outh that
belong to a syllable, but can produce them himself very correctly. He is
like the patients that Kussmaul calls "word-blind," who can not, in
spite of good sight, read the written words they see, but can express
them in speech and writing. For the same word, e. g., _atta_, which the
child does not read off from the mouth and does not repeat, he uses
himself when he wants to be taken out; thus the inability is not
expressive-motor, but central or intercentral. For the child can
already see very well the movement of mouth and tongue; the impressive
sight-path has been long established.

Herein this sort of word-blindness agrees fully with the physiological
word-deafness of the normal child without speech, whose hearing is good.
For he understands wrongly what he hears, when, e. g., in response to
the order, "No! no!" he makes the affirmative movement of the head,
although he can make the right movement very well. Here too, then, it is
not centrifugal and centripetal peripheral lines, but intercentral paths
or centers, that are not yet sufficiently developed--in the case of my
child, in the fourteenth month. The path leading from the word-center to
the dictorium, and the word-center itself, must have been as yet too
little used.

From all this it results, in relation to the question, how the child
comes to learn and to use words, that in the first place he has ideas;
secondly, he imitates sounds, syllables, and words spoken for him;
and, thirdly, he associates the ideas with these. E. g., the idea
"white+wet+sweet+warm" having arisen out of frequent seeing, feeling,
and tasting of milk, it depends upon what primitive syllable is
selected for questioning the hungry infant, for talking to him, or
quieting him, whether he expresses his desire for food by _moem_,
_mimi_, _nana_, _ning_, or _maman_, or _maem_, or _mem_, or _mima_, or
yet other syllables. The oftener he has the idea of food (i. e.,
something that banishes hunger or the unpleasant feeling of it), and
at the same time the sound-impression "milk," so much the more will
the latter be associated with the former, and in consideration of the
great advantages it offers, in being understood by all, will finally
be adopted. Thus the child learns his first words. But in each
individual case the first words acquired in this manner have a wider
range of meaning than the later ones.

By means of pure echolalia, without associating ideas with the word
babbled in i