Wernicke discovered this form, and has separated it sharply from other disturbances of speech. He designated it sensory aphasia. Kussmaul later named this abnormal condition word-deafness (surditas verbalis).
b.The connections between the impressive sound-centers and the motor speech-center are injured. Then we have intercentral conductive dysphasia and aphasia. What is spoken is heard and understood correctly even whenvis completely interrupted. The articulation is not disturbed, and yet the patient utters no word ofhimself. He can, however, read aloud what is written. (Kussmaul.) The word that has just been read aloud by the patient can not be repeated by him, neither can the word that has been pronounced to him; and, notwithstanding this, he reads aloud with perfect correctness. In this case, then, it is impossible for the patient of his own motion, even if the memory of the words heard were not lost, to set in activity the expressive mechanism of speech, although it might remain uninjured.
c.The motor speech-center is injured. Then we have centro-motor dysphasia and aphasia. If the center is completely and exclusively disturbed, then it is a case of pure ataxic aphasia. Spontaneous speaking, saying over of words said by another, and reading aloud of writing, are impossible. (Kussmaul.) On the other hand, words heard are understood, although the concepts belonging with them can not be expressed aloud. The verbal memory remains; and the patient can still express his thoughts in writing and can copy in writing what he reads or what is dictated to him.
The centrifugal paths from the motor speech-center to the motor nerves of speech and to their extremities, or else these nerves themselves, are injured. Then occursdysarthria, and, if the path is totally impassable at any place,anarthria. The hearing and understanding of words are not hindered, but speaking, repeating the words of others, and reading aloud are, as in the last case (2,c), impossible. In general this form can not be distinguished from the foregoing when both are developed in an extreme degree, except in cases of peripheral dysarthria, i. e., dyslalia, since, as may be easily understood, it makes no difference in the resulting phenomena whether the motor center itself is extirpated or its connections with the motor outlet are absolutely cut off just where the latter begins; but if this latter is injured nearer to the periphery, e. g., if the hypoglossus is paralyzed, then the phenomena are different (paralalia, mogilalia). Here belongs all so-called mechanical dyslalia, caused by defects of the peripheral speech-apparatus.
Of these five forms each occurs generally only in connection with another; for this reason the topical diagnosis also is often extraordinarily difficult. But enough cases have been accurately observed and collected to put it almost beyond a doubt that each form may also appear for a short time purely by itself. To be sure, the anatomical localization of the impressive and expressive paths is not yet ascertained, so that for the present the centripetal roads from the acusticus to the motor speech-center, and the intercentral fibers that run to the higher centers, are as much unknown as the centrifugal paths leading from them to the nuclei of the hypoglossus; but that the speech-center discovered by Broca is situated in the posterior portion of the third frontal convolution (in right-handed men on the left, in left-handed on the right) is universally acknowledged.
Further, it results from the abundance of clinical material, that the acoustic-center K must be divided into a sound-center L, a syllable-center S, a word-center W, each of which may be in itself defective, for cases have been observed in which sounds were still recognized and reproduced, but not syllables and words, also cases in which sounds and syllables could be dealt with but no words; and, finally, cases in which all these were wanting. The original diagram is thereby considerably complicated, as the simple path of connection between K and M has added to it the arcs L S M and L S W M (Fig. 2).
fig_2Fig. 2.
The surest test of the perfect condition of all the segments is afforded by the repetition of sounds, syllables, and words pronounced by others.
Syllables and sounds, but no words, can be pronounced if W is missing or the path S W or W M is interrupted; no syllables if S is missing or L S or S M is interrupted. If L is missing, then nothing can be repeated from hearing. If L M is interrupted, then syllables and words are more easily repeated than simple sounds, so far as the latter are not syllables. If L S isinterrupted, then simple sounds only can be repeated. All these abnormal states have been actually observed. The proofs are to be found in Kussmaul's classic work on the disturbances of speech (1877). Even the strange case appears in which, L M being impracticable, syllables are more easily repeated than simple sounds.
Ifais interrupted before the acquirement of speech, and thus chronic deafness is present in very early childhood, articulation may still be learned through visual and tactile impressions; but in this case the sound-center L is not developed. Another, a sound-touch-center, comes in its place in deaf-mutes when they are instructed, chiefly through the tactile sensations of the tongue; and, when they are instructed in reading (and writing), a sound-sight-(or letter) center. This last is, on the contrary, wanting to those born blind; and both are wanting to those born blind and deaf. Instead is formed in them through careful instruction, by means of the tactile sensations of the finger-tips, a center for signs of sound that are known by touch (as with the printed text for the blind).
Accordingly, the eye and ear are not absolutely indispensable to the acquirement of a verbal language; but for the thorough learning of the verbal language in its entire significance both are by all means indispensable. For, the person born blind does not get the significance of words pertaining to light and color. For him, therefore, a large class of conceptions, an extensive portion of the vocabulary of his language, remains empty sound. To the one born deaf there is likewise an extensive district of conceptions closed, inasmuch asall words pertaining to tone and noise remain unintelligible to him.
Moreover, those born blind and deaf, or those born blind and becoming deaf very early, or those born deaf and becoming blind very early, though they may possess ever so good intelligence, and perhaps even learn to write letters, as did the famous Laura Bridgman, will invariably understand only a small part of the vocabulary of their language, and will not articulate correctly.
Those born deaf are precisely the ones that show plainly how necessary hearing is for the acquirement of perfectly articulate speech. One who is deaf from birth does not even learn to speak half a dozen sounds correctly without assistance, and the loss of speech that regularly follows deafness coming on in children who have already learned to speak, shows how inseparably the learning and the development of perfect articulation are bound up with the hearing. Even the deafness that comes on in maturer years injures essentially the agreeable tone, often also the intelligibility, of the utterance.
How is it, now, with the normal child, who is learning to speak? How is it as to the existence and practicability of the nervous conduction, and the genesis of the centers?
In order to decide these questions, a further extension of the diagram is necessary (Fig. 3).
fig_3Fig. 3.
For the last diagram deals only with the hearing and pronouncing of sounds, syllables, and single words,not with the grammatical formation and syntactical grouping of these; there must further be a center of higher rank, thedictorium, or center of diction (Kussmaul), brought into connection with the centers L S and W. And, on the one hand, the word-image acquired (by hearing) must be at the disposition of the diction-center, an excitation, therefore, passing from W to D (throughm); on the other hand, an impulse must go out from the diction-center to pronounce the word that is formed and placed so as to correspond to the sense (throughn). The same is true for syllables and sounds, whose paths to and from are indicated bykandl, as well as bygandi. These paths of connection must be of twofold sort. The excitement can not pass off to thediction-center D on the same anatomical path as the return impulse from D, because not a single case is known of a nerve-fiber that in natural relations conducts both centrifugallyandcentripetally, although this possibility of double conduction does occur under artificial circumstances. Apart, then, from pathological experience, which seems to be in favor of it, the separation of the two directions of the excitement seems to be justified anatomically also. On the contrary, it is questionable whether the impulse proceeding from D does not arrive directly at the motor speech-center, instead of passing through W, S, or L. The diagram then represents it as follows (Fig. 4). Here the paths of direct connectioni,l, andnfrom D to M represent that which was justnow represented byiLdandlSeandnWf, respectively; in Fig. 4,iconducts only sound-excitations coming from L,lonly excitations coming from S, andnonly those coming from W, as impulses for M. For the present, I see no way of deciding between the two possibilities. They may even exist both together. All the following statements concerning the localization of the disturbances of speech and the parallel imperfections of child-speech apply indifferently to either figure; it should be borne in mind that the nerve-excitement always goesonlyin the direction of the arrows, never in the opposite direction, through the nervous path corresponding to them. Such a parallel is not only presented, as I have found, and as I will show in what follows, by the most superficial exhibition of the manifold deviations of child-speech from the later perfect speech, but is, above all, necessary for the answering of the question: what is the condition of things in learning to speak?
fig_4Fig.4.
In undertaking to draw such a parallel, I must first of all state that in regard to the pathology of the subject, I have not much experience of my own, and therefore I rely here upon Kussmaul's comprehensive work on speech-disturbances, from which are taken most of the data that serve to characterize the individual deviations from the rule. In that work also may be found the explanations, or precise definitions, of almost all the names—with the exception of the following, added here for the sake of brevity—skoliophasia, skoliophrasia, and palimphrasia. On the other hand, the statements concerning the speech of the child rest on my own observations of children—especially of my own son—and readers who give their attention to little children may verify them all; most of them, indeed, with ease. Only the examples added for explaining mogilalia and paralalia are taken in part from Sigismund, a few others from Vierordt. They show more plainly (at least concerning rhotacism) than my own notes, some imperfections of articulation of the child in the second year, which occur, however, only in single individuals. In general the defects of child-speech are found to be very unequally distributed among different ages and individuals, so that we can hardly expect to find all the speech-disturbances of adults manifested in typical fashion in one and the same child. But with very careful observation it may be done, notwithstanding; and when several children are compared with one another in this respect, the analogies fairly force themselves upon the observer, and there is no break anywhere.
The whole group into which I have tried to bring in organic connection all the kinds of disturbances and defects of speech in systematic form falls into three divisions:
1. Imperfections not occasioned by disturbance of the intelligence—pure speech-disturbances orlalopathies.
2. Imperfections occasioned solely by disturbances of the intelligence—disturbances of continuous speech or discourse (Rede)—dysphrasies.
3. Imperfections of the language of gesture and feature—dysmimies.
Deafness.—Persons able to speak but who have become deaf do not understand what is spoken simply because they canno longerhear. The newly born do not understand what is spoken because they cannot yethear. The pathsoandaare not yet practicable. All those just born are deaf and dumb.
Difficulty of Hearing.—Persons who have become hard of hearing do not understand what is spoken, or they misunderstand, because theyno longerhear distinctly. Such individuals easily hear wrong (paracusis).
Very young infants do not understand what is spoken, for the reason that they donot yethear distinctly;oandaare still difficult for the acoustic nerve-excitement to traverse. Little children very easily hear wrong on this account.
Dysphasia.—In the child that can use only a small number of words, the cerebral and psychical act through which he connects these with his ideas and gives them grammatical form and syntactical construction in order to express the movement of his thought isnot yetcomplete.
Sensory Aphasia(Wernicke),Word-Deafness(Kussmaul).—The child, in spite of good hearing and sufficiently developed intelligence, cannot yetunderstand spoken words because the pathmis not yetformed and the storehouse of word images W is still empty or is just in the stage of origination.
Amnesia, Amnesic Dysphasia and Aphasia, Partial and Total Word-Amnesia, Memory-Aphasia.—The child has as yet no word-memory, or only a weak one, utters meaningless sounds and sound-combinations. He cannot yetuse words because he does not yet have them at his disposal as acoustic sound-combinations. In this stage, however, much that is said to him can be repeated correctly in case W is passable, though empty or imperfectly developed.
Acataphasia(Steinthal).—The child that has already a considerable number of words at his disposal isnot yetin condition to arrange them in a sentence syntactically. He cannot yetframe correct sentences to express the movement of his thought, because his diction-center D is still imperfectly developed. He expresses a whole sentence by a word; e. g.,hot!means as much as "The milk is too hot for me to drink," and then again it may mean "The stove is too hot!"Man!means "A strange man has come!"
Dysgrammatism(Kussmaul)and Agrammatism(Steinthal).—Children cannot yetput words into correct grammatical form, decline, or conjugate. They like to use the indefinite noun-substantive and the infinitive, likewise to some extent the past participle. They prefer the weak inflection, ignore and confound the articles, conjunctions, auxiliaries, prepositions, and pronouns. In place of "I" they say their own names, alsotint(for "Kind"—child or "baby"). Instead of "Du, er, Sie" (thou,he, you), they use proper names, or man, papa, mamma. Sometimes, too, the adjectives are placed after the nouns, and the meaning of words is indicated by their position with reference to others, by the intonation, by looks and gestures. Agrammatism in child-language always appears in company with acataphasia, often also in insane persons. When the imbecile Tony says, "Tony flowers taken, attendant come, Tony whipped" (Tony Blumen genommen, Wärterin gekommen, Tony gehaut), she speaks exactly like a child (Kussmaul), without articles, pronouns, or auxiliary verbs, and, like the child, uses the weak inflection. The connectionmof the word-image-center W with the diction-center D, i. e., of the word-memory with grammar, and the centers themselves, are as yet very imperfectly developed, unused.
Bradyphasia.—Children that can already frame sentences take a surprising amount of time in speaking on account of the slowness of their diction. In D and Wmin the cerebral cortex the hindrances are still great because of too slight practice.
a. Centro-motor Dysphasia and Aphasia, Aphemia, Asymbolia, Asemia.—Children have not yet learned, or have hardly learned, the use of language, although their intelligence is already sufficient. There is no longer any deficiency in the development of the external organs of speech, no muscular weakness, no imperfection of the nervous structures that effect the articulation of the separate sounds, for intelligence shows itself in the child's actions; he forms the separatesounds correctly, unintentionally; his hearing is good and the sensory word-memory is present, since the child already obeys. Hisnot yetspeaking at this period (commonly as late as the second year) must accordingly be essentially of centro-motor character.
In the various forms of this condition there is injury or lack of sufficient relative development either in the centro-motorium M or in the paths that lead into it,d,e,fas well asi,l,n.
α. Central Dysarthria and Anarthria.—In the child at the stage of development just indicated articulation isnot yetperfect, inasmuch as while he often unintentionally pronounces correctly sounds, syllables, and single words, yet he can not form these intentionally, although he hears and understands them aright. He makes use of gestures.
Ataxic Aphasia (Verbal Anarthria).—The child that already understands several words as sound-combinations and retains them (since he obeys), can not yet use these in speech because he has not yet the requisite centro-motor impulses. He forms correctly the few syllables he has already learned of his future language, i. e., those he has at the time in memory as sound-combinations (sensory), but cannot yetgroup them into new words; e. g., he saysbiandtecorrectly, learns also to say "bitte," but not yet at this period "tibe," "tebi." He lacks still the motor co-ordination of words.
At this period the gesture-language and modulation of voice of the child are generally easy to understand, as in case of pure ataxic aphasia (the verbal asemia or asymbolia of Finkelnburg) are the looks and gesturesof aphasic adults. Chieflyn,f, and M are as yet imperfectly developed.
Central Stammering and Lisping (Literal Dysarthria).—Children just beginning to form sentences stammer, not uttering the sounds correctly. They also, as a rule, lisp for a considerable time, so that the words spoken by them are still indistinct and are intelligible only to the persons most intimately associated with them.
The pathsdandi, and consequently the centro-motorium M, come chiefly into consideration here; but L also is concerned, so far as from it comes the motor impulse to make a sound audible through M.
The babbling of the infant is not to be confounded with this. That imports merely the unintentional production of single disconnected articulate sounds with non-coördinated movements of the tongue on account of uncontrolled excitement of the nerves of the tongue.
Stuttering (Syllabic Dysarthria).—Stutterers articulate each separate sound correctly, but connect the consonants, especially the explosive sounds, with the succeeding vowels badly, with effort as if an obstacle were to be overcome. The pathsiandlare affected, and hence M is not properly excited. S, too, comes under consideration in the case of stuttering, so far as impulses go out from it for the pronunciation of the syllables.
Children who can not yet speak of themselves but can repeat what is said for them, exert themselves unnecessarily, making a strong expiratory effort (with the help of abdominal pressure) to repeat a syllable still unfamiliar, and they pause between the doubled or tripled consonant and vowel. This peculiarity, which soonpasses away and is to be traced often to the lack of practice and to embarrassment (in case of threats), and which may be observedoccasionallyin every child, is stuttering proper, although it appears more seldom than in stutterers. Example: The child of two years is to say "Tischdecke," and he begins with an unnecessary expiratory effort,T-t-itt-t, and does not finish.
Stuttering is by no means a physiological transition-stage through which every child learning to speak must necessarily pass. But it is easily acquired, in learning to speak, by imitation of stutterers, in frequent intercourse with them. Hence, stutterers have sometimes stuttering children.
β. Stumbling at Syllables.—Children that already articulate correctly separate sounds, and do so intentionally, very often put together syllables out of the sounds incorrectly, and frame words incorrectly from the syllables, where we can not assume deficient development of the external organs of speech; this is solely because the co-ordination is still imperfect. The child accordingly saysbetibefore he can saybitte; so toogrefesseninstead ofgefressen.
The tractslandnare still incompletely developed; also S and W, so far as impulses come thence to utter syllables by means of M.
b. Paraphasia.—Children have learned some expressions in their future language, and use them independently but wrongly; they put in the place of the appropriate word an incorrect one, confounding words because they cannot yetcorrectly combine their ideas with the word-images. They say, e. g.,Kindinstead of "Kinn," andSandinstead of "Salz"; alsoNetzfor"Nest" andBillardfor "Billet,"Matronefor "Patrone."
The connection of D with M throughnis still imperfect, and perhaps also M is not sufficiently developed.
Making Mistakes in Speaking (Skoliophasia).—In this kind of paraphasia in adults the cause is a lack of attention; therefore purely central concentration is wanting, or one fails to "collect himself"; there is distraction, hence the unintentional, frequently unconscious, confounding of words similar in sound or connected merely by remote, often dim, reminiscences. This kind of mis-speaking through carelessness is distinguished from skoliophrasia (see below) by the fact that there is no disturbance of the intelligence, and the correction easily follows.
Skoliophasia occurs regularly with children in the second and third years (and later). The child in general has not yet the ability to concentrate his attention upon that which is to be spoken. Hewillsto do it butcannot yet. Hence, even in spite of the greatest effort, occur often erroneous repetitions of words pronounced for him (aside from difficulties of articulation, and also when these are wanting); hence confounding (of words), wrong forms of address, e. g.,MamaorHeleneinstead of "Papa," andPapainstead of "Marie."
c. Taciturnity (Dumbness).—Individual human beings of sound physical condition who can speak very well are dumb, or speak only two or three words in all for several years, because they no longerwillto speak (e. g., in the belief that silence prevents them from doing wrong).
This taciturnity is not to be confounded with theparanoic aphrasia in certain insane persons—e. g., in catatonia, where the will is paralyzed.
It also occurs—seldom, however—that children who have already learned to speak pretty well are dumb, or speak only a few words—among these the wordno—during several months, or speak only with certain persons, because theywill notspeak (out of obstinacy, or embarrassment). Here an organic obstacle in the motor speech-center is probable. For voluntary dumbness requires great strength of will, which is hardly to be attributed to the child. The unwillingness to speak that is prompted byfunnever lasts long.
The infant cannot yetarticulate correctly, or at all, on account of the still deficient development, and afterward the lack of control, of the nerves of speech and the external organs of speech. The complete inability to articulate is called alalia. The newly born is alalic. Dyslalia continues with many children a long time even after the learning of the mother-tongue. This is always a case simply of imperfections inhandz.
a. Bulbo-nuclear Stammering (Literal Bulbo-nuclear Dysarthria and Anarthria).—Patients who have lost control over the muscles of speech through bulbo-nuclear paralysis, stammer before they become speechless, and along with paralysis and atrophy of the tongue occur regularly fibrillar contractions of the muscles of the tongue. The tongue isno longerregulated by the will.
The child that has not yet gained control over his vocal muscles stammers before he can speak correctly, and, according to my observations, regularly shows fibrillar contractions of the muscles of the tongue along with an extraordinary mobility of the tongue. The tongue isnot yetregulated by the will. Its movements are aimless.
b. Mogilalia.—Children, on account of the as yet deficient control of the external organs of speech, especially of the tongue, cannot yetform some sounds, and therefore omit them. They say, e. g.,infor "hin,"ätzfor "Herz,"eitunfor "Zeitung,"erefor "Schere."
Gammacism.—Children find difficulties in the voluntary utterance of K and Ks (x), and indeed of G, and therefore often omit these sounds without substituting others; they say, e. g.,atsenfor "Klatschen,"attenfor "Garten,"assefor "Gasse,"allfor "Karl,"etefor "Grete" (in the second year),wesenfor "gewesen,"opffor "Kopf."
Sigmatism.—All children are late in learning to pronounce correctly S, and generally still later with Sch, and therefore omit both, or in a lisping fashion put S in place of Sch; more rarely Sch in place of S. They say, e. g.,saf.in place of "Schaf,"intfor "singt,"anzfor "Salz,"lafenandslafenfor "schlafen,"issfor "Hirsch,"pittefor "Splitter,"tulfor "Stuhl,"weinfor "Schwein,"Tuttavfor "Gustav,"torchfor "Storch" (second year),emelefor "Schemel,"webenaufor "Fledermaus," but alsoKuschfor "Kuss." But in no case have I myself heard a child regularly put "sch" in place ofs, asJoscheffor "Josef." This form, perhaps,occurs in Jewish families; but I have no further observations concerning it as yet.
Rhotacism.—Many children do not form R at all for a long time and put nothing in place of it. They sayduchfor "durch,"botfor "Brot,"untefor "herunter,"tautechfor "traurig,"ulefor "Ruhe,"tänenfor "Thränen,"ukkafor "Zucker." On the contrary, some form early the R lingual, guttural, and labial, but all confound now and then the first two with each other.
Lambdacism.—Many children are late in learning to utter L, and often omit it. They say, e. g.,ichtfor "Licht,"vogefor "Vogel,"atennefor "Laterne,"batnfor "Blatt,"mantefor "Mantel."
Children who are beginning to repeat intentionally what is said, often put another sound in place of the well-known correct (no doubt intended) one; this on account of deficient control of the tongue or other peripheral organs of speech. e. g., they saytin place ofp, orbforw(bassefor "Wasser" and for "Flasche"),eforiandoforu, as inbetefor "bitte," andOhrfor "Uhr."
Paragammacism.—Children supply the place of the insuperably difficult sounds G, K, X by others, especially D and T, also N, saying, e. g.,ittefor "Rike,"finnefor "Finger,"teinfor "Klein,"tossfor "gross,"atittefor "Karnickel,"otutefor "Kuk,"attallfor "Axel,"wodalfor "Vogel,"tutfor "gut,"tatzefor "Katze."
Parasigmatism.—Children are late in learning toutter S and Sch correctly. They often supply the place of them, before acquiring them, by other sounds, saying, e. g.,tulefor "Schule,"adefor "Hase,"webbefor "Wasser,"bebfor "bös,"bebefor "Besen,"gigodfor "Schildkröte,"baubeefor "Schwalbe."
Pararhotacism.—Most children, if not all, even when they have very early formed R correctly (involuntarily), introduce other sounds in place of it in speaking—e. g., they saymoigjenfor "morgen,"mattafor "Martha,"annoldfor "Arnold,"jeibenfor "reiben,"amumfor "warum,"welfenfor "werfen."
Paralambdacism.—Many children who do not learn until late to utter L put in its place other sounds; saying, e. g.,bindfor "Bild,"bampefor "Lampe,"tinnefor "stille,"degenfor "legen,"wewefor "Löwe,"ewebaufor "Elephant."
Children reciting for the first time something learned by heart speak not always indistinctly, but, on account of the incomplete practicability of the motor-paths, slowly, monotonously, without modulation. Sounds and syllables donot yetfollow one another quickly, although they are already formed correctly. The syllables belonging to a word are often separated by pauses like the words themselves—a sort of dysphasia-of-conduction on account of the more difficult and prolonged conduction of the motor-impulse. I knew a boy (feeble-minded, to be sure) who took from three to eight seconds for answering even the simplest question; then came a regular explosion of utterance. Yet he did not stutter or stammer. When he had onlyyesornoto answer, the interval between question and answer was shorter.
Here belong in part also the imperfections of speech that are occasioned by too large a tongue (macroglossia). When a child is born with too large a tongue, he may remain long alalic, without the loss of intellectual development, as was observed to be the case by Paster and O. von Heusinger (1882).
The child that can already speak pretty correctly deforms his speech after the manner of insane persons, being moved by strange caprices, because his understanding is not yet sufficiently developed.
Logorrhœa(Loquaciousness).—It is a regular occurrence with children that their pleasure in articulation and in vocal sound often induces them to hold long monologues, sometimes in articulate sounds and syllables, sometimes not. This chattering is kept up till the grown people present are weary, and that by children who can not yet talk; and their screaming is often interrupted only by hoarseness, just as in the case of the polyphrasia of the insane.
Dysphrasia of the Melancholy.—Children exert themselves perceptibly in their first attempts to speak, answer indolently or not at all, or frequently with embarrassment, always slowly, often with drawl and monotone, very frequently coming to a stop. They also sometimes begin to speak, and then lose at once the inclination to go on.
Dysphrasia of the Delirious(Wahnsinnigen).—Children that have begun to speak often make new words for themselves. They have already invented signs before this; they are also unintelligible often-times because they use the words they have learned in a different sense.
Dysphrasia of the Insane(Verrückten).—The child is not yet prepared to speak. He possesses only non-co-ordinated sounds and isolated rudiments of words, primitive syllables, roots, as the primitive raw material of the future speech.
In many insane persons only the disconnected remains or ruins of their stock of words are left, so that their speech resembles that of the child at a certain stage.
Dysphrasia of the Feeble-minded.—The child at first reacts only upon strong impressions, and that often indolently and clumsily and with outcry; later, upon impressions of ordinary strength, without understanding—laughing, crowing, uttering disconnected syllables.
So the patient reacts either upon strong impressions only, and that indolently, bluntly, with gestures that express little and with rude words, or he still reacts upon impressions of ordinary strength, but in flat, silly, disconnected utterances.
Dysphrasia of Idiots.—Children have command at the beginning of no articulate sounds; then they learn these and syllables; after this also words of one syllable; then they speak short words of more than one syllable and sentences, but frequently babble forth words they have heard without understanding their meaning, like parrots.
Imbeciles also frequently command only short words and sentences or monosyllabic words and sounds, or, finally, they lack all articulate sound. Many microcephalous idiots babble words without understanding their meaning, like little children.
Echo-speech or Echolalia(Imitative Reflex Speech).—Children not yet able to frame a sentence correctly like to repeat the last word of a sentence they have heard; and this, according to my observations and researches, is so general that I am forced to call this echolalia a physiological transition stage. Of long words said to them, the children usually repeat only the last two syllables or the last syllable only. The feeble-minded also repeat monotonously the words and sentences said by a person in their neighborhood without showing an awakened attention, and in general without connecting any idea with what they say. (Romberg.)
Interjectional Speech.—Children sometimes have a fancy for speaking in interjections. They express vague ideas by single vowels (likeä), syllables (e. g.,na,da), and combinations of syllables, and frequently call out aloud through the house meaningless sounds and syllables. D and W are as yet undeveloped.
Often, too, children imitate the interjections used by members of the family—hop!patsch,bauz!an interjectional echolalia. Many deranged persons express their feelings in like manner, in sounds, especially vowels, syllables, or sound-combinations resembling words, which are void of meaning or are associated merely with obscure ideas (Martini). Then D is connected with M only through L and S, and so throughiande.
Embolophrasia.—Many children, long after they have overcome acataphasia and agrammatism, delightin inserting between words sounds, syllables, and words that do not belong there; e. g., they double the last syllable of every word and put aneffto it:ich-ich-eff,bin in-eff, etc., or they make a kind of bleat between the words (Kussmaul); and, in telling a story, put extra syllables into their utterance while they are thinking.
Many adults likewise have the disagreeable habit of introducing certain words or meaningless syllables into their speech, where these do not at all belong; or they tack on diminutive endings to their words. The syllables are often mere sounds, likeeh,uh; in many cases they sound likeeng,ang(angophrasia—Kussmaul).
Palimphrasia.—Insane persons often repeat single sounds, syllables, or sentences, over and over without meaning; e. g., "I am-am-am-am."
"The phenomenon in many cases reminds us of children, who say or sing some word or phrase, a rhyme or little verse, so long continuously, like automata, that the by-standers can endure it no longer. It is often the ring of the words, often the sense, often both, by which the children are impressed. The child repeats them because they seem to him strange or very sonorous." (Kussmaul.)
Bradyphrasia.—The speech of people that are sad or sleepy, and of others whose mental processes are indolent, often drags along with tedious slowness; is also liable to be broken off abruptly. The speaker comes to a standstill. This is not to be confounded with bradyphasia or with bradyarthria or bradylalia (see above).
In children likewise the forming of the sentence takes a long time on account of the as yet slow rise and combination of ideas, and a simple narrative is onlyslowly completed or not finished at all, because the intellectual processes in the brain are too fatiguing.
Paraphrasia.—Under the same circumstances as in the case of bradyphrasia the (slow) speech may be marred and may become unintelligible because the train of thought is confused—e. g., in persons "drunk" with sleep—so that words are uttered that do not correspond to the original ideas.
In the case of children who want to tell something, and who begin right, the story may be interrupted easily by a recollection, a fresh train of thought, and still they go on; e. g., they mix up two fairy tales, attaching to the beginning of one the end of another.
Skoliophrasia.—Distracted and timid feeble-minded persons easily make mistakes in speaking, because they can not direct their attention to what they are saying and to the way in which they are saying it, but they wander, allowing themselves to be turned aside from the thing to be said by all sorts of ideas and external impressions; and, moreover, they do not notice afterward that they have been making mistakes (cf. p. 53).
Children frequently put a wrong word in place of a right one well known to them, without noticing it. They allow themselves to be turned aside very easily from the main point by external impressions and all sorts of fancies, and often, in fact, say the opposite of what they mean without noticing it.
Perceptive Asemia.—Patients have lost the ability tounderstandlooks and gestures (Steinthal).
Children can not yet understand the looks and gestures of persons about them.
Amnesic Amimia.—Aphasic persons can sometimes imitate gestures, but can not execute them when bid, but only when the gestures are made for them to imitate. Children that do not yet speak can imitate gestures if these are made for them to see, but it is often a long time before they can make them at the word of command.
Ataxic Dysmimia and Amimia(Mimetic Asemia).—Patients canno longerexecute significative looks and gestures, on account of defective co-ordination.
Children can not express their states of desire, etc., because they donot yetcontrol the requisite co-ordination for the corresponding looks and gestures.
Paramimia(Paramimetic Asemia).—Many patients can make use of looks and gestures, but confound them.
Children have not yet firmly impressed upon them the significance of looks and gestures; this is shown in their interchanging of these; e. g., the head is shaken in the way of denial when they are affirming something.
Emotive Language(Affectsprache)in Aphrasia.—In Aphrasia it happens that smiling, laughing, and weeping areno longercontrolled, and that they break out on the least occasion with the greatest violence, like the spinal reflexes in decapitated animals. (Hughlings-Jackson.)
Emotive language may continue when the language of ideas (Begriffssprache) is completely extinguished, and idiotic children without speech can even sing.
In children, far slighter occasions suffice normallyto call forth smiles, laughter, and tears, than in adults. These emotional utterances arenot yetoften voluntarily inhibited by the child that can not yet speak; on the contrary, they are unnecessarily repeated.
Apraxia.—Many patients areno longerin condition, on account of disturbed intellect, to make right use of ordinary objects, the use of which they knew well formerly; e. g., they can no longer find the way to the mouth; or they bite into the soap.
Children arenot yetin condition, on account of deficient practice, to use the common utensils rightly; e. g., they will eat soup with a fork, and will put the fork against the cheek instead of into the mouth.
We may now take up the main question as to the condition of the child that is learning to speak, in regard to the development and practicability of the nerve-paths and of the centers required for speech. For the comparison of the disturbances of speech in adults with the deficiencies of speech in the child, on the one hand, and the chronological observation of the child, on the other hand, disclose to us what parts of the apparatus of speech come by degrees into operation. First to be considered are theimpressiveandexpressivepaths in general.
All new-born human beings are deaf or hard of hearing, as has already been demonstrated. Since the hearing but slowly grows more acute during the first days, no utterances of sound at this period can be regarded as responses to any sound-impressions whatever. The first cry is purely reflexive, like the croaking of thedecapitated frog when the skin of his back is stroked (Vol. I, p. 214). The cry is not heard by the newly-born himself and has not the least value as language. It is on a par with the squeaking of the pig just born, the bleating of the new-born lamb, and the peeping of the chick that is breaking its shell.
Upon this first, short season of physiological deaf-mutism follows the period during which crying expresses bodily conditions, feelings such as pain, hunger, cold. Here, again, there exists as yet no connection of the expressive phenomena with acoustic impressions, but there is already the employment of the voice with stronger expiration in case of strong and disagreeable excitations of other sensory nerves than those of general sensation and of the skin. For the child now cries at a dazzling light also, and at a bitter taste, as if the unpleasant feeling were diminished by the strong motor discharge. In any case the child cries because this loud, augmented expiration lessens for him the previously existing unpleasant feelings, without exactly inducing thereby a comfortable condition.
Not until later does a sudden sound-impression, which at first called forth only a start and then a quivering of the eyelids, cause also crying. But this loud sign of fright may be purely reflexive, just like the silent starting and throwing up of the arms at a sudden noise, and has at most the significance of an expression of discomfort, like screaming at a painful blow.
It is otherwise with the first loud response to an acoustic impressionrecognizedas new. The indefinable sounds of satisfaction made by the child that hears music for the first time are no longer reflexive, and are notsymptoms of displeasure. I see in this reaction, which may be compared with the howling of the dog that for the first time in his life hears music—I see in this reaction of the apparatus of voice and of future speech,the first sign of the connection now just established between impressive(acoustic) andexpressive(having the character of emotive language)paths. The impressive, separately, were long since open, as the children under observation after the first week allowed themselves to be quieted by the singing of cradle-songs, and the expressive, separately, must likewise have been open, since various conditions were announced by various sorts of crying.
Everything now depends on a well-establishedintercentral communicationbetween the two. This is next to be discussed.
The primitive connection is already an advance upon that of a reflex arc. The sound-excitations arriving from the ear at the central endings of the auditory nerve are not directly transformed into motor excitations for the laryngeal nerves, so that the glottis contracts to utter vocal sound. When the child (as early as the sixth to the eighth week) takes pleasure in music and laughs aloud, his voice can not in this case (as at birth) have been educed by reflex action, for without a cerebrum he would not laugh or utter joyous sounds, whereas even without that he cries.
From this, however, by no means follows the existence of a speech-center in the infant. The fact that he produces sounds easily articulated, although without choice, liketahuandamma, proves merely the functional capacity of the peripheral apparatus of articulation (in the seventh week) at a period long before it is intentionally used for articulation. The unintentionally uttered syllables that make their appearance are, to be sure, simple, at least in the first half-year. It is vowels almost exclusively that appear in the first month, and these predominate for a long time yet. Of the consonants in the third monthmalone is generally to be noted as frequent. This letter comes at a later period also, from the raising and dropping of the lower jaw in expiration, an operation that is besides soon easy for the infant with less outlay of will than the letterb, which necessitates a firmer closing of the lips.
But in spite of the simplicity of all the vocal utterances and of the defectiveness of the articulatory apparatus, the child is able (often long before the seventh month) to respond to address, questions, chiding, either with inarticulate sounds or with vowels or by means of simple syllables, likepa,ta,ma,na,da,mä,mö,gö,rö[aas infather; ä as infate; ö likeiinbird.] Since these responses are entirely, or almost entirely, lacking in microcephali and in children born deaf, they are not purely reflexive, like sneezing, e. g.; therefore there must be in the case of these a cerebral operation also, simple indeed, but indubitably intellectual, interposed between sound-perception and vocal utterance, especially as the infant behaves differently according to what he hears, and he discriminates very well the stern command from the caress, forbidding from allowing, in the voice of the person speaking to him. Yet it is much more thetimbre, the accent, the pitch, the intensity of the voice and the sounds, the variation of which excites attention, than it is the spoken word. In the first half-year the child hears the vowels muchbetter than he does the consonants, and will imperfectly understand or divine the sense of a few sounds only—e. g., when his name is uttered in a threatening tone he will hear merely the accented vowel, for at the first performance taught him, purposely postponed to a very late period (in his thirteenth month), it made no difference to my child whether we asked without changing a feature, "Wie gross?" (how tall?) or "ooss?" or "oo?" In all three cases he answered with the same movement of the hand.
Now, although all infants in normal condition, before they can repeat anything after others or can understand any word whatever,expresstheir feelings by various sounds, even by syllables, anddistinguishvowels and many consonants in the words spoken to them, yet this does not raise them above the intelligent animal. The response to friendly address and loud chiding by appropriate sounds is scarcely to be distinguished as to its psychical value from the joyous barking and whining of the poodle.
The pointer-dog's understanding of the few spoken utterances that are impressed upon him in his training is also quite as certain at least as the babe's understanding of the jargon of the nurse. The correctly executed movements or arrests of movement following the sound-impressions "Setz dich! Pfui! Zurück! Vorwärts! Allez! Fass! Apporte! Such! Verloren! Pst! Lass! Hierher! Brav! Leid's nicht! Ruhig! Wahr Dich! Hab Acht! Was ist das! Pfui Vogel! Pfui Hase! Halt!" prove that the bird-dog understands the meaning of the sounds and syllables and words heard as far as he needs to understand them. The training in theEnglish language accomplishes the same result with "Down! Down charge! Steady! Toho! Fetch! Hold up!" as the training in the French language, with yet other words—so that we can by no means assume any hereditary connection whatever between the quality of the sound heard and the movement or arrest of movement to be executed, such as may perhaps exist in the case of the chick just hatched which follows the clucking of the hen. Rather does the dog learn afresh in every case the meaning of the words required for hunting, just as the speechless child comprehends the meaning of the first words of its future language without being able to repeat them himself—e. g., "Give! Come! Hand! Sh! Quiet!" Long before the child's mechanism of articulation is so far developed that these expressions can be produced by him, the child manifests his understanding of them unequivocally by corresponding movements, by gestures and looks, by obedience.
No doubt this behavior varies in individual cases, inasmuch as in some few the imitative articulation may be to some extent earlier developed than the understanding. There are many children who even in their first year have a monkey-like knack at imitation and repeat all sorts of things like parrots without guessing the sense of them. Here, however, it is to be borne in mind that such an echo-speech appears only after thefirstunderstanding of some spoken word can be demonstrated; in no case before the fourth month. Lindner relates that when he one day observed that his child of eighteen weeks was gazing at the swinging pendulum of the house-clock, he went with him to it, saying, "Tick-tack," in time with the pendulum; and when heafterward called out to the child, who was no longer looking at the clock, "Tick-tack!" this call was answered, at first with delay, a little later immediately, by a turning of the look toward the clock. This proved that there was understanding long before the first imitation of words. Progress now became pretty rapid, so that at the end of the seventh month the questions, "Where is your eye? ear? head? mouth? nose? the table? chair? sofa?" were answered correctly by movements of hand and eyes. In the tenth month this child for the first time himself used a word as a means of effecting an understanding, viz.,mama(soon afterward, indeed, he called both parentspapa). The child's inability to repeat distinctly syllables spoken for him is not to be attributed, shortly before the time at which he succeeds in doing it, to a purely psychical adynamy (impotence), not, as many suppose, to "being stupid," or to a weakness of will without organic imperfections determined by the cerebral development, for the efforts, the attention, and the ability to repeat incorrectly, show that the will is not wanting. Since also the peripheral impressive acoustic and expressive phonetic paths are intact and developed, as is proved by the acuteness of the hearing and the spontaneous formation of the very syllables desired, the cause of the inability to repeat correctly must be solely organic-centro-motor. The connecting paths between the sound-center and the syllable-center, and of both these with the speech motorium, are not yet or not easily passable; but the imitation of a single sound, be it onlya, can not take place without the mediation of the cerebral cortex. Thus in the very first attempt to repeat something heard thereexists an unquestionable advance in brain development; and the first successful attempt of this kind proves not merely the augmented functional ability of the articulatory apparatus and of the sound-center, and the practicability of the impressive paths that lead from the ear to the sound-center—it proves, above all, the establishment of intercentral routes that lead from the sound-center and the syllable-center to the motorium.
In fact, the correctrepeatingof a sound heard, of a syllable, and, finally, of a word pronounced by another person, is the surest proof of the establishment and practicability of the entire impressive, central, and expressive path. It, however, proves nothing as to theunderstandingof the sound or word heard and faultlessly repeated.
As the term "understanding" or "understand" is ambiguous, in so far as it may relate to the ideal content (the meaning), and at the same time to the mere perception of the word spoken (or written or touched)—e. g., when any one speaks indistinctly so that we do not "understand" him—it is advisable to restrict the use of this expression.Understandshall in future apply only to themeaningof the word;hear—since it is simply the perceiving of a word through the hearing that we have in view—will relate to the sensuous impression. It is clear, then, that all children who can hear but can not yet speak, repeat many words without understanding them, and understand many words without being able to repeat them, as Kussmaul has already observed. But I must add that the repeating of what is not understood begins only after some word (even one that can not be repeated) has been understood.
Now it is certain that the majority, if not all, ofthe children that have good hearing develop the understanding more at first, since the impressive side is practiced more and sooner than the expressive-articulatory. Probably those that imitate early and skillfully are the children that can speak earliest, and whose cerebrum grows fastest but also soonest ceases to grow; whereas those that imitate later and more sparingly, generally learn to speak later, and will generally be the more intelligent. For with the higher sort of activity goes the greater growth of brain. While the other children cultivate more the centro-motor portion, the sensory, the intellectual, is neglected. In animals, likewise, a brief, rapid development of the brain is wont to go along with inferior intelligence. The intelligence gets a better development when the child, instead of repeating all sorts of things without any meaning, tries to guess the meaning of what he hears. Precisely the epoch at which this takes place belongs to the most interesting in intellectual development. Like a pantomimist, the child, by means of his looks and gestures, and further by cries and by movements of all sorts, gives abundant evidence of his understanding and his desires, without himself speaking a single word. As the adult, after having half learned a foreign language from books, can not speak (imitate) it, and can not easily understand it when he hears it spoken fluently by one that is a perfect master of it, but yet makes outsingleexpressions and understands them, and divines the meaning of the whole, so the child at this stage can distinctly hear single words, can grasp the purport of them, and divine correctly a whole sentence from the looks and gestures of the speaker, although the child himself makes audible no articulateutterance except his own, for the most part meaningless, variable babble of sounds and syllables and outcries.
The causes of the slowness of the progress in expressing in articulate words what is understood and desired, on the part of normal children, is not, however, to be attributed, as it has often been, to a slower development of the expressive motor mechanism, but must be looked for in the difficulty of establishing the connection of the various central storehouses of sense-impressions with the intercentral path of connection between the acoustic speech-centers and the speech-motorium. For the purely peripheral articulatory acts are long since perfect, although as yet a simple "a" or "pa" can not be repeated after another person; for these and other sounds and syllables are already uttered correctly by the child himself.
The order of succession in which these separate sounds appear, without instruction, is very different in individual cases. With my boy, who learned to speak rather late, and was not occupied with learning by heart, the following was the order of the perfectly pure sounds heard by me:
On the left are the sounds or syllables indicated by one letter; on the right, the same indicated by more than one letter; and it is to be borne in mind that the child needs to pronounce only fourteen of the nineteen so-called consonants of the German alphabet in order to master the remaining five also; for
and of the fourteen four require no new articulation, because
Of the ten positions of the mouth required for all the consonants of the alphabet, nine are taken by the child within the first six months:*