PAROXYSMAL TACHYCARDIA

HERBERT M. RICH
1910 Journal of the American Medical Association  
citing causes would be unusual. And it is fair to pre¬ sume that in the majority of cases incipient stammering could actually be arrested before the habit had become firmly fixed in.the mental life of the child. Consider the saving in money, in effort, in character, in individual education, in mental suffering, and in successful lives, and such a possibility becomes of extreme importance. Another advantage in the utilization of the schools for the public treatment of stammering would lie in the
more » ... enevitable reception of nearly all stammerers, for nearly all children go to the public schools. And, also, it would lie in the permanence of the hold the system would have in each case. Only those who know the dog¬ ged tenacity of this disorder can realize the importance of such long-continued watchfulness and control. The following suggestions are offered rather to open up the question of certain detailed methods which might be employed than as settled opinions, and they have reference in part to beginning efforts, when, as is the case in the Chicago schools, funds are apt to be inade¬ quate. A TENTATIVE PLAN . Scattered through the grades there would naturally be found a considerable number of fully developed stam¬ merers offering more or less serious individual diffi¬ culties. In the practical attempt at the start to get at so extensive a problem these older cases might be passed over and the facilities available concentrated on the few lowest grades from kindergarten up. Having ap¬ proached the problem through the incipient cases the full development of a system for all the stammerers could be made to accord with the success or failure in arresting the disorder in those already treated. The young stammerers who failed to respond to the more general measures first adopted would be taken one by one and together made the occasion of further steps in the development of the system. I am strongly dis¬ posed to emphasize treatment of the very beginners, to stand or fall, as it were, on the ability of a proper sys¬ tem to head off and to arrest a still incipient disorder. To this end the stammerers, as has been said, could be brought into the classes, so far as possible, before the regular school age. Especial attention could then be given to the study of exciting causes, and the treatment carried out, as far as possible, from that point of view. In so far as practicable it would seem best to bring these beginning stammerers together from a number of schools into classes composed wholly of stammerers. Thus the most favorable conditions could be secured, and economy of time and expense encouraged. How the problem could be worked out with a few beginning stammerers in each school, in case it were impracticable to unite the cases from several schools, is hard to say. If the grade teachers were capable of instituting general vocal training, including instruction in breath¬ ing, in chest control and in clearness of enunciation, per¬ haps with musical adjuncts, their cooperation with the especial stammering teachers could be utilized to ad¬ vantage, for they, under those circumstances, could keep intelligent watch over the stammerers during the en¬ tire school period. But the plan of segregation, with the continuous care of a small class by especially trained stammering teachers seems much more likely to suc¬ ceed. The following suggestion is mentioned as a possible means of overcoming a practical difficulty connected with segregation. Let the plan of treating the stam¬ merers by the schools be put forward at first, not as a universal proposal, but as an especial opportunity to be taken advantage of or not as the parents elect. Then let centralized schools be chosen for carrying on the work in the best and most economical manner pos¬ sible. In this way there would be provided the needed opportunity to work out and prove a successful plan. Ultimately, as the public became convinced and funds became available, new centers could be created and finally all children provided for. CONCLUSION A practical degree of success in the treatment of stammering in the public schools seems possible, and yet one approaches the problem with profound respect. To a certain extent the road to success must be created through experience. With the determina¬ tion to meet, as far as possible, the conditions of suc¬ cess, however exacting, the outcome must at any rate be as successful as the intrinsic conditions permit, and that degree of success would, I believe, be gratifying. It means very much in possibility that this proposed plan for the public treatment of stammering should be studied and tried out. It means so much that failure would be a serious calamity. The wisest plan, from every point of view, as it seems to me, would be to concentrate the beginning efforts on a relatively small number of cases, to work out plans with great care, and to ad¬ vance the system only in the light of painstaking trial and observation. The whole country would be the gainer from such an effort, and Chicago might well be proud to have made it. It could not but result in added knowledge which would aid greatly in the final solution of this difficult community problem.
doi:10.1001/jama.1910.92550490006002i fatcat:6oig4onbqjgrzb6hm2of7ubyfy