expirations, this in preparation for speech. She was unable to do this, the
expiration being short, jerky and interrupted. Thereupon the examiner placed
his two hands, one on each side of her chest, instructed her to inspire, and
when she was instructed to expire forced his hands against her ribs in order
to complete the expiratory act. After about fifteen or twenty minutes of
this combination of instruction and help the patient was able to breathe by
herself and freely. She was then instructed to make the sound "e" at the end
of expiration. This she was unable to do at first, but upon persistence and
passive placing of her mouth in the proper position for the sound, she was
able to whisper "e." From this she rapidly went on to the other vowel
sounds. Then the aspirate "h" was added, later the explosives, "p," etc.,
until at the end of about two hours she was enabled to whisper anything
desired. Her husband was instructed not to allow her to use her pencil any
more, and she promised faithfully to enter into whispered conversation with
him, although it was evident that she promised this with reluctance.

Upon the next visit, two days later, she was still whispering, and when
asked if she could talk aloud, shook her head and whispered "No," that she
was sure she could not. Efforts to have her make the sound "a," or any of
the vowels in a voiced manner failed completely. She was then instructed to
cough. Although it is evident that a cough is a voiced sound, she was able
to do this, in a very low and indistinct manner. She was then instructed to
add the sound "e" at the end of her cough. This she did, but with
difficulty. Finally, after much the same manoeuvering which has been
indicated in the account of how she was instructed to whisper, she talked
freely and well. When this was accomplished the husband was instructed to
have her dress herself and to take her to: some place of amusement, and to
keep her out of doors almost continuously.

At all times the patient had complained of a pain in her side which she