articulate speech becomes impossible, and the only expression remaining to
the patient is laryngeal phonation, slightly modulated and broken into the
rhythm of formless syllables.

The laryngeal palsy _rarely_ becomes complete. The nervous structures in
the _physiological mechanism_ of speech and phonation are affected in this
disease; but there are degenerative diseases of the brain in which the
_psychical mechanism_ of speech is affected, e.g. General Paralysis of the
Insane, in which the affection of speech and hand-writing is quite
characteristic. There is at first a hesitancy which may only be perceptible
to practised ears, but in which there is no real fault of articulation once
it is started; sometimes preparatory to and during the utterance there is a
tremulous motion about the muscles of the mouth. The hesitation increases,
and instead of a steady flow of modulated, articulate sounds, speech is
broken up into a succession of irregular, jerky, syllabic fragments,
without modulation, and often accompanied by a tremulous vibration of the
voice. Syllables are unconsciously dropped out, blurred, or run into one
another, or imperfectly uttered; especially is difficulty found with
consonants, particularly explosive sounds, b, p, m; again, linguals and
dentals are difficult to utter. Similar defects occur in written as in
vocal speech; the syllables and even the letters are disjointed; there is a
fine tremor in the writing, and inco-ordination in the movements of the
pen. Silent thoughts leave out syllables and words in the framing of
sentences; consequently they are not expressed by the hand. The ideation of
a written or spoken word is based upon the association of the component
syllables, and the difficulty arises primarily from the progressive
impairment of this function of association upon which spoken and written
language so largely depends. Examination of the brain in this disease
explains the cause of the speech trouble and the progressive dementia (loss
of mind) and paralysis with which it is associated. There is a wasting of