200 years of speech and language therapy
The film ‘the King’s Speech’ may have reminded older readers about how the real King George
VI struggled to speak, but speech therapy was only available for a few people until very
recently.
There are suggestions that characters from antiquity, such as Moses had speech problems,
however it is only the last 200 years that we have real evidence of people who might be called
speech therapists. John Thelwall (1764-1834) is said to be the first real speech therapist. He
was a political agitator, struggling to achieve reform of parliament in the late 1700s. After a
period in jail for his political activities, he decided that speech was an easier way to make a
living. He worked with people who had a wish to improve their public speaking and also those
with speech disorders.
During the mid 1800s there were some rather disturbing approaches to speech problems.
There were about 7 British surgeons who carried out tongue surgery to ‘cure’ stammering, with
different amounts and sections of the tongue being removed. As there was no modern
anaesthetic, no antibiotics and a limited concept of hygiene, these operations were highly
dangerous and patients died. Meanwhile, an America invention also designed to ‘cure’
stammering was a ‘larynx compressor’ exhibited in London in 1862. It comprised a leather neck
band that could be tightened by a buckle and a screw thus strangling the wearer.
Unsurprisingly, it had lost popularity by 1867!
However, across Europe, the nineteenth century saw a number of other practitioners emerging
from different professional backgrounds. Signing developed to support deaf communication.
Medical men discovered a great deal about brain activity and what could go wrong after a stroke
and at least one opera singer (Garcia) was interested in how the voice functioned, and invented
the laryngoscope in 1854 to observe the vocal cords directly. The 1st laryngectomy (voice box
removal) was carried out in 1873, in Germany, with artificial laryxes being created for patients
who survived surgery.
1854 Langygoscope (Garcia)
Over that century, a few people who offered ‘therapy’ for people who stammered and also those
with cleft palates and speech difficulties following a stroke. Most of the ones we know about
were based in the south of England. One example is Dr Thomas Hunt, who practised in
London and Sussex. He estimated that in the whole of Cheshire there was only 1 person who
stammered (and 6 in Lancashire). Taking travelling times into account, it is unlikely he would
know about all who stammered in the north west, as they would be beyond his reach.
At the end of the nineteenth century children did not survive infections (2 older daughters of the
family below died of diphtheria before they were 10 and a cousin had brain damage and a
chronic voice disorder as a result of croup). It was rare to survive to very old age as general ill
health, physically hard lives, accidents, strokes and their after effects killed most relatively
young. As a result there was limited demand for speech therapy for adults beyond voice and
stammering and even more limited availability unless a family had money and lived near
someone who offered private therapy.
Martha, Mark (standing) Mary and George, 1894
Things started to change in the 1900s and although Stockport was not at the forefront, the first
local authority ‘stammering’ clinics were offered in Manchester (and London), so Mary and
George pictured here in 1894 may have got some help if needed and were prepared to travel.
The approach to therapy was the ‘Berquand method’, which required a long period of absolute
silence, followed by relaxation and speech drills to ‘re-educate’ the tongue.
Lewis, John and Mary,1925
The first real speech therapy training was set up at the Albert Hall by 1908, but speech
therapists were pretty much self-taught up until the end of the 1920s. Senior members of the
emerging profession provided on the job training in their clinics for a select few people, and they
attended lectures on medicine, phonetics and psychology as and when they could locate them.
The first world war created both huge damage and huge demand for support. Many war
wounded developed speech impairments, some physical or neurological, (eg as a result of
wounds), some psychological (shell shock) and a few areas of the UK were able to offer
speech therapy, working alongside medical practitioners, although no records have yet been
located of the situation in Stockport. There was a rapid increase in knowledge during and
immediately after the war years, especially about neurology and the impact of brain damage,
but many patients died.
If young John had had a cleft palate he may have had access to surgery but was unlikely to get
speech therapy help and may have failed in school and have very limited employment
opportunities as a result. If he had any other speech problems these would probably not be
addressed until school age.
Accessibility increased over the next 10-15 years, but there was still a very small numbers of
practitioners. Lionel Logue (the King’s speech therapist) was typical, largely self taught and in
private practice in London. Successful therapists were found by word of mouth. In London
there was also better access to lectures and other training than many other areas and
therapists travelled from across the UK to attend these.
The 1930s were a very busy time in the SLT world. Formal training for SLTs was becoming
established and there was increasing knowledge, but a great deal of competition and
antagonism. Adults may get therapy for voice disorder, stuttering, or speech disability caused by
organic conditions, while for children, cleft palate, stuttering and articulation disorders were
treated. This story is typical:
P…had surgery on his ‘hare lip’ and cleft palate when he was about 6 months old,
….started going for Speech “Training” around age 5, until age 10, (1934 – 1939).
Treatment was in the big hospital out-patients hall– there were sparrows all up in the
roof…… had lots of other medical treatments there at a similar age e.g. pressure
treatment on his ears / sinuses.... ……he had appointments something like once a term /
3 monthly. ….
There were many technical gadgets by this time too, three of which are shown below.
1934 Measuring the direction of air when practising saying ‘s’
1938 Cleft palate: measuring air escaping through the nose (Oldfield)
1940. Measuring breathing for speech
The second world war was another turning point. Early introduction of antibiotics to veterans’
hospitals meant that many more survived facial and head injuries. Plastic surgery advances
had impact on service provision for cleft palate and oral cancers. Brain surgery become more
sophisticated and stroke patients were more likely to survive (unless they had swallowing
problems, which were often fatal) and receive therapy.
The NHS was created out of the ideal that good healthcare should be available to all, regardless
of wealth. It was based on three core principles: that it meet the needs of everyone; that it be
free at the point of delivery; that it be based on clinical need, not ability to pay. The school
health service established and SLT offered for ‘speech’ problems, although there was a severe
shortage of therapists, with only 500 across the UK by 1950. Children had free but limited
access to therapy, and even in the 1960s, severely intellectually impaired children (or adults)
were not considered ‘educable’ and this continued until the 1970s.
Again, technical support was being invented. Two approaches to stammering are shown below.
The Edinburgh Masker consisted of a throat microphone a small control unit that could be worn
on the belt or carried in a pocket, and either two separate earpieces or a headphone set.
A noise was activated by speech detected by the throat microphone and as soon as an
utterance is completed the noise cut off. The electronic metronome was activated in a similar
way, but had a regular beat either as a sound or as a flashing light. Both aimed to enable
people to speak fluently.
Edinburgh masker
Electronic metronome (Wohl)
For children and adults, from the 1970s onwards there has been increasing provision. The
number of training schools expanded and Manchester gained its first at Elizabeth Gaskell
College (now Manchester Metropolitan University) in 1961 and a second and the University of
Manchester in 1974. Many graduates from these 2 universities have worked in Stockport over
the years. In the 1980s and 90s, community SLT for the elderly with stroke or dementia was
added and today speech therapy covers all ages from birth to very old age.
There are NHS and private speech therapists in Stockport as follows.
Stockport NHS
Children https://www.stockport.nhs.uk/serviceview/8/childrens-speech-and-language-therapy
Children with special needs
http://www.stockportcypdisp.org.uk/ourservices/speechlanguagetherapy/
Adults https://www.stockport.nhs.uk/serviceview/107/outpatient-therapies
Private
Contact ASLTIP for local provision http://www.helpwithtalking.com/Default.aspx
Jois Stansfield 20.5.14
Jois is a speech and language therapist who works at Manchester Metropolitan University and
she is a Trustee of Borough Care
Invitation
Jois is currently working on a project to record ‘oral histories’ of people who had speech therapy
in or before the 1970s. If you are interested to tell your story, please get in touch:
[email protected], or 0161 246 2577 and leave a message.