Part 3 The First Flowerings
Those few authors who have written about the 19th century European history of speech pathology have located its beginnings in two main cities in Central Europe: Berlin, Germany and Vienna, Austria (Black, 1980). In Berlin, the activities took place in the speech and voice clinics headed by otolaryngologist and phoniatrician Hermann Gutzmann Sr. (1865-1922). In Vienna, the source of activity came from the speech and voice clinics of Emil Froeschels (1885-1972). Froeschels, while contending with Herman Gutzmann Sr. for the most important center for this new specialty of speech and voice, was an appreciative student of Hermann Gutzmann Sr. He described Gutzmann as the “father of voice and speech medicine” (Lahey, 1999).
Both men, trained as otolaryngologists, sought to establish the field of phoniatrics as a legitimate subspecialty in medicine. They did this through their scholarly contributions and their clinical innovations. Once they had their feet on the ground, they developed centers for training clinicians in the field to be specialists in phoniatrics, a European term for voice. Both men founded speech clinics, one private and one associated with their city’s universities. These clinics served as centers from which they provided direct services to patients, conducted research, and conducted clinical practica for their students.
Herman Gutzmann Sr. advanced the profession of phoniatrics (now called speech pathology) through his 300 articles and 13 books qualifying, according to some as a founding father of the this new profession (Lahey, 1999; Vrticka, 2009). Gutzmann not only contributed to the content in the field through his research and publications, he also worked to disseminate information about phoniatrics throughout the world through his teachings and writings and by creating a journal (Vox), dedicated to the new field. He was influential in creating speech pathology as a subspecialty of medicine in Germany. He did this not only through his organizational efforts but by creating courses that were delivered at the University of Berlin and in his private practice.
Gutzmann studied medicine in Berlin, graduating from the University of Berlin in 1887. In 1891 he set up a private practice in Berlin specializing in identification and treatment of language and speech disorders. He also founded a clinic in the Berlin’s medical school, Berlin Charite.
Herman Gutzmann Sr. was both a first and second generation “speech doctor.” Some of his work was built on that of his predecessors, thereby qualifying him as a second generation contributor to the field. His predecessors, the diagram makers, deaf educators, and otologists informed his writings and practice.
When theorizing about the nature of language, Gutzmann built upon the work of the diagram makers who conceived of localized centers in the brain that served various speech and language functions. A translation of his comments shows his effort to lay out such brain/speech/language relationships, creating his own brain diagram:
It may be assumed that the supposed center of higher order from which inner language, or diction, depends, dominates a number of centers of a lower order. These, in turn, are forcing other centers still further below them to joint or isolated action. Thus, a voluntary act of inhaling, interrupting the automatic breathing in the state of rest, must be interpreted as depending on a center in the frontal cortex. Consequently, there has to be a center for voice production which obviously does not simply govern the adduction and abduction of the vocal cords, (since this alone does not lead to voice production), but also at the same time forces the cortical breathing center to cooperate. A center of still higher order will finally have to set the articulation movements in motion, starting from the individual focal points of the speech nerves, sometimes with and sometimes without the utilization of voice….(Reiber, 1980 p. 207 translated from Froeschels, 1918)
Gutzmann, like the educators of the deaf who preceded him, worked to provide speech services as part of school curricula. He recommended that school teachers and physicians be trained in the new specialty. He worked to have the school clinicians collude with physicians to offer speech training in the schools of Berlin.
Gutzmann drew from his training in otology when theorizing about speech disorders. He saw speech and language disorders in children as being caused by adenoid dysfunction. He regarded the adenoid relationship to speech as being one of close association between the lymph ducts in the throat and nose and those in the brain.
Emil Froeschels. Emil Froeschels was a student as well as long-time peer of Hermann Gutzmann Sr. He also studied with Albert Urbantschitsch, the otologist who promoted auditory training for the hearing impaired (Urbantschitsch, 1892). Finally, he was a strong proponent of the Adlerian Individual Psychology, and applied ideas from that theory to the field of phoniatrics, especially when designing psychotherapeutic approaches to stuttering (Froeschels, 1951).
Froeschels established a speech and voice clinic at the The Vienna General Hospital, known in German as Allgemeines Krankenhaus der Stadt Wien, abbreviated AKH. This is the general hospital of the city of Vienna, Austria. It is also the city's university hospital, and the site of the Medical University of Vienna. Froeschels’ clinic occupied a spacious ground floor in the AKG. He called his clinic the Ambulatorium fur Sprach und Stimmstorungen” (a walk in clinic for speech and voice) was part of the Ear, Nose, and Throat Department headed by Heinrich Neumann. A glimpse of Froeschels clinic and his way of operating is offered in the following description:
The clinic occupied a spacious ground floor. As there was no waiting room, the children sat in rows waiting to be examined. By the light streaming in through a large window and reflecting on the mirror of his forehead, Dr. Froeschels, of Professor Victor Urbantschitsch’s school, carefully examined the children, one by one, as he moved among them surrounded by his pupils. Before stating his own diagnosis, he would ask his assistants’ opinions and comment upon them. All of this, under a pendant hanging from the roof with the command, SILENCE, printed on it (Lahey, 1999, p. 4).
In 1920, Froeschels together with colleagues and school therapists (whom he trained), created a system for providing speech and language services to school children in the city of Vienna. In 1921 he organized special courses on voice and speech medicine for teachers and speech clinicians. Froeschels and Karl Rothe created five-session short courses for teachers to specialize in logopedics. By 1928 there were 39 schools in Vienna offering teacher training courses in speech therapy. Karl Rothe served as supervisor of these “Preparatory Courses for Teachers” (Lahey, 1999).
Froeschels’ clinical practices drew from a wide variety of sources, including the auditory training methods of Viktor Urbantschitsch (Urbantschitsch, 1892), and from Froeschels’ own general background in otology (Froeschels, Dittrich, & Wilheim (1932). He also incorporated the psychotherapy techniques of Alfred Adler (Froeschels, 1945). Finally, Froeschels devised his own therapy methods. Among his most popular clinical methods was his chewing therapy (Froeschels, 1933; Froeschels, 1952; Weiss & Beebe, 1951; Duchan, 2021). In this method, Froeschels’ advocated making chewing movements while speaking to effect a different way of innervating the speech muscles. In Froeschels’ terms:
Chewing…serves to show the muscles which are over or under contracted how to work in a physiologic way.…Ilsen suggest the term “sensory feedback” for this central mechanism (Froeschels, 1964, p. 8). The chewing method was used by Froeschels and his followers to improve the speech of those with cerebral palsy, multiple sclerosis, voice disorders, deafness, and stuttering (Weiss & Beebe, 1951).
Froeschel’s innovativeness in his implementation of different methods and sources in his therapies is described by Henry Freund, one of Froeschels’ clients:
Now let me tell of my experiences in being treated by Emil Froeschels. Although young, when I first met him, he was already one of the foremost European speech pathologists. His clinic at the Vienna School of Logopedics attracted students and stutterers from all over the world. I first went to him when I was a medical student; later, as a physician, I studied speech pathology under him.
Compared with the organic views of Gutzmann, Froeschels' approach to stuttering was much more psychological. Indeed, I originally went to him because I was greatly impressed by his texts, which described very vividly the feelings and suffering that stutterers have to endure. Although Froeschels called stuttering a neurosis, he actually believed that it was caused by a "logical error." In his words, because the stutterer believed that speech was difficult, it became so. He felt that emotional factors, such as anticipatory anxiety and inhibition, were consequences not sources of stuttering. In many ways, Froeschels' thinking resembled that of Wendell Johnson, whose emphasis on incorrect evaluations and perceptions formed the heart of his therapy. Froeschels also had a knack for abstract philosophical thinking and this too, like Johnson's semantics, colored his approach to stuttering.
To prove to me that my idea that speech is difficult was illogical and senseless, Froeschels used various approaches. First, he explained that a thorough knowledge of the physiology of how speech sounds are made would eliminate my stuttering. Accordingly, I had to learn how to use the phonetic alphabet, speaking the sounds as I wrote their symbols. This proved to be unsuccessful, perhaps because I rejected the idea that such knowledge should be a precondition to good speaking, since speech was largely automatic and even small children managed to speak fluently without such knowledge. Next, Froeschels switched to a more philosophical approach, based on his contention that our ideas create our reality, that as our idea of "red" creates the modality of "red," so too, does the idea that speech is difficult makes it so. Somehow, I was to insist to myself that speech was easy and then I would be cured. This sophistry didn't work. I fear I was a refractory patient. It is difficult to convince a severe stutterer that speaking is not difficult.
Nevertheless, my inventive and scholarly therapist was not at his wits end. Not being able to talk an obstinate skeptic like myself out of his stuttering, Froeschels resorted to the ancient method of rhythmical speech, used by Columbat 100 years earlier. Again, as in the singing therapy of my early childhood, this speech-modifying procedure had an almost miraculous effect. I was immediately able to speak smoothly and with apparent ease, so long as I followed the beat of the metronome. However, in real life situations, I could not bring myself to use this sing-song rhythmical way of talking, because of its conspicuousness, and so the improvement lasted only as long as I was in Froeschels' office. Despite this, Froeschels used the ephemeral success to terminate treatment immediately although, as a medical student, he permitted me to visit his clinic whenever I so wished. (Van Riper on Freund, 1984, pp. 96-97)
Following his expulsion from Austria during the holocaust, Froeschels emigrated to the United States. From 1940 to 1949 he was the director of the speech and voice clinic that he founded at Mount Sinai Hospital in New York City, and from 1950 to 1955 he founded and directed a speech clinic Beth David Hospital, also in New York.