French woman and giving her three months' training, thus with the assistance, instruction and management of a few head nurses, he found that he had just as efficient service as when he had all graduate nurses. To demonstrate the presence of a sacred circle of nurses in our midst, we shall mention the experience of a very prominent young physician, who a few days ago rang up a nurse and asked her to go to attend a case. She hesitated and then said: “Before accepting, doctor, I would like to know the college from which you graduated." The doctor hung up the telephone and took his chances of getting someone else. From our observation and conversations with physicians, we believe that it is absolutely necessary that the California State Board of Health establish an entirely new regime. There are four young women in the eighth grade of our school-that is, the last grammar grade-to where there is one in the senior high school class, and in making the rule that a young woman must graduate from the high school before she be permitted to enter any training school, the California State Board of Health has taken away all possibility of becoming nurses from three out of every four really qualified young women. To deprive the families of the possibility of having a fair proportion of these grammar-grade young women as nurses is a calamity to the people, while closing the door of this great profession against them is a great injustice to the young women themselves. It is unreasonable to require the nurse who is going out to nurse in families to have the same preliminary education or to take the same course as the nurse who expects to teach nursing. We suggest that hospitals employ intelligent women, who might be termed nurse-maids, to wait on the trained nurses, thus developing much-needed practical nurses; a one year's course for nurses who will go out to do general nursing, and a three-year course for nurses who expect to be teachers and official nurses in hospitals. Los Angeles Daily Times, February 9, 1919. THE INFLUENCE OF PSYCHIC ACTS. Tohru Ishagami of Osaka, Hamadera, Japan, discusses the influences of psychic acts on the progress of pulmonary tuberculosis in the October number of the American Review of Tuberculosis. A variety of clinical observations were made with the following conclusions: 1. Psychic acts frequently influence the course of pulmonary tuberculosis unfavorably and render the treatment difficult. 2. Psychic acts often cause transient glycosuria. 3. The psychic influences upon the disease are accompanied by a lowering of the opsonic index. 4. Sugar and adrenalin both inhibit opsonic reaction. 5. Lowering of the opsonic index in emotional excitement is caused by an increase in the amount of sugar and adrenalin in the blood. 6. Impairment in the progress of the disease is caused both by a decrease in the opsonic reaction and in the digestive function. 7. Overtaxation of the mind of our youths by our unsatisfactory educational system seems to be the cause of the high mortality of young consumptives in our country. 8. The high mortality of our youths from tuberculosis is also partly due to the infection from tuberculous teachers, who in turn are the victims of excessive mental strain. 9. Prevention of excessive mental strain by an improvement in our educational system is one effective means of preventing the spread of consumption among our youths. Ishagami, Tohru: The Influence of Psychic Acts on the Progress of Pulmonary Tuberculosis, Am. Rev. Tub., 1918, Vol. II, No. 8. 1 Vol. XXXIV. LOS ANGELES, MARCH, 1919 Editor, DR. GEO. E. MALSBARY. Associate Editors, No. 3 Dr. Walter Lindley, Dr. W. W. Watkins, Dr. Ross Moore, Dr. George L. Cole, Dr. Cecil E. Reynolds, Dr. William A. Edwards, Dr. Andrew W. Morton, STAMMERING; ITS CAUSE AND TREATMENT BY CHARLES G. STIVERS, M.D.* Chairman Eye and Ear Section Los Angeles County Medical Association. Major, Los Angeles Public Schools What are stammering and stuttering? The distinction between them is purely artificial. Stuttering is usually defined as a form of defective speech, manifesting itself in repetition of the initial consonant. Stammering is defined as a form of defective utterance characterized by strangulatory and compressive effort, or as any minor form of speechhesitation, that is not stuttering. Much of the confusion has arisen in these definitions through English and American authors translating the German word stammeln (lalling or baby-talk in its milder forms) as stammering. In this article the word stammering is used, to refer to all forms of speech defects except lisping. The Cause of Stammering Volumes have been written on the cause of stammering. Some authors say the difficulty lies with the consonants, as the stammerer appears to repeat the initial consonant which he has great trouble in getting away from. The consonant may be prolonged for several seconds and the difficulty ends as soon as a vowel sound is added to it. There is never any trouble with a final consonant. The fallacy of the above argument is shown by the fact that as the stammerer utters many correct consonant sounds, the trouble is not with consonants but with the vowel sound. The consonant is prolonged and repeatedthe stammerer begins again and again trying to get to the vowel, but as he does not remember its sound he cannot reproduce it. That the trouble does not lie with the consonant, but with the vowel, is borne out by the fact that stammering occurs when the word begins with a vowel. There may be as great difficulty pronouncing I, as Pie. There may be no consonant in the word at all, yet the stammering occurs with such words as I and A. Stammering is almost never met in singing. Song differs from speech mainly in the method of vowel production, *Read before the Los Angeles County Medical Association, March 6, 1919. ence of difficulty then that the the difficulty that The stammerer's ilure to remember roduce the vowel, ging of the larynbe seen from the should disappear spers-there being pering. The fact 65 per cent of all whispering. The lie with the pro ch. There is usually some mental bias or external evidence of nervous instability in the stammerer. He is often a highly imaginative child, and given to coloring his tales, or actually telling lies and evading responsibility. The fact is that there is a pronounced Psychological factor in all cases, and no study or treatment of stammering will be successful that fails to take into account the unstable nervous system and adopt measures to restore its balance. not one of vocalie following: Stamthe effort to pro; when the Mis mming or musical ✓ in larynx action. clearly associated vel color, or vowel words, the stamthe vowel sounds er it. Stammering is quite often associated with a low grade mentality. In the ungraded school rooms are found a large per cent of stammerers for two reasons -first, they cannot keep up with their unhandicapped fellows, and second, the quality of their mental and physical endowments not being up to normal, they cannot compete successfully in a struggle with studies mainly designed for normal children. es on for aids, in - feeling of the and the rememFound desired. cent of all school eech defect, either - In Los Angeles are about 3,000 tims of this disstammerer is not but owing to his public, and to his e cannot advance is retarded from The Treatment of Stammering Physical defects must be remedied as far as possible. Hypertrophic cryptic tonsils containing foci of infection, from which poisonous toxins are constantly given off, thereby lowering the bodily resistance, should be removed. Care must be taken that the removal is skillfully done, that permanent injury to the muscles used in speech, be not inflicted. much more com, and much harder to meet a woman Len are quite freof this serious gis a great drawmuch greater in ause of the more Adenoids, post-nasal hypertrophies, septal deviations, tongue-tie, carious teeth, crowded or mal-occluded teeth should receive proper attention. No operation per se will cure stammering, but may put the physical body into better condition to be the servant of the mind. Stammerers have poor voluntary control of their speech mechanism, including breathing, which is usually of a shallow, catchy nature. As speech is built out of breath, the stammerer must be taught breath control. Diaphragmatic breathing should be taught by lecture and example, emphasizing the fact merer to practice diaphragm As stammering is associa The stammerer's attention to the faulty sounds he ma is shown by comparison, sounds. Syllabication or di into syllables is one of th cises, and much training m to it. Mental drill, for pois ation and the use of sug Auto-suggestion are useful the treatment of the menta Short poems dealing with jects may be memorized recitations to emphasize the and color of the different w ing something, and doing which by repetition the sta do well and usually witho ing, has a marked value i sists in the restoration and of the self-confidence which The treatment of a stam not be undertaken lightly without the full co-operatio -especially the mother. I usually to see that the sta tices several times a day. the task, also, of supervis ute details of the patient lating his diet, sleep, exerc according to his necessiti nervous children an hour in complete rest in bed, noon, will go far to conser energy. : S As the treatment of practically the supervision life of a child for a period ; months to several years, it times, and not only when in r's presence. mering is associated with an n of the breath, and as stamver occurs when the breath is red freely, the aim in treatd be to keep the breath flowin fact to insist on an exagt first of the breath in the merer's attention is directed ty sounds he makes, and he by comparison, the correct -llabication or dividing words les is one of the best exermuch training may be given tal drill, for poise and relaxthe use of suggestion and stion are useful adjuncts for ent of the mental instability. ems dealing with simple subbe memorized and used in to emphasize the sound, form f the different words. Learnming, and doing something epetition the stammerer can d usually without stammermarked value in that it asrestoration and continuance confidence which he lacks. ment of a stammerer should Hertaken lightly, and never full co-operation of parents the mother. It is her duty ee that the stammerer prac1 times a day. To her falls Eso, of supervising the minof the patient's life; reguiet, sleep, exercise and play o his necessities. In very Idren an hour or two spent rest in bed, in the aftero far to conserving nervous reatment of stammering is the supervision of the entire ild for a period of from six everal years, it is the prov undertake these cases. Bibliography. Bluemel: stammering, etc.; Makuen: Treatment of Stammering. The Treatment of Lisping or Baby-Talk The treatment of lisping or baby-talk consists in a replacement of the faulty sounds by correct ones. In beginning the treatment a record chart of each sound that is made incorrectly, is kept for reference. The correct sound is then made for the lisper who repeats it until the memory of it is firmly fixed in the mind. Actual demonstrations to the lisper, showing correct mouth, tongue, lips and teeth positions are made daily. In the case of lispers who have not learned to read, pictures, blocks, toys, games, advertisements, colored yarns, and simple geometrical forms are used to associate sounds with form. In the treatment of both stammering and lisping the fullest co-operation of parents and friends, teachers and pupils must be insisted on with the admonition that the difficulty must be overcome in early life, before it becomes a well formed, stubborn habit. We hear a great deal about shell shock and the mutism and stammering associated with it. While in San Francisco last Fall, I saw some cases treated successfully by the use of suggestion and the adoption of a manner of living that is found useful in all forms of acute or chronic nervous unbalance, together with the same drill in speech mechanism as is used in other stam mer cases. Dr. Ross Moore, who was a Major in the Neurological Section of the Army for 18 months, has returned from France and located in the Brockman building. Dr. Moore was very much missed in Los Angeles and we are glad to see him among us again. ence of difficulty then that the he difficulty that The stammerer's lure to remember roduce the vowel, ging of the larynDe seen from the should disappear pers-there being pering. The fact 65 per cent of all whispering. The lie with the proch. There is usually some mental bias or external evidence of nervous instability in the stammerer. He is often a highly imaginative child, and given to coloring his tales, or actually telling lies and evading responsibility. The fact is that there is a pronounced Psychological factor in all cases, and no study or treatment of stammering will be successful that fails to take into account the unstable nervous system and adopt measures to restore its balance. not one of vocalie following: Stamthe effort to pro; when the Mis mming or musical in larynx action. clearly associated vel color, or vowel words, the stamthe vowel sounds er it. Stammering is quite often associated with a low grade mentality. In the ungraded school rooms are found a large per cent of stammerers for two reasons -first, they cannot keep up with their unhandicapped fellows, and second, the quality of their mental and physical endowments not being up to normal, they cannot compete successfully in a struggle with studies mainly designed for normal children. es on for aids, in - feeling of the and the rememLound desired. cent of all school eech defect, either - In Los Angeles are about 3,000 tims of this disstammerer is not but owing to his public, and to his e cannot advance is retarded from much more com, and much harder to meet a woman en are quite freof this serious gis a great drawmuch greater in cause of the more The Treatment of Stammering Physical defects must be remedied as far as possible. Hypertrophic cryptic tonsils containing foci of infection, from which poisonous toxins are constantly given off, thereby lowering the bodily resistance, should be removed. Care must be taken that the removal is skillfully done, that permanent injury to the muscles used in speech, be not inflicted. Adenoids, post-nasal hypertrophies, septal deviations, tongue-tie, carious teeth, crowded or mal-occluded teeth should receive proper attention. No operation per se will cure stammering, but may put the physical body into better condition to be the servant of the mind. Stammerers have poor voluntary control of their speech mechanism, including breathing, which is usually of a shallow, catchy nature. As speech is built out of breath, the stammerer must be taught breath control. Diaphragmatic breathing should be taught by lecture and example, emphasizing the fact merer to practice diaphragma As stammering is associat The stammerer's attention to the faulty sounds he ma is shown by comparison, sounds. Syllabication or div into syllables is one of the cises, and much training ma to it. Mental drill, for poise ation and the use of sug Auto-suggestion are useful a the treatment of the mental Short poems dealing with jects may be memorized s recitations to emphasize the and color of the different w ing something, and doing which by repetition the sta do well and usually witho ing, has a marked value in sists in the restoration and of the self-confidence which The treatment of a stam not be undertaken lightly without the full co-operatio -especially the mother. I usually to see that the sta tices several times a day. the task, also, of supervis ute details of the patient lating his diet, sleep, exerc according to his necessiti nervous children an hour in complete rest in bed, noon, will go far to conser energy. S As the treatment of practically the supervision life of a child for a perio 1 months to several years, i |