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 PLACE MAP FOR HIGH PRESSURE CONSONANTS

p, b - f, v Labial–Labiodental

th Dental

t, d, s, z Alveolar

sh, ch, j k, g sh, ch, j Palatal

t, d, s, z
k, g Velar

h Glottal
p, b
th
f, v

h
THE CLINICIAN’S GUIDE TO

Treating
Cleft Palate
Speech
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THE CLINICIAN’S GUIDE TO

Treating
Cleft Palate
Speech Second Edition

Sally J. Peterson-Falzone, PhD, CCC-SLP

Clinical Professor Emerita and ASHA Fellow
University of California, San Francisco
San Francisco, California

Judith E. Trost-Cardamone, PhD, CCC-SLP

Professor Emeritus and ASHA Fellow
Department of Communication Disorders and Sciences
California State University at Northridge
Northridge, California

Michael P. Karnell, PhD, CCC-SLP

Associate Professor and ASHA Fellow
Department of Otolaryngology-Head and Neck Surgery
Department of Speech Pathology and Audiology
University of Iowa Hospitals and Clinics
Iowa City, Iowa

Mary A. Hardin-Jones, PhD, CCC-SLP

Professor and ASHA Fellow
Division of Communication Disorders
University of Wyoming
Laramie, Wyoming
3251 Riverport Lane
St. Louis, Missouri 63043

THE CLINICIAN’S GUIDE TO TREATING CLEFT PALATE SPEECH, ISBN: 978-0-323-33934-6

EDITION 2
Copyright © 2017 by Elsevier Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
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This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical treatment
may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds, or experiments described herein. In using such
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parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
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To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume
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Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1

PREFACE

The Care of a Child With a Cleft

Speech-language pathologists who work in the public schools or other nonmedi-
cal settings are unlikely to encounter a child or adult with a cleft palate or other
craniofacial birth defect more than a few times in their entire career. When they
do, they may feel hesitant to devise a treatment plan for that individual if their
training did not include a course in cleft palate or if that training was so long ago
that they fear their knowledge and clinical skills may be outdated. Each of the
authors of this book has had multiple telephone calls and e-mails from clinicians
expressing exactly that fear. The goal of this book is to provide enough informa-
tion so that clinicians can feel comfortable in the diagnosis and treatment of
speech for an individual with a cleft palate or other form of velopharyngeal dys-
function. In addition, we hope this book can help in the education of the graduate
students who will soon become speech pathologists.
This second edition of The Clinician’s Guide is a consolidation of the previous
edition (2006) and portions of the fourth edition of Cleft Palate Speech (Peterson-
Falzone, Hardin-Jones, and Karnell, 2010). The latter book is no longer in print.
Although there are many hard-working, knowledgeable surgeons, dentists,
orthodontists, speech-language pathologists, and other clinicians devoting large
chunks of their professional time to caring for individuals with clefts and other
congenital craniofacial disorders, a basic premise of this book is that care for such
a patient is likely to be fragmented and inadequate if it is not provided by an
interdisciplinary team. On-site interaction among professionals in plastic and
reconstructive surgery, speech-language pathology, orthodontics, dentistry, pedi-
atrics, nursing, oral surgery, otolaryngology, and psychology or social work (prefer-
ably both) is key to maintaining a high standard of integrated and well-coordinated
care (Dailey and Wilson, 2015). The American Cleft Palate-Craniofacial
Association (ACPA) makes this point very clearly in its “Standards for Cleft and
Craniofacial Teams” document, and also in its “Parameters for Evaluation and
Treatment…” document first published in 1993 and twice revised and upheld by
consensus of the Association in the past 22 years. The bottom line is simply that
team care is essential.
If you are a speech-language pathologist in the public schools or other non-
medical setting, you may well be the key professional who first identifies the child
in need of a team or you may be the first professional who realizes that the care
previously provided for the child with a cleft has been inadequate. Never under-
estimate how important your observations and evaluations are to the child, the
family, and whoever is providing the surgical and dental management. The
treating team needs your input. You are the one who sees the child on a regular
basis, while the team may see him or her only once every few weeks or months.

v
 vi PREFACE

Dailey and Wilson (2015) stress the importance of good communication across
treatment settings.
Just as important: If you are the one who finds a child NOT being treated by
an interdisciplinary team, do not let a “gatekeeper” in the office of a third-party
payer tell you that referral to such a team is not necessary. Teams usually have
someone on staff who knows how to deal with third-party payer obstinacy.
Following are three scenarios: In the first, a child with nasal emission, hyper-
nasal resonance, and perhaps even compensatory misarticulations turns up in your
caseload and has had no previous diagnostic work-up, although he may have had
previous speech therapy (either appropriate or inappropriate). In the second, a
child in your caseload has a repaired cleft palate or other source of inadequate
velopharyngeal closure but is clearly in need of more physical management. In
the third scenario, you have a child or adult who is already under team care but
you need to interact with the team in order to develop a good therapy plan for
his current speech problems. All of these scenarios demand that you make and
maintain contact with the professionals on the interdisciplinary team.

THE LONG-TERM PERSPECTIVE ON CARE FOR THE CHILD

WITH A CLEFT PALATE
Following is a typical schedule of the evaluations and procedures that will con-
stitute the long-term care for children born with clefts (children born with cleft
lip only will generally not require such rigorous care). Please keep in mind that
the “schedule” will vary somewhat across teams.

• At birth: neonatal evaluation, including hearing assessment if possible, and

referral to an interdisciplinary team, as well as to local pediatrician; team evalu-
ation as soon as possible; counseling for parents as needed
• Monitoring of weight gain
• Evaluation of baby and family by dysmorphologist/geneticist as soon as the
family is emotionally ready for it
• Age 3 months: surgical closure of cleft lip and initial reconstruction of the nose
(often preceded by lip-taping or nasoalveolar molding)
• Age 6 months: follow-up team evaluation
• Age 12 to 18 months: another team evaluation; surgical closure of palate,
preferably around 1 year of age (may take place earlier)
• Age 2 years: team evaluation
• Annual or semiannual team evaluations, scheduling dependent upon the needs
of the particular child
• Lip-nose revision if necessary before child enters school
• First-stage orthodontic care once the first molars have erupted (approximately
age 7 or 8 years)
• Alveolar bone-grafting if necessary, preferably after completion of orthodontic
preparation, specifically expansion of the maxilla so that the occlusion is sta-
bilized in the correct position
• Secondary velopharyngeal surgery whenever it is determined that this system
is not functioning adequately
 PREFACE vii

• Phase II of orthodontic treatment, beginning after the eruption of most of the

permanent teeth (e.g., approximately 12 to 14 years of age)
• Ongoing orthodontic care and monitoring of facial growth as the child pro-
gresses through the preteen and teen-age years
• Final lip-nose revision after child has reached full growth (around age 17 in
boys, earlier in girls)
• Final team evaluation around age 18 (patient will have to be prepared to say
good-bye to the team, and parents will have to get a new job)

This book was written by four experienced speech-language pathologists who

have devoted most of their careers to the diagnosis and therapeutic management
of speech problems in speakers with cleft palate (with or without cleft lip) and
noncleft velopharyngeal inadequacy. The authors strongly encourage those of you
who may feel intimidated by the task of providing therapy for this patient popula-
tion to keep in mind that this therapy is not magic. We provide you with inter-
ventional approaches in early speech development to prevent the takeover of the
notorious maladaptive compensatory misarticulations that can sabotage the
child’s early phonological development and compromise his intelligibility so that
early speech attempts are met with failure. We also provide you with techniques
for replacing glottal stops, pharyngeal fricatives, and other compensatory misar-
ticulations with appropriately produced consonants. The goal for all of us is to
eradicate the stigmata of “cleft palate speech.”

Reference
Dailey S, Wilson K: Communicating with a cleft palate team: improving coordination of care across
treatment settings. Perspectives on Speech Science and Orofacial Disorders 25: 35-38, 2015.
This page intentionally left blank
ACKNOWLEDGMENTS

FROM SALLY PETERSON-FALZONE

It seems unlikely that I will ever write about cleft palate without having the faces
and souls of Samuel Pruzansky, Donna Pruzansky, and Hughlett L. Morris pop to
the front of my brain. They are forever with me. HL Morris is still here to monitor
me. Just ask him.
An additional “presence” for me is the late Katy Hufnagle. I cannot grasp that
I will never again hear her voice on the end of the phone, with an enthusiastic
new observation (“Bet you’ve never seen THIS!”) or a clinical predicament. She
loved predicaments, and the solutions got her even more excited.
My co-authors know that I respect and love them. That’s why I picked them.
My husband Nicholas has now suffered through two books and two major revi-
sions. He has many stories to tell. Ironically, he is the one who convinced me
that it was important “not to let the little book disappear.”
We have had the blessing of working with many Elsevier editors over the years.
Their patience has always been amazing and their skills enviable. For this edition,
we are particularly aware of what we owe Jolynn Gower, Penny Rudolph, Kellie
White, Jaime Pendill, David Stein, and Nathan Wurm-Cutter.
As clinicians, all four of the authors of this book are forever indebted to our
patients and their families for what they have taught us. We know we cannot
waste that knowledge or assume that we were naturally entitled to it. The smiles
on our faces are for the kids.

FROM JUDITH TROST-CARDAMONE (AKA DOC T-C)

First and foremost my thanks go to Sally Peterson-Falzone, whose leadership and
persistence have made this text come to fruition, now in its second edition.
Deepest appreciation goes to my many colleagues who have indirectly contributed
to this book through their mentoring, teaching, and our collaborative work. Chief
among these are Mary O’Gara, Lynn Grames, Kathy Chapman, Mary Hardin-
Jones, Rodger Dalston, David Kuehn, and Michael Karnell. A special thanks also
goes to Penny Wheeler Davis who encouraged me to take the “part-time” position
she was vacating at the Northwestern University Cleft Lip and Palate Institute
(in 1973) to have her first child. Thus began my lifelong passion for the study
and care of individuals with cleft palate speech disorders. And to my many gradu-
ate students, thank you for meeting the challenges of a “tough course” and thank
you for challenging me to continuously upgrade my teaching skills. Last, but by
no means least, my deepest love and respect go to my husband, Frank Cardamone,
for his selfless devotion to me and my work.

ix
 x ACKNOWLEDGMENTS

FROM MICHAEL P. KARNELL

I echo and amplify previously stated gratitude to my co-authors, the editorial
board at Elsevier, and the patients we have been privileged to serve. I would
expand that gratitude to include the many members of the cleft palate-craniofacial
teams with whom we have worked.
Heartfelt thanks to Lucy Hynds Karnell for her support, brilliance, and wisdom
throughout 30+ years of life together. I am particularly grateful for her taste in
spouses.
This text was written primarily for graduate students in speech-language
pathology. The authors owe our sincere thanks to the hundreds of students who
have helped us learn how to teach the topics covered in these pages.
Special thanks to the patients and families who have given consent for us to
include some of their stories in the media content supporting this text.

FROM MARY HARDIN-JONES

Thanks go out to the many collaborators who shared my journey throughout the
years and contributed to my professional growth (including but not limited to
Kathy Chapman, Michael Karnell, Sally Peterson-Falzone, Nancy Scherer, and
Judith Trost-Cardamone). I am particularly grateful to my cherished colleague
and spouse, David Jones, for the many years of encouragement, advice, and
support. As always, I am indebted to the many patients, families, and students
who have taught me so much throughout the years.
CONTENTS

Chapter 1 Cleft Lip and Palate, 1

Chapter 2 Feeding an Infant With a Cleft Palate, 20

Chapter 3 Physical Management of Clefts: Primary, 32

Chapter 4 Early Phonological Development, 47

Chapter 5 Effects of Cleft and Noncleft VPI on Speech, 56

Chapter 6 Other Consequences of Clefts, 88

Chapter 7 The Orofacial Exam: What to Look For, 126

Chapter 8 Perceptual Assessment of Speech, 149

Chapter 9 Instrumental Evaluation of Velopharyngeal Function, 195

Chapter 10 Physical Management of Velopharyngeal Inadequacy, 210

Chapter 11 Early Intervention for Infants and Toddlers, 220

Chapter 12 Speech Therapy for Cleft-Related Misarticulations, 236

Chapter 13 Four Multianomaly Craniofacial Conditions That

Include Clefts, 278

xi
This page intentionally left blank
VIDEO AND AUDIO
CONTENTS

Audio 4-1 Oral stops in babbling

Video 4-1 Severely limited phonological development
Video 4-2 Limited phonological development
Audio 5-1 Samples of hypernasal speech
Audio 5-2 Samples of hypernasal speech
Audio 5-3 Samples of hypernasal speech
Audio 5-4 Samples of three speakers with different sources of nasal air
emission
Audio 5-5 Child with VP insufficiency but good articulation
Audio 5-6 Adult with VP incompetency secondary to acquired dysarthria
Audio 5-7 Child with phoneme-specific nasal emission
Audio 5-8 Speaker with hypernasality and rampant glottal stops
Audio 5-9 Speaker using glottal stops
Audio 5-10 Hypernasal speaker who substitutes pharyngeal stops for velar
stops
Audio 5-11 Speaker using pharyngeal fricatives
Audio 5-12 Child with VPI but also substitution of nasal fricatives for /s/
with no oral placement
Video 5-1 Pervasive hypernasality and nasal emission in a school-age boy
with good articulation
Video 5-2 Preschooler with hyponasality (due to adenoid hypertrophy)
and glottal stops
Video 5-3 Child with a repaired cleft palate in the presence of Robin
sequence who exhibits pervasive use of glottal stops
Video 5-4 Phoneme-specific nasal emission in a noncleft child
Video 5-5 Boy using ingressive airflow (primarily on stop-plosives, less so
on sibilants) as a compensatory articulation
Video 5-6 Demonstration of compensatory (mis)articulations
Video 5-7 School-age boy using velar fricatives for sibilants
Video 5-8 School-age boy using velar fricatives for sibilants but also
inconsistently using glottal stops
Video 8-1 Testing for nasal emission (mirror fogging) and hypernasality
(resonance shift)

xiii
 xiv Video and Audio Contents

Video 8-2 A quick verification of phoneme-specific nasal emission

(PSNE)
Video 8-3 VPI with associated ingressive airflow (often heard as clicks)
and nasal grimace
Video 8-4 Modeling the target and a quick stimulability check
Video 8-5 EC assessment excerpts to accompany Appendix 8-H
Video 8-6 Fistula-based nasal air emission
Video 9-1 Velopharyngeal inadequacy in 3-year-old with bilateral cleft lip
and palate
Video 9-2 Marginal velopharyngeal inadequacy
Video 9-3 Marginal velopharyngeal inadequacy
Video 9-4 Videofluoroscopy, lateral view
Video 9-5 Videofluoroscopy, anterior-posterior view
Video 9-6 Videofluoroscopy, Towne’s view
Video 9-7 7-year-old with 22q deletion syndrome (mild to moderate
hypernasality)
Video 9-8 Persistent VPI after physical management
Video 10-1 Pharyngeal flap check
Video 10-2 Sphincter pharyngoplasty check
Video 11-1 Limited consonant development
Video 11-2 Modeling simple speech targets
Video 12-1 Monitoring nasal versus oral air emission
Video 12-2 Phonetic placement: /k/ production
Video 12-3 Phonetic placement: /t/ production
Video 12-4 Place map activities
Video 12-5 Teaching oral stops using nasal occlusion technique
Video 12-6 Normal stop versus pharyngeal stop: production contrasts
Video 12-7 Establishing /s/ and /ʃ/: eliminating pharyngeal fricatives
Video 12-8 Phonetic placement: /tʃ/ production
Video 12-9 Teaching and monitoring for oral versus nasal airflow
Video 12-10 Oral versus nasal airflow learning
Video 12-11 Treating phoneme-specific nasal emission
Video 12-12 Phoneme-specific nasal emission: pre- and post-treatment
excerpts
Video 12-13 Treating phoneme-specific nasal emission: articulation and
phonological approach
 1
Cleft Lip and Palate

C
left lip and palate assume many forms. These structural defects occur very
early in the development of the baby-to-be. A cleft of the lip or palate
can occur separately, although these defects are more likely to occur
together. Clefts can occur as isolated defects, but more often they occur with at
least one minor or one major associated malformation. Approximately 70% of
children with cleft lip with or without cleft palate (CL ± P) and 50% of children
with cleft palate only (CPO) have no other abnormal findings (Calzolari et al.,
2007; Jones, 1988). This means that individuals with CPO are much more likely
to have associated anomalies. Male infants are more vulnerable to CL ± P than
to CPO, and female infants are more vulnerable to CPO than to CL ± P.

Please see pages 24 to 27 in Peterson-Falzone et al. (2010) for references on these points
and information regarding frequency of occurrence by type of cleft and gender, the
frequency of occurrence by racial groups, and recurrence risks.

TYPES OF CLEFTS
CL ± P may be either unilateral or bilateral and incomplete or complete. The
latter designation speaks only to whether any tissue is present across the line of
the cleft, although the amount of tissue may be minimal. It helps to keep in mind
that, in addition to unilateral versus bilateral, clefts vary in three other dimen-
sions: anterior to posterior, width, and vertical depth or top-to-bottom (nasal
mucosa, bone of the hard palate or muscle of the soft palate, oral mucosa). Even
the dichotomy of unilateral versus bilateral is not always helpful in describing
severity because some unilateral clefts are wider than some bilateral clefts. Thus
a clinician who has not seen the child from early infancy will not be aware of the
severity of the original defect and the influence of that severity on both the
success of surgical repair and the development of speech.

Median clefts, oblique facial clefts, and lateral facial clefts are all very rare forms of clefts and
are not discussed here. See pages 19 to 20 of Peterson-Falzone et al. (2010) for
illustrations.

1
 2 The Clinician’s Guide to Treating Cleft Palate Speech

Although the terminology may seem confusing without taking a course in

embryology, the ability to conceptualize types of clefts will be enhanced if it is
noted that the middle portion of the lip (that portion extending from one lateral
incisor to the other lateral incisor) and the anterior portion of the hard palate
are formed from an embryonic structure termed the primary palate. This structure
is triangular, with the tip of the triangle corresponding to the incisive foramen.
The remainder of the hard palate and all of the soft palate form from the embry-
onic secondary palate.

Some clinicians term a cleft of the lip or a cleft of the lip and alveolus a cleft of the primary
palate. Similarly, a cleft of the palate only may be termed a cleft of the secondary palate.
Unfortunately, too many clinicians mistakenly think that “primary palate” means hard palate
and “secondary palate” means soft palate.

In the embryo, the development of the primary palate begins in the region of
the incisive foramen and moves forward. Thus the last part to form is the lip itself.
The development of the secondary palate is just the reverse: It starts with the
region of the incisive foramen and moves posteriorly. The last part to form is the
uvula. A cleft of the lip and palate is thus the result of two problems in embryonic
development, one in the primary palate and one in the secondary palate, either
of which may be incomplete or complete.

CLEFT LIP
Clefts of the lip vary from a small defect (Fig. 1-1, A) to a complete cleft extend-
ing through the floor of the nostril (Fig. 1-1, B). Microforms of cleft lip may
include a minimal notch in the vermilion border (the vermilion border is the red
portion of the lip), a fibrous band or depressed groove running up to the nostril,
or a minor deformity of the nose on the same side.

A B

FIGURE 1-1 A unilateral cleft of the lip may vary from a barely detectable microform (A) to a
complete cleft through the lip and the base of the nose (B). The tape seen on the lateral segments
in B is there in preparation for a small acrylic device or additional tape that will serve to bring the
protrusive premaxilla (baby’s left) into better position for surgical repair of the lip. (From Peterson-
Falzone SJ, Hardin-Jones MA, Karnell MP: Cleft palate speech [4th ed]. St. Louis: Elsevier, 2010.)
 CHAPTER 1 Cleft Lip and Palate 3

A B

FIGURE 1-2 A and B, Incomplete cleft of the lip and alveolus on the right, with intact secondary
palate. Note flattening of the nose on the cleft side. (From Peterson-Falzone SJ, Hardin-Jones MA,
Karnell MP: Cleft palate speech [4th ed]. St. Louis: Elsevier, 2010.)

FIGURE 1-3 Infant with complete bilateral cleft of the primary palate but intact secondary palate.
(From Peterson-Falzone SJ, Hardin-Jones MA, Karnell MP: Cleft palate speech [4th ed]. St. Louis: Elsevier,
2010.)

Minimal lip defects may be associated with a minor deformity of the anterior
portion of the maxillary alveolar arch. The term forme fruste is often applied to
a minor defect of the lip with or without a minimal defect of the alveolus.
Minimal defects of the lip and alveolus have no effect on speech, but the patient
(and family) may want to seek evaluation by a geneticist/dysmorphologist because
the same genes that contribute to complete clefts also contribute to minor defects.

Some further points about cleft lip:

1. Both unilateral and bilateral clefts of the lip can occur without cleft palate
(Figs. 1-2 and 1-3).
2. Bilateral clefts of the lip are often asymmetrical, with one side wider or more
complete than the other (Fig. 1-4).
3. If there is a complete bilateral cleft of the lip, the central portion of the lip
and alveolus (known as the premaxilla) is attached directly to the tip of the
nose, with little or no columella (Fig. 1-5). In these cases the premaxilla is
very protrusive (Fig. 1-6).
 4 The Clinician’s Guide to Treating Cleft Palate Speech

FIGURE 1-4 Asymmetrical bilateral cleft lip, complete on the baby’s left side but incomplete on the
right. (From Peterson-Falzone SJ, Hardin-Jones MA, Karnell MP: Cleft palate speech [4th ed]. St. Louis:
Elsevier, 2010.)

FIGURE 1-5 Bilateral cleft lip and alveolus with the central portion of the upper lip and alveolus
attached to the tip of the nose with little or no columella. (From Peterson-Falzone SJ, Hardin-Jones
MA, Karnell MP: Cleft palate speech [4th ed]. St. Louis: Elsevier, 2010.)

A B

FIGURE 1-6 A and B, Two views of the protrusive premaxilla in an infant with complete bilateral
cleft lip. (From Peterson-Falzone SJ, Hardin-Jones MA, Karnell MP: Cleft palate speech [4th ed]. St. Louis:
Elsevier, 2010.)
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reports, or accounts of criminal deeds, or pictures, or stories of
deeds of bloodshed, lust or crime; or who,
3. In any manner, hires, employs, uses or permits any minor or
child to do or assist in doing any act or thing mentioned in this
section, or any of them,
Is guilty of a misdemeanor, and, upon conviction, shall be
sentenced to not less than ten days nor more than one year
imprisonment or be fined not less than fifty dollars nor more than one
thousand dollars or both fine and imprisonment for each offense.
Sec. 1143. Mailing or carrying obscene prints and articles. A
person who deposits, or causes to be deposited, in any post-office
within the state, or places in charge of an express company, or of a
common carrier, or other person, for transportation, any of the
articles or things specified in the last two sections, or any circular,
book, pamphlet, advertisement, or notice relating thereto, with the
intent of having the same conveyed by mail or express, or in any
other manner, or who knowingly or wilfully receives the same, with
intent to carry or convey, or knowingly or wilfully carries or conveys
the same, by express, or in any other manner except in the United
States mail, is guilty of a misdemeanor.
 Footnotes
[1] “James Branch Cabell is making a clean getaway with Jurgen,
quite the naughtiest book since George Moore began ogling
maidservants in Mayo. How come? Dreiser had the law hot after
him for The Genius and Hager Revelly came close to landing
Daniel Carson Goodman in Leavenworth, yet these volumes are
innocent compared with Jurgen, which deftly and knowingly treats
in thinly veiled episodes of all the perversities, abnormalities and
damn-foolishness of sex. There is an undercurrent of extreme
sensuality throughout the book, and once the trick of transposing
the key is mastered one can dip into this tepid stream on every
page. Cabell has cleansed his bosom of much perilous stuff—a
little too much, in fact, for Jurgen grows tiresome toward the end
—but he has said everything about the mechanics of passion and
said it prettily. He has a gift of dulcet English prose, but I like
better the men who say things straight out and use gruff Anglo-
Saxon monosyllables for the big facts of nature that we are
supposed to ignore.
“It is curious how the non-reading public discovered Jurgen. A few
days after it appeared on the newsstands a male vampire of the
films who once bought Stevenson’s Underwoods in the belief that
it was a book of verses hymning a typewriter, began saying up
and down Broadway: ‘Say, kid, get a book called Jurgen. It gets
away with murder.’
“This sold the first edition quickly. How do they discover these
things?”
Walter J. Kingsley.
[2] See page 77.
[3] “John S. Sumner, Agent New York Society for the Suppression
of Vice, being duly sworn, says: That on the 6th day of January,
1920, and prior, and sworn thereto at the city and county
aforesaid Robert M. McBride & Company, a corporation, and Guy
Holt, manager of said corporation, Book Department, did at No.
31 East 17th Street in the city and county aforesaid, unlawfully
print, utter, publish, manufacture and prepare, and did unlawfully
sell and offer to sell and have in their possession with intent to sell
a certain offensive, lewd, lascivious and indecent book, in
violation of Section 1141 of Penal Code of the State of New York.
At the time and place aforesaid, the said Robert M. McBride &
Company by and through its officers, agents and employees did
print, publish, sell and distribute and on information and belief the
said Guy Holt did prepare for publication and cause to be printed,
published, sold and distributed a certain book entitled Jurgen by
one James Branch Cabell, which said book represents and is
descriptive of scenes of lewdness and obscenity, and particularly
upon pages 56, 57, 58, 59, 61, 63, 64, 67, 80, 84, 86, 89, 92, 93,
98, 99, 100, 102, 104, 105, 106, 107, 108, 114, 120, 124, 125,
127, 128, 134, 135, 142, 144, 148, 149, 150, 152, 153, 154, 155,
156, 157, 158, 161, 162, 163, 164, 165, 166, 167, 168, 170, 171,
174, 175, 176, 177, 186, 196, 197, 198, 199, 200, 203, 206, 207,
211, 228, 229, 236, 237, 238, 239, 241, 242, 271, 272, 275, 286,
321, 340, 342, 343, thereof, and which said book is so obscene,
lewd, lascivious and indecent that a minute description of the
same would be offensive to the Court and improper to be placed
upon the records thereof. Wherefore a fuller description of the
same is not set forth in this complaint....”
[4] COURT OF GENERAL SESSIONS OF THE PEACE IN AND
FOR THE COUNTY OF NEW YORK

People of the State of New York:

vs
Guy Holt, Robert M. McBride & Co.,
and Robert M. McBride:

THE GRAND JURY OF THE COUNTY OF NEW YORK by this

indictment, accuse Guy Holt, Robert M. McBride & Co. and
Robert M. McBride of the crime of UNLAWFULLY POSSESSING
AN INDECENT BOOK, committed as follows:
The said Guy Holt, Robert M. McBride & Co., a corporation at
all times herein mentioned existing under the laws of the State of
New York, and Robert M. McBride, acting together and in concert,
in the County of New York aforesaid, on the 14th day of January,
1920, and for a considerable time prior thereto, with intent to sell
and show, unlawfully possessed a lewd, lascivious, indecent,
obscene and disgusting book entitled JURGEN, a more particular
description of which said book would be offensive to this Court
and improper to be spread upon the records thereof, wherefore
such description is not here given; against the form of the statute
in such case made and provided, and against the peace of the
people of the State of New York, and their dignity.
Edward Swann,
District Attorney.
[5] The numerals in parentheses refer to the pages.
[6] (Cf. the old Scottish Border legend, “The Eve of St. John”, to
be found in Scott’s “Minstrelsy of the Scottish Border”; and
Compton Mackenzie’s latest novel, “Altar Steps”.)
[7] It would be impossible to go further except by quoting all (290–
308). It should be read.
 Transcriber’s Notes
The prologue has numbered footnotes and the body text used footnotes
marked with asterisks. Continued the numbered footnotes through the
body text. Moved the footnotes to the end of the text.
Changed three instances of “mediaeval” to “mediæval” which was used in
four other instances.
Changed three instances of "to-day" to "today", which was used more
frequently in both plain and quoted texts.
The author uses "St. Hubert’s Guild v. Quinn (64 Misc. 336)" both with and
without the possessive on "Hubert." These inconsistencies left as in the
original.
p. 43 Corrected "typefies" to "typifies".
p. 52 Removed duplicate “have” from “should never have have been
allowed”.
p. 64 Added missing end quote after “city of Pseudopolis”.
p. 65 Section (d) in the original was originally labelled as section (e) and
there was no section (d).
p. 78 In the New York state code, the paragraph starting with "3." ends with
a comma. Corrected this to be consistent with other numbered paragraphs.
p. 78 Corrected "misdeameanor" to "misdemeanor".
All other uncommon or contemporary spellings and punctuation left as in
the original.
The text under discussion is available from Project Gutenberg: Jurgen: A
Comedy of Justice by James Branch Cabell.
*** END OF THE PROJECT GUTENBERG EBOOK JURGEN AND
THE LAW ***

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