greatest effort,
occur often erroneous repetitions of words pronounced for him (aside
from difficulties of articulation, and also when these are wanting);
hence confounding (of words), wrong forms of address, e. g., _Mama_ or
_Helene_ instead of "Papa," and _Papa_ instead of "Marie."

_c. Taciturnity (Dumbness)._--Individual human beings of sound physical
condition who can speak very well are dumb, or speak only two or three
words in all for several years, because they no longer _will_ to speak
(e. g., in the belief that silence prevents them from doing wrong).

This taciturnity is not to be confounded with the paranoic aphrasia in
certain insane persons--e. g., in catatonia, where the will is
paralyzed.

It also occurs--seldom, however--that children who have already learned
to speak pretty well are dumb, or speak only a few words--among these
the word _no_--during several months, or speak only with certain
persons, because they _will not_ speak (out of obstinacy, or
embarrassment). Here an organic obstacle in the motor speech-center is
probable. For voluntary dumbness requires great strength of will, which
is hardly to be attributed to the child. The unwillingness to speak that
is prompted by _fun_ never lasts long.

C. THE EXPRESSIVE PERIPHERAL PROCESSES DISTURBED.

(1) Dyslalia and Alalia (Peripheral Dysarthria and Anarthria).

The infant can _not yet_ articulate correctly, or at all, on account of
the still deficient development, and afterward the lack of control, of
the nerves of speech and the external organs of speech. The complete
inability to articulate is called alalia. The newly born is alalic.
Dyslalia continues with many children a long time even after the
learning of the mother-tongue. This is always a case simply of
imperfections in _h_ and _z_.

_a. Bulbo-nuclear Stammering (Literal Bulbo-nuclear Dysarthria and
Anarthria)._--Patients who have lost control over the muscles of speech
through bulbo-nuclear paralysis, stammer before they become speechless,
and along with paralysis and atrophy of the tongue occur regularly
fibrillar contractions of the muscles of the tongue. The tongue is _no
longer_ regulated by the will.

The child that has not yet gained control over his vocal muscles
stammers before he can speak correctly, and, according to my
observations, regularly shows fibrillar contractions of the muscles of
the tongue along with an extraordinary mobility of the tongue. The
tongue is _not