The Nature and Treatment of Stammering
MENTAL WELFARE 23 :Type: Book Reviews *82 Abstracts :Author: E. J. Boome, and M. A. Richardson.
Methuen. 1931. 3/6 net.
The collaboration of a doctor in medicine and a teacher, experienced in the treatment of speech disorder, is one of the most perfect one c?uld wish to deal with the subject of stam- mering. This book, as the wrapper states, is 110 result of several years of research and Practical experience, and, as such, should Prove of inestimable value to all who are atllicted with stammering, as well as to those ^ho come into contact with them.
In the first chapters, the authors do much to tr:ar away false conceptions of the origin of 1118 distressing disorder, and give a brief ac- pount of the beliefs held by experts of to-day. hey do not hesitate to condemn ” secret ^Ures ” and many methods of treatment prac- lSed in the past, some of which, unfortunately, are still in vogue. An extremely interesting and unusual feature of the book is a chapter t5v?ted to the stammerer’s own Point of View. , ere a dozen cases, of all ages and both sexes, iii(Ve .recorc^ec^ their own experiences and feel- ? in regard to their stammer, and the way Xvhich the people they meet react to it. This v ^cst thing of its kind that has been an(l repay very careful study, tai?rcling, as it does, an insight into the men- ol ^r?Cesses of a stammerer which could be -j, ained in no other way. The section on inre^tment *s PerliaPs the most disappointing fa t k0?k- The authors’ emphasis on the fr ^at this disorder must be approached Hi 111 a Physical> psychological and environ- hontal standpoint is excellent. One feels, that in their condemnation of Tr ?1?-(^s ” Voice Production,” ” Speech difjllllriS,” and ” Breathing,” rather more a (rCrentiation might have been made between also? anc^ ^ad use SL1C11 things. One feels, p0s,that for the book to be of the greatest anth value to those who stammer, the ins^ 0rs might have given rather more definite o^^^ions for carrying out the exercises they a {J.11?- These, however, are minor faults in m0st?k which is a great achievement and a iiig ]?Sane and valuable addition to the exist- 1 erature on the subject.
M.F. Report of Departmental Committee on Colonies for Mental Defectives. H.M. Stationery Office. 1931. 2/- net. A Departmental Committee was appointed by the Board of Control with the approval of the Ministry of Health in January, 1930, with the following terms of reference :?” To con- sider and report what are the essential struc- tural requirements of a complete colony for mental defectives of all types and to what ex- tent the cost would be reduced by the adoption of semi-permanent or temporary buildings or other new methods of construction, having regard to the comparative cost of mainten- ance, as well as the initial capital expenditure involved.”
The Committee acknowledge in submitting their Report that the proposals put forward are in no sense startling or revolutionary and that it has been no easy task to cut estimates finer than they have been cut already. Throughout the Report suggestions have been confined to the minimum requirements con- sistent with the reasonable welfare of the in- mates of colonies and the efficient administra- tion of the Mental Deficiency Acts.
The Report is divided into two parts; Part I deals with the essential standard require- ments of a complete colony and Part II with the economic effects of adopting other than permanent methods of construction.
In discussing and investigating the question of the minimum size of a colony for efficient working, the Committee give 880 patients as representing the practical minimum size desirable. This number may appear rather high but it must be borne in mind that for the efficient organisation of a colony there must be classification not only of grade of defect but of sex and age. The following table giving the suggested classification for 880 patients is given on page 12 : ? ADULTS M. F. Total High grade patients, homes for 60 60 120 Medium ? ? ? 60 60 120 Lower ,, ,, ,, 60 60 120 Selected adolescents ,, ,, 60 60 120 Troublesome patients ,, 40 40 80 CHILDREN Higher grade patients ,, 50 50 100 Lower ,, ,, ? 50 50 100 LOWEST GRADE Homes for … … ??? 40 40 80 HOSPITAL 20 20 40 440 440 880
The evidence submitted on the subject of the desirable maximum size of a colony varied a good deal. It was submitted that in an in- stitution accommodating over 1,000 patients, the patients tend to lose identity and the Medical Superintendent is unable to keep in personal touch with the progress of each case. This was considered unsatisfactory in view of the fact that the Medical Superintendent is not only responsible for the classification of the cases, and has to prescribe the occupation and training they need, but he is also the only person empowered to sign the certificates upon which the original order in each case is con- tinued. After close consideration the Com- mittee felt that these arguments were uncon- vincing. They considered that the unit that matters from this point of view is the villa, and not the colony; provided that the number of patients in each villa is not too large (60 or under is suggested), the individuality of each case should be adequately safeguarded, no matter how many the number of villas. In the case of large numbers the Medical Super- intendent would act on the reports of respon- sible officers who in turn would obtain their information from the staff actually in charge of the patients. The Committee see no reason why a colony should not expand to 2,000 beds, though in order to ensure that the visits of relatives should not be unduly difficult or ex- nensive, the ereneral limit would probably fall between 1,000 and 1,500 except in crowded industrial areas.
The Committee urge that in every case the oroposal to erect a colony should be preceded bv an exhaustive ennuirv into the number of defectives requiring institutional accommoda- tion in the area or areas to be served. After a suitable site has been acquired and the gen- eral lay-out agreed unon. it is then possible to determine the order in which the scheme shall be developed. The tendency during recent years has been to space homes or groups of homes, which are the most important units, widely apart, imitating the scattered village. The Committee, however, are of opinion that fairly close grouping of units can be carried out without rendering the colony unattractive and that this would result in greater economy and efficiency.
After careful consideration on the second part of their reference the Committee have concluded that there is little likelihood in general economy resulting from the adop- tion of semi-permanent or temporary methods of construction, except in the case of work- shops, farm buildings and similar structures, for which any light and especially cheap type of building might be adopted.
Suggestions for reducing cost have been made with regard to detailed equipment and general administration, such as the use of semi- detached instead of detached homes, the limit- ation of the number of single rooms, etc. Several plans, illustrating the various sug- gestions made are given in Appendix B of the Report. The Committee do not suggest that these should result in any standardisation of design, but hope they may prove useful to local authorities.
The Manual for Mental Deficiency Nurses- Compiled by Royal Medico-Psychologica Association. Bailliere, Tindall & Cox. 1931- 6/- net.
This book, produced under the authority the Royal Medico-Psychological Association* is a happy event in the History of Mental De’ ficiency Work, for it appears to put a seal 011 the ever-widening gap between Mental Denc’ iency nursing, and nursing in Mental Hospitals’ There is much to praise, but chapters ?n and five stand out above the rest.
Chapter One on the duties and qualification^ of a nurse is especially fine, both for simphc1i y of phrasing and lucidity of arrangement, W-h} Chapter Five is notable for the ease with ^h1^ it explains and makes interesting, a ve difficult subject.
There would appear to be some over-elabo tion of teaching in some of the other chapte ‘ and it is extremely doubtful whether nlir^ either male or female, are vitally intereste ^ or admitting the interest?in any wayimpr? Qf as nurses by such things as a knowledge the microscopic structure of a motor nel1 the intermedio-precentral area of the left c bral hemisphere, or even the pyramidal (s V granula or association) cortical level; Pe ue ally, I think a Mental Deficiency Nurse ea ^ quite efficient without a knowledge ot things.
This is perhaps cavilling at very fine P but I feel that the Royal Medico-Psycholo Association would do well to avoid 1 curriculum for its examinations, any burdening of candidates, with knowledge of Medicine at the expense of pure nursing. The advice given on how to prepare for the nursing examinations is excellent, but many of the questions, taken from recent Final Examina- tion papers would surely feel more at home in the Final Year paper of a medical student. The Manual on the whole is a worthy con- tribution, admirably set out, and with one or t^’o exceptions, the chapters will be under- wood by probationer nurses without much ex- planation.
The book should obtain immediate and last- *ng success and in its production the Royal Medico-Psychological Association has fulfilled a long felt want. N. M. H.
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