Nervous and mental diseases . er,bearing in mind the special location of this disease, is referred. Theorganic changes of associated atrophies and scleroses or of primary con-ditions, such as tabes, syringomyelia, insular sclerosis, and descendingcerebral degenerations are at times encountered. Symptoms.—The symptoms begin insidiously and progress tongue is usually the first affected. This is manifest in a thick-ened pronunciation, particularly of the letters which require definitelingual movements. The linguodentals and linguopalatals (see table,p. 66) and the vowel e and later on
Nervous and mental diseases . er,bearing in mind the special location of this disease, is referred. Theorganic changes of associated atrophies and scleroses or of primary con-ditions, such as tabes, syringomyelia, insular sclerosis, and descendingcerebral degenerations are at times encountered. Symptoms.—The symptoms begin insidiously and progress tongue is usually the first affected. This is manifest in a thick-ened pronunciation, particularly of the letters which require definitelingual movements. The linguodentals and linguopalatals (see table,p. 66) and the vowel e and later on the explosive labial sounds arelost. Finally speech is reduced to unmodified laryngeal noises that arequite unintelligible. When the disease is only slightly developed, by aneffort the patient can often enunciate clearly and the embarrassment maybe noticed only in ordinary inattentive conversation. The tongue alsoprogressively loses its muscular strength and range of motion until it MULTIPLE PARALYSES OF CRANIAL NERVES. 155. lies a flabby, inert, rugose, atrophic mass on the floor of the mouth. Itloses its function of maintaining the food between the teeth during mas-tication and of carrying the bolus backward and thrusting it into thepharynx in efforts at swallowing. It can no longer be protruded,turned to either side, rolled up, or hollowed into a gutter. In most ofthe cases it notably wastes, but as the atrophy is confined to the mus-cular portion of the tongue, the dermal covering appears too large andmay even suggest epidermal hypertrophy. The lips are affected shortly after the tongue, and this adds to the speechdifficulty by rendering the pro-nunciation of the vowels o and u uncertain or labial consonants are lost asabove indicated, and little be-sides the sibilant s and theopen vowel a remain. The or-bicularis oris is usually the firstlabial muscle invaded, but allof the labial group are even-tually paralyzed. Their nuclearassociation with the hypogloss
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