The other was an eighteen-year-old Jewish boy, who before beginning to speak gave vent to a hard sound like "kh" four or five times in succession, each being accompanied by a violent rotation of the head to the right, wrinkling of the face, and a little jump. The patient then addressed himself to speak with the utmost assurance, there being no sign of tic or stammer unless he stopped for a moment and endeavoured to recommence. On the other hand, he could sing to perfection. There may also be troubles of speech of a tonic kind, whereby a more or less complete and sustained mutism is produced, an excellent example of which has recently come under our notice: A young girl, various members of whose family are stammerers, occasionally suffers from an extraordinary sensation of anguish in the course of conversation; she flushes and then becomes suddenly immobile, finding it impossible to articulate or even to utter a sound. Her glottis contracts forcibly; her efforts at expiration are ineffectual, or else the air escapes in little explosive puffs, and at the same time her lips twitch and her eyelids flicker. The whole seizure is over in a few seconds, whereupon the patient launches into conversation with volubility, until pulled up by a fresh attack. She shows remarkable acumen, moreover, in an analysis of her symptoms. "What happens is that I am suddenly overwhelmed with the fear of being unable to pronounce a given word, and at the thought my lips are sealed, I cannot make a sound, my throat is compressed, my tongue refuses to obey me, and my condition becomes one of abject misery." Curiously enough her phobia is not related to a particular word, and moreover her articulation is accurate and not embarrassed in presence of certain of the consonants. Phonation and respiration are implicated as well as articulation. The origin of this "cramp of speech" in psychical abnormalities is manifest. To a similar affection characterised by total inability to speak in a high or a low voice, whispering only being practicable, the term "spastic aphonia" has been applied. It is at the moment when the patient wishes to speak that the spasm occurs, as in a case reported by Hasslauer,[123] which resisted all treatment and was considered by him to have features in common with hysteria and occupation neuroses. There can be little doubt that the arrest of movement in these cases is comparable to what obtains in writers' cramp, and therefore, rigorously speaking, a tonic tic. A case has been recorded by F. Pick[124] of a man of thirty-eight years of age afflicted with convulsive movements of the face and troubles of speech.