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.
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