ILY TYPE WITHOUT DEAFNESS OR OB

VIOUS MENTAL DEFECT.

BY HAROLD N. MOYER, M. D.

ASSISTANT PROFESSOR OF MEDICINE, RUSH MEDICAL COLLEGE, CHICAGO.

The first to direct attention to this interesting class of cases was Sir William Wilde in his work on Aural Surgery, 1853. They were described as individuals who were dumb, but were not deaf nor imbecile. He analyzed the returns of the Irish census for 1851 and found that dumbness without deafness existed in 334 of 4,485 mutes residing in Ireland. Of these 203 were either imbecile, paralytic, or both. Of those remaining 124 suffered from paralysis of the tongue or other defect of the organs of articulation. In seven there was no local paralysis, they could hear well, could understand what was said and displayed generally a fair amount of intelligence, only they could not speak. John Wyllie, The Disorders of Speech, in commenting on these cases said they all showed the existence of peculiarities indicative of some mental defect. They were noted to be restless or mischievous or to display other indications of want of mental power. To his mind these cases were suggestive of a defective intelligence, strong enough to have acquired the power of interpreting words, but too weak to train the motor side of the speech centers to their production. Later Wyllie elaborates this explanation, and we shall again refer to it, as we think the distinctly hereditary character in this case lends support to the views of Bastian regarding the genesis of speech, a view adopted by Wyllie in explaining this peculiar group.

The father of the patient whom I shall describe died of consumption at forty-nine years of age. He was an intelligent man, occupying a good position and had an excellent command of language. He did not speak until he was six years of age.

A paternal uncle died at thirty-seven. We cannot learn if this individual was late in learning to speak, but he was affected with lalling all his life. He had six children, all of whom developed normally. One son alone was affected with lalling.

Another paternal uncle was free from speech defect, as was his six children.

A paternal aunt had no children. She was free from speech defect.

In the family to which the patient belongs were twelve children, five of whom died soon after birth.

Chicago Medical Society.

Of the remaining seven children four were girls, three of whom could speak as well as the average child at two years. One girl died at the age of ten. Speech with her did not begin until four years of age. Lalling was marked in this child, and she was always understood with difficulty owing to defective utterance.

The three boys were all defective in speech in early years. One now twelve years of age is well advanced in school; is bright and learns casily. He did not speak until four years of age, but, once begun, language was quickly developed. At first his articulation was defective, but in three or four months his speech was free from defect and was equal to the average boy of his age.

Another brother is twenty-six years of age, is active and intelligent. Did not speak a word until nearly four years of age. At ten years he substituted "n" for "1." His speech is now free from defect. He has three children, all normally developed as to speech.

John at the time he was seen was nine years of age. Until he was eight his only spoken word was "mamma." It is not known at what time he acquired this word. His hearing has always been acute. He walked at the usual age. He has always seemed as bright as the average child and understands fully all that is said to him. About one year before he was examined he began to speak, and now his vocabulary is quite extensive. He was placed in school, and has progressed well with his education.

Physical examination shows no defects in the organs of articulation. He is a persistent mouth breather; consequently his expression is somewhat vacant. This is probably due to adenoids. The dentition is irregular. The head is well developed. There are no obvious defects of development, with the exception of a marked "webbing" of two toes, a peculiarity that the mother says exists in both her and her husband's family.

FIG. 1. Squares indicate males, circles females. Those presenting any defect of speech or delay in its development are represented in black.

By reference to the accompanying figure it will be seen that there are nineteen descendants from three brothers. The sister

had no children. Of these five presented marked anomalies of speech. Four of these were males. The four children of one family alone presented congenital aphasia. The other brother was a mere example of lalling and the defect was the same in the son. The term congenital aphasia has been adopted from Wyllie. Undoubtedly it should not be used for mere delay in development of language, but when several years have passed in an otherwise healthy child, and there is no effort at speech the term is justified.

I believe that this condition of delayed speech is more common than is generally supposed, though it rarely persists in otherwise normal children until such time as it could be called dumbness. It is allied to other speech defects which have been classed under the incorrect term stigmata of degeneracy, but which Dr. Christopher has so well said should be called anomalies of development.

A number of cases are described in which dumbness existed and persons spoke suddenly. Bastian, Brain as an Organ of the Mind, records the case of a boy five years of age who had not spoken a word, who, on the occasion of breaking a favorite toy said, "What a pity." Some years later his speech was as fluent as the average child.

Dr. Bastian refers in this connection to the old story of the dumb son of Croesus, who, when at the siege of Sardis, his father was threatened by a Persian soldier, is reported by Herodotus to have cried out, "Oh, man do not kill Croesus;" also the story of the Samian athlete, previously dumb, who, on detecting foul play, suddenly spoke.

Dr. Bastian (Wyllie, Disorders of Speech, page 132) thinks that speech has been practiced by so many generations of men that the power of speech is now inherited by each succeeding generation almost as if the act of speech were an instinctive and automatic one, and that in the normal condition of things, including a normal condition of hearing and the mental faculties, the productive speech centers easily learn to call forth the requisite movements whenever the proper level of structural development has been reached. The young swallow leaves its nest and flies automatically when it is mature enough to do so. The young child, if it be normal in structure and development, presents something of the same automatic facility in acquiring at the proper time the movements of speech. When a slight abnormality interferes with the action of the speech centers it may in some cases be overcome by the stimulus of strong emotion, which may break down a barrier that the weaker stimulus has failed to penetrate.

FIG. 2. Wyllie's table showing development of speech, in average normal child.

an articulate sound until four years of age, when he suddenly began to speak, and in three months his speech was equal to the average child of his age.

Some such explanation as Bastian's will alone account for these cases. One of the children mentioned in this paper did not utter

Wyllie regards all these cases as defective mentally and says that an analogy is found in normal minds, some being strongly receptive and able to accumulate much information, while others are strikingly productive. In imbecile minds there are probably the same varieties, and one can find it likely that in the development of speech, which is so closely allied to thought, the receptive faculties sometimes display a normal activity, while the productive are slow in their development.

If speech is considered a part of one's mentality, then these cases can be grouped under the term imbecile, because they are lacking in some of the capacities of normal individuals. Certainly they are not imbecile in the ordinary sense of the word. Many curious anomalies of development in language are met with and it seems to me unwise to classify every defect of this kind under the term imbecility. A physician recently told me of a well-developed child that made no sound when laughing, although all of the usual facial contortions were present. At eight years of age he laughed normally.

I append to this article Wyllie's table showing the normal development of speech in the average child. I have found this table. to be very useful in the study of defective children.

103 STATE STREET.

THE RESULTS OF WIDAL'S TEST IN THE DIAGNOSIS OF TYPHOID FEVER FROM DRIED BLOOD

SPECIMENS.

BY ADOLPH GEHRMANN, M. D., CHICAGO.

The use of dried blood as a means of collecting and preserving specimens of blood for the diagnosis of typhoid fever, first suggested by Wyatt Johnston in 1896, has been generally used by health authorities as a means of diagnosis since that time. It has been subject to some modifications, but as used in most places it is essentially the same method originally proposed by Dr. Johnston.

In Europe dried blood is seldom examined—at least, published statements of this use are not to be found. Indeed, Widal's test has been more widely adopted as a public health diagnosis in America and England than it has been on the continent, and in the United States and Canada it has been used to especial advantage.

The Chicago Society for Internal Medicine.