The treatment of this difficulty involves the removal of the causes, so far as possible, by the improvement of the general health, by tonic baths, nourishing diet, and exercise, especially lung gymnastics, Swedish movements, and tonic applications of electricity. The direct treatment of the disease itself begins with exercises in breathing. Some require the patient to spend a week in absolute silence before beginning exercises of any sort. The first thing to be learned by the stutterer is how to fill his lungs completely, and then to expire it slowly and steadily. After this power has been acquired, the patient should be practiced in the pronunciation of all the different vowels, both singly and in combination. He must be made to speak them in loud tones, prolonged as much as possible, to speak them in a louder than ordinary voice, and in a whisper. He should also be taught to sing them, and to continue practice with each vowel in combination until he acquires perfect confidence in his ability to pronounce them all. This acquirement of confidence in himself is one of the essentials of treatment. Without it, a cure cannot be effected.

The next thing to be accomplished is the acquirement of power to combine consonants and vowels. This should be done by practice, first, in combinations in which the vowel comes before tho consonant; and when this has been mastered, combinations in which the consonant comes first should be practiced upon. All the while the most careful attention must be given to the respiration. By degrees the patient will become able to pronounce words of one syllable, afterward the ability will extend to the pronunciation of words of two or more syllables, and then to combinations of words, and finally to sentences, periods, and paragraphs. Phrases and short combinations of words must first be spoken like words of many syllables. When the patient reaches this stage of improvement, ho should be practiced in reading aloud, first poetry and then prose. After a time, ho may be allowed to repeat short pieces of poetry or prose which have been committed to memory. After two or three months, a series of exercises should be given in which the pupil should be taught to keep time, speaking very slowly and giving to each syllable the same length, drawing breath whenever there is a grammatical pause. This regulated speech must be continued for months.

During all this time, the patient must never allow himself to speak otherwise than he has been taught to do in the exercises. When he finds himself unable to speak without stuttering, he should keep silence. The employment of measured or rythmic speech should be resorted to whenever he finds himself getting excited in conversation. Relapses are very likely to occur, which necessitate a new course of treatment.

Many mechanical devices have been adopted for the relief of stut tering. It is said that Demosthenes spoke with stones under his tongue. Little wooden plates, shaped like the lower jaw, "tongue forks," or "tongue bridles," and a great variety of other contrivances have been invented and used for this purpose. This plan of treatment is rarely successful and often does harm. It never effects a permanent cure. Various surgical operations have been performed for the relief of stuttering, but never with permanent benefit.

A peculiar affection somewhat resembling stuttering, known as aphthongia, has been occasionally observed. It consists in a spasm of the tongue, mouth, and jaw, whenever the patient attempts to speak. This difficulty is fortunately very rare, for no special means of relief has yet been devised.