Part 2 Planting the Seeds

Beginning around the middle of the 19th century many new areas of study were being forged. With the new emphasis on empiricism, scholars of that time began to create research programs to examine the brain, to identify patterns in children’s development and language acquisition, and to find reasons and remedies for hearing loss. Researchers also invented new ways of measuring different aspects of speech, language, and hearing. Finally, it was a time when some researchers and clinicians looked beyond the behavioral surface for the presence of psychological problems underlying communication disorders. All of these scientific and clinical happenings led to the an accumulation of knowledge that was used by the next generation of our ancestors to create what we now call the discipline of communication disorders.

Locating language in the brain, the “diagram makers.” An important historical thread that came out of those times was the work of a group of neuroscientists looking for brain/language relationships. The Austrian physician and anatomist Franz Joseph Gall (1757-1828) was the first of this generation of scientists to propose a localization theory of the brain. He argued that each mental faculty is localized in the cortex (Gall, 1822-5, 1835). Paul Broca (1824–1880), a surgeon, supported Gall’s theory by locating language in left frontal gyrus of the brain (Broca, 1861, 1863, 1865). Broca also proposed that the two hemispheres of the brain supported different mental activities. He based his theories on findings from his autopsy of a person with aphasia.

Carl Wernicke (1848–1905), also a physician-researcher practicing in Austria, built upon Broca’s localization theory as he argued that speech perception was localized in the temporal lobe of the brain (Wernicke, 1874). He claimed further that language was located in two brain centers, one for speech perception and one for speech production. Wernicke held that lesions in Broca’s or Wernicke’s brain centers or in the pathway between them cause different patterns of language impairments in aphasia.

Adolf Kussmaul (1822–1902), along with his contemporary Wernicke, also subscribed to the localization theory. He argued for a language processing model of the brain to explain the language patterns found in his aphasic patients (Kussmaul, 1877). Ludwig Lichtheim (1845–1928) took Kussmaul’s theory a step further, adding another brain center for processing concepts (Lichtheim 1885). This group of 19th century neuroscientists, along with others that followed them, became known as the “diagram makers.”

A movement to study children’s development. Another arena of research activity In the mid to late 19th Century, were studies that examined various aspects of children’s development. Among these were those who documented what children said and did over time (Bar Adon 1971; Weiner, 1986). Wilhelm Preyer (1841-1897), for example, kept a detailed diary of the mental development of his son during his first three years. In it Preyer reported on his child’s day-to-day activities. In 1881, Preyer published the results in a book: The Mind of the Child. He proposed a developmental scheme in which early instinct and reflex are replaced, through gradual development, by language and purposeful action. Preyer also speculated about the brain mechanisms involved in language development (Dennis, 1985). Finally Preyer proposed that stages in children’s acquisition of language mirrored in reverse the stages involved in the loss of language in adult aphasia.

Thirty some years later, after World War I, child development researchers succeeded in acquiring a permanent place in European universities. The psychologist William Stern (1871–1938) and his wife Clara Stern (1887-1945), taught at the German University of Hamburg. Among their contributions to child language, were their longitudinal diaries of the development of their own three children (Stern & Stern, 1914). The Sterns later published their work on language acquisition and the development of memory in young children (Stern & Stern, 1907). Austrians Karl Buhler (1879–1963) and Charlotte Buhler (1893–1974), also researched children’s development, studying them in their natural habitats, as well as experimenting with them during their free play (Buhler, C. 1930, 1937; Buhler, K. . )The Buhlers had a laboratory at Vienna Institute of Psychology. An important part of their work were their detailed studies of normal speech and language development in children.

Language disorders in children, another new specialty. The period just before the second world war, saw a surge in studies of childhood language disorders. Many of these researchers worked in Germany and Austria. German physicians with a specialty in speech (the spracharzte) described children in their practices who were not intellectually compromised (idiocy) or deaf, but had severe language disorders. The children were diagnosed as “audimute” as having “congential aphasia” and, in German, as Horstummheit (Weiner, 1986). Among the child language “speech doctors” were Raphael Coen, Leopold Treitel, and Albert Liebmann.

Raphael Coen (1839-1904) was a Viennese speech doctor. He was the first to describe childhood language disorders, their presumed etiologies, and to recommend treatments (Coen, 1886, 1888, 1897, see Weiner, 1986 for a review).

Coen’s therapies and educational programs for children with language disorders included body gymnastics, speech and language practice and medical remedies. The "bodily gymnastic" phase of therapy consisted of methodical, exercises of the limbs and body musculature ‘to cause the general strengthening and enlivening of the organism" (Coen, 1886, p. 230 as cited in Weiner, 1986, p. 8). The speech and language training included object and picture naming and speech sound practice.

Coen’s therapy regimen involved different exercises to be carried out 1 to 1 1/2 hours per day for 70 weeks. To ready the child’s body for the gymnastic exercises, Coen used medical interventions such as arsenic, iron, iodine, electrotherapy and hydrotherapy.

Leopold Treitel (1865-1905) felt that children’s lack of drive to speak was a cause of their language problems (See Weiner 1986 for translated descriptions of Treitel 1892, 1893, 1894, 1900). He also emphasized memory and attention problems as factors contributing to children’s language difficulties. He used the term congenital aphasia to describe language problems, whereas Coen used “audimute.” Finally, Treitel described children with congenital aphasia as having delays in other areas, besides language.

Treitel used Coen’s therapy methods, but individualized them to the fit the child’s needs. He also placed more emphasis on auditory than motor practice, recommending continuing therapy until the children talked on their own. Finally, Treitel recommended social inclusion of children with language difficulties in nursery schools with normal children (Weiner, 1986, p. 15)

Albert Liebmann (1876-1942), working in Berlin, classified children with speech/language disorders into three categories (borrowed from adult aphasia literature): Motor, sensory, and sensory motor. A fourth type of disorder posed by Liebmann was agrammatism. Liebmann portrayed agrammatism as being the name of grammatical problems that evolve from articulation disorders (Liebmann, 1898, p. 83 cited in Weiner, 1986, p. 22).

Liebmann saw attention and memory as playing a key role in language development, regarding these faculties as as modality based. In so doing, he created a model of language development with separate areas of visual attention, visual memory, auditory attention and auditory memory (Weiner, 1986, p. 22).

Exercise-based therapy methods. As is seen above, the speech doctors of the 19th century, such as Raphael Coen, not only engaged in research and diagnosis of speech and language disorders, but they also designed treatment methods. Coen’s methods resembled those used at the time by educators of the deaf and hearing impaired (Weiner, 1986, see Conradi, 1904, for a review of these exercise-based therapies)

Among those deaf educators that Coen drew from was Albert Gutzmann (1837-1910). Gutzmann was influenced by a physical culture movement in Germany at that time, a movement that promoted physical gymnastics for all children in schools. Gutzmann felt that gymnastics should be part of a curriculum for children who are deaf (Gutzmann, 1878). His gymnastic exercises involved the whole body.

Albert Gutzmann also wrote about diagnosis and remediation of language problems and stuttering in children (1887). His approach to these problems involved breathing and articulation exercises. In 1884 he developed a teacher-training program designed to identify and remediate language disorders in Berlin’s school children. His remediation techniques for these children also involved physical gymnastics.

Another Berlin-based proponent and designer of exercise-based therapies and training was Oskar Guttmann. In his book on Gymnastics of the Voice (in German 1859, in English, 1882) Guttmann proposed exercises of various parts of the body as a means for training normal as well as the diseased voice (Guttmann, 1882; Stathopoulos & Duchan, 2006). His book contained descriptions of different body exercises to strengthen the muscles of the head, neck, upper limb and lower limbs, and voice exercises for singers and those with voice problems (Guttmann, 1882).

The birth of hearing science. The first half of the 18th century witnessed dramatic advances in the study of the anatomy, physiology and pathology of the ear. A hundred years or so later, in the middle of the 19th century, anesthetics and antiseptics were introduced. These two medical advances merged into a newly formed specialty field of otology. There were three researchers who were among the most influential figures during this period of change. Adam Politzer (1835-1920), Victor Urbantschitsch (1847-1921), and Heinrich Neumann (1873-1939) were all involved in doing hearing research.

Adam Politzer studied medicine in Vienna, graduating in 1859. It was during this time that laboratories became sites of histologic analysis. They were also the place of research into the causes of pathologic processes of the ear. Politzer adopted this kind of laboratory medicine, promoted it, and taught it to others. In 1873 he became a professor at the Clinic of Otology in Vienna. This was the first clinic in the world to deal solely with otology. The clinic had about 20 beds and saw 12,000 to 15,000 patients annually (Mudry, 2010).

Victor Urbantschitsch (1847-1921) also studied at the University of Vienna, receiving his medical doctorate in 1870, some 10 years after Politzer. Urbantschitsch was named head of the Otology Department at the General Polyclinic in Vienna in 1885 and in 1907 he succeeded Adam Politzer as head of Vienna University’s Otology Department. He made many contributions to the field of otology, among which were to design an auditory training regimen to make use of the residual hearing and to teach speech to deaf children. His method involved having those with severe hearing impairments and no speech imitate single sounds and short sentences presented to them (Urbantschitsch, 1962).

Heinrich Neumann was the youngest of the group of first generation otologists (Wikipedia contributors, 2021). He studied in Budapest and then Vienna, graduating from the University of Vienna in 1898, 18 years after Victor Urbantschitsch. He joined the faculty of Vienna University in 1918 and in 1919 he became head of the university clinic for diseases of the ear, nose and larynx, succeeding Viktor Urbantschitsch as such. It was this clinic that Emil Froeschels eventually directed, converting it from an otology clinic to a speech and voice clinic. The clinic, under Froeschel’s direction, was an outpatient (ambulatory) clinic called, in German, Ambulatorium für Sprach-und Stimmstörungen. The clinic was later called the Neumann Clinic, in Heinrich Neumann’s honor.

The invention of experimental instruments and methods. The late 19th century also witnessed a burgeoning of activities designed to measure behavior and to design research approaches to study them. This affected many areas of study. Two that were pertinent to future generations of speech scientists were experimental psychology and experimental phonetics. The most well-know laboratory that pioneered in these areas was that of Wilhelm Wundt. Wundt’s laboratory was located at the University of Leipzig in Germany.

Wilhelm Wundt (1832-1920) opened his Institute for Experimental Psychology in 1879. This was the first laboratory dedicated to psychology and its opening is sometimes considered to be the beginning of modern psychology with Wundt being dubbed the father of psychology. His work served to create a separate kind of science, thereby separating psychology from philosophy (Wundt, 1896). The “new science” involved the creation of methods and instruments to objectively measure the workings of the mind and body. Among the instruments that were invented and worked with in his laboratory by his 15 laboratory assistants between the years 1885 and 1909 were: tachistoscopes, chronoscopes, pendulums, electrical devices, timers, and sensory mapping devices. Wundt assigned instruments to his graduate students and asked them to invent uses for them.

Psychodynamic theories and therapies. Sigmund Freud (1856-1939) was the originator of psychoanalysis, that he presented as both a theory and as a method of therapy. In 1891, at the beginning of his career and before he invented psychoanalysis, Freud published a book on aphasia. In it he argued against the specifics of the diagram makers or brain localizationists such as Broca and Wernicke . He contended that there was but one area of the brain that subsumed language. He supported a functional conception of brain activity over a structural, localized one. Later in his career, Freud and his followers promoted psychoanalytic interpretations of stuttering (Freud, 1893; Glauber, 1958). They saw stuttering as emanating from repressed emo­tions or con­flicts resulting in a “conversion” or physical manifestation of stuttering (Mahr & Leith, 1992). The psychotherapy was designed to resolve these deep-seated conflicts in the unconscious mind of the person who stutters.

Alfred Adler (1870-1937) was also an Austrian physician and psychotherapist. He founded a school of psychotherapy that he called Individual Psychology (Adler & Jelliffe, 1917; Adler, 1931). His emphasis was on the importance of feelings of inferiority in the development of personality and of discovering underlying psychological reasons for manifest symptoms. Adler was one of the earliest theorists to utilize short-term, goal-oriented approaches to psychotherapy. In the 1920s Adler established a number of child guidance clinics in Austria and travelled widely promoting his theories and practices (Hoffman, 2020). His followers, such as Emil Froeschels applied Adlerian theories and psychotherapeutic methods to remedy the psychological problems associated with speech disorders (Froeschels, 1945).

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