SPASMODIC STAMMERING: This marks the stage of the disorder where the effort to speak brings about marked muscular contractions and pronounced spasmodic efforts, resulting in all sorts of facial contortions, grimaces and uncontrolled jerkings of the head, body and limbs. THOUGHT STAMMERING: This, like Thought-Stuttering, is a form of Aphasia and manifests itself in the inability of the stammerer to think of what he wishes to say. In other words, the thought-stammerer, like the thought-stutterer, is unable to recall the mental images necessary to the production of a certain word or sound--and is, therefore, unable to produce sounds correctly. The manifestations described under Thought Stuttering are present in Thought Stammering also. COMBINED STAMMERING AND STUTTERING: This is a compound form of difficulty in which the sufferer finds himself at times not only unable to utter a sound or begin a word or a sentence but also is found to repeat a sound or syllable several times before the following syllable can be uttered. Any case of stuttering or stammering in the Simple or Elementary Stages may pass into Combined Stammering and Stuttering without warning or without the knowledge, even, of the stammerer or stutterer. CHAPTER II THE CAUSES OF STUTTERING AND STAMMERING One of the first questions asked by the stutterer or stammerer is, "What is the cause of my trouble?" In asking this question, the stammerer is getting at the very essence of the successful method of treatment of his malady, for there is no method of curing stuttering, stammering and kindred defects of speech that can bring real and permanent relief from the affliction unless it attacks the cause of the trouble and removes that cause. Inasmuch as this book has to do almost entirely with the two defective forms of utterance known as stuttering and stammering, we will at this time drop all reference to the other forms of speech impediments and from this time forth refer only to stuttering and stammering. These forms of defective speech are manifested by the inability to express words in the normal, natural manner--freely and fluently. In other words, there is a marked departure from the normal in the methods used by the stammerer in the production of speech. It is necessary, therefore, before taking up the discussion of the causes of stuttering and stammering, to determine the method by which voice is produced in the normal individual, so that we can compare this normal production of speech with the faulty method adopted by the stutterer or stammerer and learn where the fault is and what is the cause of it. Let us now proceed to do this: In other words, let us ask the question: "How is speech produced in the normal person not afflicted with defective utterance?"