The Medical History of Speech Disorders

microphone-1716069_1920Dr Marjore Lorch from Birkbeck’s Department of Applied Linguistics and Communication talks to us about her recent investigation into the first recorded case of spasmodic dysphonia (SD) – a condition in which  involuntary spasms in the tiny muscles of the larynx cause the voice to break up, or sound strained, tight, strangled, breathy, or whispery. The below interview is adapted from an interview given to the National Spasmodic Dysphonia Association and published in their newsletter Our Voice, 2016, 26 (1) 14-15.

What did this piece of research entail?

Together with Dr Renata Whurr, I investigated the very first case of spasmodic dysphonia that is regularly cited in the current research literature. We found that the picture presented by this patient, translated from German in the 1870s, was not what it seemed. The clinical description was not consistent with our current view and it is likely that the patient didn’t actually have SD. Subsequently, we discovered that research by a British clinician, writing at the same time, contained observations very similar to our current characterization.

How did you get involved in historical research?

I was fortunate to have teachers throughout my training who stressed that the way to understand neurogenic disorders, observed clinically, was to go back and read earlier descriptions to understand how syndromes were characterized by the perspective of the observers which changed over time.

Can you explain how historical research impacts current and future research?

I believe that applied medical history can contribute important insights into current clinical issues. This method puts a spotlight on understanding the way assumptions, concerns and questions change over time and how that influences the types of answers that are pursued. This kind of approach may be particularly useful in making progress on points that have been debated over the years by analyzing the types of symptoms that have been considered central to different formulations in the past. For example, whether clinicians considered SD to be psychogenic or neurogenic has changed over time. To develop a more nuanced and detailed picture to drive forward future avenues of research, it is valuable to go back and review historical observations. It can be a source of inspiration to revisit previous hypotheses and characterizations. The benefit is that it may produce a reassessment of things that were held as unquestioned assumptions.

What drew you to spasmodic dysphonia research?

I began my involvement with spasmodic dysphonia research in the early 1990s through my work with Dr Renata Whurr who was head of Speech and Language Therapy at the National Hospital for Neurology and Neurosurgery at Queen Square London. Over the years we have collaborated on a variety of aspects regarding SD. Initially, this was focused on treatment. However, I later became interested in the linguistics aspects of the problem. We investigated how the vocal cord movement disorder interacted with the articulatory properties of different languages. One important finding drew attention to the fact that speakers with SD will have different vocal symptoms depending on what language they speak. For example, the diagnostic features of SD for English will not adequately describe the characteristics of French SD speakers. Put more simply, if you have SD, your symptoms will be slightly different depending on the language you speak.

What has surprised you the most about researching the history of spasmodic dysphonia?

When my colleague, Dr Whurr, and I went back to the original case of SD reported in the 1870s that is still cited today, we were amazed to find that the individual didn’t have a voice disorder that we would recognize as SD. This research revealed the common practice of perpetuating a reference to historical literature without necessarily going back to the source. The selection of emblematic cases is also influenced by the assumptions held by the researcher. Our work highlighted how a particular view of the past may be colored by present day biases. In this instance, a strong belief in Freudian psychology in the mid-20th century may have played a part in choosing a historical case that was formulated as “hysterical”. It also highlighted how more significant and worthwhile observations may not be promoted, because of social rather than scientific reasons. By reading the 19th century literature, we recovered important observations about SD that had been lost to posterity.

How do you think this research will help people with SD?

Our research has highlighted the contribution of the 19th-century clinician, Morell Mackenzie, who described the particular sound of a person’s voice, which will lead directly to the diagnosis of SD. This is of vital importance as there is often a long delay in diagnosing SD. It is important to recognize that changes in voice may be the only symptom of this neurogenic disorder.

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Just Enough for the City!

Dr William Ackah is a lecturer in Community and Voluntary Sector Studies at Birkbeck. He is a co-convenor of the Transatlantic Roundtable on Religion and Race and a Fulbright All Disciplines award holder based at Pittsburgh Theological Seminary for the academic year 2016-17.

Growing up as young man in East London the words and music of Stevie Wonder had a profound influence on me. I would play the powerful and evocative songs emanating from albums like Songs in the Key of Life, Fulfilling his First Finale and Talking Book for hours and hours. I would think about what kind of society could exist where “love was in need of love today”? Or who indeed was Mr Know it all? One song that affected me then and still does today is the chilling but epic tale of youth migration from rural to urban America;  Living Just Enough for the City. Even as I write this piece the harsh sounds and those cutting words ‘back in the cell’ still send chills down my spine. Stevie’s profound lyrics come to mind as I sit here in my room in Pittsburgh one of the key stopping points on the great migration of African Americans from the South to the North in the twentieth century. Pittsburgh historically has had a great reputation as a centre for Jazz and was the home of the one of the great American playwrights August Wilson. Most of his impressive body of work – some of which I have had the pleasure to see in London – are set in the Hill District in Pittsburgh. It was all these reasons and more that have drawn me to the city.

Hill District, Pittsburgh is undergoing regeneration

Hill District, Pittsburgh

I have the privilege of being in Pittsburgh this academic year as a Fulbright Scholar, based at the Metro Urban Institute of Pittsburgh Theological Seminary. I am here to conduct research on the impact of regeneration and gentrification on African American church congregations in two neighbourhoods: Larimer and the Hill District. I will be exploring the role that the Black Church plays when neighbourhoods experience economic and social change as a result of urban redevelopment. I have seen in London over the past twenty years areas of the city with large Black and Minority Ethnic populations which were considered undesirable and  plagued by crime, poor schools and lack of amenities, get investment and rapidly become very desirable places to live. With desirability comes rising house prices that then make those areas unaffordable for those same Black and Minority Ethnic populations that had lived through and endured the difficult times in those neighbourhoods.

A sign about regeneration in Larimer district, Pittsburgh

A sign about regeneration in Larimer district, Pittsburgh

What is happening in parts of London is not unique; these same processes of urban redevelopment have and are impacting African American communities in a number of US cities including Pittsburgh. What should be the role of the Church when these things are happening? The Black Church historically has been the key social institution in the African American community and is still a major institutional force throughout Africa and the African Diaspora.  In the US context it was the incubator of credit unions and schools, it birthed the doctors, lawyers, intellects, workers and leaders that enabled Black communities to endure the horrors and indignities of racism and to win important rights and freedoms. The church was also an incubator for black creativity and although its relationship to some creative forms has been tense at times, the spiritual energy of the Church has birthed some of the most amazing musical and artistic forms the world has known. In the post-civil-rights era, however, the importance of the Black Church to the wider community has increasingly been called into question. As poor urban areas have suffered from the blight of drugs, under-employment mass incarceration and police brutality it has been said of the Church that it has become so heavenly minded that it is of no earthly good! That it has not been pro-active in protecting it’s communities from these injustices. Is this however really a fair assessment? It can be argued that the Black Church has never been a monolithic entity and that over the years it has had many strands of engagement with urban communities ranging from social and political activism to non-engagement.

The past however is the past. What can the Church do in the 21st century?  Can it be an incubator for social housing, enabling poorer residents to stay in their communities? Can it be a champion for youth development, rupturing the school to prison pipeline? Can the church be an example for sustainable urban living, promoting positive ways for diverse communities to flourish together in changing contexts?

I do not think it is the role of the Church to do everything in a neighbourhood, as it virtually did in the past but as a key social institution it can create and nurture spaces that enable marginalized and excluded communities not just to live but be able to flourish in the city. I hope to discover some evidence of this during my Fulbright year in Pittsburgh.

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Hard Brexit? Only if it’s free

This post was contributed by Professor Eric Kaufmann from Birkbeck’s Department of Politics. It was originally published on the LSE’s British Politics and Policy blog.

Lowering immigration was the key motivation behind the Brexit vote, and how to achieve it dominates the current political debate. Drawing on new data, Eric Kaufmann analyses the propsects of support for a hard and a soft Brexit, based on how much Britons would be willing to pay to reduce the number of Europeans entering the UK.

A new survey shows most Britons are not willing to pursue hard Brexit if it will cost them personally. Thus far, the economic indicators post-Brexit don’t look bad. Consumer spending and investment are holding up well, despite a lower pound. But if the going gets tough, there is a two-thirds majority willing to accept current levels of EU migration to retain access to the single market.

The leading motivation for Leave voters was reducing immigration while Remain voters prioritised the economy. This hasn’t changed. According to my YouGov/Birkbeck/Policy Exchange survey data, two-thirds of British people want less immigration, including 47 percent of Remainers and over 91 percent of Leavers.

Hard Brexit is a good way to bring numbers down. However, some suggest that when Theresa May triggers Article 50, the EU will drive a hard bargain, inflicting pain on the British economy. With economistsclaiming entry to the single market is worth 4 percent of GDP by 2030, I asked how much the average Briton is willing to sacrifice to reduce European immigration in the event the doomsayers are right. The final deal between Britain and the EU over leaving will hinge on how much economic pain, in the form of reduced market access, Britain is prepared to absorb to restrict European immigration.

The survey, carried out by the polling firm YouGov, asked a sample of over 1500 people the following question: “Roughly 185,000 more people entered Britain last year from the EU than went the other way. Imagine there was a cost to reduce the inflow. How much would you be willing to pay to reduce the number of Europeans entering Britain?” The options ranged from “pay nothing” for no reduction to paying 5 percent of personal income to reduce numbers to zero. Each percent of income foregone reduced the influx by 35,000. The results are shown in figure 1.

kaufmann_1

Source: YouGov survey, August 20, 2016.

Among those surveyed, and excluding those who didn’t know, 62 percent said they were unwilling to pay anything to reduce numbers, and would accept current levels of European immigration.

kaufmann_2

Source: YouGov survey, August 20, 2016.

As figure 2 shows, even among those who said they voted to leave the European Union, 30 percentreported they would prefer the current inflow of 185,000 to paying any of their income to cut the inflow. In other words, there is a significant ‘soft’ component within the Leave vote.

On the other hand, there is a considerable core of Brexit voters willing to tighten their belts to reduce migration: over a third of Leave voters indicated they would contribute 5 percent of their income to cut European migration to zero. More than half of Brexiteers are willing to pay at least 3 percent of their income to reduce European net migration from the current 185,000 to under 80,000. The average person who voted Conservative in the 2015 General Election is willing to stump up 2.5 percent of their pay packet to reduce European immigration to half its current level.

This means that if the costs of Brexit mount in line with pessimistic predictions, most British people favour a deal that preserves market access even if this results in only limited reductions in European immigration. May’s Conservative voters will put up with more pain, but not if it costs more than 2 percent of GDP. This suggests a deal between Theresa May and her EU interlocutors based on significant market access in exchange for limited migration controls may be acceptable to the 45 per cent of voters who currently back her party. It certainly will pass muster with a majority of the electorate.

If the economy continues to hold steady, the question is moot and hard Brexit remains a strong option. But if pain is on the way after Article 50, Middle Britain will be inclined to prefer soft over hard Brexit.

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The Painful Tooth: sampling crocodilian mouth bacteria

This post was contributed by Dr Simon Pooley, Lambert Lecturer in Environment (Applied Herpetology) in Birkbeck’s Department of Geography, Environment and Development Studies

Professor Ward sampling a Nile Crocodile

Professor Ward sampling a Nile Crocodile

Adverse encounters between humans and eight species of crocodilians are widespread, from the Americas and the Caribbean, across Africa, Asia and parts of Australia and Oceania. Crocodile attacks, particularly by large animals, are always traumatic and can be fatal or result in permanent disability with devastating personal and social consequences. Most occur in rural areas in developing countries with limited resources for prevention or medical treatment for attack victims. While the initial trauma can prove fatal, as crocodiles have more than 60 teeth and their jaws have tremendous crushing power, many victims survive the attack only to succumb to vicious infections which can result in death or amputations.

Record keeping of attack data has been poor in developing countries, something we are trying to remedy through the online database CrocBITE, developed by Dr Adam Britton and Brandon Sideleau. The medical literature on crocodile attacks is particularly sparse, and a recent survey (Pooley, unpublished) shows that many published papers repeat a small number of research studies, some in obscure journals which are difficult to access. Some microbiological analysis of crocodiles’ mouths and cloaca has been undertaken, most on American alligators (A. mississippiensis), and using now dated techniques. There is some information on infections in bite wounds, but again the literature cites a handful of studies, and little recent microbiological analysis has been undertaken.

nile-croc-bacteria-in-dishFor these reasons I have begun working with Dr John Ward, Professor of Synthetic Biology for Bioprocessing at UCL, on sampling the mouth microbiomes of crocodilians. This study is in its infancy, but in order to see whether crocodiles of various kinds harbour interesting bacteria in their mouths, John and his team have taken samples from captive crocodiles at the UK’s only crocodile zoo, Crocodiles of the World. John’s group will look at both the microorganisms they can culture on agar plates and also the DNA extracted from microbes in the oral cavity of the crocodiles. This DNA can be used to search for genes from microbes that cannot be cultured. This work is in partnership with Prof Helen Hailes, Professor of Chemical Biology at UCL, who with members of her group helped with the sampling.

We have focussed on crocodiles known to bite humans, notably the Nile crocodile (Crocodilus niloticus) and the saltwater crocodile (C. porosus), but also sampled species representing the full geographical range of crocodilians. Thanks to Shaun Foggett and his keepers Jamie and Terry at Crocodiles of the World, we sampled 12 species including crocodilians from the USA, Central and South America, the Caribbean, Africa, Asia and Australia.

Should John and his team find interesting results, we will develop a proposal to fund an in-depth study using more advanced sampling techniques and identification procedures drawing on his lab’s expertise in epigenetics and bioinformatics. We will work with partners in Australia, the USA, India and Africa to obtain samples from wild crocodiles. In addition to the pure scientific interest of such a study, my primary intention is to discover whether it is bacteria in crocodiles’ mouths that cause the nasty infections we see in crocodile bite wounds on humans. In order to develop an effective treatment protocol, we need to know whether it is just unusual aquatic bacteria, or something peculiar to crocodiles, which we need to treat for. Further, there may be variations between species of crocodilian, or within species across regions (as is the case with snake venom). The next stage will be to medical research partners to study infections in bite wounds, so we can compare these with what I hope John and his team will find.

An additional dimension to this research is discovering how local people in the areas where bites occur respond to bites. My recent research suggests that there are very varied explanations for the causality of crocodile bites across Africa, and treatments for bites and infections may also vary. Working out what is causing infections in crocodile bites, and how we can treat these is a vital step, but convincing local peoples of the efficacy of medical treatments will also be important.

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